Introduction
The prevalence of adult obesity with Body Mass Index (BMI) greater than 30 is expected to reach nearly 50% of the United States (U.S.) population by 2030 (Centers for Disease Control and Prevention,
2022; Ward et al.,
2019). While obesity is associated with multiple deleterious health outcomes, including cardiometabolic diseases and cancers (Afshin et al.,
2017; Dixon,
2010; Lauby-Secretan et al.,
2016; Wannamethee, Gerald Shaper, Whincup, Lennon, & Sattar,
2011), lifestyle weight-loss interventions have been shown to be beneficial in reducing a variety of these negative health conditions (Anderson et al.,
2014; Appel et al.,
2011; Elmer et al.,
2006; Maruthur, Wang, & Appel,
2009) by improving glucose metabolism and reducing inflammation and oxidative stress, all of which contribute to cardiovascular and metabolic health risks (Esposito et al.,
2003; Lofgren et al.,
2005; Van Gaal, Wauters, & De Leeuw,
1997).
Studies have documented the effect of neighborhood social conditions, including social support and cohesion, a sense of community, crime and violence, and informal social control, on how people interact with others and with the environment (Bursik & Grasmick,
1993; Sampson,
2003; Shaw & McKay,
1942; Zorbaugh,
1929). Furthermore, neighborhood economic conditions that limit options for healthy good and opportunities for physical activity have been shown to be associated with obesity and weight gain (Black & Macinko,
2008; Coogan et al.,
2012; Zhang, Bauer, Powell-Wiley, & Xiao,
2021). As such, neighborhood social and economic conditions determine the built environment (i.e., the physical aspects of where one lives). Research on the built environment has increased significantly over the past decades (Jackson et al.,
2013), with an emphasis on how the built environment influences lifestyle behaviors that in turn affect weight management (Brownson et al.,
2009; Laddu, Pauluch, & LaMonte,
2021; Scott, Dubowitz, & Cohen,
2009).
The built environment may influence individuals’ health by either facilitating or impeding healthy lifestyle behaviors, including adequate physical activity (Barnett et al.,
2017). One important feature of the built environment is walkability. Walkability relates to aspects of physical structures that influence walking as a method of travel U.S. (Environmental Protection Agency,
2021). Studies have documented that people living in more walkable areas tend to be more physically active (Chen et al.,
2019; Colley, Christidis, Michaud, Tjepkema, & Ross,
2019) and tend to have lower BMI (Casagrande et al.,
2011; Cerin et al.,
2018; Creatore et al.,
2016; Hoehner, Handy, Yan, Blair, & Berrigan,
2011). Interestingly, however, Zenk and colleagues compared the effects of a weight management program between people living in neighborhoods with variations in the levels of walkability and access to recreational places and found no difference in the program’s effect by the level of neighborhood walkability (Zenk et al.,
2019).
Prevalent crime as a component of the built environment, may be a barrier to walkability and physical activity (Gomez et al.,
2004; Robinson, Carnes, & Oreskovic,
2016), and yet, research has produced conflicting findings regarding the association between physical activity and neighborhood crime rates (Foster et al.,
2014a; Loukaitou-Sideris,
2006; Loukaitou-Sideris & Eck,
2007). While some studies show that higher crime rates and lower reported safety are associated with lower levels of physical activity (Boehmer et al.,
2006; Gomez et al.,
2004; Richardson, Troxel, Ghosh-Dastidar, et al.,
2017; Schoeny, Fogg, Buchholz, Miller, & Wilbur,
2016), other studies have found no effect between these factors and physical activity (Prince et al.,
2011; Ruijsbroek, Droomers, Groenewegen, Hardyns, & Stronks,
2015).
Perceptions of neighborhood safety may influence these contradictory findings (Giles-Corti & Donovan,
2002). Perceived neighborhood safety seems to determine levels of physical activity, even after controlling for observed safety, such as neighborhood crime (Janssen,
2014). Other studies have documented the relationship between perceived neighborhood safety, physical activity, and obesity (Bacha et al.,
2010; Chaparro, Bilfield, & Theall,
2019; Prins et al.,
2013), with higher levels of perceived safety and access to recreational facilities associated with higher physical activity levels among low-income adults (Wilson-Frederick et al.,
2014). A meta-analysis found that perceived fear of crime and actual crime rates were inversely correlated with physical inactivity (Rees-Punia et al.,
2018). Overall, people who reported feeling safe from crime had 27% greater odds of achieving higher levels of physical activity, whereas those living in areas with high levels of actual crime had 28% lower odds of achieving higher levels of physical activity (Rees-Punia et al.,
2018).
Interestingly, Foster and colleagues (Foster et al.,
2014a) found that higher levels of certain types of crime, such as burglary and other personal crimes, were associated with increased walkability (Foster et al.,
2014a). The authors speculated that walkable conditions may promote walking, while at the same time more people in the public sphere may increase opportunities for crime to take place. There is some evidence to suggest that the relationship between crime and physical activity may vary depending on the type of crime. Although high homicide rates (Kerr et al.,
2015) and fear of crime (McGinn et al.,
2008) seem to be associated with decreased walking, perceived drug-related crime has been associated with a higher level of walkability (Mason et al.,
2013). Overall, the relationship between crime and walkability in current literature seems to be inconclusive.
This study aims to elucidate the role of walkability and neighborhood crime on weight loss using data from older Chicago residents participating in a randomized controlled trial (RCT) lifestyle intervention. This original RCT included predominantly Black older adults who lived on the South Side of Chicago, which is highly racially segregated and affected by increased crime. We hypothesized that neighborhood walkability and homicide would have differential effects on participants’ weight loss and physical activity. Specifically, pre- and post-intervention weight loss would be greater for participants living in neighborhoods with high walkability and lower for participants living in neighborhoods with high homicide rates.
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