Understanding nutrition environments and their association with obesity prevalence in South Korean adolescents: A multilevel approach

The prevalence of overweight and obesity among children from two to eighteen years of age in South Korea increased from 13.3% in 1997 to 19.0% in 2005. Previous studies from various geographical regions have reported the impact of the food and the built environment on the development of childhood obesity. However, the role of the environment in childhood obesity has not been extensively studied in South Korea to date. The objectives of this study are to examine the association between the school and neighborhood nutrition environments and adolescent nutrition behaviors and weight status.;Twenty in-depth interviews and two focus groups with nine parents and seventeen teachers revealed that food monitoring at home and mother's employment status were emerged as key aspects of the home nutrition environment. The school social nutrition environments were considered to be important for students' nutrition knowledge and behaviors. The school social nutrition environments include teachers' perceptions of school-based health programs and the availability of resources.;The formative findings from qualitative inquiries guided the development of the nutrition environment assessment tools. School dietitians from fifteen schools in Seoul, South Korea, completed the structured survey questionnaire on school nutrition environment. The neighborhood nutrition environment was documented by counting the number of various food outlets via a walking survey within a 500-meter radius of the participating schools. The school survey showed that the majority of schools did not have classroom-based nutrition education or nutrition counseling. The neighborhood walking survey showed that food stores were abundant with some variations between neighborhoods.;For the multilevel modeling, a total of one thousand three hundred forty two students from fifteen schools, where the nutrition environment surveys were conducted, participated in a structured survey for measuring students' nutrition behaviors and socio-demographic factors. A higher density of supermarkets in the school neighborhoods were associated with a higher likelihood of being obese among the students after controlling for age, sex, weekday screen time, mothers' employment status, and family affluence scale. However, the school nutrition environments did not have a significant association with the student's healthy eating habits and weight status.;This is the first study to examine the characteristics of school and neighborhood nutrition environments and their relationships with students' eating behaviors and weight status in urban South Korea. Future intervention programs and research that address childhood obesity may benefit from this study by implementing the environmental assessment instruments or by adapting the processes of developing the instruments.