Obesity is inversely associated with natural amenities and recreation facilities per capita.

Background: Little is known about the associations between natural amenities, recreation facility density, and obesity, at a national level. Therefore, the purpose of this paper was to examine associations between county-level natural amenities, density of recreation facilities, and obesity prevalence among United States counties. Methods: Data were obtained from a compilation of sources within the United States Department of Agriculture Economic Research Service Food Environment Atlas. Independent variables of interest were the natural amenities scale and recreation facilities per capita. The dependent variable was county-level obesity prevalence. Potential covariates included a measure of county-level percent Black residents, percent Hispanic residents, median age, and median household income. All models were stratified by population loss, persistent poverty, and metro status. Multilevel linear regression models were used to examine the association between obesity and natural amenities and recreation fa...