The impact of greenspace and condition of the neighbourhood on child overweight

The moderating effects of greenspace on the association between neighbourhood disadvantage and obesity among mid-to-older aged Australian adults

This study examined whether the association between neighbourhood disadvantage and obesity was moderated by quantity and quality of greenspace. The sample included 2848 mid-to-older aged adults residing in 200 neighbourhoods in Brisbane, Australia from the HABITAT study. Self-reported height and weight were used to calculate body mass index (BMI), neighbourhood disadvantage was measured using a census-derived composite index and greenspace was measured geospatially. We found evidence of moderation by park quality: lower average BMI at higher levels of park quality was shown in the Q3 rather than the Q1 (least disadvantaged) neighbourhood disadvantage group. The findings suggest that, for reducing socioeconomic inequalities in obesity, the quality of greenspace is imperative.

Greenspace and children's lung function in China: A cross-sectional study between 2013 and 2015

This study aims to investigate how surrounding greenspace density and proximity were associated with children's lung function. Between 2013 and 2015, spirometry and a parental survey were performed with children from four primary schools in two Chinese cities. Forced expiratory volume in 1 s (FEV₁, L), forced vital capacity (FVC, L), peak expiratory flow rate (PEF, L/s), and forced expiratory flow at 25 % (FEF₂₅, L/s) and 75 % (FEF₇₅, L/s) of FVC were measured. Outdoor surrounding greenspace index incorporated residential, school and commuting greenness and was weighted using assumed daytime hours spent at home and school. Residential proximity to greenspace index was defined as walking distance to nearest park. A total of 913 children (48.7 % female) were included. Overall, an interquartile range (IQR) increase in outdoor surrounding greenspace was associated with decreased FVC (0.06 L, 95%CI 0.01-0.11), but increased FEV₁/FVC (2.03, 1.13-3.04), PEF (0.26 L/s, 0.13-0.39), and FEF₂₅ (0.30 L/s, 0.17-0.42). Residential proximity to greenspace was associated with increased FEV₁ (0.05 L, 0.02-0.08) and FVC (0.04 L, 0.01-0.07) per IQR decrease in distance. Protective effect was significant for children whose parents were less educated and those living in higher road density areas, though interactions were not significant. Structural equation modeling showed that higher level of surrounding greenspace was associated with lower ambient air pollution and in turn with better lung function. Greenspace density and proximity could influence children's lung function differently.

Incorporating interactions into structured life course modelling approaches: A simulation study and applied example of the role of access to green space and socioeconomic position on cardiometabolic health

Background

Structured life course modelling approaches (SLCMA) have been developed to understand how exposures across the lifespan relate to later health, but have primarily been restricted to single exposures. As multiple exposures can jointly impact health, here we: i) demonstrate how to extend SLCMA to include exposure interactions; ii) conduct a simulation study investigating the performance of these methods; and iii) apply these methods to explore associations of access to green space, and its interaction with socioeconomic position, with child cardiometabolic health.

Methods

We used three methods, all based on lasso regression, to select the most plausible life course model: visual inspection, information criteria and cross-validation. The simulation study assessed the ability of these approaches to detect the correct interaction term, while varying parameters which may impact power (e.g., interaction magnitude, sample size, exposure collinearity). Methods were then applied to data from a UK birth cohort.

Results

There were trade-offs between false negatives and false positives in detecting the true interaction term for different model selection methods. Larger sample size, lower exposure collinearity, centering exposures, continuous outcomes and a larger interaction effect all increased power. In our applied example we found little-to-no association between access to green space, or its interaction with socioeconomic position, and child cardiometabolic outcomes.

Conclusions

Incorporating interactions between multiple exposures is an important extension to SLCMA. The choice of method depends on the researchers' assessment of the risks of under- vs over-fitting. These results also provide guidance for improving power to detect interactions using these methods.

The impact of social determinants of health on obesity and diabetes disparities among Latino communities in Southern California

BACKGROUND

Social determinants of health (SDoH) describe the complex network of circumstances that impact an individual before birth and across the lifespan. SDoH contextualize factors in a community that are associated with chronic disease risk and certain health disparities. The main objective of this study was to explore the impact of SDoH on the prevalence of obesity and diabetes, and whether these factors explain disparities in these health outcomes among Latinos in Southern California.

METHODS

We utilized three composite indices that encompass different SDoH: the Healthy Places Index (HPI), Social Vulnerability Index (SVI), and CalEnviroScreen (CES). Univariate linear regression models explored the associations between index scores with adult obesity, adult diabetes, and childhood obesity.

RESULTS

Communities with lower HPI scores were associated with higher prevalence of metabolic disease and a greater proportion of Latino residents. Cities in the lowest decile of HPI scores had 71% of the population identifying as Latino compared to 12% in the highest decile. HPI scores explained 61% of the variability in adult obesity (p < 0.001), 41% of the variability in childhood obesity (p < 0.001), and 47% of the variability in adult diabetes (p < 0.001). Similar results were observed when examining SVI and CES with these health outcomes.

CONCLUSIONS

These results suggest that Latinos in Southern California live in communities with adverse SDoH and face a greater burden of adult obesity, diabetes, and childhood obesity.

Greenspace and health outcomes in children and adolescents: A systematic review

An increasing body of evidence has linked greenspace and various health outcomes in children and adolescents, but the conclusions were inconsistent. For this review, we comprehensively summarized the measurement methods of greenspace, resultant health outcomes, and potential mechanisms from epidemiological studies in children and adolescents (aged ≤19 years). We searched for studies published and indexed in MEDLINE and EMBASE (via Ovid) up to April 11, 2022. There were a total of 9,291 studies identified with 140 articles from 28 countries finally assessed and included in this systematic review. Over 70% of the studies were conducted in highly urbanised countries/regions, but very limited research has been done in low-and middle-income countries and none in Africa. Measures of greenspace varied. Various health outcomes were reported, including protective effects of greenspace exposure on aspects of obesity/overweight, myopia, lung health, circulatory health, cognitive function, and general health in children and adolescents. The associations between greenspace exposure and other health outcomes were inconsistent, especially for respiratory health studies. We pooled odds ratios (OR) using random-effects meta-analysis for health outcomes of asthma (OR = 0.94, 95%CI: 0.84 to 1.06), allergic rhinitis (OR = 0.95; 95% CI: 0.73 to 1.25), and obesity/overweight (OR = 0.91, 95%CI: 0.84 to 0.98) with per 0.1 unit increase in normalized difference in vegetation index (NDVI). These associations have important implications for the assessment and management of urban environment and health in children and adolescents.

Green Space Exposure and Obesity in the Mexican Adult Population

Green space or natural vegetation may reduce obesity risk by increasing opportunities for physical activity or reducing stress and exposure to other pollutants. Obesity prevalence in Mexico is ranked among the highest in the world. However, research on the association between green space and obesity in Mexico is lacking. We used data from the National Nutrition Survey in Mexico (2018-2019), a nationally representative sample of Mexican adults. The analytical sample included participants between 20-59 years of age (n = 12,631). We assessed exposure to green space using a 30 m resolution Landsat satellite Normalized Difference Vegetation Index (NDVI) from 2018. Linear regression models examined associations between NDVI and body mass index (BMI), adjusting for confounders. The mean age of the study sample was 38 (SD 0.19) years. Participants living in areas with the highest green space exposure had the lowest education level (53.51%) and socioeconomic status (28.38%) and were located in central (33.01%), south (30.37%), and rural areas (21.05%). Higher residential exposure to green space was associated with a mean decrease in BMI of -1.1 kg/m² (95% CI: -1.59, -0.68). This is one of the first studies in Latin America to suggest a protective association between green space and obesity among Mexican adults.

Measuring Obesogenicity and Assessing Its Impact on Child Obesity: A Cross-Sectional Ecological Study for England Neighbourhoods

Both major influences on changing obesity levels (diet and physical activity) may be mediated by the environment, with environments that promote higher weight being denoted obesogenic. However, while many conceptual descriptions and definitions of obesogenic environments are available, relatively few attempts have been made to quantify obesogenic environments (obesogenicity). The current study is an ecological study (using area units as observations) which has as its main objective to propose a methodology for obtaining a numeric index of obesogenic neighbourhoods, and assess this methodology in an application to a major national dataset. One challenge in such a task is that obesogenicity is a latent aspect, proxied by observed environment features, such as poor access to healthy food and recreation, as well as socio-demographic neighbourhood characteristics. Another is that obesogenicity is potentially spatially clustered, and this feature should be included in the methodology. Two alternative forms of measurement model (i.e., models representing a latent quantity using observed indicators) are considered in developing the obesogenic environment index, and under both approaches we find that both food and activity indicators are pertinent to measuring obesogenic environments (though with varying relevance), and that obesogenic environments are spatially clustered. We then consider the role of the obesogenic environment index in explaining obesity and overweight rates for children at ages 10-11 in English neighbourhoods, along with area deprivation, population ethnicity, crime levels, and a measure of urban-rural status. We find the index of obesogenic environments to have a significant effect in elevating rates of child obesity and overweight. As a major conclusion, we establish that obesogenic environments can be measured using appropriate methods, and that they play a part in explaining variations in child weight indicators; in short, area context is relevant.

Mediators of socioeconomic differences in overweight and obesity among youth in Ireland and the UK (2011–2021): a systematic review

Background

By 2025, adult obesity prevalence is projected to increase in 44 of 53 of European-region countries. Childhood obesity tracks directly onto adult obesity, and children of low socioeconomic position families are at disproportionately higher risk of being obese compared with their more affluent peers. A previous review of research from developed countries identified factors mediating this relationship. This systematic review updates and extends those findings specifically within the context of Ireland and the United Kingdom.

Objective

The aim of this systematic review is to summarise peer-reviewed research completed in Ireland and the United Kingdom between 2011–2021 examining mediators of socioeconomic differentials in adiposity outcomes for youth.

Design

An electronic search of four databases, Ovid MEDLINE, Embase, Web of Science and EBSCOhost was conducted. Quantitative studies, published in the English language, examining mediators of socioeconomic differentials in adiposity outcomes in youth, and conducted in Ireland and the United Kingdom between 2011–2021 were included. An appraisal of study quality was completed. The systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Results

Following screening, a total of 23 papers were eligible for inclusion. Results indicate socioeconomic differentials for Ireland and the United Kingdom follow similar patterns to other developed countries and have similar mediating factors including early life and parent-level factors. However, this review identified additional factors that mediate the relationship, namely access to green space and favorable neighborhood conditions. Identifying these factors present further opportunities for potential interventions and confirm the requirement for tailored and appropriate research and interventions for Ireland and the United Kingdom.

Conclusion

This review identified several modifiable factors that should be considered when planning interventions aimed at reducing socioeconomic differentials in adiposity among youth in Ireland and the United Kingdom. Support was found for interventions to be made as early as possible in an at-risk child’s life, with the prenatal and preschool periods considered the most efficacious. Results were equivocal about the role of physical activity in the risk of childhood overweight and obesity. While multi-country analyses provide excellent overviews, country- or area-specific research may produce more nuanced, and potentially more powerful findings, which can help better inform policy responses and interventions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14004-z.

Could greenness modify the effects of physical activity and air pollutants on overweight and obesity among children and adolescents?

Greenness could theoretically increase the impact of physical activity (PA) and reduce the adverse effects of air pollution on overweight/obesity. However, no evidence systematically compares these two pathways, especially in longitudinal studies of children and adolescent's cohort. Greenness, PA, and air pollution were assessed by Normalized Difference Vegetation Index (NDVI), International Physical Activity Short Form, and 7 pollutants (PM₁, PM_2.5, PM₁₀, SO₂, NO₂, CO, and O₃). Each exposure was divided into low-/high-level groups based on the 50% quantile. Proportional hazards and logistic regression model were used to assess the associations of greenness, PA, pollutants with overweight/obesity. The incidence of overweight/obesity was 1.98% in the national survey, and the cumulative incidence and incidence density were 12.76% and 3.43 per 100 person-year in the dynamic cohort, separately. An increase of 0.1 units in NDVI was associated with a 12% lower risk of overweight/obesity, but no significant link between PA and incidence was observed. The HRs of the high-level of PM₁, PM_2.5, PM₁₀, SO₂, NO₂, CO, and O₃ on the risk of overweight/obesity were 2.21, 2.63, 1.88, 2.38, 1.33, 2.43, and 1.33 in the low-level of greenness, which was higher than those in the high-level of greenness. The AFs of PM₁, PM_2.5, PM₁₀, SO₂, NO₂, CO, and O₃ were 25.58%, 44.37%, 22.96%, 29.15%, 11.55%, 29.50%, and 10.92% in the low-level of greenness, which simultaneously was higher than those in the high-level of greenness. Moreover, the risk of overweight/obesity associated with high-level of greenness in the high-level of PM₁₀, SO₂, CO were 0.83, 0.81, and 0.83 respectively. Our findings confirmed that greenness has a moderating effect on the effects of air pollutants on childhood overweight/obesity especially in heavy-industry areas where PM₁₀, SO₂, and CO are the major pollutants, although it did not influence the association between PA and overweight/obesity risks.

Associations between the home environment and childhood weight change: a cross-lagged panel analysis

BACKGROUND

The obesogenic quality of the home environment is hypothesised to play an important role in children's weight development but few prospective studies have investigated relationships between the home environment and adiposity across childhood.

OBJECTIVE

To investigate the continuity and stability of the home environment from ages 4 to 12, and bi-directional relationships between the home environment and BMI-SDS from ages 4 to 12.

METHODS

Parents from the Gemini cohort completed the Home Environment Interview (HEI), a comprehensive measure of the obesogenic home environment, when their children were aged 4 and 12 (n = 149 families, n = 298 children). The obesogenic home environment was measured using four composite scores capturing the food, activity, media environments, and the overall home environment. Child weights and heights were used to calculate BMI-SDS. Continuity was assessed with Pearson's correlations between scores at each time point, and stability by changes in mean scores over time. Cross-lagged analyses were performed (HEI composites at age 4 to BMI-SDS at age 12 and the reverse) to measure the magnitude and direction of associations.

RESULTS

The home environment showed moderate-to-high continuity from ages 4 to 12 (r = 0.30-0.64). The overall home environment (r = 0.21, p < 0.01) and media composites (r = 0.23, p < 0.01) were cross-sectionally associated with child BMI-SDS at age 12, but not at age 4. Longitudinally, the home media environment at age 4 predicted increases in child BMI-SDS at age 12 (β; 95% CI = 0.18; 0.08,0.28, p < 0.01). No associations were observed for the reverse path, or the remaining composites (the overall, food and activity) in either direction.

CONCLUSION

This study provides evidence that the obesogenic home environment tracks across childhood and highlights the importance of the early home media environment for child weight development. The findings provide insight into key aspects of the home environment that could be targeted when developing obesity treatment or prevention strategies.

The Association between Greenness and Urbanization Level with Weight Status among Adolescents: New Evidence from the HBSC 2018 Italian Survey

Recent studies have examined how the environment can influence obesity in young people. The research findings are conflicting: in some studies, green spaces have shown a protective association with obesity and urbanization has turned out to worsen this condition, while other studies contradicted these results. The aim of the study was to examine the relationships between greenness, urbanization, and weight status among Italian adolescents. Student data (11-13 years old) on weight and height, physical activity (PA), and demographic characteristics were extracted from the 2018 Health Behaviour in School-aged Children (HBSC) survey in Piedmont, Northwest of Italy. Data on Normalized Difference Vegetation Index (NDVI) and urbanization were obtained from satellite images and the National Institute of Statistics (ISTAT). A multilevel regression model was used to assess the association between NDVI, urbanization, and obesity, controlling for PA. Students living in greener areas reported a lower likelihood of being obese [OR = 0.11, 95% CI 0.02-0.56, p = 0.007], while students living in areas with a higher level of urbanization showed a significantly increased risk of obesity [OR = 2.3, 95% CI:1.14-4.6, p = 0.02]. Living surrounded by higher amounts of greenness and lower levels of urbanization may positively influence health status through lower risk of obesity among youth.

The Potential for Outdoor Nature-Based Interventions in the Treatment and Prevention of Depression

There is growing interest in nature-based interventions (NBI) to improve human health and wellbeing. An important nascent area is exploring the potential of outdoor therapies to treat and prevent common mental health problems like depression. In this conceptual analysis on the nature-depression nexus, we distil some of the main issues for consideration when NBIs for depression are being developed. We argue that understanding the mechanisms, or 'active ingredients' in NBIs is crucial to understand what works and for whom. Successfully identifying modifiable mediating intervention targets will pave the way for interventions with increased efficacy. We highlight a non-exhaustive list of five clinically relevant putative, candidate mechanisms which may underly the beneficial effects of NBIs on depression: stress, rumination, mindfulness, sleep and exercise. We also make the case that when developing NBIs it is important to not neglect young people, explore personalised approaches and focus on both treatment and prevention approaches. To achieve these aims methodologically rigorous programmes of clinical research are needed that include well-powered and controlled experimental designs including randomised controlled trials, qualitative research, longitudinal studies and large prospective cohorts.

The built environment as determinant of childhood obesity: A systematic literature review

We evaluated the epidemiological evidence on the built environment and its link to childhood obesity, focusing on environmental factors such as traffic noise and air pollution, as well as physical factors potentially driving obesity-related behaviors, such as neighborhood walkability and availability and accessibility of parks and playgrounds. Eligible studies were (i) conducted on human children below the age of 18 years, (ii) focused on body size measurements in childhood, (iii) examined at least one built environment characteristic, (iv) reported effect sizes and associated confidence intervals, and (v) were published in English language. A z test, as alternative to the meta-analysis, was used to quantify associations due to heterogeneity in exposure and outcome definition. We found strong evidence for an association of traffic-related air pollution (nitrogen dioxide and nitrogen oxides exposure, p < 0.001) and built environment characteristics supportive of walking (street intersection density, p < 0.01 and access to parks, p < 0.001) with childhood obesity. We identified a lack of studies that account for interactions between different built environment exposures or verify the role and mechanism of important effect modifiers such as age.

The Home Environment Interview and associations with energy balance behaviours and body weight in school-aged children - a feasibility, reliability, and validity study

BACKGROUND

The home environment is thought to influence children's weight trajectories. However, few studies utilise composite measures of the home environment to examine associations with energy balance behaviours and weight. The present study aimed to adapt and update a comprehensive measure of the obesogenic home environment previously developed for pre-schoolers, and explore associations with school-aged children's energy balance behaviours and weight.

METHODS

Families from the Gemini cohort (n = 149) completed the Home Environment Interview (HEI) via telephone when their children were 12 years old. The HEI comprises four composite scores: one for each domain (food, activity and media) of the environment, as well as a score for the overall obesogenic home environment. The primary caregiver also reported each child's height and weight (using standard scales and height charts), diet, physical activity and sedentary screen-based behaviours. A test-retest sample (n = 20) of caregivers completed the HEI a second time, 7-14 days after the initial interview, to establish test-retest reliability.

RESULTS

Children (n = 298) living in 'higher-risk' home environments (a 1 unit increase in the HEI obesogenic risk score) were less likely to consume fruits (OR; 95% CI = 0.40; 0.26-0.61, p < 0.001), and vegetables (0.30; 0.18-0.52, p < 0.001), and more likely to consume energy-dense snack foods (1.71; 1.08-2.69, p = 0.022), convenience foods (2.58; 1.64-4.05, p < 0.001), and fast foods (3.09; 1.90-5.04, p < 0.001). Children living in more obesogenic home environments also engaged in more screen-time (β (SE) = 4.55 (0.78), p < 0.001), spent more time playing video games (β (SE) = 1.56 (0.43), p < 0.001), and were less physically active (OR; 95% CI = 0.57; 0.40-0.80, p < 0.01). Additionally, there was a positive association between higher-risk overall home environment composite score and higher BMI-SDS (β (SE) = 0.23 (0.09), p < 0.01). This finding was mirrored for the home media composite (β (SE) = 0.12 (0.03), p < 0.001). The individual home food and activity composite scores were not associated with BMI-SDS.

CONCLUSION

Findings reveal associations between the overall obesogenic home environment and dietary intake, activity levels and screen-based sedentary behaviours, as well as BMI in 12 year olds. These findings suggest that the home environment, and in particular the home media environment, may be an important target for obesity prevention strategies.

Associations between Parent-Child Nature Visits and Sleep, Physical Activity and Weight Status among Finnish 3-6-Year-Olds

Nature visits and nature exposure have been shown to be favorably associated with children's health and development, but the research regarding their associations with children's lifestyle habits is limited. The current study aimed to investigate the associations between the frequency of parent-child nature visits and sleep, moderate-to-vigorous physical activity (MVPA) and weight status among three- to six-year-old Finnish preschoolers. Parents and their children (n = 864) participated in a cross-sectional DAGIS (increased health and wellbeing in preschools) study, which was conducted between 2015 and 2016 in Finland. In total, 798 parents answered a questionnaire on the frequency of parent-child nature visits, which also included questions on sociodemographic factors and their children's sleep habits. Parents also reported children's bedtimes and wake-up times and children wore an accelerometer for seven days. Trained researchers measured children's weight and height. Linear and logistic regression analyses were conducted. More frequent parent-child nature visits were associated with children's longer sleep duration at night, higher amounts of MVPA outside preschool time and, among girls, good sleep consistency. The frequency of parent-child nature visits was not significantly associated with whether children were overweight or obese or not. Promoting parent-child nature visits could be a cost-effective way to increase young children's MVPA and enhance night-time sleep.

Nature and Children's Health: A Systematic Review

CONTEXT

Daily outdoor play is encouraged by the American Academy of Pediatrics. Existing evidence is unclear on the independent effect of nature exposures on child health.

OBJECTIVE

We systematically evaluated evidence regarding the relationship between nature contact and children's health.

DATA SOURCES

The database search was conducted by using PubMed, Cumulative Index to Nursing and Allied Health Literature, PsychInfo, ERIC, Scopus, and Web of Science in February 2021.

STUDY SELECTION

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In all searches, the first element included nature terms; the second included child health outcome terms.

DATA EXTRACTION

Of the 10 940 studies identified, 296 were included. Study quality and risk of bias were assessed.

RESULTS

The strongest evidence for type of nature exposure was residential green space studies (n = 147, 50%). The strongest evidence for the beneficial health effects of nature was for physical activity (n = 108, 32%) and cognitive, behavioral, or mental health (n = 85, 25%). Physical activity was objectively measured in 55% of studies, and 41% of the cognitive, behavioral, or mental health studies were experimental in design.

LIMITATIONS

Types of nature exposures and health outcomes and behaviors were heterogenous. Risk of selection bias was moderate to high for all studies. Most studies were cross-sectional (n = 204, 69%), limiting our ability to assess causality.

CONCLUSIONS

Current literature supports a positive relationship between nature contact and children's health, especially for physical activity and mental health, both public health priorities. The evidence supports pediatricians in advocating for equitable nature contact for children in places where they live, play, and learn.

"Kids Get in Shape with Nature": A Systematic Review Exploring the Impact of Green Spaces on Childhood Obesity

Green and blue spaces (GABS) are vital components of sustainable and healthy communities. Evidence suggest that GABS positively affect population health and wellbeing. However, few studies examine GABS influence on childhood obesity. This systematic review investigates the impact of GABS on childhood obesity particularly on children's physical activity and eating behavior. The search protocol identified 544 studies from PubMed, Medline, PsycINFO, CINAHL, and Web of Science. A two-tier screening process document using the PRISMA flow diagram identified 16 studies which underwent quality analysis using the National Heart, Lung, and Blood Institute (NHLBI) and Critical Appraisal Skills Programme (CASP) tools. Data were interpreted using thematic analysis and narrative synthesis. Selected studies show varying sociodemographic characteristics of sampled populations located in urban and rural settings. The influence of GABS on children's physical activity and eating behaviour depends on the type, location, proximity, density, facilities, and activity types that interplay with gender, ethnicity, and parent-child relationship. The review demonstrates the significant effect of GABS on children's physical activity and eating behaviour. GABS provide children with safe venues for socialisation and long, intensive, and enjoyable physical activity; and influence children's perceptions on vegetable consumption supporting healthier eating behaviour. These spaces have the potential to eradicate childhood obesity if policy, social, economic, environmental, and organisational considerations are addressed.

Comparing different data sources by examining the associations between surrounding greenspace and children's weight status

Background

Studies on the association between surrounding greenspace and being overweight in childhood show inconsistent results, possibly because they differ widely in their definition and measurement of surrounding greenspace. Our aim was to evaluate whether the association of greenspace with being overweight depends on the measurement of greenspace in different data sources.

Methods

Based on data from the school entry examinations of 22,678 children in the city of Hannover, Germany, from 2010 to 14, the association between greenspace availability and overweight was examined. Three different sources of greenspace availability were derived for a set of 51 areas of the city: The Normalized Difference Vegetation Index (NDVI), the OpenStreetMap (OSM) dataset, and the European Urban Atlas (UA) dataset. Agreement between the indicators on the quantity of greenspace coverage was compared. The association with children's BMI z-score, including potential interaction terms, was assessed using multilevel regression analysis.

Results

Greenspace availability per district area derived by NDVI was on average 42%, by OSM 29% and UA 22%, with OSM and UA being strongly correlated. Only the greenspace availability derived by NDVI showed an association with children's BMI z-score: The higher the greenspace availability was, the lower the BMI. The trend of association was higher for boys and migrant children than for girls and non-migrants and was restricted to the highest levels of greenspace availability.

Conclusions

Associations of greenspace with children's weight status depend on the greenspace measurement chosen. Surrounding greenspace was measured more comprehensively by NDVI. Data sources based on land use categories such as UA and OSM may be less suitable to reflect surrounding greenspace relevant for health outcomes. Potential mechanisms warrant further analysis and investigation.

Obesity and Natural Spaces in Adults and Older People: A Systematic Review

BACKGROUND

Obesity is an important public health issue that has increased globally in the last decade and continues to be one of the main causes of morbidity and premature mortality. An accumulating body of evidence suggests that contact with nature is a valuable resource for the promotion of a more active lifestyle and seems to have a central role in maintaining a healthy weight. The authors conducted a systematic review to summarize the findings of studies that investigated the relationship between natural spaces and obesity.

METHODS

Following Primary Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a literature search was conducted using 11 databases for studies fully available in English and published between 2010 and 2020, with adults (18-64 y) and/or older people (≥65 y).

RESULTS

Fifty studies were found that met all the inclusion criteria. The majority (68%) of papers found that higher availability and less distance to green and blue spaces are associated with lower levels of adiposity. These associations were positive, even after adjusting for the demographic and socioeconomic factors.

CONCLUSIONS

Exploring the characteristics of green and blue spaces seems to be a promising tool for urban planning and health policies. The authors suggest the implementation of exercise programs in contact with nature for future interventions.

Green Space and Health Equity: A Systematic Review on the Potential of Green Space to Reduce Health Disparities

Disadvantaged groups worldwide, such as low-income and racially/ethnically minoritized people, experience worse health outcomes than more privileged groups, including wealthier and white people. Such health disparities are a major public health issue in several countries around the world. In this systematic review, we examine whether green space shows stronger associations with physical health for disadvantaged groups than for privileged groups. We hypothesize that disadvantaged groups have stronger protective effects from green space because of their greater dependency on proximate green space, as they tend to lack access to other health-promoting resources. We use the preferred reporting items for systematic reviews and meta-analyses (PRISMA) method and search five databases (CINAHL, Cochrane, PubMed, Scopus, and Web of Science) to look for articles that examine whether socioeconomic status (SES) or race/ethnicity modify the green space-health associations. Based on this search, we identify 90 articles meeting our inclusion criteria. We find lower-SES people show more beneficial effects than affluent people, particularly when concerning public green spaces/parks rather than green land covers/greenness. Studies in Europe show stronger protective effects for lower-SES people versus higher-SES people than do studies in North America. We find no notable differences in the protective effects of green space between racial/ethnic groups. Collectively, these results suggest green space might be a tool to advance health equity and provide ways forward for urban planners, parks managers, and public health professionals to address health disparities.

Green space access in the neighbourhood and childhood obesity

Access to green space may influence individual physical activity (PA) and subsequently weight status, as increased exposure to green space could improve health by increasing opportunities and the actual levels of PA. However, whether such associations hold empirically remains inconclusive. This study reviewed articles that analysed the association between access to green space and weight-related behaviours/outcomes among children, published before 1 January 2019. The sample sizes ranged from 108 to 44 278. Four cohorts and 17 cross-sectional studies conducted in nine countries were identified. Overall, evidence showed a positive association between access to green space and PA and a negative association between access to green space and television-watching time, body mass index (BMI) and weight status among children. Distance to the nearest green space, measured by geographic information system (GIS) in 10 studies, was often used to represent access to the nearest green space. It still remains difficult to draw a clear conclusion on the association between access to green space and BMI. Longitudinal studies can directly estimate the strength of the association between exposure and disease, which is needed to determine the causal association between access to green space and weight status.

A cross-sectional study of the impact of school neighbourhood on children obesity and body composition

Schools' neighbourhoods provide an important environmental context that may influence the risk of obesity among children. The aim of this study was to assess the effect of neighbourhood surrounding schools on obesity and body composition in schoolchildren. Data on 845 children aged 7 to 12 years old from 20 primary schools were considered. Anthropometric measurements and bioelectrical impedance analysis were performed to assess body mass index (BMI) and characterize body composition. Land use characteristics were quantified within a 500-m buffer zone around schools. Mixed-effect models measured the effects of school neighbourhood on obesity and body composition. The results showed a tendency between green urban areas around schools and lower values of BMI and better body composition parameters compared with built areas, being BMI z-scores CDC, and body fat percentage significantly higher in-built than in green urban areas (β = 0.48, 95% CI 0.05; 0.90, and β = 2.56, 95% CI 0.39; 4.73, respectively).Conclusion: Our findings suggest that the school neighbourhood has an effect on BMI and body fat percentage in schoolchildren. These results may contribute to the creation of healthier cities and help reduce health expenses by focusing on prevention programmes towards the expansion of green spaces. What is Known: • Living in greener areas has been associated with healthy weight outcomes and to the lower impact of obesogenic urban environments. • The school environment may be especially important for youth health outcomes. What is New: • Neighbourhoods around schools may affect child health, specifically the development of obesity. • The presence of urban green areas around school may promote a framework of lifestyle or behaviours conducive to achieving a healthy weight.

The relationship between the home environment and child adiposity: a systematic review

BACKGROUND

Extensive research has demonstrated the role of the Home Environment (HE) in shaping children's energy balance behaviours. Less is known about direct relationships with bodyweight. This review examines associations between the social and physical aspects of three pre-defined Home Environment domains (food, physical activity and media) and adiposity measures in children ≤12 years.

METHODS

Six electronic databases (PubMed, Medline, EBSCO CINAHL, EMBASE, Web of Science, PsycInfo) were systematically searched up to October 2020. Studies reporting at least one physical and/or social aspect of the food, physical activity and/or media domains of the Home Environment in relation to child adiposity outcomes were included (n = 62).

RESULTS

Most studies examined one (n = 41) or two domains (n = 16). Only five studies assessed all three domains of the Home Environment. Most consistent relationships were observed for physical aspects of the home media environment; with greater availability of electronic devices associated with higher child adiposity (21/29 studies). Findings were less consistent for the smaller number of studies examining physical aspects of the home food or physical activity environments. 8/15 studies examining physical food environments reported null associations with adiposity. Findings were similarly mixed for physical activity environments; with 4/7 reporting null associations, 2/7 reporting negative associations and 1/7 reporting positive associations between access to physical activity equipment/garden space and adiposity. Fewer studies assessed social aspects (e.g. caregiver modelling or limit setting) of the Home Environment in relation to child adiposity and findings were again mixed; 9/16 media environment, 7/11 food environment and 9/13 physical activity environment studies reported null associations with child adiposity outcomes.

CONCLUSIONS

The home media environment was most consistently associated with adiposity in childhood. Findings were less consistent for the home food and physical activity environments. Greater agreement on definitions and the measurement of the obesogenic home environment is required in order to clarify the strength and direction of relationships with child adiposity. Robust longitudinal research using comprehensive measures of the holistic home environment is needed to better identify which aspects contribute to excess weight gain in childhood.

TRIAL REGISTRATION

PROSPERO Systematic review registration number:  CRD42018115139 .

Landscapes of becoming social: A systematic review of evidence for associations and pathways between interactions with nature and socioemotional development in children

BACKGROUND

Existing research indicates that spending time in nature is associated with diverse aspects of children's health and wellbeing. Although fundamental to later life chances and health, no systematic reviews, to our knowledge, have focused specifically on the effects of interaction with nature on socioemotional functioning in childhood.

OBJECTIVES

Amongst children, what is the consistency of associations between the availability of or spending time in nature on socioemotional function and development? Furthermore, which child behaviours and states independently associate with socioemotional function and availability of or spending time in nature, and what is the consistency of associations between these behaviours and states and contact with nature?

DATA SOURCES

Embase, Environment Complete, MEDLINE, and APA PsycINFO. Eligible studies were backward and forward snowball-searched.

STUDY ELIGIBILITY CRITERIA

Studies investigating effects of, or associations between, availability of or interaction with nature on socioemotional or proximal outcomes in children under the age of 12 years were included in this review.

STUDY APPRAISAL AND SYNTHESIS METHODS

The internal validity of studies investigating socioemotional outcomes were based on assessments of elements of study design, conduct, and reporting to identify potential issues related to confounding or other biases. The number of analyses indicating positive, negative, and non-significant associations between availability or interaction with green space and the outcomes were summed.

RESULTS

A total of 223 eligible full-texts, of which 43 pertained to socioemotional outcomes and 180 to proximal outcomes, met eligibility criteria. Positive associations between availability of and spending time in green space were found with children's intra- and interpersonal socioemotional function and development. Proportions of positive findings ranged from 13.9% to 55% across experimental and observational research, exposures, populations, and contexts. Modifying and mediating factors were identified. We found consistent evidence for improved aspects of cognition and, for children over six years, reduced risk of obesity and overweight in association with green space; consistent links between movement behaviours in the experimental, but not observational research; tentative trends suggesting associations with play, motor skills, language, screen time, and communication skills; little evidence for positive associations between green space and mood, physical wellbeing, and stress; some evidence for associations with healthy birth outcomes, and little evidence for direct associations between availability of green space and asthma and allergy prevalence, however, mediation via, for example, air pollution was likely.

LIMITATIONS

We identified few studies without either probable or severe risk of bias in at least one item. Improved study quality may therefore result in different results. Restricting analyses to include only studies considered at low risk of bias indicated similar or slightly lower proportions of positive findings. Risk of bias in proximal outcomes was not assessed.

CONCLUSIONS

The empirical evidence for benefits of availability of and interaction green space for child socioemotional function and development must currently be considered limited. A number of proximal indicators were identified. Systematic review registration number.

PROSPERO ID

CRD42019135016.

Greenness surrounding schools and adiposity in children and adolescents: Findings from a national population-based study in China

BACKGROUND

Previous studies have indicated that exposure to green space may benefit human health. However, the available evidence concerning the effects of greenness, especially school-based greenness, on pediatric obesity is scarce.

OBJECTIVE

To explore the association between school-based greenness and adiposity in children and adolescents in China.

METHOD

We conducted a nationwide cross-sectional study of 56,620 children and adolescents (aged 6-18 years) in seven provinces/municipalities across China. School-based greenness was assessed using satellite-derived Normalized Difference Vegetation Index (NDVI) and Soil Adjusted Vegetation Index (SAVI) within 100-, 500-, and 1000-m circular buffers around each school's address. Generalized linear mixed regression models were used to estimate associations of greenness with BMI z-scores (zBMI), waist circumference, and prevalent overweight/obesity. We also explored the potential mediating role of ambient air pollution and physical activity in the greenness-adiposity associations.

RESULT

In the adjusted model, an IQR increase in NDVI_-1000m was associated with lower zBMI (β: -0.11, 95% confidence interval[CI]: -0.13,-0.09) and waist circumference (β: -0.64, 95%CI: -0.78,-0.50). Consistently, an IQR increase in NDVI_-100m, NDVI_-500m, NDVI_-1000m was associated with 7-20% lower odds of overweight/obesity in the adjusted models. Air pollutants mediated 6.5-29.1% of the association between greenness and zBMI. No significant mediation effect was observed for physical activity.

CONCLUSION

Higher school-based greenness levels were associated with lower zBMI, waist circumference, and lower odds of overweight and obesity in children and adolescents. Ambient air pollutants may partially mediate the greenness-adiposity associations.

Greenspace with overweight and obesity: A systematic review and meta-analysis of epidemiological studies up to 2020

Several reviews have been conducted to assess the association between greenspace and overweight or obesity, but the conclusions were inconsistent. However, an updated comprehensive review and meta-analysis is warranted, because several high-quality papers have been published more recently. The objectives of this study are to systematically and quantitatively assess the evidence for a link between greenspace with overweight/obesity and to make specific recommendations for further research. We searched three English language databases, four Chinese language databases and the reference lists of previously published reviews for epidemiological studies on greenspace and overweight/obesity published before January 2020. We developed inclusion criteria, screened the literature and extracted key data from selected papers. We assessed methodological quality and risk of bias, and we graded the credibility of the pooled evidence. We also performed sensitivity analyses. Fifty-seven records met our inclusion criteria and were included in the study. Most studies were cross-sectional designs (81%) and were from developed nations (88%). More than half (55%) of the included studies found beneficial associations between greenspace and overweight/obesity in overall or subpopulations. Our meta-analytical results showed that greater normalized difference vegetation index was associated with lower odds of overweight/obesity in a statistically significant fashion (odds ratio [OR]: 0.88; 95% CI: 0.84, 0.91) but not residential proximity to greenspace (OR: 0.99; 95% CI: 0.99, 1.00), proportion of greenspace (OR: 0.96; 95% CI: 0.85, 1.08) or number of parks in an area (OR: 0.99; 95% CI: 0.97, 1.01). However, we detected high between-study heterogeneity in two of the four meta-analyses, which reduced the credibility of the pooled evidence. Current evidence indicates that there might be an association between greater access to greenspace and lower odds of overweight/obesity. However, additional high-quality studies are needed to more definitively assess the evidence for a causal association.

Neighbourhood greenspace influences on childhood obesity in Sheffield, UK

BACKGROUND

One cause of childhood obesity is a reduction in the amount of unstructured time spent outdoors, resulting in less physical activity. Greenspaces have the potential to increase children's physical activity levels, so it is desirable to understand how to create spaces that promote visitation and activity.

OBJECTIVES

We investigate the relationship between rates of obesity at ages 4 to 5 and 10 to 11 in small-area census geographies, and indicators of the neighbourhood greenspace environment, in the northern English city of Sheffield.

METHODS

To capture the environment at scales relevant to children, we test the importance of overall green cover; garden size; tree density around residential addresses; and accessibility within 300 m of any greenspace, greenspaces that meet quality criteria, and greenspaces with play facilities. We use a multimodel inference approach to improve robustness.

RESULTS

The density of trees around addresses is significant at both ages, indicating the importance of the greenspace environment in the immediate vicinity of houses. For 10 to 11 year olds, accessibility of greenspaces meeting quality criteria is also significant, highlighting that the wider environment becomes important with age and independence.

CONCLUSIONS

More attention should be given to children's requirements of greenspace when considering interventions to increase physical activity or planning new residential areas.

Analytical approaches to testing pathways linking greenspace to health: A scoping review of the empirical literature

BACKGROUND

Inadequate translation from theoretical to statistical models of the greenspace - health relationship may lead to incorrect conclusions about the importance of some pathways, which in turn may reduce the effectiveness of public health interventions involving urban greening. In this scoping review we aimed to: (1) summarize the general characteristics of approaches to intervening variable inference (mediation analysis) employed in epidemiological research in the field; (2) identify potential threats to the validity of findings; and (3) propose recommendations for planning, conducting, and reporting mediation analyses.

METHODS

We conducted a scoping review, searching PubMed, Scopus, and Web of Science for peer-reviewed epidemiological studies published by December 31, 2019. The list of potential studies was continuously updated through other sources until March 2020. Narrative presentation of the results was coupled with descriptive summary of study characteristics.

RESULTS

We found 106 studies, most of which were cross-sectional in design. Most studies only had a spatial measure of greenspace. Mental health/well-being was the most commonly studied outcome, and physical activity and air pollution were the most commonly tested intervening variables. Most studies only conducted single mediation analysis, even when multiple potentially intertwined mediators were measured. The analytical approaches used were causal steps, difference-of-coefficients, product-of-coefficients, counterfactual framework, and structural equation modelling (SEM). Bootstrapping was the most commonly used method to construct the 95% CI of the indirect effect. The product-of-coefficients method and SEM as used to investigate serial mediation components were more likely to yield findings of indirect effect. In some cases, the causal steps approach thwarted tests of indirect effect, even though both links in an indirect effect were supported. In most studies, sensitivity analyses and proper methodological discussion of the modelling approach were missing.

CONCLUSIONS

We found a persistent pattern of suboptimal conduct and reporting of mediation analysis in epidemiological studies investigating pathways linking greenspace to health; however, recent years have seen improvements in these respects. Better planning, conduct, and reporting of mediation analyses are warranted.

Built Environment and Childhood Weight Status: A Multi-Level Study Using Population-Based Data in the City of Hannover, Germany

In recent years, built environmental characteristics have been linked to childhood overweight, but the results remain inconsistent across studies. The present study examines associations between several built environmental features and body weight status (BMI) z-score among a large sample of preschool children in the city of Hannover, Germany. Walkability (Index), green space availability, and playground availability related to preschool children's home environments were measured using data from OpenStreetMap (OSM). These built environment characteristics were linked to the data from the 2010-2014 school entry examinations in the Hannover city (n = 22,678), and analysed using multilevel linear regression models to examine associations between the built environment features and the BMI z-score of these children (4-8 years old). No significant associations of built environmental factors on children's BMI were detected, but the effect between green space availability and BMI was modified by the parental educational level. In children with lower compared to higher educated parents, a higher spatial availability of greenspace was significantly associated with reduced body weight. Future research should continue to monitor the disparities in diverse built environment features and how these are related to children's health.

Decline of childhood overweight and obesity in Italy from 2008 to 2016: results from 5 rounds of the population-based surveillance system

Background

Given the effects of childhood obesity on future health, and the lack of information of its prevalence in Italy, a national surveillance system was implemented in 2007. It is OKkio alla SALUTE, part of the WHO/Europe Childhood Obesity Surveillance Initiative (COSI). This study reports the 2008–2016 trends by sex, area of residence and socio-demographic characteristics in the prevalence of overweight and obesity in primary school children (8–9 years).

Methods

In each round of the surveillance held in 2008, 2010, 2012, 2014 and 2016, a nationally representative sample of about 45,000 children, was weighed and measured with standard equipment and methods by trained personnel. Children were classified as normal weight, overweight or obese using World Obesity Federation (WOF) (formerly the International Obesity Task Force (IOTF)) and WHO cut-offs. Children’s sex, area of residence and mothers’ education and citizenship, were obtained using self-reported questionnaires and were assessed using multivariate logistic regression models.

Results

Between 2008 and 2016, the overall prevalence of obesity dropped from 12.0 to 9.3% (WOF-IOTF) and from 21.2 to 17.0% (WHO), while the overall prevalence of overweight (including obesity) from 35.2 to 30.6% (WOF-IOTF) and from 44.4 to 39.4% (WHO). Reduction in the prevalence of overweight and obesity was greater in boys (− 14.5%, p for trend< 0.001; and − 24.7%, p = 0.001) compared to girls (− 11.1%, p < 0.001; and − 19.2%, p = 0.034). Decreasing trends were observed in overweight prevalences within children resident in the center and in the south. Decreasing trends in obesity prevalences were observed among boys resident in the north and in the south, and among girls resident in the center. Decreasing trends were observed in overweight prevalences within socio–demographic characteristics, except among children with low educated and foreign mothers; and in obesity prevalences for children with medium educated mothers, and girls with Italian mothers.

Conclusions

From 2008 to 2016 a decrease of childhood overweight and obesity was observed in Italy. However, as these prevalences are still among the highest in Europe, there is need to continue their monitoring and implement more interventions to promote healthy lifestyles. More effort should be focused on children belonging to low social classes.

Factors influencing obesity among preschoolers: multilevel approach

BACKGROUND

Childhood obesity is a complex and multifaceted problem involving interactions among child, family and community environment.

AIM

The purpose of this study was to examine the contributing factors to early childhood obesity within a multilevel context, including child and family, childcare setting and community.

METHODS

A cross-sectional, quantitative research design was employed. A total of 129 preschoolers and their parents in northwest Florida participated in this study. Child height and weight were measured, and body mass index (BMI) was calculated. Parents and directors of preschools completed survey questionnaires to assess child/family, childcare setting and community factors, respectively. Hierarchical multiple regression was used to evaluate the association of each level of factors with child BMI z-score.

RESULTS

Twenty-one per cent of children were overweight or obese (≥85th BMI percentile). In hierarchical multiple regression, household income, parent beliefs, attitudes and practices for child feeding, family obesogenic environment, child routines (screen time on weekends, sleep hours, bedtime) and physical activity environment were significantly related to child BMI z-score.

CONCLUSIONS

The findings of this study provide a broader understanding of factors that influence child BMI z-score. Shaping a non-obesogenic environment by establishing healthy routines for children in the home, childcare setting and community is essential in childhood obesity prevention.

IMPLICATIONS FOR NURSING PRACTICE AND HEALTH POLICY

Paediatric nurses should routinely assess accurate parental perception of child weight, feeding style and child routines in well-child care visits. Healthcare professionals and health policymakers should enact policies that build a healthy environment for preschoolers in their childcare setting and community.

Greenspace, physical activity, and BMI in children from two cities in northern Mexico

Numerous previous studies have reported positive associations between exposure to greenspace and children's physical activity, but in high-income countries only. Prior studies have also examined greenspace and obesity in children, but these have yielded inconsistent results and focused mostly on older children. The purpose of this study was to assess associations between time children spent in greenspace as the primary exposure and our outcomes of interest, including 1) minutes of physical activity, and 2) body mass index (BMI) z-score. Our sample was 102 children ages 3 to 5 years living in Ensenada and Tijuana, Mexico. We fit linear mixed models to estimate associations between greenspace and children's physical activity and BMI z-score. After adjustment for potential confounders, greater time in greenspace was associated with decreased sedentary time (−0.08 min per hour for each additional 30 min in greenspace; 95% CI −0.13, −0.04; p = 0.002) and increased moderate-to-vigorous physical activity (MVPA) (0.06; 95% CI 0.03, 0.10; p < 0.001). Results were driven primarily by children in Tijuana (−0.22; 95% CI −0.38, −0.06; p = 0.008 for sedentary time and 0.15; 95% CI 0.06, 0.38; p = 0.007 for MVPA). Time in greenspace was not associated with BMI z-score in children in Ensenada (0.001; 95% CI −0.008, 0.01; p = 0.83) or Tijuana (−0.009; 95% CI −0.02, 0.004; p = 0.17). Greater time in greenspace was associated with physical activity but not BMI in our sample of children—more so in Tijuana compared to Ensenada. Given high rates of obesity, interventions should aim to increase physical activity in young children in Northern Mexico.

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Greater time in greenspace was associated with decreased sedentary time.

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Greater time in greenspace was associated with increased physical activity.

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Associations were mainly driven by children in Tijuana compared to Ensenada.

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Time spent in greenspace was not associated with body mass index z-score.

Does environment influence childhood BMI? A longitudinal analysis of children aged 3-11

BACKGROUND

Childhood overweight/obesity has been associated with environmental context, such as green space, gardens, crime and deprivation. This paper assesses the longitudinal association between environment and body mass index (BMI) for children across the ages of 3-11 years. It also investigates the relationship between environment and child overweight/obesity METHODS: 6001 children from the UK Millennium Cohort Study living in England were analysed. We estimated fixed effects linear and logistic regression models of the association between environment (levels of green space, gardens, crime and deprivation) and BMI/overweight of children at four time points between the ages of 3 and 11. Models were adjusted for age-related changes in weight, child sex and education level of the main carer.

RESULTS

Statistically significant associations were found between environmental measures of both more gardens and lower levels of crime and lower BMI (effect size (95% CI) respectively: -0.02 (-0.04 to 0.00), -0.04 (-0.07 to -0.02)). Areas with less crime were associated with a slightly lower odds of overweight among children with a higher educated parent (OR 0.93 (0.87-0.99)) CONCLUSIONS: By exploiting longitudinal measures of environment and BMI this study is able to establish a more causal association between environment and BMI. Environments with more gardens and lower crime tend to result in slightly lower BMI. However, the effect sizes are small and non-significant odds of changing weight status do not support environmental factors as a key determinant of cohort changes in childhood overweight/obesity.

Impact of the Social and Natural Environment on Preschool-Age Children Weight

Background: The complex impact of environmental and social factors on preschool children being overweight/obese is unclear. We examined the associations between the levels of green space exposure and the risk of being overweight/obese for 4–6 year-old children and assessed the impact of maternal education on these associations. Methods: This cross-sectional study included 1489 mother-child pairs living in Kaunas, Lithuania, in 2012–2013. We assessed children overweight/obesity by standardized questionnaires using international body mass index cut-off points, and the level of greenness exposures by satellite-derived normalized difference vegetation index (NDVI) of each child’s home and by the distance to a nearest city park. The maternal education was used as the SES indicator. We used logistic regression models to investigate the strength of the associations. Results: Children from families with poorer maternal education, pathological mother-child relations and smoking mothers, and living in areas with less greenness exposure (NDVI-100 m), had significantly higher odds ratios of being overweight/obese. Lower maternal education and distance to a city park modified the effect of greenness cover level exposure on the risk of children being overweight/obese. Conclusions: Higher greenness exposure in the residential settings has beneficial effects on children’s physical development. The green spaces exposures for psychosocial stress management is recommended as a measure to prevent overweight/obesity among children.