Prospective Associations Between Play Environments and Pediatric Obesity

To identify school typologies based on the availability of play equipment and installations. We also examined the associations between availability of play items and child adiposity.

Secondary analysis of longitudinal data.

Elementary schools in Montreal, Canada.

We used data from the Quebec Adipose and Lifestyle Investigation in Youth study (QUALITY), an ongoing investigation of the natural history of obesity and type 2 diabetes in Quebec children of Caucasian descent.

The presence of play items was assessed in each child's school. A trained nurse directly assessed child anthropometric measurements to derive body mass index and waist circumference. Body fat composition was measured using DEXA Prodigy Bone Densitometer System.

The final analytic sample comprised 512 students clustered in 296 schools (81% response). We used K-cluster analyses to identify school typologies based on the variety of play items on school grounds. Generalized estimation equations were used to estimate associations between school clusters and outcomes.

We identified 4 distinct school typologies. Children in schools with the most varied indoor play environments had lower overall body fat, B = -1.26 cm (95% confidence interval [CI], -2.28 to -0.24 cm), and smaller waist circumference, B = -4.42 cm (95% CI, -7.88 to -0.96 cm), compared to children with the least varied indoor play environment.

Our results suggest that policies regulating the availability of play items in schools may enrich comprehensive school-based obesity prevention strategies. Extending research in this area to diverse populations is warranted.