The role of urban design in childhood obesity: A case study in Lisbon, Portugal.

Objective: We hypothesize that physical features of the urban environment might enhance or prevent childhood obesity. Thus, this study's main goal was to verify if there is an association between the neighborhood urban design and childhood obesity-independent of well-known childhood obesity determinants, such as, father's level of schooling (as a proxy for socioeconomic status), and parent's weight status.

Methods: This study classifies neighborhoods according to land use and building features using hierarchical clusters analysis and examines their association with childhood obesity through logistic regression models.

Results: Four clusters resulted from the analysis: Cluster 1 represents areas with older buildings and mixed land use, cluster 2 is an area with small rented buildings and urban areas, cluster 3 comprises newer buildings with parking and urban green space, and cluster 4 is a forest area. Living in cluster 3 protects from childhood obesity, even when adjusting for father's level of schooling or parent's weight status.

Conclusions: There are distinct urban configurations in Lisbon's municipality and children who live in Cluster 3 (more recent and greener neighborhoods) seem to be protected from obesity. Therefore, public policy should focus on healthy urban planning at the neighborhood level, to promote positive impacts on peoples' health.