Environmental and Policy Factors Associated with Overweight among Adults in Missouri

Purpose. To measure the association between environmental and policy factors (i.e., community perceptions, community infrastructure, and worksite infrastructure) and being overweight. Design. Cross-sectional data from the Missouri Cardiovascular Disease Survey, a one-time random-digit–dialed telephone interview of noninstitutionalized adults. Setting. Missouri, 1999 to 2000. Subjects. The response rate was 69.6%. A total of 2821 adults completed the interview. The sample was weighted to represent the population of Missouri: 52% female, 71% white, and 59% overweight. Measures. The survey comprised 92 closed-ended multiple-choice items. Overweight was defined as a body mass index greater than or equal to 25 kg/m 2 on the basis of self-reported height and weight. Results. After adjustment for demographic and behavioral factors, environmental variables associated with being overweight included negative (i.e., unsafe and unpleasant) community perceptions (adjusted odds ratio [OR] = 1.6; 95% confidence interval [CI] = 1.1, 2.3) and the absence of outdoor exercise facilities (OR = 1.2; CI = 1.0, 1.5). Worksite policy variables were not related to the outcome; however, negative community perceptions (OR = 2.8; CI = 1.5, 5.2) and the absence of sidewalks and shoulders (OR = 1.7; CI = 1.3, 2.4) were associated with overweight among employed persons. Conclusions. An ecological perspective, focusing on the physical and social environment, was adopted to address the subject of overweight and obesity. Results of this study show that negative perceptions of the physical environment and the absence of enabling infrastructure are modestly associated with overweight, in comparison with other known risk factors. Environmental and policy interventions that promote healthier lifestyles by encouraging physical activity and healthy eating may have an effect on reducing the prevalence of overweight and obesity.