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Background: Neighborhood environments are known to impact health behaviors, but little data are available to support local decision making in the Kansas City region.

Objective: This project investigated childhood obesity rates across neighborhoods in the Kansas City metropolitan area and associations with four neighborhood environment characteristics: walkability, parks, healthy food access, and poverty.

Methods: Using Children’s Mercy primary care patient data from ~20,000 children ages 6-17 (2017-2020), obesity rates were calculated and mapped for all census tracts in the 6-county Kansas City region with ≥15 patients. Publicly available socioeconomic and built environment data were integrated to investigate associations and map co-occurrences of childhood obesity with the four neighborhood characteristics. Park quality was measured using observational audits. Mixed effects regression models were used to test associations and were adjusted for sociodemographics.

Results: The association between greater walkability and lower BMIz was specific to 9–17-year-olds (B=-0.03 [95% CI=-0.06, 0], p=.033). Children living in one of the 25% highest walkable census tracts were 7% less likely to have obesity than those living in one of the 25% lowest walkable tracts. A greater number of parks was associated with a lower BMIz (B=-0.02 [-0.04, -0.01], p=.020). Children living in a census tract with 3 or more parks were 7% less likely to have obesity than those living in a tract with 0 parks. Children whose nearest park had better overall park quality were less likely to have obesity (OR=0.94 [0.89,0.98], p=.034) and this association was strongest among 12–14-year-olds, girls, and higher income neighborhoods. Healthy food access was not associated with BMIz or obesity. Large differences were observed in obesity rates by neighborhood poverty. Children living in one of the 25% lowest poverty census tracts were 20% less likely to have obesity than those living in one of the 25% highest poverty tracts.

Conclusions: These data show a clear link between neighborhood environment characteristics and childhood obesity in the Kansas City region, revealing health inequities that are based on where a child lives. Children in the region are less likely to have obesity if they live in a neighborhood that has high walkability, high park access, and/or a moderate-to-low rate of poverty. There are many areas of the city where high poverty, low walkability, and low park access co-occur. Multiple sectors must work together and strive for ambitious community transformations to combat the existing environmental health disparities in the region.

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Neighborhood Environments and Childhood Obesity in the Kansas City Region