# The Relationship Between Accessibility to Food Destinations and Places for Physical Activity and Children’s BMI: A Sex-Stratified Analysis

## TL;DR

This study found that the relationship between access to food and activity spaces and children's BMI differs between boys and girls in Valencia, Spain.

## Contribution

The study is novel in examining both food and activity accessibility simultaneously and stratifying results by sex.

## Key findings

- Being a boy was positively associated with BMI percentile, while physical activity was negatively associated.
- Access to healthy restaurants and higher neighborhood income were linked to lower BMI percentiles in girls.
- Built environment attributes showed no significant association with BMI in boys.

## Abstract

Background/Objectives: Few studies have simultaneously evaluated spatial accessibility to both food destinations and spaces for physical activity in relation to body weight in children. The aim of this study was to determine whether spatial accessibility to food destinations and places for physical activity is associated with body weight among children, differentiating between boys and girls. Neighborhood socio-economic status and walkability were incorporated as covariates. Methods: This cross-sectional study was conducted in Valencia, Spain. The initial sample comprised a sample of 808 children. GIS-based procedures were used to evaluate access to food outlets, walkability and socio-economic status (i.e., household income) among home neighborhoods. Access to different types of food destinations and destinations where children can engage in physical activity was assessed using the Neighborhood Environment Walkability Scale for Youth (NEWS-Y-IPEN). Weight and height were objectively assessed. The body mass index (BMI) percentile was calculated. Mixed-model regression analyses were performed. Results: Being a boy was positively associated with BMI percentile (p = 0.003), whereas physical activity was negatively related to this outcome (p = 0.028) in the whole sample. None of the built environment attributes were significantly associated with BMI percentile in boys. Access to healthy restaurants (p = 0.035), as well as neighborhood income (p = 0.049), were negatively associated with BMI percentile among girls. Conclusions: The relationship between built environmental attributes and BMI varies significantly between boys and girls. Understanding these differences is key for designing effective public health interventions with the aim of reducing childhood obesity.