Effect of Individual or Neighborhood Disadvantage on the Association Between Neighborhood Walkability and Body Mass Index

Objectives. We sought to test whether the association between walkable environments and lower body mass index (BMI) was stronger within disadvantaged groups that may be particularly sensitive to environmental constraints. Methods. We measured height and weight in a diverse sample of 13102 adults living throughout New York City from 2000-2002. Each participant's home address was geocoded and surrounded by a circular buffer with a 1-km radius. The composition and built environment characteristics of these areas were used to predict BMI through the use of generalized estimating equations. Indicators of individual or area disadvantage included low educational attainment, low household income, Black race, and Hispanic ethnicity. Results. Higher population density, more mixed land use, and greater transit access were most consistently associated with a lower BMI among those with more education or higher incomes and among non-Hispanic Whites. Significant interactions were observed for education, income, race, and ethnicity. Conclusions. Contrary to expectations, built environment characteristics were less consistently associated with BMI among disadvantaged groups. This pattern may be explained by other barriers to maintaining a healthy weight encountered by disadvantaged groups. (Am J Public Health. 2009;99:279-284. doi:10.2105/AJPH.2008.138230)