The study's main aim was to examine whether adults' accelerometer-based physical activity and sedentary time mediated the associations of neighbourhood physical environmental perceptions with body mass index (BMI) and weight status across 10 high- and middle-income countries. Data from the IPEN Adult study, an observational multi-country study (n = 5712) were used. Results showed that sedentary time was a non-significant or inconsistent mediator in all models. MVPA mediated the associations of street connectivity, land use mix-diversity, infrastructure/safety for walking and aesthetics with BMI in single models. In the multiple model, MVPA only fully mediated the relation between land use mix-diversity and BMI. This finding was replicated in the models with weight status as outcome. MVPA partially mediated associations of composite environmental variables with weight status. So, although MVPA mediated some associations, future comprehensive studies are needed to determine other mechanisms that could explain the relation between the physical environment and weight outcomes. Food intake, food accessibility and the home environment may be important variables to consider. Based on the consistency of results across study sites, global advocacy for policies supporting more walkable neighbourhoods should seek to optimize land-use-mix when designing and re-designing cities or towns.

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

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

Department of Family Medicine and Public Health University of California San Diego La Jolla CA USA

Department of Health Sciences Public University of Navarra Navarra Spain; IdiSNA Navarra Institute for Health Research Navarra Spain

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

Graduate Program in Urban Management Pontifical Catholic University of Paraná; Curitiba Brazil; Prevention Research Center Brown School Washington University Saint Louis Missouri USA

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

Mary MacKillop Institute for Health Research Australian Catholic University Melbourne Australia

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

Mary MacKillop Institute for Health Research Australian Catholic University Melbourne Australia; School of Public Health The University of Hong Kong Hong Kong China; Baker IDI Heart and Diabetes Institute Melbourne Australia

Prevention Research Center Brown School Washington University Saint Louis Missouri USA

Research Foundation Flanders Brussels Belgium; Department of Movement and Sports Sciences Faculty of Medicine and Health Sciences Ghent University Ghent Belgium

School of Medicine Universidad de los Andes Bogotá Colombia

See more in PubMed

Alber JM, Green SH, Glanz K. Perceived and observed food environments, eating behaviors and BMI. Am J Prev Med 2018; 54: 423–429. PubMed

Atkin AJ, Gorely T, Clemes SA, et al. Methods of measurement in epidemiology: sedentary behaviour. Int J Epidemiol 2012; 41: 1460–1471. PubMed PMC

Berrigan D, Troiano RP. The association between urban form and physical activity in U.S. adults. Am J Prev Med 2002; 23: 74–79. PubMed

Bivoltsis A, Cervigni E, Trapp G, Knuiman M, Hooper P, Ambrosini GL. Food environments and dietary intakes among adults: does the type of spatial exposure measurement matter? A systematic review. Int J Health Geogr 2018; 17: 19. PubMed PMC

Brown BB, Smith KR, Hanson H, Fan JX, Kowaleski-Jones L, Zick CD. Neighborhood design for walking and biking, physical activity and body mass index. Am J Prev Med 2013; 44: 231–238. PubMed PMC

Burnham KP, Anderson DR. Model Selection and Multimodel Inference: a Practical Information-theoretic Approach. 2nd ed. New York: Springer; 2002.

Cain KL. Accelerometer Scoring Protocol for the IPEN-Adult Study. University California; San Diego, CA: [Web page]. http://www.ipenproject.org/documents/methods_docs/Accelerometer_Data_Collection_and_Scoring_Manual_Updated_June2012.pdf Accessed December 5, 2019.

Campbell SDI, Brosnan BJ, Chu AKY, et al. Sedentary behaviour and body weight composition in adults: a systematic review and meta-analysis of prospective studies. Sports Med 2018; 48: 585–595. PubMed

Cerin E, Cain K, Conway TL, et al. Neighborhood environments and objectively measured physical activity in 11 countries. Med Sci Sports Exerc 2014; 46: 2253–2264. PubMed PMC

Cerin E, Conway TL, Cain KL, et al. Sharing good NEWS across the world: developing comparable scores across 12 countries for the Neighborhood Environment Walkability Scale (NEWS). BMC Public Health 2013; 13:309. PubMed PMC

Cerin E, Saelens BE, Sallis JF, Frank LD. Neighborhood environment walkability scale: validity and development of a short form. Med Sci Sports Exerc 2006; 38: 1682–91. PubMed

Chastin SFM, Schwarz U, Skelton DA. Development of a consensus taxonomy of sedentary behaviors (SIT): Report of Delphi round 1. PLoS ONE 2013; 8: e82313. PubMed PMC

Chu DT, Minh Nguyet NT, Dinh TC, et al. An update on physical health and economic consequences of overweight and obesity. Diabetes Metab Syndr 2018; 12: 1095–1100. PubMed

Cleland VJ, Patterson K, Breslin M, Schmidt MD, Dwyer T, Venn AJ. Longitudinal associations between TV viewing and BMI not explained by the ‘mindless eating’ or ‘physical activity displacement’ hypotheses among adults. BMC Public Health 2018; 18: 797. PubMed PMC

Ekelund U, Kolle E, Steene-Johannessen J, et al. Objectively measured sedentary time and physical activity and associations with body weight gain: does body weight determine a decline in moderate and vigorous physical activity? Int J Obes 2017; 41: 1769–1774. PubMed

Freedson PS, Miller K. Objective monitoring of physical activity using motion sensors and heart rate. Res Q Exerc Sport 2000; 71: S21–9. PubMed

Freedson PS, Lyden K, Kozey-Keadle S, Staudenmayer J. Evaluation of artificial neural network algorithms for predicting METs and activity type from accelerometer data: Validation on an independent sample. J Appl Physiol 2011; 111: 1804–1812. PubMed PMC

Gibbs BB, Gabriel KP, Carnethon MR, et al. Sedentary time, physical activity, and adiposity: cross-sectional and longitudinal associations in CARDIA. Am J Prev Med 2017; 53: 764–771. PubMed PMC

Golubic R, Wijndaele K, Sharp SJ, et al. Physical activity, sedentary time and gain in overall and central body fat: 7-year follow-up of the ProActive trial cohort. Int J Obes 2015; 39: 142–148. PubMed PMC

Heath G, Brownson R, Kruger J, et al. The effectiveness of urban design and land use and transport policies and practices to increase physical activity: a systematic review. J Phys Act Health. 2006; 1: S55–S71. PubMed

Jansen M, Kamphuis CBM, Pierik FH, Ettema DF, Dijst MJ. Neighborhood-based PA and its environmental correlates: a GIS- and GPS based cross-sectional study in the Netherlands. BMC Public Health 2018; 18: 233. PubMed PMC

Jauregui A, Pratt M, Lamadrid-Figueroa H, Hernandez B, Rivera JA, Salvo D. Perceived neighbourhood environment and physical activity: the International Physical Activity and the Environment Network adult study in Mexico. Am J Prev Med 2016; 51: 271–279. PubMed

Kerr J, Sallis JF, Owen N, et al. Advancing science and policy through a coordinated international study of physical activity and built environments: IPEN Adult methods. J Phys Act Health 2013; 10: 581–601. PubMed

Lakerveld J, Mackenbach J. The upstream determinants of adult obesity. Obes Facts 2017; 10: 216–222. PubMed PMC

Mackenbach JD, Rutter H, Compernolle S, et al. Obesogenic environments: a systematic review of the association between the physical environment and adult weight status: the SPOTLIGHT project. BMC Public Health 2014; 14:233. PubMed PMC

MacKinnon DP, Luecken LJ. How and for whom? Mediation and moderation in health psychology. Health Psychol 2008; 27: S99–S100. PubMed PMC

Malambo P, Kengne AP, Lambert EV, De Villiers A, Puoane T. Does physical activity mediate the association between perceived neighborhood aesthetics and overweight/obesity among South African adults living in selected urban and rural communities? J Phys Act Health 2017; 14: 925–932. PubMed

Matthews CE, Chen KY, Freedson PS, et al. Amount of time spent in sedentary behaviors in the United States, 2003–2004. Am J Epidemiol 2008; 167: 875–881. PubMed PMC

McAdams MA, Van Dam RM, Hu FB. Comparison of self-reported and measured BMI as correlates of disease markers in US adults. Obesity 2007; 15:188–96. PubMed

Morenga LT, Mallard S, Mann J. Dietary sugars and body weight: review and meta-analyses of randomized controlled trials and cohort studies. BMJ 2013; 346: e7492. PubMed

NCD Risk Factor Collaboration (NCD-RisC). Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19.2 million participants. Lancet 2016; 387: 1377–1396. PubMed PMC

Nejat EJ, Polotsky AJ, Pal L. Predictors of chronic disease at midlife and beyond – the health risks of obesity. Maturitas 2010; 64: 106–111. PubMed

O’Donoghue G, Perchoux C, Mensah K, et al. A systematic review of correlates of sedentary behaviour in adults aged 18–65 years: a socio-ecological approach. BMC Public Health 2016; 16: 163. PubMed PMC

Oliver M, Witten K, Blakely T, et al. Neighbourhood built environment associations with body size in adults: mediating effects of activity and sedentariness in a cross-sectional study of New Zealand adults. BMC Public Health 2015; 15: 956. PubMed PMC

Owen N, Sugiyama T, Koohsari MJ, et al. Associations of neighborhood environmental attributes with adults’ objectively-assessed sedentary time: IPEN adult multi-country study. Prev Med 2018; 115: 126–133. PubMed

Oyeyemi AL, Deforche B, Sallis JF, De Bourdeaudhuij I, Van Dyck D. Behavioral mediators of the association between neighborhood environment and weight status in Nigerian adults. Am J Health Promot 2013; 28: 23–31. PubMed

Poortinga W Perceptions of the environment, physical activity and obesity. Soc Sci Med 2006; 63: 2835–2846. PubMed

Reiner M, Niermann C, Jekauc D, Woll A. Long-term health benefits of physical activity – a systematic review of longitudinal studies. BMC Public Health 2013; 13: 813. PubMed PMC

Saelens BE, Sallis JF, Black JB, Chen D. Neigborhood-based differences in physical activity: an environment scale evaluation. Am J Public Health 2003; 93: 1552–8. PubMed PMC

Sallis JF, Cerin E, Conway TL, et al. Physical activity in relation to urban environments in 14 cities worldwide: a cross-sectional study. Lancet 2016; 387: 2207–2217. PubMed PMC

Sallis JF, Owen N. Ecological models of health behavior In: Glanz K, Rimer BK, Viswanath K, eds. Health behavior: Theory, research and practice. San Francisco, CA: Jossey-Bass; 2015. pp. 43–64.

Van Dyck D, Cerin E, Cardon G, Deforche B, Sallis JF, Owen N, Bourdeaudhuij I. De Physical activity as a mediator of the associations between neighborhood walkability and adiposity in Belgian adults Health Place, 16 (2010), pp. 952–960 PubMed

Wood SN. Generalized Additive Models: an Introduction with R. Boca Raton: Chapman and Hall; 2006