Built environment characteristics and obesity in underserved populations: A systematic review

Introduction: In the United States, health disparities in obesity and obesity-related illnesses have been identified and targeted for elimination. Our objective was to better understand whether obesity-related health disparities could be explained by differential exposure to obesigenic environments.

Methods: We conducted a systematic review of the published scientific literature, screening for studies with relevance to underserved individuals or areas, which were identified by low socioeconomic status, black race, or Hispanic ethnicity. We identified 34 studies published between 2001 and 2007 which either (1) separately estimated the obesity-related effects of the built environment for one or more underserved groups or (2) described the relative exposure underserved groups had to potentially obesigenic built environment characteristics.

Results: Based on available evidence, built environment characteristics were categorized as relevant to the food environment, urban form (walkable versus sprawling patterns), places to exercise, and safety/aesthetics. When considering the obesity-related effects of built environment characteristics, we found the strongest support for the importance of food stores (supermarkets instead of smaller grocery/convenience stores), places to exercise, and safety as potentially beneficial for underserved groups. We also found that underserved groups are likely to be at a disadvantage with respect to food stores, aesthetic problems, and traffic or crime-related safety.

Conclusion: One potential strategy to reduce obesity would involve changing the built environment to be more supportive of physical activity and a healthy diet. Based on our review, increasing supermarket access and safety may be especially promising strategies to reduce obesity-related health disparities.