Association Between Neighborhood Socioeconomic Status and Obesity in 89,160 Lifelines Participants

Background: We examined to what extent the association between neighborhood socioeconomic status (NSES) and obesity among the Dutch adult general population is moderated by exposure to pay-for-use physical activity (PA) facilities and fast-food (FF) outlets. Methods: Data from the baseline adult Lifelines cohort, Statistics Netherlands and LISA were used. Individuals’ residential addresses were linked to neighborhood data and pay-for-use PA facility (0, 1, or >1 within 1 km) and FF outlet locations (0, 1, or >1 within 1 km) using geocoding. Multivariable logistic regression was used to investigate the association between NSES (categorised as low, middle and high) and obesity (Body Mass Index ≥ 30.0), adjusting for neighborhood address density, age, sex, education, partner status, occupational prestige, and income. If the interaction term with NSES was significant, analysis was stratified for having 0, 1, >1 pay-for-use PA facility and 0, 1, or >1 FF outlet within 1 km around the residential address. Results: Obesity was present among 14.7% of the 89,160 participants. People living in low NSES or middle NSES more often had obesity than people living in high NSES (OR (95%CI): 1.56 (1.48 to 1.64), OR (95%CI):1.22 (1.16 to 1.28), respectively). The association between low NSES and obesity was weaker in neighborhoods without any FF outlet within 1 km (OR (95%CI)=1.32 (1.10 to 1.59)) compared to neighborhoods with one FF outlet (OR (95%CI)=1.58 (1.37 to 1.82)) or more than one FF outlet (OR (95%CI): 1.52 (1.43 to 1.62)). Exposure to pay-for-use PA facilities did not moderate the association between NSES and obesity. Conclusions: People living in low NSES more often had obesity than people living in high NSES. This association became weaker if no FF outlets are available within 1km around the residential address. These results indicate that health disparities may be reduced if fewer FF outlets are available.