Does Place Matter? Food Insecurity, Perceptions of Neighborhood Walkability, and Acculturation as Predictors of Treatment Outcome in an Early Childhood Obesity Prevention Study

BACKGROUND: Though cross-sectional studies have established a relationship between environmental factors and weight status, few have looked at how these environmental factors influence response to obesity intervention in adults or children. This study explored the impact food insecurity, neighborhood walkability, and acculturation may have had on the outcomes of an obesity prevention study for low-income, Black and Latinx preschool-aged children. METHODS: Prior to the start of the primary care-based intervention program (Cloutier et al., 2015), caregivers (n=203) completed measures assessing their household’s food insecurity, their perceptions of their neighborhoods’ walkability, and for Latinx participants, levels of acculturation. Baseline responses were analyzed as potential predictors of their 2- to 4-year old children’s BMI percentile change during a 12-month obesity prevention intervention. RESULTS: There was little variability in food insecurity and neighborhood walkability scores in the sample, and scores did not predict BMI change from study start to 12-month follow-up. Among Latinx participants, acculturation significantly predicted BMI change (ß = -0.29, t = -3.32, p = 0.001). Degree of identification with mainstream U.S. culture appeared to drive this effect (ß = -0.25, t = -2.30, p \u3c 0.05). CONCLUSION: Contrary to the “Latino health paradox,” caregiver identification with mainstream U.S. culture predicted better child participant response to treatment in the form of a decrease or no change in BMI percentile. Lack of variability in food insecurity and neighborhood walkability scores limits conclusions that can be drawn about these factors. More research with a more economically and geographically diverse sample is needed to understand these unexpected findings