No Neighborhood Park? Kids Risk Becoming Overweight Adults Interview with:
Annemarie Schalkwijk, MSc/MD
PhD candidate, GP in training
Diabetes Research Group
EMGO Institute for Health and Care Research
VU University Medical Center
Amsterdam The Netherlands

Medical Research: What is the background for this study?

Dr. Schalkwijk: Overweight and obese children are at increased risk of becoming overweight and obese adults and therefore are an important risk factor for developing type 2 diabetes. It is known from the literature that being overweight or obese is associated with environmental, parental and socioeconomic status (SES) characteristics. However, the interdependence of these variables has not been studied before.Therefore, the aim of our study is to assess the influence of the amount of green space, accessibility to a garden and the safety of the surroundings during ages 3-5 on being overweight or obese at age 7. Furthermore, we want to assess if parental choices and SES moderate or mediate this influence.

Medical Research: What are the main findings?

Dr. Schalkwijk: Statistically significant associations (p≤0.05) were found between low levels green space, not having access to a garden, shabbiness of the neighborhood and childhood obesity (OR (95% CI) respectively: 1,14 (1,02-1,27), 1,35 (1,16-1,58), 1,22 (1,05-1,42)). Parental determinants were related to the environmental determinants and childhood overweight/obese but did not moderate or mediate the association between the latter two. Therefore no parental variables were left in the model. As for SES, the highest level of education in the household did diminish the magnitude of the associations found between the environmental determinants and being overweight/obese. In the final model the remaining significant associations with childhood overweight/obese were no garden access for lower educated households and shabbiness of the neighborhood for higher educated households (OR (95% CI) respectively: 1,38 (1,16-1,58), 1,38 (1,12-1,70). We can conclude from our study, that environmental factors do have an association with children being overweight or obese. However, these associations are complex and might not be as distinct as previously assumed.

AHA-Image-Kids-PlaygroundMedical Research: What should clinicians and patients take away from your report?

Dr. Schalkwijk: It is important for clinicians during treatment of obese children to inform about the (green) environment in which one lives, like is there a greenspace (i.e. garden) and is it also used? Next, clinicians could encourage the use of the green environment around the house in the treatment of obese children as a way to be physically active. It is important for patients, particularly lower educated parents of overweight or obese children, to know that the park or the garden are (cheap) opportunities to let a child play or be physically active. They should be aware that they are also going to use these areas for this purpose.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Schalkwijk: Since the current data are analyzed at one moment in time, it would be interesting to analyze whether the same associations exist when you evaluate the data longitudinal i.e. does a change in environment change the chances of a child to become overweight or obese. Adding to the environmental variables, it would be interesting to analyze the influence of shops where one can buy (fast) food, like snack bars, supermarkets, take-away in the association of being overweight.


51st EASD Annual Meeting, Stockholm, Sweden, 14-18 September 2015

Is access to the outdoors associated with childhood overweight and obesity? B.C. van der Zwaard1,2, A. Schalkwijk1,2, P.J.M. Elders1,2, G. Nijpels1,2, L. Platt3 ; 1 General practice and elderly care medicine, VU medical center, 2 EMGO+ Institute for Health and Care research, Amsterdam, Netherlands, 3 Social Policy, London School of Economics and Political Science, London, UK.

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Last Updated on September 16, 2015 by Marie Benz MD FAAD