Becky McCall

September 23, 2015

STOCKHOLM — Children with no yard and limited access to green space in their early years are more likely to be obese at age 7, a new study based on UK families indicates.

Specifically, in families with a low level of education, a lack of yard at age 3 to 5 was associated with around a 40% increased risk of being overweight/obese at age 7. Limited green space, more generally, was associated with a greater than 25% increased risk of obesity.

The analysis was reported at the European Association for the Study of Diabetes (EASD) 2015 Meeting by Giel Nijpels, MD, from the EMGO Institute, VU University Medical Center, Amsterdam, the Netherlands, who was a study coinvestigator.

The researchers also showed that when parental education was factored in, the children of those who had gone to college were 38% more likely to be obese at age 7 if their parents had a "poor" perception of their surroundings.

Reflecting on the findings with respect to the higher socioeconomic class, moderator Nick Wareham, MD, director of the MRC Epidemiology Unit at the University of Cambridge, United Kingdom, said: "The important point is whether the problem is one of reality, so is the environment really less safe? Or are parents just more worried about it?"

Over 6000 British Children Surveyed

Dr Nijpels explained that overweight and obese children are at increased risk of becoming overweight and obese adults and going on to be at high risk for developing type 2 diabetes. He and his colleagues set out to examine the impact of the early years' environment on risk of subsequent overweight/obesity.

Data were drawn from the Millennium Cohort Study, a nationally representative study of around 19,000 children born in the United Kingdom in 2000 and 2001.

For this particular analysis, data from 6467 British children were assessed from surveys carried out at age 9 months, 3 years, 5 years, and 7 years.

At age 7, 19.9% of all the children studied were overweight or obese.

Overall, nearly 90% of children (aged 3–5) had access to a yard, but 24.2% of parents perceived that their surroundings fell into the category of the "worst," while 16.3% considered their surroundings as "not so good."

Among children with the lowest access to green space there was a 14% greater chance of being overweight or obese at age 7 (odds ratio [OR], 1.14); this increased to 35% for those with no access to a yard, and the "worst" perception of the environment was associated with a 22% greater risk (all three comparisons P < .05).

The researchers then went on to look at whether parental behaviors moderated or mediated the findings, and they also looked at the impact of socioeconomic status.

Regarding socioeconomic status, "we found that just over 60% of parents were [university educated] or had vocational training," Dr Nijpels explained. A total of 17.7% were considered to live in poverty.

The highest level of education among parents in the household did diminish the magnitude of the associations found between the environmental determinants and being overweight/obese.

Not having access to a yard at age 3 to 5 years for less educated households thereby further increased the risk of childhood overweight/obesity at age 7 years.

In the final model, the remaining significant associations with childhood overweight/obesity were no yard access for less educated households, which resulted in a 38% increased risk of obesity at age 7 (OR, 1.38) and "shabbiness" of the neighborhood for more educated households, which also led to a 38% increased risk of obesity.

Is Perception of Danger Real Among the Better Educated?

"We showed that limits on access to outdoor space are associated with future childhood overweight/obesity, although moderated by education level. More research is needed to see how we can deploy these findings in the prevention of type 2 diabetes," Dr Nijpels concluded.

With respect to the findings among the better educated, Dr Wareham pointed out that "this study didn't…look at actual measures of safety or use of the environment, so it could be a perception problem rather than the real impact of what is happening in the environment."

And opinions about environmental safety have definitely changed over time, he said. "Years ago, parents thought it was safer to play outside, but now there's a feeling that danger lurks in every corner, but there might be an issue about whether this [hazard] is actually a reality."

Dr Nijpels and Dr Wareham have declared no relevant financial relationships.

European Association for the Study of Diabetes (EASD) 2015 Meeting; Stockholm, Sweden. Abstract 187, presented September 17, 2015.


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