News Release

Quality of neighborhood residence in early life may be linked to Body Mass Index (BMI) trajectories and obesity risk through adolescence

Peer-Reviewed Publication

Harvard Pilgrim Health Care Institute

Boston, MA - Residence in neighborhoods with higher opportunity or lower vulnerability in early life, especially at birth, may be associated with lower mean BMI trajectory and lower risk of obesity through adolescence, according to a new study led by researchers at the Harvard Pilgrim Health Care Institute.

“Our findings support the notion that the quality of neighborhoods where children reside is an important factor that may promote the development of favorable BMI patterns, potentially mitigating future chronic disease risk”, said lead author Izzuddin Aris, PhD, Assistant Professor in the Department of Population Medicine at the Harvard Pilgrim Health Care Institute and Harvard Medical School. 

The study, “Associations of Neighborhood Opportunity and Social Vulnerability with Trajectories of Child Body Mass Index and Obesity Among U.S. Children”, was published December 22, 2022 in JAMA Network Open.

The physical and social attributes of neighborhoods where children reside is increasingly recognized as an important determinant of health across the lifecourse. Compared with adults, children may be particularly vulnerable to adverse neighborhood conditions with consequences for lifelong health. The extent to which these attributes relate to childhood BMI and obesity risk remains understudied.

Prior studies have often been limited by small sample sizes, lack of geographical diversity, and insufficient variation in individual-level characteristics, all of which might hamper the ability to detect these associations.

The study team addressed these research gaps by examining novel neighborhood indices and using a geographically diverse cohort of over 20,000 children from 54 birth cohorts across the US participating in the Environmental influences on Child Health Outcomes (ECHO) program. They linked geocoded residential addresses obtained at birth, infancy, early childhood, and mid-childhood to census-tract level Child Opportunity Index (ChOI) and Social Vulnerability Index (SVI) and examined the associations of ChOI or SVI with child BMI and obesity over time.

Study researchers found that at every life stage, children who resided in areas with higher ChOI had lower mean BMI trajectories and lower risk of obesity from childhood to adolescence, independent of family sociodemographics and prenatal characteristics. The team observed similar patterns of findings for children who resided in areas with lower SVI.

These associations were strongest for children residing in neighborhoods with highest opportunity or lowest vulnerability. Importantly, these associations were strongest for exposure to neighborhoods at birth compared with exposure at later life stages, indicating that pregnancy is an important window for exposure.

“This study bolsters the need for a focus on investments that address the structures that consistently compromise the health of marginalized communities,” said Dr. Aris. “Results may also inform future studies on whether initiatives or policies that alter specific components of neighborhood environment would be effective in preventing excess weight and obesity in children.”

Other Harvard Pilgrim Health Care Institute co-authors of the study included Peter James and Emily Oken.


The Harvard Pilgrim Health Care Institute's Department of Population Medicine is a unique collaboration between Harvard Pilgrim Health Care and Harvard Medical School. Point32Health is the parent company of Harvard Pilgrim Health Care and Tufts Health Plan. Created in 1992, it is the first appointing medical school department in the United States based in a health plan. The Institute focuses on improving health care delivery and population health through innovative research and education, in partnership with health plans, delivery systems, and public health agencies.

ECHO is a nationwide research program supported by the National Institutes of Health (NIH). Launched in 2016, ECHO aims to enhance the health of children for generations to come. ECHO investigators study the effects of a broad range of early environmental influences on child health and development. The program consists of two major components, including 69 existing and ongoing observational study cohorts and a pediatric clinical trials network. Research conducted through ECHO focuses on five key pediatric outcomes that have a high public health impact: pre-, peri- and postnatal outcomes; upper and lower airway health; obesity; neurodevelopment; and positive health, such as happiness and a sense of well-being.

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