LAUSR

Abstract Obesity is a significant public health concern in the United States. The relationship between recreational opportunity and health conditions have been examined at an individual level by several studies. However, few studies have examined this relationship at a regional or national level. Public health and regional science studies recently have examined spatial disparities of chronical disease and its related factors at a population level. We aimed to build a model for the estimation of the multi-level spatial relationships (global vs. local) between obesity and its related key determinants at the regional and national level, in the United States (US). This study specifically examined the association between obesity and socio-demographic, economic, and environmental factors using manipulated spatial data for 3,109 counties in the continental US. First, the dependent variable (age-adjusted adult obesity rate) was obtained from the CDC. Public and private levels of secondary data as independent variables were transformed into spatial data with the preservation of their attributes. Traditional regression (OLS) and Geographically Weighted Regression (GWR) was conducted in GWR 4.0.9. Specifically, GWR modeling could detect the differential associations between obesity rate and its key determinants at the local and national geographical levels. The results of OLS regression analysis supported previous research findings. The proportion of African-American people and poverty rate were positively related, while a university-level education was negatively related to obesity prevalence. In the analysis of GWR, park proximity showed the strongest negative association with obesity prevalence, especially in the western regions. Obesity prevalence was influenced by natural and recreational built environments in the continental US. The methodological approaches we employed may aid in the formulation of appropriate guidelines for the balanced provision of recreation and leisure services to mitigate spatial disparities in obesity prevalence from a regional recreation planning perspective.