The study aimed to examine associations of neighborhood built environments and proximity of food outlets (BE measures) with body weight status using pooled data from an international study (IPEN Adult). Objective BE measures were calculated using geographic information systems for 10,008 participants (4463 male, 45%) aged 16-66 years in 14 cities. Participants self-reported proximity to three types of food outlets. Outcomes were body mass index (BMI) and overweight/obesity status. Male and female weight status associations with BE measures were estimated by generalized additive mixed models. Proportion (95% CI) of overweight (BMI 25 to <30) ranged from 16.6% (13.1, 19.8) to 41.1% (37.3, 44.7), and obesity (BMI ≥ 30) from 2.9% (1.3, 4.4) to 31.3% (27.7, 34.7), with Hong Kong being the lowest and Cuernavaca, Mexico highest for both proportions. Results differed by sex. Greater street intersection density, public transport density and perceived proximity to restaurants (males) were associated with lower odds of overweight/obesity (BMI ≥ 25). Proximity to public transport stops (females) was associated with higher odds of overweight/obesity. Composite BE measures were more strongly related to BMI and overweight/obesity status than single variables among men but not women. One standard deviation improvement in the composite measures of BE was associated with small reductions of 0.1-0.5% in BMI but meaningful reductions of 2.5-5.3% in the odds of overweight/obesity. Effects were linear and generalizable across cities. Neighborhoods designed to support public transport, with food outlets within walking distance, may contribute to global obesity control.

Behavioural Epidemiology Laboratory Baker Heart and Diabetes Institute Melbourne Australia

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

Centre for Research and Action in Public Health University of Canberra Canberra Australia; Therapeutic Goods Administration Department of Health Australia

Centre for Sports and Exercise University of Hong Kong Hong Kong China

College of Health Solutions Arizona State University Phoenix USA

Department of Geography University of Hong Kong Hong Kong China

Department of Movement and Sports Sciences Ghent University Belgium; Research Foundation Flanders Belgium

Family Medicine and Public Health University of California San Diego USA

Family Medicine and Public Health University of California San Diego USA; Mary MacKillop Institute for Health Research Australian Catholic University Melbourne Australia

Human Potential Centre Auckland University of Technology New Zealand

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

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

Mary MacKillop Institute for Health Research Australian Catholic University Melbourne Australia; Family Medicine and Public Health University of California San Diego USA

Mary MacKillop Institute for Health Research Australian Catholic University Melbourne Australia; School of Public Health University of Hong Kong Hong Kong China

Prevention Research Center in St Louis and Center for Diabetes Translation Research Brown School Washington University in St Louis USA; Center for Nutrition and Health Research National Institute of Public Health of Mexico Cuernavaca Mexico

Prevention Research Center in St Louis Brown School Washington University in St Louis St Louis USA; Graduate Program in Urban Management Curitiba Brazil

School of Community and Regional Planning University of British Columbia Vancouver Canada; Urban Design 4 Health Rochester New York USA

School of Medicine Universidad de los Andes Bogota Colombia

Urban Design 4 Health Rochester New York USA

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