Individual and structural determinants of obesity: a population‑based study from Poland

Although clinical management of obesity has improved substantially, progress in population‑level prevention is still limited. Lifestyle modification remains challenging and structural and environmental determinants of excess body weight are insufficiently characterized. The aim of this study was to extend conventional analyses of obesity determinants by examining the associations of both individual‑level factors and structural, population‑level environmental characteristics with obesity in the general population. This cross‑sectional study included 252,427 residents of the Świętokrzyskie voivodeship (Poland) aged 45–64 years who participated in a regional prevention program between 2019 and 2022. Physical activity was assessed through structured interviews, and body mass index (BMI) was calculated from self‑reported height and weight. Data on fast‑food outlets, convenience stores, and petrol stations per 1,000 inhabitants were obtained from OpenStreetMap; data on green spaces and sports facilities from the Central Statistical Office of Poland. Associations with obesity were analyzed using multivariable cluster-robust logistic regression. Among 249,654 participants with complete data analyzed (mean age 52 ± 5.6 years; 50.3% men), 33% had BMI ≥30 kg/m²). At the individual level, male sex (OR = 1.51; 95% CI: 1.33–1.72), older age (OR = 1.007 per year; 95% CI: 1.003–1.011), low physical activity (OR = 1.11; 95% CI: 1.07–1.15) were associated with higher odds of obesity. Higher fast‑food outlet density increased obesity odds (OR = 1.34; 95% CI: 1.02–1.75), whereas petrol stations, green spaces, and sports facilities were inversely associated. Excess body weight reflects not only individual lifestyle behaviors but also characteristics of the local environment, supporting population‑level prevention strategies that integrate environmental and behavioral interventions.

Key messages

• Obesity is shaped not only by individual behavior but also by local environments, highlighting the need for population‑level prevention that tackles both structural determinants and lifestyle change.

• Greater fast‑food availability and limited supportive environments increase obesity prevalence, indicating the importance of environmental policies in effective obesity prevention strategies.