Longitudinal Associations of Neighborhood Food Access with Child Body Mass Index and Obesity

Neighborhood food access is considered a structural determinant of childhood obesity, yet prior studies report inconsistent findings, and longitudinal weight trajectories are understudied. This study sought to examine the association between neighborhood food access and obesity risk across the COVID-19 pandemic, which exacerbated pediatric obesity disparities.

We conducted a retrospective longitudinal cohort study of 13,832 children aged 2-11 years receiving primary care in eastern Massachusetts between 2019 and 2024. Baseline residential addresses were geocoded to classify a child's residence in low-income, low-food access neighborhoods with low vehicle availability (LILV). Mixed-effects models examined associations between LILV residence and repeated BMI z-scores and obesity risk over follow-up, adjusting for insurance type. Secondary analyses among publicly insured children (n = 3548) explored the association between LILV residence and obesity risk, adjusting for household food insecurity.

At baseline, 26.1% of children resided in LILV neighborhoods. No significant differences in BMI z-scores or obesity risk were observed at age 5 years. By age 10, LILV residence was associated with higher BMI z-scores [β = 0.08; 95% confidence interval (CI): 0.01-0.16] and increased obesity risk [risk ratio (RR) = 1.55; 95% CI: 1.01-2.39]. By age 15, associations strengthened [BMI z-score β = 0.14; 95% CI: 0.05-0.22; obesity RR = 1.94; 95% CI: 1.17-3.23]. Among the subset of children with public insurance, these associations were not observed.

Residence in low-income, low-food access neighborhoods is associated with higher BMI and obesity risk across childhood and adolescence, independent of insurance type. These findings highlight neighborhood food access as a potentially modifiable structural determinant of pediatric obesity disparities.