What is the association between healthy weight in 4-5-year-old children and spatial access to purposefully constructed play areas?

Background: Childhood obesity is a global issue. Understanding associated factors is essential in designing interventions to reduce its prevalence. There are knowledge gaps concerning the leptogenic potential of play areas for very young children and particularly whether there is an association between levels of childhood obesity and play area quality. Methods: A cross-sectional observational study was conducted to investigate whether spatial access to play areas had an association with healthy weight status of 4-5-year-old children. Data from the English National Childhood Measurement Programme 2012/13 was used to measure healthy weight status and a geographic information system was used to calculate (a) the number of purposefully constructed play areas within 1 km (density), and (b) the distance to nearest play area (proximity), from child's residential postcode. A play area quality score was included in predictive models. Multilevel modelling was used to adjust for the clustering of observations by school. Adjustment was also made for the effects of gender and deprivation. Results: 77% of children had a healthy weight status (>= 2nd and < 85th centile). In a fully adjusted multilevel model there was no statistically significant association between healthy weight status and density or proximity measures, with or without inclusion of a play area quality score, or when accounting for the effects of gender and deprivation. Conclusions: Among 4-5-year-old children attending school, there was no association between healthy weight status and spatial access to play areas. Reasons may include under-utilisation of play areas by reception age children, their minimal leptogenic influence or non-spatial influences affecting play area choice.