Download Full Text (3.0 MB)

Publication Date



Background and Purpose. Despite evidence of the importance of neighborhood walkability features in relation to physical activity and obesity, research has been limited in informing localized practice due to small sample sizes and limited geographic coverage. This demonstration study integrated data from the Children’s Mercy pediatric health system with nationally available neighborhood walkability data to inform local decision making around neighborhood environments and childhood obesity.

Methods. Height/weight from clinic visits available in the Electronic Health Record (EHR) and home neighborhood walkability measures from the U.S. Environmental Protections Agency (EPA) were obtained for 15,989 6-17 year olds. Multilevel models accounted for the nested data structure and were adjusted for neighborhood income and child sociodemographics. Findings were mapped across the metropolitan area to inform where stronger neighborhood walkability improvement efforts are likely needed to combat childhood obesity.

Results. In 6-8 year olds, no neighborhood walkability measures were associated with BMIz or obesity. In 9-17 year olds, greater street connectivity and overall walkability were associated with a 0.01-0.04 lower BMIz (Ps = .009-.017), and greater residential density, street connectivity, and overall walkability were associated 5-7% lower odds of being overweight/obese (Ps = .004-.044) per standard deviation increase in environment variable. 45.9% of children in the lowest walkability tertile were overweight or obese, whereas 43.1% of children in the highest walkability tertile were overweight or obese. Maps revealed areas with low walkability and a high income-adjusted percent of children overweight/obese.

Conclusions. Integrating electronic health records with neighborhood environment data is a replicable process that can inform local practice by highlighting the importance of neighborhood features locally and pointing to areas most in need of health promotion efforts. In the Kansas City area, present findings showed that fewer children were overweight/obese in more walkable neighborhoods. The findings point to recommendations for primary care provider and local decision makers (e.g., community leaders, city officials). Children in low-walkable neighborhoods need to be supported to gain access to other/more physical activity opportunities and through advocacy efforts that aim to improve neighborhood-based opportunities for physical activity. Opportunities exist for improving neighborhood walkability through the use of smart growth and pedestrian-oriented development.

Document Type


Neighborhood Walkability And Obesity Among Children’s Mercy Primary Care Patients