Does Physical Activity Mediate the Association Between Perceived Neighborhood Aesthetics and Overweight/Obesity Among South African Adults Living in Selected Urban and Rural Communities?

BACKGROUND

To investigate the mediation effects of physical activity (PA) on the relationship between the perceived neighborhood aesthetic environment and overweight/obesity in free-living South Africans.

METHODS

A cross-sectional study of 671 adults aged ≥ 35 years was analyzed. PA was assessed using the validated International Physical Activity Questionnaire. Perceived neighborhood aesthetics was assessed using the Neighborhood Environment Walkability Scale Questionnaire.

RESULTS

Of 671 participants, 76.0% were women, 34.1% aged 45-54 years, and 69.2% were overweight or obese. In adjusted logistic regression models, overweight/obesity was significantly associated with neighborhood aesthetics [odds ratio (OR) = 0.68; 95% confidence interval (CI), 0.50-0.93] and PA (OR = 0.65; 95% CI, 0.65-0.90). In expanded multivariable models, overweight/obesity was associated with age 45-55 years (OR = 1.59; 95% CI, 1.05-2.40), female gender (OR = 6.24; 95% CI, 3.95-9.86), tertiary education (OR = 4.05; 95% CI, 1.19-13.86), and urban residence (OR = 2.46; 95% CI, 1.66-3.65).

CONCLUSIONS

Aesthetics was positively associated with PA; both aesthetics and PA were negatively associated with overweight and obesity. There was no evidence to support a significant mediating effect of PA on the relationship between aesthetics and overweight/obesity. Future studies should consider objective assessment of aesthetics and PA. In addition, future studies should consider using longitudinal design to evaluate food-related environments, which are related to overweight or obesity.