Ambiente construído e ambiente social - associações com o excesso de peso em adultos

Abstract

Characteristics of the environment in which people live, such as neighborhoods socioeconomic status, availability and access to purchase healthy food, opportunities for physical activity and commuting on foot or by bicycle, have been proposed as factors associated with epidemic of obesity in many countries. The aim of this study was to evaluate individual variables and variables within the built and social environment for their potential association with overweight and obesity in an urban Brazilian population. Participants were selected from the Surveillance of Risk Factors for Chronic Diseases through TelephoneInterview (VIGITEL), organized by the Ministry of Health and conducted annually in all Brazilian state capitals. For the present study, samples from the years 2008 and 2009 for the city of Belo Horizonte were used. Individual variables were divided into three categories: sociodemographic, lifestyle and health. To verify and analyze the spatial distribution of variables, the VIGITEL database was geocoded using the Brazilian System of Postal Codes (CEPs) for participant residences. To characterize the built and social environment, a geocoded database was developed that incorporated the individual data for each participant.An updated, existing list based on the current addresses of supermarkets and hypermarkets in the city was used as an indicator variable of the availability and access to food. Georeferenced information on parks, public squares and places for practicing physical activity and thepopulation density were also used to create data on the built environment. To characterize the social environment, we used the health vulnerability index (HVI) and the data for homicide locations were used to map homicide rates by census tract. The results of multilevelregression showed that the data had no structure in two levels. Thus, we used five adjusted Poisson regression models in a single level. The variables that independently negatively associated with overweight/obesity were the second and the fourth quartile of populationdensity. The census tracts with very high HVI had a higher prevalence of overweight/obesity and this relationship remains consistent on all models. The homicide rate was also associated with overweight/obesity. In other models, we added individual variables related to lifestyleand health behaviors. The individual variables that independently associated with overweight/obesity were watching television every day of the week and commuting to work by foot or bicycle, the poorest self-reported health status. Variables related to food consumption such as the habit of consuming whole milk and the habit of consuming chickenwith skin were also independently associated with overweight/obesity. The evidence from this study shows that characteristics of the places people live are associated with excess overweight/obesity.