General and Central Obesity in Two Iranian Ethnic Groups Living in Urmia, West Azerbaijan, Iran: Effect of the Neighborhood Environment

Emerging evidence suggests that neighborhood characteristics can have direct and indirect effects on the weight
status of the residents.
Objectives: To assess the relationshipbetweengeneral and centralobesity and theneighborhood environmentin two ethnicgroups
(Azeri Turks and Kurds) living in Urmia city, Northwestern Iran.
Patients and Methods: In this cross-sectional study, 723 participants (427 women and 296 men) aged 20 - 64 years from two ethnic
groups (Azeri Turks, n = 445; Kurds, n = 278) were selected from 38 neighborhoods using a combination of cluster, random, and
systematic sampling methods. Neighborhood characteristics were obtained by a validated 22-item neighborhood and health observational checklist. General and central obesity were measured and evaluated using standard methods. Principal component
analysis (PCA) was used to define the dominant neighborhood environment. The association of neighborhood characteristics with
general and central obesity was analyzed by a logistic regression model.
Results: Three common neighborhood environments were identified: modern and affluent, central-high access, and 3) marginal.
These three factors explained 73.2% of the total variance. Overall, the participants living in a higher tertile of the central-high access
neighborhoods had an increased chance of central obesity (OR = 1.63, 95% CI: 1.13 - 2.34). Azeri Turks living in the highest tertile of the
modern-affluent neighborhoods had a significantly higher likelihood of having general obesity (OR = 2.49, 95% CI: 1.37 - 4.01). Adjustment for age, gender, marital status, socioeconomic status (SES), energy intake, and physical activity did not change the results.
However, after adjustment for educational level, the association was not significant.
Conclusions: The findings point to a relationship between neighborhood characteristics and obesity only in the Azeri Turks. However, educational level was more important than neighborhood quality in predicting the risk of obesity
Keywords: Obesity, Residence Characteristics, Ethnology, Iran
1. Background
Obesity is a multifactorial health problem, influenced
by various social, behavioral, cultural, socioeconomic,
physiological,metabolic, andgeneticfactors(1). Up tonow,
most obesity research have focused on individual risk factors (2, 3). Such approaches have been partly successful
in treating individual cases of obesity; however, they have
failed to prevent or restrict obesity trends at the population level(4). Recently, neighborhood-level characteristics,
including the availability of healthy food, quality of the
physical environment, and socioeconomic status (SES) of
the residents, have been reported to be important factors
affecting the continuing obesity epidemic (5, 6). Neighborhood characteristics can have direct and indirect effects on
the health status of the residents (7). The previous literature confirmed that theprevalenceof obesity variedwidely
among countries, states, cities, and neighborhoods (8, 9).
Therefore, exploring the wider social and contextual determinants of body weight and obesity-related behaviors
seems necessary to define the exact causes of obesity. Previous studies have also shown that the prevalence of obesity
and possible individual risk factors varied among various
ethnic groups. However, the effect of the physical neighborhood environment on the risk of obesity in various ethnic groups living in a multiethnic environment has been
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