Access to bike lanes and childhood obesity: A systematic review and meta‐analysis

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Summary

The lack of bike lane access has been a proven risk factor for childhood obesity due to its role in discouraging healthy lifestyles. However, there has not been a systematic review of this important association in the existing literature. This study aims to fill this gap. A literature search was conducted in the Cochrane Library, PubMed, Embase, and Web of Science for studies published from 1 January 2019 onwards that examined the association between bike lane access and weight‐related behaviours and outcomes among children aged <18 years. A total of 21 studies were included in this systematic review. Among them, most of the studies showed that bike lane access was significantly associated with children and adolescents' physical activity (PA), whereas only two studies showed a negative association. Meta‐analysis also supported these findings and showed that bike lane access was significantly associated with children and adolescents' PA (odds ratio [OR] = 1.57, 95% confidence interval [CI]: 1.37–1.81). Additionally, we reviewed how bike lane characteristics and microenvironment variables such as children and adolescents' choice of bicycle travel mode, the degree of separation of cycle path, cycle path unevenness, and street maintenance were associated with adolescents' preferences and intention to cycle. This systematic review and meta‐analysis strongly suggests that bike lane access is associated with children and adolescents' PA. Nonetheless, it was difficult to draw a conclusion on the association between bike lane access and weight‐related outcomes.

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Most cited references 66

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Bias in meta-analysis detected by a simple, graphical test

Jos I. M. Egger, G D Smith, M. Schneider … (1997)

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Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults

Leandra Abarca-Gómez, Ziad A Abdeen, Zargar Abdul Hamid … (2019)

Summary Background Underweight, overweight, and obesity in childhood and adolescence are associated with adverse health consequences throughout the life-course. Our aim was to estimate worldwide trends in mean body-mass index (BMI) and a comprehensive set of BMI categories that cover underweight to obesity in children and adolescents, and to compare trends with those of adults. Methods We pooled 2416 population-based studies with measurements of height and weight on 128·9 million participants aged 5 years and older, including 31·5 million aged 5–19 years. We used a Bayesian hierarchical model to estimate trends from 1975 to 2016 in 200 countries for mean BMI and for prevalence of BMI in the following categories for children and adolescents aged 5–19 years: more than 2 SD below the median of the WHO growth reference for children and adolescents (referred to as moderate and severe underweight hereafter), 2 SD to more than 1 SD below the median (mild underweight), 1 SD below the median to 1 SD above the median (healthy weight), more than 1 SD to 2 SD above the median (overweight but not obese), and more than 2 SD above the median (obesity). Findings Regional change in age-standardised mean BMI in girls from 1975 to 2016 ranged from virtually no change (−0·01 kg/m2 per decade; 95% credible interval −0·42 to 0·39, posterior probability [PP] of the observed decrease being a true decrease=0·5098) in eastern Europe to an increase of 1·00 kg/m2 per decade (0·69–1·35, PP>0·9999) in central Latin America and an increase of 0·95 kg/m2 per decade (0·64–1·25, PP>0·9999) in Polynesia and Micronesia. The range for boys was from a non-significant increase of 0·09 kg/m2 per decade (−0·33 to 0·49, PP=0·6926) in eastern Europe to an increase of 0·77 kg/m2 per decade (0·50–1·06, PP>0·9999) in Polynesia and Micronesia. Trends in mean BMI have recently flattened in northwestern Europe and the high-income English-speaking and Asia-Pacific regions for both sexes, southwestern Europe for boys, and central and Andean Latin America for girls. By contrast, the rise in BMI has accelerated in east and south Asia for both sexes, and southeast Asia for boys. Global age-standardised prevalence of obesity increased from 0·7% (0·4–1·2) in 1975 to 5·6% (4·8–6·5) in 2016 in girls, and from 0·9% (0·5–1·3) in 1975 to 7·8% (6·7–9·1) in 2016 in boys; the prevalence of moderate and severe underweight decreased from 9·2% (6·0–12·9) in 1975 to 8·4% (6·8–10·1) in 2016 in girls and from 14·8% (10·4–19·5) in 1975 to 12·4% (10·3–14·5) in 2016 in boys. Prevalence of moderate and severe underweight was highest in India, at 22·7% (16·7–29·6) among girls and 30·7% (23·5–38·0) among boys. Prevalence of obesity was more than 30% in girls in Nauru, the Cook Islands, and Palau; and boys in the Cook Islands, Nauru, Palau, Niue, and American Samoa in 2016. Prevalence of obesity was about 20% or more in several countries in Polynesia and Micronesia, the Middle East and north Africa, the Caribbean, and the USA. In 2016, 75 (44–117) million girls and 117 (70–178) million boys worldwide were moderately or severely underweight. In the same year, 50 (24–89) million girls and 74 (39–125) million boys worldwide were obese. Interpretation The rising trends in children's and adolescents' BMI have plateaued in many high-income countries, albeit at high levels, but have accelerated in parts of Asia, with trends no longer correlated with those of adults. Funding Wellcome Trust, AstraZeneca Young Health Programme.

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The incidence of co-morbidities related to obesity and overweight: A systematic review and meta-analysis

Daphne Guh, Wei Zhang, Nick Bansback … (2009)

Background Overweight and obese persons are at risk of a number of medical conditions which can lead to further morbidity and mortality. The primary objective of this study is to provide an estimate of the incidence of each co-morbidity related to obesity and overweight using a meta-analysis. Methods A literature search for the twenty co-morbidities identified in a preliminary search was conducted in Medline and Embase (Jan 2007). Studies meeting the inclusion criteria (prospective cohort studies of sufficient size reporting risk estimate based on the incidence of disease) were extracted. Study-specific unadjusted relative risks (RRs) on the log scale comparing overweight with normal and obese with normal were weighted by the inverse of their corresponding variances to obtain a pooled RR with 95% confidence intervals (CI). Results A total of 89 relevant studies were identified. The review found evidence for 18 co-morbidities which met the inclusion criteria. The meta-analysis determined statistically significant associations for overweight with the incidence of type II diabetes, all cancers except esophageal (female), pancreatic and prostate cancer, all cardiovascular diseases (except congestive heart failure), asthma, gallbladder disease, osteoarthritis and chronic back pain. We noted the strongest association between overweight defined by body mass index (BMI) and the incidence of type II diabetes in females (RR = 3.92 (95% CI: 3.10–4.97)). Statistically significant associations with obesity were found with the incidence of type II diabetes, all cancers except esophageal and prostate cancer, all cardiovascular diseases, asthma, gallbladder disease, osteoarthritis and chronic back pain. Obesity defined by BMI was also most strongly associated with the incidence of type II diabetes in females (12.41 (9.03–17.06)). Conclusion Both overweight and obesity are associated with the incidence of multiple co-morbidities including type II diabetes, cancer and cardiovascular diseases. Maintenance of a healthy weight could be important in the prevention of the large disease burden in the future. Further studies are needed to explore the biological mechanisms that link overweight and obesity with these co-morbidities.

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Author and article information

Contributors

Li Zhao: zhaoli@scu.edu.cn

Peng Jia:

ORCID: https://orcid.org/0000-0003-0110-3637

p.jia@utwente.nl

Journal

Journal ID (nlm-ta): Obes Rev

Journal ID (iso-abbrev): Obes Rev

Journal ID (doi): 10.1111/(ISSN)1467-789X

Journal ID (publisher-id): OBR

Title: Obesity Reviews

Publisher: John Wiley and Sons Inc. (Hoboken )

ISSN (Print): 1467-7881

ISSN (Electronic): 1467-789X

Publication date (Electronic): 18 May 2020

Publication date (Print): February 2021

Volume: 22

Issue: Suppl 1 , Obesogenic Environment and Childhood Obesity ( doiID: 10.1111/obr.v22.S1 )

Electronic Location Identifier: e13042

Affiliations

[ ¹ ] Department of Maternal and Child Health, Xiangya School of Public Health Central South University Changsha China

[ ² ] International Institute of Spatial Lifecourse Epidemiology (ISLE) Hong Kong China

[ ³ ] Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital Sichuan University Chengdu China

[ ⁴ ] Research Center for Healthy City Development Sichuan University Chengdu China

[ ⁵ ] Melbourne School of Population and Global Health University of Melbourne Melbourne Victoria Australia

[ ⁶ ] Victorian Comprehensive Cancer Centre The University of Melbourne Centre for Cancer Research Melbourne Victoria Australia

[ ⁷ ] Research Center for Eco‐Environmental Sciences Chinese Academy of Sciences Beijing China

[ ⁸ ] School of Nursing The University of Auckland Auckland New Zealand

[ ⁹ ] Department of Land Surveying and Geo‐Informatics The Hong Kong Polytechnic University Hong Kong China

[ ¹⁰ ] Faculty of Geo‐information Science and Earth Observation University of Twente Enschede the Netherlands

Author notes

[*] [* ] Correspondence

Peng Jia, PhD, Director, International Institute of Spatial Lifecourse Epidemiology (ISLE); Department of Land Surveying and Geo‐Informatics, The Hong Kong Polytechnic University, Hong Kong, China.

Email: jiapengff@ 123456hotmail.com

Li Zhao, PhD, MPH, Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.

Email: zhaoli@ 123456scu.edu.cn

Xiongfeng Pan and Li Zhao contributed equally to this study.

Author information

Lin Zhang https://orcid.org/0000-0002-2064-8440

Shaoqing Dai https://orcid.org/0000-0003-0858-4728

Peng Jia https://orcid.org/0000-0003-0110-3637

Article

Publisher ID: OBR13042 Other ID: OBR-04-20-4342.R1

DOI: 10.1111/obr.13042

PMC ID: 7988585

PubMed ID: 32419305

SO-VID: a5c71e8f-2dbb-4bd2-8c6e-8ae61aedfa07

License:

This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

History

Date revision received : 03 April 2020

Date received : 01 April 2020

Date accepted : 03 April 2020

Page count

Figures: 2, Tables: 1, Pages: 11, Words: 7878

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Funding

Funded by: State Key Laboratory of Urban and Regional Ecology , open-funder-registry 10.13039/501100011411;

Award ID: SKLURE2018‐2‐5

Funded by: National Science & Technology Basic Resource Investigation Program of China

Award ID: (2017FY101100)

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source-schema-version-number 2.0

cover-date February 2021

details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.0 mode:remove_FC converted:24.03.2021

ScienceOpen disciplines: Medicine

Keywords: bike lane,built environment,child,obesity,overweight,physical activity

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ScienceOpen disciplines: Medicine

Keywords: bike lane, built environment, child, obesity, overweight, physical activity

Access to bike lanes and childhood obesity: A systematic review and meta‐analysis

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Chinese Journal of School Health

Most cited references 66

Bias in meta-analysis detected by a simple, graphical test

Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults

The incidence of co-morbidities related to obesity and overweight: A systematic review and meta-analysis

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