title: Childhood overweight in Berlin: intra-urban differences and underlying influencing factors.
abstract: BACKGROUND
  In recent years, childhood overweight and obesity have become an increasing and challenging phenomenon in Western cities. A lot of studies have focused on the analysis of factors such as individual dispositions and nutrition balances, among others. However, little is known about the intra-urban spatial patterns of childhood overweight and its associations with influencing factors that stretch from an individual to a neighbourhood level. The aim of this paper is to analyse the spatial patterns of childhood obesity in Berlin, and also to explore and test for associations with a complex set of risk factors at the individual, household and neighbourhood levels.
  
  
  METHODS
  We use data from a survey of 5-6 year-olds that includes health status, height, and weight, as well as several socioeconomic and other risk variables. In addition, we use a set of neighbourhood variables, such as distance, and density measures of parks or fast food restaurants. Our outcome variable is the percentage of children of 5-6 years who were reported overweight or obese in 2012. The aggregated data is available for 60 areas in Berlin. We first analyse the outcome and risk factor data descriptively, and subsequently apply a set of regression analyses to test for associations between reported overweight and obesity, and also individual, household and neighbourhood characteristics.
  
  
  RESULTS
  Our analysis returned a distinct spatial distribution of childhood overweight in Berlin with highest shares in the city centre. Moreover, we were able to identify significant effects regarding the social index, and the percentage of non-German children being obese or overweight; additionally, we identified fast food restaurant density as a possible influencing factor. For the other variables, including the neighbourhood variables, we could not identify a significant association on this aggregated level of analysis.
  
  
  CONCLUSIONS
  Our findings confirm the results of earlier studies, in which the social status and percentage of non-German children is very important in terms of the association with childhood overweight and obesity. Unlike many studies conducted in North America, this study did not reveal an influence of neighbourhood variables. We argue that European urban structures differ from North American structures and highlight the need for a more detailed analysis of the association between the neighbourhood environment and the physical activity of children in urban setting.
authors.affiliation: Geography Department, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099, Berlin, Germany. Tobia.Lakes@geo.hu-berlin.de.
authors.forename: Tobia
authors.initials: T
authors.lastname: Lakes
authors.affiliation: Geography Department, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099, Berlin, Germany.|Department of Environmental Health Science, Mailman School of Public Health, Columbia University in the City of New York, New York, NY, USA.
authors.forename: Katrin
authors.initials: K
authors.lastname: Burkart
mesh_terms: D001604:Berlin / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004779:Environment Design / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D050177:Overweight / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology*; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012307:Risk Factors; D012959:Socioeconomic Factors; D014505:Urban Population / Q000706:statistics & numerical data*
keywords: Childhood; Neighbourhood; Obesity; Overweight; Spatial analyses; Urban health