Neighborhood and 1-Year Weight-Related Factors in the Look AHEAD Study

Previous studies have shown that neighborhood factors are associated with obesity, but few studies have examined their association with weight-related health behaviors. Therefore, we conducted a multi-level analysis examining neighborhood socioeconomic status (SES) and weight-related health behaviors at 1 year in Look AHEAD, a randomized trial of intensive lifestyle intervention (ILI) vs. diabetes support and education (DSE) in persons with type 2 diabetes. Individual-level data on 958 participants were linked to neighborhood-level data (2000 US Census tracts). Neighborhood variables included SES (% living below the federal poverty level) and the availability of food stores, convenience stores, and restaurants. Outcomes at 1 year included individual-level weight and eating patterns collected on participants in the Look AHEAD study. Multi-level models were used to adjust for individual-level SES and potential confounders. Results were stratified to determine if the associations with neighborhood characteristics differed by intervention group. Although neighborhood variables were not significantly associated with weight loss in either intervention group, the availability of restaurants in neighborhoods was related to several eating patterns. Participants in neighborhoods with more restaurants reported that they were less likely to eat breakfast at a fast food restaurant (prevalence Ratio [PR] 0.55 95% CI: 0.30-1.00) in the ILI and more likely to have lunch at non –fast food restaurants (PR=1.72, 1.21-2.45) in the DSE. In this selected group of weight-loss trial participants, restaurant availability in neighborhoods was associated with some individual-level eating patterns after one year of intervention, but had no significant effects on the success of the ILI intervention.