Neighborhood design for walking and biking: Physical activity and body mass index

Background: Neighborhood designs often relate to physical activity and to BMI. Purpose: Does neighborhood walkability/bikeability relate to BMI and obesity risk and does moderate-to-vigorous physical activity (MVPA) account for some of the relationship? Methods: Census 2000 provided walkability/bikeability measures - block group proportions of workers who walk or bike to work, housing age, and population density - and National Health and Nutrition Examination Study (NHANES 2003-2006) provided MVPA accelerometer measures. Regression analyses (2011-2012) adjusted for geographic clustering and multiple control variables. Results: Greater density and older housing were associated with lower male BMI in bivariate analyses, but there were no density and housing age effects in multivariate models. For women, greater proportions of neighborhood workers who walk to work (M=0.02) and more MVPA was associated with lower BMI and lower obesity risk. For men, greater proportions of workers who bike to work (M=0.004) and more MVPA was associated with lower BMI and obesity risk. For both effects, MVPA partially mediated the relationships between walkability/bikeability and BMI. If such associations are causal, doubling walk and bike-to-work proportions (to 0.04 and 0.008) would have -0.3 and -0.33 effects on the average BMIs of adult women and men living in the neighborhood. This equates to 1.5 pounds for a 64-inch-tall woman and 2.3 pounds for a 69-inch-tall man. Conclusions: Although walking/biking to work is rare in the U.S., greater proportions of such workers in neighborhoods relate to lower weight and higher MVPA. Bikeability merits greater attention as a modifiable activity-friendliness factor, particularly for men.