Proximal and Distal Environmental Correlates of Adolescent Obesity

in Journal of Physical Activity and Health
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The purpose of this study was to determine how proximal (home) and distal (neighborhood) environmental characteristics interact to influence obesity in early and middle adolescents.


This was a descriptive, cross-sectional study using the 2007 National Survey of Children’s Health (NCSH). Participants were 39,542 children ages 11 to 17 years. Logistic regressions were used to examine the relationship between adolescent obesity and environmental factors, the relative strength of these factors, and the influence of age and gender.


Proximal environmental factors were stronger correlates of adolescent obesity than distal environmental factors. Sedentary behavior related to TV watching time at home was the strongest correlate of adolescent obesity overall (OR 1.13, 95% CI 1.11–1.15). Parks and playgrounds (OR 0.86, 95% CI 0.08–0.92), as well as recreation centers (OR 0.91, 95% CI 0.85–0.97) were significant distal environmental factor correlates. Girls and middle adolescents were at less risk for obesity than boys and early adolescents (OR 0.51, 95% CI 0.68–0.82; OR 0.75, 95% CI 0.68–0.96).


The results of this study reveal the importance of proximal environmental characteristics on adolescent obesity relative to distal environmental characteristics. Obesity intervention strategies for adolescents should target sedentary behavior and opportunities for physical activity with a focus on early adolescents and boys.

Nesbit ( is with the Dept of Physical Therapy, University of the Pacific, Stockton, CA. Kolobe and Arnold are with the Dept of Rehabilitation Sciences, University of Oklahoma, Oklahoma City, OK. Sisson is with the Dept of Nutritional Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Anderson is with the Dept of Biostatistics and Epidemiology, University of Oklahoma, Oklahoma City, OK.