The association between Hong Kong neighbourhood food environments and weight status in adolescents : the influence of parenting control

Abstract

The World Health Organization (WHO) proclaims that overweight in adolescents is one of the greatest public health challenges of the 21st century. Research shows that urban food environments play a role in its causality and that the ‘food deserts’, are likely part of the problem. Studies analysing the links between objectively measured urban food environments and overweight in adolescents have mostly been Western-oriented, disregarded the problem of both availability of and access to the neighbourhood food environments, omitted other influences from the urban, natural and ambient environments, and also the influence of parenting control.

Chinese urban areas have seen unparalleled increases in the number of overweight adolescents and, given the future predicted massive urban expansions; they should be a key research focus. Due to long work/school hours and numerous extracurricular activities, eating out of home is commonplace in China. Moreover, Chinese parents are known to play a predominant role in their children’s upbringing and this cannot be disregarded when exploring this subject. This study therefore aims to address two main questions: (i) How are Hong Kong neighbourhood food environments associated with weight status in adolescents? (ii) Does parenting control, have an influence on these associations?

Geographical Information Systems (GIS) were used to process the spatial data. Principal component analyses (PCA) were used to create indices of (i) availability and access to supermarkets, wet markets, and restaurants, (ii) potential other urban, natural and ambient environmental covariates and confounders, and (iii) parenting control as potential moderators. Generalised Linear Mixed Modelling (GLMM) was used to estimate the associations between neighbourhood food environments and weight status in Hong Kong adolescents, and the moderating effects of parenting control on this association, while adjusting for other urban, natural and ambient environmental factors.

The study population comprised 1203 adolescents between 11-18 years old, of whom 53.60% were female, 92.40% were Chinese, and 13.20% overweight/obese. The results showed that all the neighbourhood food environments had lower availability of and access to supermarkets, wet markets, and restaurants (food deserts) and were positively associated with weight status in adolescents. After adjusting for potential co-explanatory variables, socio-demographic and climatic, air pollution, and topography variables were found to be relevant variables in the statistical models. When (male) adolescents perceived their parents as having a ‘low parenting control’ regarding their dietary behaviour, those associations remained significant and when they perceived their parents as having a ‘high parenting control’ regarding their dietary behaviour, they became non-significant.

The results indicated that the neighbourhood food environments in Hong Kong play a role in explaining the overweight epidemic in adolescents and also that the influence of parenting control and also adolescents’ gender cannot be left out. This is the first study to confirm a link between ‘food deserts’ and increased weight status in Asian adolescents and to find that parents have an influence on that association. Future research is recommended to investigate the dynamics behind the links of Hong Kong neighbourhood food environments and parenting control and their impact on overweight in adolescents.