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Int J Environ Res Public Health. 2019 Feb 24;16(4). pii: E664. doi: 10.3390/ijerph16040664.

Area-Level Walkability and the Geographic Distribution of High Body Mass in Sydney, Australia: A Spatial Analysis Using the 45 and Up Study.

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The University of Sydney, School of Public Health, Sydney, NSW 2006, Australia.
Illawarra Shoalhaven Local Health District, Public Health Unit, Warrawong, NSW 2502, Australia.
University of Wollongong, School of Medicine, Wollongong, NSW 2522, Australia.
Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW 2522, Australia.
The University of Sydney, School of Public Health, Sydney, NSW 2006, Australia.
The University of Sydney, University Centre for Rural Health, Rural Clinical School-Northern Rivers, Sydney, NSW 2006, Australia.
Ingham Institute, University of New South Wales, Sydney, NSW 2052, Australia.
Epidemiology, Healthy People and Places Unit, Population Health, South Western Sydney Local Health District, Liverpool, NSW 1871, Australia.
The University of Sydney, School of Public Health, Sydney, NSW 2006, Australia.


Improving the walkability of built environments to promote healthy lifestyles and reduce high body mass is increasingly considered in regional development plans. Walkability indexes have the potential to inform, benchmark and monitor these plans if they are associated with variation in body mass outcomes at spatial scales used for health and urban planning. We assessed relationships between area-level walkability and prevalence and geographic variation in overweight and obesity using an Australian population-based cohort comprising 92,157 Sydney respondents to the 45 and Up Study baseline survey between January 2006 and April 2009. Individual-level data on overweight and obesity were aggregated to 2006 Australian postal areas and analysed as a function of area-level Sydney Walkability Index quartiles using conditional auto regression spatial models adjusted for demographic, social, economic, health and socioeconomic factors. Both overweight and obesity were highly clustered with higher-than-expected prevalence concentrated in the urban sprawl region of western Sydney, and lower-than-expected prevalence in central and eastern Sydney. In fully adjusted spatial models, prevalence of overweight and obesity was 6% and 11% lower in medium-high versus low, and 10% and 15% lower in high versus low walkability postcodes, respectively. Postal area walkability explained approximately 20% and 9% of the excess spatial variation in overweight and obesity that remained after accounting for other individual- and area-level factors. These findings provide support for the potential of area-level walkability indexes to inform, benchmark and monitor regional plans aimed at targeted approaches to reducing population-levels of high body mass through environmental interventions. Future research should consider potential confounding due to neighbourhood self-selection on area-level walkability relations.


body mass; disease mapping; geographic variation; obese; overweight; spatial analysis; walkability

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