Evaluating causal relationships between urban built environment characteristics and obesity: a methodological review of observational studies
BACKGROUND A burgeoning literature links attributes of neighbourhoods' built environments to residents' physical activity, food and transportation choices, weight, and/or obesity risk. In cross-sectional studies, non-random residential selection impedes researchers' ability to conclude that neighbourhood environments cause these outcomes. METHODS Cross-sectional data for the current study are based on 14,689 non-Hispanic white women living in Salt Lake County, Utah, USA. Instrumental variables techniques are used to adjust for the possibility that neighbourhoods may affect weight but heavier or lighter women may also choose to live in certain neighbourhoods. All analyses control for the average BMI of siblings and thus familial predisposition for overweight/obesity, which is often an omitted variable in past studies. RESULTS We find that cross-sectional analyses relating neighbourhood characteristics to BMI understate the strength of the relationship if they do not make statistical adjustments for the decision to live in a walkable neighbourhood. Standard cross-sectional estimation reveals no significant relationship between neighbourhood walkability and BMI. However, the instrumental variables estimates reveal statistically significant effects. CONCLUSIONS We find evidence that residential selection leads to an understatement of the causal effects of neighbourhood walkability features on BMI. Although caution should be used in generalizing from research done with one demographic group in a single locale, our findings support the contention that public policies designed to alter neighbourhood walkability may moderately affect the BMI of large numbers of individuals.