"The weight of place": Neighborhood disadvantage in adolescence and obesity trajectories into early midlife.

PURPOSE: To determine whether neighborhood concentrated disadvantage (NCD) in adolescence predicts membership in distinct body mass index (BMI) trajectory classes in early midlife, and whether the food retail environment mediates this association.

METHODS

Using the National Longitudinal Study of Adolescent to Adult Health (Waves I, III, IV, V; 1994-2018; n = 8951), we derived NCD from five census block-group indicators at Wave I. Latent class growth modeling identified three BMI trajectory classes from ages 16-38: normal stable (59.7%), overweight rising (31.3%), and obese accelerating (9.0%). Survey-adjusted multinomial logistic regression, pooled across 20 multiply imputed datasets, estimated associations between NCD and trajectory class membership.

RESULTS

Each standard deviation increase in NCD was associated with 18% higher odds of belonging to the obese accelerating trajectory (OR = 1.18, 95% CI: 1.01, 1.37; P = .034). The food retail environment did not mediate this association. Approximately 63% of the association was attributable to higher baseline BMI in adolescence. The population attributable fraction for high NCD was 13.6%.

CONCLUSIONS

Neighborhood disadvantage in adolescence independently predicted a severe obesity trajectory extending into early midlife, operating primarily through elevated baseline weight rather than the food retail environment.