Neighborhood Food Access in Early Life and Trajectories of Child Body Mass Index and Obesity
Authors: Aris Izzuddin M. , Wu Allison J. , Lin Pi-I D. , Zhang Mingyu , Farid Huma , Hedderson Monique M. , Zhu Yeyi , Ferrara Assiamira , Chehab Rana F. , Barrett Emily S. , Carnell Susan , Camargo Carlos A. , Chu Su H. , Mirzakhani Hooman , Kelly Rachel S. , Comstock Sarah S. , Strakovsky Rita S. , O’Connor Thomas G. , Ganiban Jody M. , Dunlop Anne L. , Dabelea Dana , Breton Carrie V. , Bastain Theresa M. , Farzan Shohreh F. , Call Christine C. , Hartert Tina , Snyder Brittney , Santarossa Sara , Cassidy-Bushrow Andrea E. , O’Shea T. Michael , McCormack Lacey A. , Karagas Margaret R. , McEvoy Cindy T. , Alshawabkeh Akram , Zimmerman Emily , Wright Rosalind J. , McCann Mariel , Wright Robert O. , Coull Brent , Amutah-Onukagha Ndidiamaka , Hacker Michele R. , James-Todd Tamarra , Oken Emily ,   ECHO Cohort Consortium, Smith P Brian , Newby L Kristin , Adair Linda , Jacobson Lisa P. , Catellier Diane , McGrath Monica , Douglas Christian , Duggal Priya , Knapp Emily , Kress Amii , Blackwell Courtney K. , Mansolf Maxwell A. , Lai Jin-Shei , Ho Emily , Cella David , Gershon Richard , Macy Michelle L. , Das Suman R. , Freedman Jane E. , Mallal Simon A. , McLean John A. , Shah Ravi V. , Shilts Meghan H. , Alshawabkeh Akram N. , Cordero Jose F. , Meeker John , Trasande Leonardo , Camargo Carlos A. , Hasegawa Kohei , Zhu Zhaozhong , Sullivan Ashley F. , Dabelea Dana , Perng Wei , Bekelman Traci A. , Wilkening Greta , Magzamen Sheryl , Moore Brianna F. , Starling Anne P. , Rinehart Deborah J. , Koinis Mitchell Daphne , D'Sa Viren , Deoni Sean C.L. , Mueller Hans-Georg , Duarte Cristiane S. , Monk Catherine , Canino Glorisa , Posner Jonathan , Murray Tenneill , Lugo-Candelas Claudia , Dunlop Anne L. , Brennan Patricia A. , Hockett Christine , Elliott Amy , Ferrara Assiamira , Croen Lisa A. , Hedderson Monique M. , Ainsworth John , Bacharier Leonard B. , Bendixsen Casper G. , Gern James E. , Gold Diane R. , Hartert Tina V. , Jackson Daniel J. , Johnson Christine C. , Joseph Christine  L.M. , Kattan Meyer , Khurana Hershey Gurjit K. , Lemanske, Jr. Robert F. , Lynch Susan V. , Miller Rachel L. , O’Connor George T. , Ober Carole , Ownby Dennis , Rivera-Spoljaric Katherine , Ryan Patrick H. , Seroogy Christine M. , Singh Anne Marie , Wood Robert A. , Zoratti Edward M. , Habre Rima , Farzan Shohreh , Gilliland Frank D. , Hertz-Picciotto Irva , Bennett Deborah H. , Schweitzer Julie B. , Schmidt Rebecca J. , LaSalle Janine M. , Hipwell Alison E. , Keenan Kate E. , Karr Catherine J. , Bush Nicole R. , LeWinn Kaja Z. , Sathyanarayana Sheela , Zhao Qi , Tylavsky Frances , Carroll Kecia N. , Loftus Christine T. , Leve Leslie D. , Ganiban Jody M. , Neiderhiser Jenae M. , Weiss Scott T. , Litonjua Augusto A. , McEvoy Cindy T. , Spindel Eliot R. , Tepper Robert S. , Newschaffer Craig J. , Lyall Kristen , Volk Heather E. , Landa Rebecca , Ozonoff Sally , Piven Joseph , Hazlett Heather , Pandey Juhi , Schultz Robert , Dager Steven , Botteron Kelly , Messinger Daniel , Stone Wendy , Ames Jennifer , O'Connor Thomas G. , Miller Richard K. , Oken Emily , Hacker Michele R. , James-Todd Tamarra , O'Shea T. Michael , Fry Rebecca C. , Frazier Jean A. , Singh Rachana , Rollins Caitlin , Montgomery Angela , Vaidya Ruben , Joseph Robert M. , Washburn Lisa K. , Gogcu Semsa , Bear Kelly , Rollins Julie V. , Hooper Stephen R. , Taylor Genevieve , Jackson Wesley , Thompson Amanda , Daniels Julie , Hernandez Michelle , Lu Kun , Msall Michael , Lenski Madeleine , Obeid Rawad , Pastyrnak Steven L. , Jensen Elizabeth , Sakai Christina , Santos Hudson , Kerver Jean M. , Paneth Nigel , Barone Charles J. , Elliott Michael R. , Ruden Douglas M. , Fussman Chris , Herbstman Julie B. , Margolis Amy , Schantz Susan L. , Geiger Sarah Dee , Aguiar Andrea , Tabb Karen , Strakovsky Rita , Woodruff Tracey , Morello-Frosch Rachel , Padula Amy , Stanford Joseph B. , Porucznik Christina A. , Giardino Angelo P. , Wright Rosalind J. , Wright Robert O. , Collett Brent , Baumann-Blackmore Nicole , Gangnon Ronald , McKennan Chris G. , Wilson Jo , Altman Matt , Aschner Judy L. , Stroustrup Annemarie , Merhar Stephanie L. , Moore Paul E. , Pryhuber Gloria S. , Hudak Mark , Reynolds Lyndaker Ann Marie , Lampland Andrea L. , Rochelson Burton , Jan Sophia , Blitz Matthew J. , Katzow Michelle W. , Brown Zenobia , Chiuzan Codruta , Rafael Timothy , Lewis Dawnette , Meirowitz Natalie , Poindexter Brenda , Gebretsadik Tebeb , Osmundson Sarah , Straughen Jennifer K. , Eapen Amy , Cassidy-Bushrow Andrea , Wegienka Ganesa , Sitarik Alex , Woodcroft Kim , Urquhart Audrey , Levin Albert , Johnson-Hooper Tisa , Davidson Brent , Ma Tengfei , Barrett Emily S. , Blaser Martin J. , Dominguez-Bello Maria Gloria , Horton Daniel B. , Jimenez Manuel , Rosen Todd , Palomares Kristy , Avalos Lyndsay A. , Zhu Yeyi , Hunt Kelly J . , Newman Roger B. , Bloom Michael S. , Alkis Mallory H. , Roberts James R. , Mumford Sunni L. , Burris Heather H. , DeMauro Sara B. , Yee Lynn M. , Hamvas Aaron , Olidipo Antonia F. , Haddad Andrew S. , Eiland Lisa R. , Spillane Nicole T. , Suri Kirin N. , Fisher Stephanie A. , Goldstein Jeffrey A. , Mithal Leena B. , DeRegnier Raye-Ann O. , Maitre Nathalie L. , Nguyen Ruby H.N. , JaKa Meghan  M. , Sidebottom Abbey C. , Paidas Michael J. , Potter JoNell E. , Ruby Natale , Duthely Lunthita , Jayakumar Arumugam , Young Karen , Maldonado Isabel , Miller Meghan , Slaughter Jonathan L. , Keim Sarah A. , Lynch Courtney D. , Venkatesh Kartik K. , Whitworth Kristina W. , Symanski Elaine , Northrup Thomas F. , Mendez-Figueroa Hector , Mosquera Ricardo A. , Karagas Margaret R. , Madan Juliette  C. , MacKenzie Debra M. , Lewis Johnnye L. , Rennie Brandon J. , Leventhal Bennett L. , Kim Young Shin , Bishop Somer , Nozadi Sara S. , Luo Li , Lester Barry M. , Marsit Carmen J. , Everson Todd , Loncar Cynthia M. , McGowan Elisabeth C. , Sheinkopf Stephen J. , Carter Brian S. , Check Jennifer , Helderman Jennifer B. , Neal Charles R. , Smith Lynne M. 
Published: September 2024

Importance

Limited access to healthy foods, resulting from residence in neighborhoods with low food access, is a public health concern. The contribution of this exposure in early life to child obesity remains uncertain.

Objective

To examine associations of neighborhood food access during pregnancy or early childhood with child body mass index (BMI) and obesity risk.

Design, Setting, and Participants

Data from cohorts participating in the US nationwide Environmental Influences on Child Health Outcomes consortium between January 1, 1994, and March 31, 2023, were used. Participant inclusion required a geocoded residential address in pregnancy (mean 32.4 gestational weeks) or early childhood (mean 4.3 years) and information on child BMI.

Exposures

Residence in low-income, low–food access neighborhoods, defined as low-income neighborhoods where the nearest supermarket is more than 0.5 miles for urban areas or more than 10 miles for rural areas.

Main Outcomes and Measures

BMI z score, obesity (age- and sex-specific BMI ≥95th percentile), and severe obesity (age- and sex-specific BMI ≥120% of the 95th percentile) from age 0 to 15 years.

Results

Of 28 359 children (55 cohorts; 14 657 [51.7%] male and 13 702 [48.3%] female; 590 [2.2%] American Indian, Alaska Native, Native Hawaiian, or Other Pacific Islander; 1430 [5.4%] Asian; 4034 [15.3%] Black; 17 730 [67.2%] White; and 2592 [9.8%] other [unspecified] or more than 1 race; 5754 [20.9%] Hispanic and 21 838 [79.1%] non-Hispanic) with neighborhood food access data, 23.2% resided in low-income, low–food access neighborhoods in pregnancy and 24.4% in early childhood. After adjusting for individual sociodemographic characteristics, residence in low-income, low–food access (vs non–low-income, low–food access) neighborhoods in pregnancy was associated with higher BMI z scores at ages 5 years (β, 0.07; 95% CI, 0.03-0.11), 10 years (β, 0.11; 95% CI, 0.06-0.17), and 15 years (β, 0.16; 95% CI, 0.07-0.24); higher obesity risk at 5 years (risk ratio [RR], 1.37; 95% CI, 1.21-1.55), 10 years (RR, 1.71; 95% CI, 1.37-2.12), and 15 years (RR, 2.08; 95% CI, 1.53-2.83); and higher severe obesity risk at 5 years (RR, 1.21; 95% CI, 0.95-1.53), 10 years (RR, 1.54; 95% CI, 1.20-1.99), and 15 years (RR, 1.92; 95% CI, 1.32-2.80). Findings were similar for residence in low-income, low–food access neighborhoods in early childhood. These associations were robust to alternative definitions of low income and low food access and additional adjustment for prenatal characteristics associated with child obesity.

Conclusions

Residence in low-income, low–food access neighborhoods in early life was associated with higher subsequent child BMI and higher risk of obesity and severe obesity. We encourage future studies to examine whether investments in neighborhood resources to improve food access in early life would prevent child obesity.