Walkability, Mobility-Related Neighborhood Built Environment Characteristics, and Adolescent Obesity in Urban Areas of Low- and Middle-Income Countries: A Systematic Review.

Obesity among adolescents is a growing global public health challenge that has been associated with built environment factors like walkability. Existing literature is primarily based on studies from high-income countries, highlighting the need for broader geographic representation. This systematic review examined the association between neighborhood walkability, mobility-related neighborhood built environment characteristics commonly used in walkability research, and obesity-related outcomes among adolescents (10-19 years old) in urban areas of low- and middle-income countries (LMICs). A comprehensive search was conducted in PubMed, Embase, Scopus, SportDiscus, and Web of Science for observational studies published before April 2025. Inclusion criteria required studies to be set in LMICs, written in English, and utilizing anthropometric obesity measures. The ROBINS-E tool was used to assess the risk of bias. Nine cross-sectional studies conducted in India, Malaysia, China, Brazil, and South Africa met the inclusion criteria, with sample sizes ranging from 143 to 41,220 participants. Built-environment measures and walkability metrics varied across studies, incorporating factors such as land use diversity, street connectivity, distance to transit stop, residential density, and access to parks. Findings were varied across studies. Some studies reported associations between greater walkability-related attributes (e.g., greater land-use diversity and street connectivity) and lower obesity-related outcomes, whereas others reported null or contrasting associations. The relationship between urban walkability and adolescent obesity in LMICs remains inconclusive due to methodological heterogeneity and contextual variations across settings. These findings suggest that the influence of walkability may be context-dependent rather than universal across settings. Further longitudinal studies with standardized walkability indices and context-sensitive approaches are needed to better understand these associations and their potential relevance for urban planning and public health interventions aimed at obesity prevention. PROSPERO registration number: CRD420251002901.