Neighborhood commuting environment and obesity in the United States: An urban-rural stratified multilevel analysis

•The first nationally representative US study on neighborhood commuting environment and obesity•Higher automobile dependency was associated with increased obesity risk in urbanized areas.•Longer commuting time was associated with increased obesity risk except medium metro areas.

ObjectiveAutomobile dependency and longer commuting are associated with current obesity epidemic. We aimed to examine the urban-rural differential effects of neighborhood commuting environment on obesity in the USMethodsThe 1997-2005 National Health Interview Survey (NHIS) were linked to 2000 US Census data to assess the effects of neighborhood commuting environment: census tract-level automobile dependency and commuting time, on individual obesity status.ResultsHigher neighborhood automobile dependency was associated with increased obesity risk in urbanized areas (large central metro (OR 1.11[1.09, 1.12]), large fringe metro (OR 1.17[1.13, 1.22]), medium metro (OR 1.22[1.16, 1.29]), small metro (OR 1.11[1.04, 1.19]), and micropolitan (OR 1.09[1.00, 1.19])), but not in non-core rural areas (OR 1.00[0.92, 1.08]). Longer neighborhood commuting time was associated with increased obesity risk in large central metro (OR 1.09[1.04, 1.13]), and less urbanized areas (small metro (OR 1.08[1.01, 1.16]), micropolitan (OR 1.06[1.01, 1.12]), and non-core rural areas (OR 1.08[1.01, 1.17])), but not in (large fringe metro (OR 1.05[1.00, 1.11]), and medium metro (OR 1.04[0.98, 1.10])).ConclusionThe link between commuting environment and obesity differed across the regional urbanization levels. Urban and regional planning policies may improve current commuting environment and better support healthy behaviors and healthy community development.