title: Neighborhood food environment and walkability predict obesity in New York City.
abstract: BACKGROUND
  Differences in the neighborhood food environment may contribute to disparities in obesity.
  
  
  OBJECTIVE
  The purpose of this study was to examine the association of neighborhood food environments with body mass index (BMI) and obesity after control for neighborhood walkability.
  
  
  METHODS
  This study employed a cross-sectional, multilevel analysis of BMI and obesity among 13,102 adult residents of New York City. We constructed measures of the food environment and walkability for the neighborhood, defined as a half-mile buffer around the study subject's home address.
  
  
  RESULTS
  Density of BMI-healthy food outlets (supermarkets, fruit and vegetable markets, and natural food stores) was inversely associated with BMI. Mean adjusted BMI was similar in the first two quintiles of healthy food density (0 and 1.13 stores/km2, respectively), but declined across the three higher quintiles and was 0.80 units lower [95% confidence interval (CI), 0.27-1.32] in the fifth quintile (10.98 stores/km2) than in the first. The prevalence ratio for obesity comparing the fifth quintile of healthy food density with the lowest two quintiles combined was 0.87 (95% CI, 0.78-0.97). These associations remained after control for two neighborhood walkability measures, population density and land-use mix. The prevalence ratio for obesity for the fourth versus first quartile of population density was 0.84 (95% CI, 0.73-0.96) and for land-use mix was 0.91 (95% CI, 0.86-0.97). Increasing density of food outlets categorized as BMI-unhealthy was not significantly associated with BMI or obesity.
  
  
  CONCLUSIONS
  Access to BMI-healthy food stores is associated with lower BMI and lower prevalence of obesity.
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA. agr3@columbia.edu
authors.forename: Andrew
authors.initials: A
authors.lastname: Rundle
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Neckerman
authors.forename: Lance
authors.initials: L
authors.lastname: Freeman
authors.forename: Gina S
authors.initials: GS
authors.lastname: Lovasi
authors.forename: Marnie
authors.initials: M
authors.lastname: Purciel
authors.forename: James
authors.initials: J
authors.lastname: Quinn
authors.forename: Catherine
authors.initials: C
authors.lastname: Richards
authors.forename: Neelanjan
authors.initials: N
authors.lastname: Sircar
authors.forename: Christopher
authors.initials: C
authors.lastname: Weiss