title: Neighborhood deprivation and change in BMI among adults with type 2 diabetes: the Diabetes Study of Northern California (DISTANCE).
abstract: OBJECTIVE
  To compare associations between neighborhood deprivation and measures of BMI change among adults with type 2 diabetes.
  
  
  METHODS
  Using data from the Kaiser Permanente Diabetes Study of Northern California (DISTANCE) survey, we estimated the association between neighborhood deprivation and two measures of BMI change over 3 years: 1) a continuous measure and 2) a categorical measure of clinically substantive BMI loss or gain (≥7% of baseline BMI) versus stable BMI. The sample included 13,609 adults.
  
  
  RESULTS
  On average, there was little change in BMI (-0.12, SD 3.07); 17.0 and 16.1% had clinically substantive BMI loss or gain, respectively, at follow-up. There was a positive association between neighborhood deprivation and BMI change for adults in the most versus least-deprived quartile of neighborhood deprivation (β = 0.22, P = 0.02) in adjusted models. In addition, relative to the least-deprived quartile (Q1), adults in more-deprived quartiles of neighborhood deprivation were more likely to experience either substantive BMI loss (Q2 relative risk ratio 1.19, 95% CI 1.00-1.41; Q3 1.20, 1.02-1.42; Q4 1.30, 1.08-1.55) or gain (Q2 1.25, 1.04-1.49; Q3 1.24, 1.04-1.49; Q4 1.45, 1.20-1.75).
  
  
  CONCLUSIONS
  Greater neighborhood deprivation was positively associated with BMI change among adults with diabetes as well as with clinically substantive BMI loss or gain. Findings stress the importance of allowing for simultaneous associations with both gain and loss in future longitudinal studies of neighborhood deprivation and weight change, which may be particularly true for studies of patients with diabetes for whom both weight loss and gain have health implications.
authors.affiliation: University of California, San Francisco, CA, USA. pamela.stoddard@phd.sccgov.org
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Stoddard
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Laraia
authors.forename: E Margaret
authors.initials: EM
authors.lastname: Warton
authors.forename: Howard H
authors.initials: HH
authors.lastname: Moffet
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Adler
authors.forename: Dean
authors.initials: D
authors.lastname: Schillinger
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Karter
mesh_terms: D000328:Adult; D015992:Body Mass Index; D002140:California / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D012111:Residence Characteristics; D012307:Risk Factors; D012959:Socioeconomic Factors; D055815:Young Adult