title: An observational study identifying obese subgroups among older adults at increased risk of mobility disability: do perceptions of the neighborhood environment matter?
abstract: BACKGROUND
  Obesity is an increasingly prevalent condition among older adults, yet relatively little is known about how built environment variables may be associated with obesity in older age groups. This is particularly the case for more vulnerable older adults already showing functional limitations associated with subsequent disability.
  
  
  METHODS
  The Lifestyle Interventions and Independence for Elders (LIFE) trial dataset (n = 1600) was used to explore the associations between perceived built environment variables and baseline obesity levels. Age-stratified recursive partitioning methods were applied to identify distinct subgroups with varying obesity prevalence.
  
  
  RESULTS
  Among participants aged 70-78 years, four distinct subgroups, defined by combinations of perceived environment and race-ethnicity variables, were identified. The subgroups with the lowest obesity prevalence (45.5-59.4%) consisted of participants who reported living in neighborhoods with higher residential density. Among participants aged 79-89 years, the subgroup (of three distinct subgroups identified) with the lowest obesity prevalence (19.4%) consisted of non-African American/Black participants who reported living in neighborhoods with friends or acquaintances similar in demographic characteristics to themselves. Overall support for the partitioned subgroupings was obtained using mixed model regression analysis.
  
  
  CONCLUSIONS
  The results suggest that, in combination with race/ethnicity, features of the perceived neighborhood built and social environments differentiated distinct groups of vulnerable older adults from different age strata that differed in obesity prevalence. Pending further verification, the results may help to inform subsequent targeting of such subgroups for further investigation.
  
  
  BACKGROUND
  Clinicaltrials.gov Identifier =  NCT01072500.
authors.affiliation: Health Research & Policy, and Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, 259 Campus Drive, HRP Redwood Building, Room T221, Stanford, CA, USA. king@stanford.edu.
authors.forename: Abby C
authors.initials: AC
authors.lastname: King
authors.affiliation: Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA. deborah.salvo@uth.tmc.edu.|Michael and Susan Dell Center for Healthy Living, the University of Texas Health Science Center at Houston, School of Public Health (Austin Regional Campus), Austin, TX, USA. deborah.salvo@uth.tmc.edu.
authors.forename: Deborah
authors.initials: D
authors.lastname: Salvo
authors.affiliation: Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA. jorge.banda@stanford.edu.
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Banda
authors.affiliation: Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA. david.ahn@stanford.edu.
authors.forename: David K
authors.initials: DK
authors.lastname: Ahn
authors.affiliation: Department of Medicine, Yale University School of Medicine, New Haven, CT, 06504, USA. Thomas.gill@yale.edu.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Gill
authors.affiliation: Department of Biostatistical Sciences, Lake Forest School of Medicine, Winston-Salem, NC 27157, USA. mmiller@wakehealth.edu.
authors.forename: Michael
authors.initials: M
authors.lastname: Miller
authors.affiliation: Healthy Aging Research Program, University of Pittsburgh, Pittsburgh, PA, 15213, USA. mmiller@wakehealth.edu.
authors.forename: Anne B
authors.initials: AB
authors.lastname: Newman
authors.affiliation: Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, 02111, USA. roger.fielding@tufts.edu.
authors.forename: Roger A
authors.initials: RA
authors.lastname: Fielding
authors.affiliation: Healthy Aging Research Program, University of Pittsburgh, Pittsburgh, PA, 15213, USA. CAS271@pitt.edu.
authors.forename: Carlos
authors.initials: C
authors.lastname: Siordia
authors.affiliation: Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, 29208, USA. MOOREDS4@mailbox.sc.edu.
authors.forename: Spencer
authors.initials: S
authors.lastname: Moore
authors.affiliation: Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, 02111, USA. sara.folta@tufts.edu.
authors.forename: Sara
authors.initials: S
authors.lastname: Folta
authors.affiliation: Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. bspring@northwestern.edu.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Spring
authors.affiliation: Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, 32608, USA. tmanini@ufl.edu.
authors.forename: Todd
authors.initials: T
authors.lastname: Manini
authors.affiliation: Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, 32608, USA. mpahor@ufl.edu.
authors.forename: Marco
authors.initials: M
authors.lastname: Pahor
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D006233:Persons with Disabilities; D004777:Environment; D004779:Environment Design; D005006:Ethnicity; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D051346:Mobility Limitation; D009765:Obesity / Q000453:epidemiology*; D010465:Perception; D011156:Population Density; D015995:Prevalence; D044469:Racial Groups; D012111:Residence Characteristics; D012306:Risk; D012931:Social Environment