Investigating Environmental Determinants of Diet, Physical Activity, and Overweight among Adults in Sao Paulo, Brazil
There is worldwide recognition that the burden of noncommunicable diseases (NCDs) and obesity-related health problems is rapidly increasing in low- and middle-income countries. Environmental determinants of obesity are likely to differ between countries, particularly in those undergoing rapid socioeconomic and nutrition transitions such as Brazil. This study aims to describe some built environment and local food environment variables and to explore their association with the overweight rate and diet and physical activity area-level aggregated indicators of adults living in the city of Sao Paulo, the largest city in Brazil. This formative study includes an ecological analysis of environmental factors associated with overweight across 31 submunicipalities of the city of Sao Paulo using statistical and spatial analyses. Average prevalence of overweight was 41.69% (95% confidence interval 38.74, 44.64), ranging from 27.14% to 60.75% across the submunicipalities. There was a wide geographical variation of both individual diet and physical activity, and indicators of food and built environments, favoring wealthier areas. After controlling for area socioeconomic status, there was a positive correlation between regular fruits and vegetables (FV) intake and density of FV specialized food markets (r = 0.497; p < 0.001), but no relationship between fast-food restaurant density and overweight prevalence was found. A negative association between overweight prevalence and density of parks and public sport facilities was seen (r = −0.527; p < 0.05). Understanding the relationship between local neighborhood environments and increasing rates of poor diet, physical activity, and obesity is essential in countries undergoing rapid economic and urban development, such as Brazil, in order to provide insights for policies to reduce increasing rates of NCDs and food access and health inequalities.
KeywordsObesity Diet Food Physical activity Environment
We are grateful to the Fundação de Amparo à Pesquisa do Estado de São Paulo for the fellowship grant to PC Jaime at the London School of Hygiene and Tropical Medicine (process number 2009/06955-7) and to the Conselho Nacional de Desenvolvimento Científico e Tecnológico for the research grant (process number 473318/2008-3). We also thank Chris Grundy from the Centre for Spatial Analysis for Public Health of LSHTM for his advice on GIS analysis and Andreia dos Reis Lemos for her help with data collection.
- 1.World Health Organization. Diet, nutrition and the prevention of chronic diseases. Technical report series 916. Joint FAO/WHO Expert Consultation, Geneva; 2003Google Scholar
- 7.Shaw KA, O’Rourke P, Del Mar C, Kenardy J. Psychological interventions for overweight or obesity. Cochrane Database of Systematic Reviews 2005; 2:CD003818. doi: 10.1002/14651858.CD003818.pub2
- 15.Giskes K, Kamphuis CBM, Van Lenthe FJ, Kremers S, Droomers M, Brug J. A systematic review of associations between environmental factors, energy and fat intakes among adults: is there evidence for environments that encourage obesogenic dietary intakes? Public Health Nutr. 2007; 10(10): 1005–1017.PubMedCrossRefGoogle Scholar
- 19.Moura EC, Malta DC, Morais Neto OL, Monteiro CA. Prevalence and social distribution of risk factors for chronic non communicable diseases in Brazil. Rev Panam Salud Pública/Pan Am J Public Health. 2009; 26: 17–22.Google Scholar
- 20.World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. WHO Tech Rep Ser. 2000; 894(i–xii): 1–253.Google Scholar
- 25.United Nations Development Program. The human development index (HDI). http://hdr.undp.org/en/statistics/indices/hdi. Accessed on: March 14, 2010.
- 26.United Nation Development Program [UNDP]. Atlas de desenvolvimento humano do Brasil. http://www.undp.org.br/HDR/HDR2000/Metodologias%20-%20IDH-M%20e%20ICV.pdf. Accessed on: March 14, 2010.
- 27.Fundação Sistema Estadual de Análise de Dados, SEADE. Secretaria de Economia e Planejamento do Estado de São Paulo. Informações dos distritos da capital. http://www.seade.gov.br/produtos/distritos/imp.php?page=consulta&action=ordem. Accessed on: April 5, 2010.
- 28.Secretaria Municipal de Planejamento. Prefeitura de São Paulo. Infocidade. http://sempla.prefeitura.sp.gov.br/infocidade/. Accessed on: September 30, 2009.
- 29.Companhia do Metropolitano de São Paulo. Governo do Estado de São Paulo. Mapa da rede metroviária de São Paulo. http://www.metro.sp.gov.br/redes/teredes.shtml. Accessed on: September 30, 2009.
- 30.São Paulo Transportes S.A. Terminais urbanos. http://www.sptrans.com.br/sptrans08/terminais/. Accessed on: September 30, 2009.
- 31.Secretaria Municipal do Verde e Meio Ambiente. Prefeitura de São Paulo. Mapa Verde. Parques Municipais de São Paulo. http://www9.prefeitura.sp.gov.br/sitesvma/100_parques/regiao/index.php?p=25. Accessed on: September 30, 2009.
- 32.Secretaria do Meio Ambiente. Governo do Estado de São Paulo. Parques estaduais e institutos florestais. http://www.ambiente.sp.gov.br/. Accessed on: September 30, 2009.
- 33.Secretaria Municipal de Esportes. Prefeitura de São Paulo. Clubes e Unidades/Clubes-escola. http://portal.prefeitura.sp.gov.br/secretarias/esportes. Accessed on: September 30, 2009.
- 34.Secretaria do Esporte, Lazer e Turismo do Estado de São Paulo. Governo do Estado de São Paulo. Conjuntos desportivos. http://www.selt.sp.gov.br/conjuntos_desportivos.php. Accessed on: September 30, 2009.
- 57.São Paulo (city). Article no. 13.399 of 1 August 2002. Refers to the creation, structure, and activities of the Sub municipalities of the city of São Paulo. Câmara Municipal de São Paulo. July 18, 2002.Google Scholar