BACKGROUND: Ecological models of health behaviour are an important conceptual framework to address the multiple correlates of obesity. Several single-country studies previously examined the relationship between the built environment and obesity in adults, but results are very diverse. An important reason for these mixed results is the limited variability in built environments in these single-country studies. Therefore, the aim of this study was to examine associations between perceived neighbourhood built environmental attributes and BMI/weight status in a multi-country study including 12 environmentally and culturally diverse countries. METHODS: A multi-site cross-sectional study was conducted in 17 cities (study sites) across 12 countries (Australia, Belgium, Brazil, China, Colombia, Czech Republic, Denmark, Mexico, New Zealand, Spain, the UK and USA). Participants (n = 14222, 18-66 years) self-reported perceived neighbourhood environmental attributes. Height and weight were self-reported in eight countries, and measured in person in four countries. RESULTS: Three environmental attributes were associated with BMI or weight status in pooled data from 12 countries. Safety from traffic was the most robust correlate, suggesting that creating safe routes for walking/cycling by reducing the speed and volume of traffic might have a positive impact upon weight status/BMI across various geographical locations. Close proximity to several local destinations was associated with BMI across all countries, suggesting compact neighbourhoods with more places to walk related to lower BMI. Safety from crime showed a curvilinear relationship with BMI, with especially poor crime safety being related to higher BMI. CONCLUSIONS: Environmental interventions involving these three attributes appear to have international relevance and focusing on these might have implications for tackling overweight/obesity.

Baker IDI Heart and Diabetes Institute Melbourne VIC Australia

Center for Nutrition and Health Research National Institute of Public Health Cuernavaca Mexico

Centre for Research and Action in Public Health Faculty of Health Canberra University Canberra Australia

Centre of Physical Activity and Nutrition Research School of Exercise and Nutrition Sciences Deakin University Melbourne Australia

Department of Family and Preventive Medicine University of California San Diego USA

Department of Health Sciences Public University of Navarra Pamplona Navarra Spain

Department of Movement and Sport Sciences Ghent University Ghent Belgium

Department of Physical Education Federal University of Parana Curitiba Brazil

Department of Public Health School of Medicine Universidad de los Andes Bogotá Colombia

Department of Sports Science and Clinical Biomechanics University of Southern Denmark Odense Denmark

Human Potential Centre AUT University Auckland New Zealand

Institute of Active Lifestyle Faculty of Physical Culture Palacký Universitsy Olomouc Czech Republic

Institute of Human Performance The University of Hong Kong Hong Kong China

Research Foundation Flanders Brussels Belgium

School of Health and Biosciences Pontificia Universidade Catolica do Parana Curitiba Brazil

School of Population Health University of South Australia Adelaide Australia

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