Prospective associations between living in a smart growth community and children’s obesity risk measured by BMI percentile and waist circumference‑to‑height ratio

Obesity continues to be among the leading health concerns in the U.S. Smart Growth (SG) community development principles encourage physical activity and social engagement, which hold the potential to mitigate obesity risks in youth. This study examined the prospective associations of living in an SG community in Chino, California (The Preserve, N = 136), with changes in BMI percentile and waist-to-height ratio (WtHR), compared with conventionally designed communities (N = 460). Mixed-effects multiple linear regression and modified Poisson models were used to examine the interaction of the intervention by time-in-residence at baseline and follow-up waves for continuous and dichotomized anthropometric outcomes, respectively. Although we found null overall intervention effects averaged over time, participants living in The Preserve area for 7–11 months had a lower average WtHR (β = −0.09, 95%CI = −0.16, −0.01) and a lower likelihood of being overweight or obese (RR = 0.24, 95%CI = 0.06, 0.99) compared to those in conventional communities. The average BMI percentile was lower at wave 3 (β = −4.38, 95%CI = −8.26, −0.50) for The Preserve compared with those in conventional communities. Using SG principles in community planning has the potential to mitigate the development of overweight and obesity, although contextual and co-occurring historical events may confound the effects on obesity-related outcomes.