gms | German Medical Science

Background: The prevalence of overweight and obesity in children has reached concerning levels worldwide [1]. Overweight and obese children are at high risk to stay obese as adults and develop chronic diseases [2]. Because of increased morbidity and mortality in adulthood, social stigma and direct and indirect medical costs, identifying the pathways leading to childhood obesity is of high priority [3]. In this context, “obesogenic environment” is a well established term that needs further examination to identify the properties of such an environment [4]. Up to now, it is not well understood which types of physical environment potentially influence obesity outcomes [5]. Therefore, we systematically reviewed the association of built environment characteristics and obesity risk among children living in the European Union.

Methods: We included articles published from the year 2000 until early 2022 from PubMed, Cochrane Library and Web of Science. A finalizing search to detect articles published after 2022 will be processed before publication. To be included in our analysis, an article had to investigate the relationship between at least one built environment characteristic and overweight or obesity in children aged 0–18 years. We extracted data on study design, study population, built environment characteristics, weight measurement, statistical models, adjustment variables, effect size and a summary of additional findings.

Results: We identified 1.960 individual articles of which 35 met all the inclusion criteria and were therefore included in our analyses. Studies were conducted in Germany, Spain, Portugal, Sweden, Netherlands, Italy, Ireland, Denmark, Czech Republic and Lithuania and mostly had a cross-sectional design.

Overall, the studies examined the following characteristics of the built environment: green space, air pollution, noise pollution, facility richness (included businesses, educational facilities, churches, libraries, museums, post offices, banks, supermarkets, shopping centers, pharmacies, health services), sports facilities & playgrounds, food environment, land-use mix, housing, walkability, street connectivity and traffic. Studies found associations with childhood obesity for food environment, green space, and noise pollution, but those associations mostly vanished after adjustment for individual-level socioeconomic characteristics. Due to great variability in the definitions of the determinants and the methods of data collection and analysis, we did not conduct any meta-analyses. None of the examined determinants of the built environment had a consistently reported independent association with childhood obesity.

Conclusion: This review found that the association between built environment and overweight and obesity in children is mostly confounded by individual-level socioeconomic factors. Further research should specifically take this into account, when examining causal pathways between environment, and overweight and obesity.

The authors declare that they have no competing interests.

The authors declare that an ethics committee vote is not required.