The study, the largest of its type to date, appears in the March/April issue of the American Journal of Health Promotion.

"We seem to be losing the battle to prevent childhood obesity by dealing with diet and exercise in individual children. Our study notes the interaction between environment and weight and suggests that environmental approaches to childhood obesity may prove more successful than working individually with the growing number of overweight children," said Gilbert Liu, M.D., assistant professor of pediatrics at the IU School of Medicine and a Regenstrief Institute, Inc. affiliated scientist, who is the principal investigator of the new study. The study relied upon patient data from the Regenstrief Medical Record System. Neighborhood vegetation and proximity to food retail were calculated using geographic information systems.

The study, which was conducted in Marion County, Indiana, found that increased green space was closely associated with decreased risk for being overweight, but only for children residing in higher population density regions. In more suburban areas, closer distance between a child?s home and the nearest major supermarket was more closely associated with decreased risk of being overweight than proximity of the home to green space.

The study authors hypothesize that being close to green space or to a grocery store affects weight by positively influencing physical activity and dietary behaviors. "As a pediatrician, I hope this study will encourage neighborhood organizations, community activists, and others to bring more opportunities for physical activities and healthy food choices to the places where children live," said Dr. Liu.

iu

"As expected, high levels of BNP predicted worse outcomes in our study, but even taken this and other disease makers into account, we found that depressive symptoms were still independently associated with worse outcomes," said study lead investigator Andrew Sherwood, Ph.D., medical psychologist. "Our findings underscore the importance of assessing heart failure patients for depression, so that where treatment is indicated, both the quality and quantity of their lives may be improved.

Researchers still don't understand why depressed heart patients have worse outcomes. Among possible factors, depressed patients are known to have overly active immune systems, a decrease in the ability of their blood platelets to clot properly and a decrease in their heart's ability to react appropriately to the stresses of everyday life. Depressed patients also may be less likely to comply with their medical treatments, may not be as motivated to stick with exercise or rehabilitation programs, may miss doctor's appointments and tend to make unhealthy lifestyle choices in such areas as diet and smoking.

In an attempt to better understand the role of depression in the fate of heart patients, the researchers are currently enrolling patients in a new clinical trial to measure the effects of exercise and antidepressant medications on specific physiological indicators of heart disease. The trial, supported by the National Institutes of Health, has been dubbed UPBEAT -- short for "Understanding the Prognostic Benefits of Exercise and Anti-Depressant Therapy in persons with cardiac disease." Patients with stable coronary disease and symptoms of depression receive 16 weeks of exercise or pill therapy.

The researchers believe that the results of their current analysis, as well as their ongoing trial, will provide guidance for physicians in treating patients with heart failure and coronary artery disease who are also exhibiting signs of depression.

medschool.duke/