Area-level socioeconomic inequalities in overweight and obesity: Systematic review on moderation by built-environment attributes

Residents of lower socioeconomic status (SES) areas are at a higher risk of overweight/obesity than those from higher SES areas. Built environment attributes may mitigate such inequalities. This systematic review synthesised findings of studies examining built environment attributes as potential moderators of the associations between area-level SES and overweight/obesity in adults. From five databases, nine eligible studies were identified. The SES-overweight/obesity relationship was stronger in inner areas and suburbs of large cities, while it was weaker in more rural areas. Two studies examined walkability and reported contrasting findings: no moderation in one and marginally significant moderation (less inequality in higher walkability areas) in the other. No evidence of moderation was found for street connectivity, population density, the food environment, access to physical activity facilities and several perceived environmental attributes. Further research is needed on other built environment attributes (e.g., access to, quantity and quality of green spaces, active transport features), and ideally using prospective study designs and objective makers of adiposity. •We reviewed studies on environmental moderation of area-level SES-obesity association.•Area SES-obesity association was stronger in larger cities and weaker in rural areas.•Findings for the role of walkability were mixed.•No moderation was found for food environment and physical activity facilities.•Studies need to assess potential moderation by greenspace and transport features.