Assessing the obesogenic environment within an environmental justice framework in North East England

The chronic illnesses associated with obesity cause over 30,000 deaths annually in the United Kingdom alone (Moon et al 2007). Pessimistic predictions regarding future obesity trends have highlighted that without government intervention, this grave problem is only going to worsen (Foresight 2007). The most recent figures estimate that 23.3% of men and 24.4% of women are currently obese in England (Health Survey for England, 2008a), with this proliferation in levels of obesity often branded the 'obesity epidemic' (BanweH et al 2005). Although it is acknowledged that genetics play some role in the Body Mass Index (BMI) of individuals, there is significant evidence of the influence of environmental factors upon individual health (World Health Organisation 2000; Kipke et al 2007; Frank et al 2004). The 'obesogenic environment' is defined as "the sum of the influences that the surroundings, opportunities, or conditions of life have on promoting obesity in individual's or populations" and is based upon the notion that our surroundings can drive an "automatic, unconscious influence ... [upon our] behaviour" (Swinburn and Egger 2002,292; Brug et a/2006, 528). Contributing to an as yet under-developed UK research evidence-base, within which this work should be seen as a pilot, this study used a multi-level, cross-sectional study design and data from the Health Survey for England (2005-2008, n=2118, aged 16-75), combined with critically appraised area level obesogenic environment metrics (n=30, focusing on access/availability/opportunity/variety of food (consumed within and without of the home), built (walkability related, both putative and innovative, including measures of the public transport landscape) and physical activity (green space and formal leisure facility) environments, constructed from a variety of secondary data sources (including local council's environmental health records», to assess the impact of the obesogenic environment in the former North East Government Office Region upon BMI, dietary patterns (including fruit and vegetable consumption) and physical activity behaviour (walking/sport frequency/duration). Results from adjusted multivariate and unadjusted analyses suggest that there is a modest environmental effect upon these outcome variables, yet results are not robust enough to delineate specific potential public health interventions. ContrOlling for putative individual and household level confounders and other aspects of diet, increased access to 'healthy' food bought out of the home was associated with decreased fruit consumption (r=0.218, p=0.003), whilst increased access to 'unhealthy' food consumed out of the home was associated with increased vegetable consumption (r=-0.141, p=0.032), 2 and increased availability with increased pulse consumption (r=0.193, p=0.022). Increased access to 'healthy' food outlets was associated with significantly higher BMI (r=-0.134, p=0.008). Moreover, many of the relationships discovered are in unexpected directions, resulting in a close scrutiny of the methods used, and a questioning of some established theoretical relationships. This research also aimed to examine the geography of the obesogenic environment within the study area, and to assess the extent to which this geography is related to area level socio-economic status (Index of Multiple Deprivation 2007) and ethnic mix (UK Census 2001) using a-spatial regression, analysis of variance and Geographically Weighted Regression (GWR) methods. Results suggest that the obesogenic environment varies markedly throughout the study area and systematically by socio-economic status and ethnic mix, with these inequities in the geography of the obesogenic environment framed here as an environmental justice concern, especially as these inequalities may not be self-evident to the exposed individuals'. However, deprived/more ethnic minority populations are not a/ways exposed to the most obesogenic environments. Importantly, GWR was able to offer considerably more insight into particularly vulnerable populations than a-spatial analysis methods.EThOS - Electronic Theses Online ServiceGBUnited Kingdo