{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T18:35:12Z","timestamp":1786732512782,"version":"build-2736575974"},"reference-count":51,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T00:00:00Z","timestamp":1786665600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001826","name":"ZonMw","doi-asserted-by":"publisher","award":["05550032110023"],"award-info":[{"award-number":["05550032110023"]}],"id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003246","name":"Nederlandse Organisatie voor Wetenschappelijk Onderzoek","doi-asserted-by":"publisher","award":["NWA.1518.22.151"],"award-info":[{"award-number":["NWA.1518.22.151"]}],"id":[{"id":"10.13039\/501100003246","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Obesity and related health conditions are unevenly distributed across neighborhoods, often co-occuring with multiple health challenges and socioeconomic disadvantages. Using an ecosyndemic framework, which integrates ecological and social dimensions that contribute to the clustering of health problems, this study examines how adverse obesity-related health outcomes spatially cluster in relation to obesogenic environments and socioeconomic position (SEP) across Dutch neighborhoods.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Nationwide neighborhood-level data on health outcomes, obesogenic environmental exposures (food environment, walkability, drivability, bikeability, sports facilities), and SEP were combined for all inhabited Dutch administrative neighborhoods in 2016 (N\u2009=\u200912,420). Cluster analysis was used to identify distinct neighborhood profiles and descriptive statistics to characterize each cluster, with spatial patterns visualized using an interactive heatmap and principal component plots.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Five neighborhood clusters were identified. The \u2018\n                      <jats:italic>Ecosyndemic cluster\u2019<\/jats:italic>\n                      (N\u2009=\u20091,070 neighborhoods) exhibited the highest burden of obesity (17% [IQR 16;19]), chronic diseases (36% [IQR 33;38%]) and risk of anxiety\/depression (55% [IQR 51;58]), unhealthy food environments and low SEP. In contrast, the \u2018\n                      <jats:italic>Privileged cluster\u2019<\/jats:italic>\n                      (N\u2009=\u20096,425) had more favorable health outcomes and living conditions, including lower obesity prevalence (12% [IQR 11;14]). The \u2018\n                      <jats:italic>Psychosocial Vulnerability cluster\u2019<\/jats:italic>\n                      (N\u2009=\u2009991) was notable for elevated risk of anxiety\/depression (47% [IQR 43;51]) combined with relatively low obesity (11% [IQR 8;12]). The \u2018\n                      <jats:italic>Syndemic cluster\u2019<\/jats:italic>\n                      (N\u2009=\u20091,836; obesity 15% [IQR 14;17]) and \u2018\n                      <jats:italic>Towards Privileged cluster\u2019<\/jats:italic>\n                      (N\u2009=\u20092,098; obesity 12% [IQR 10;13]) represented intermediate profiles.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Obesity and related health issues frequently cluster with unfavorable environment and SEP at the neighborhood level. The ecosyndemic framework offers a novel approach for identifying high-risk areas and supports targeted, social and place-based interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0354964","type":"journal-article","created":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T17:58:14Z","timestamp":1786730294000},"page":"e0354964","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["An ecosyndemic framework for understanding obesity: Spatial clustering of health, environmental and socioeconomic disadvantage in the Netherlands"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3686-5116","authenticated-orcid":true,"given":"Mirthe","family":"Muilwijk","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4605-435X","authenticated-orcid":true,"given":"Yvonne T.","family":"van der Schouw","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8136-0918","authenticated-orcid":true,"given":"Jessica C.","family":"Kiefte-de Jong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rimke C.","family":"Vos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9237-221X","authenticated-orcid":true,"given":"Marco R.","family":"Spruit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonah J.","family":"Stunt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7981-3391","authenticated-orcid":true,"given":"Marielle A.","family":"Beenackers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0904-8268","authenticated-orcid":true,"given":"Stefan","family":"Pichler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thao M.","family":"Lam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeroen","family":"Lakerveld","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilonca","family":"Vaartjes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,8,14]]},"reference":[{"issue":"10481","key":"pone.0354964.ref001","first-page":"813","volume":"405","year":"2025","journal-title":"Global, regional, and national prevalence of adult overweight and obesity, 1990-2021, with forecasts to 2050: a forecasting study for the Global Burden of Disease Study 2021. Lancet"},{"key":"pone.0354964.ref002","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1186\/s13690-020-00461-8","article-title":"Dutch DALYs, current and future burden of disease in the Netherlands","volume":"78","author":"HBM Hilderink","year":"2020","journal-title":"Arch Public Health"},{"key":"pone.0354964.ref003","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/j.healthplace.2017.11.006","article-title":"Neighbourhood social and physical environment and general practitioner assessed morbidity","volume":"49","author":"PP Groenewegen","year":"2018","journal-title":"Health Place"},{"issue":"12","key":"pone.0354964.ref004","doi-asserted-by":"crossref","first-page":"1700","DOI":"10.3390\/ijerph21121700","article-title":"Obesogenic environment in a minas gerais state metropolis, Brazil: analysis of crime rates, food shops and physical activity venues","volume":"21","author":"MLC In\u00e1cio","year":"2024","journal-title":"Int J Environ Res Public Health"},{"issue":"1","key":"pone.0354964.ref005","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/s12916-024-03798-x","article-title":"Understanding the dynamics driving obesity in socioeconomically deprived urban neighbourhoods: an expert-based systems map","volume":"23","author":"F Ter Ellen","year":"2025","journal-title":"BMC Med"},{"issue":"1","key":"pone.0354964.ref006","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1186\/s12966-020-00944-5","article-title":"Recent changes in the Dutch foodscape: socioeconomic and urban-rural differences","volume":"17","author":"MGM Pinho","year":"2020","journal-title":"Int J Behav Nutr Phys Act"},{"key":"pone.0354964.ref007","doi-asserted-by":"crossref","first-page":"100129","DOI":"10.1016\/j.endmts.2023.100129","article-title":"Neighborhood social cohesion and obesity in the United States","volume":"11","author":"DM Alhasan","year":"2023","journal-title":"Endocr Metab Sci"},{"issue":"4","key":"pone.0354964.ref008","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1192\/S2056474000002051","article-title":"The importance of greenspace for mental health","volume":"14","author":"J Barton","year":"2017","journal-title":"BJPsych Int"},{"issue":"5","key":"pone.0354964.ref009","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1093\/eurpub\/ckae109","article-title":"Associations of neighborhood social cohesion and changes in BMI-The Maastricht Study","volume":"34","author":"JA Chan","year":"2024","journal-title":"Eur J Public Health"},{"key":"pone.0354964.ref010","doi-asserted-by":"crossref","first-page":"102769","DOI":"10.1016\/j.psychsport.2024.102769","article-title":"The relationship between physical activity environment, mental wellbeing, flourishing and thriving: a mixed method study","volume":"76","author":"S Turecek","year":"2025","journal-title":"Psychol Sport Exerc"},{"issue":"1","key":"pone.0354964.ref011","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1186\/s12889-020-09078-6","article-title":"Social cohesion, mental wellbeing and health-related quality of life among a cohort of social housing residents in Cornwall: a cross sectional study","volume":"20","author":"AJ Williams","year":"2020","journal-title":"BMC Public Health"},{"issue":"1","key":"pone.0354964.ref012","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1186\/s12966-021-01164-1","article-title":"Dynamics of the complex food environment underlying dietary intake in low-income groups: a systems map of associations extracted from a systematic umbrella literature review","volume":"18","author":"ADM Sawyer","journal-title":"Int J Behav Nutrition and Physical Activity"},{"key":"pone.0354964.ref013","article-title":"Environmental approaches to promote healthy eating: Is ensuring affordability and availability enough?","volume":"372","author":"P Monsivais","year":"2021","journal-title":"BMJ"},{"issue":"1","key":"pone.0354964.ref014","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1186\/s12889-023-15394-4","article-title":"Walkability and urban built environments-a systematic review of health impact assessments (HIA)","volume":"23","author":"J Westenh\u00f6fer","year":"2023","journal-title":"BMC Public Health"},{"key":"pone.0354964.ref015","article-title":"A scoping review of definitions and conceptualizations of ecosyndemics in syndemic research","author":"Y Gnaoui","year":"2015","journal-title":"medRxiv."},{"issue":"10072","key":"pone.0354964.ref016","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1016\/S0140-6736(17)30003-X","article-title":"Syndemics and the biosocial conception of health","volume":"389","author":"M Singer","year":"2017","journal-title":"Lancet"},{"key":"pone.0354964.ref017","doi-asserted-by":"crossref","first-page":"113037","DOI":"10.1016\/j.socscimed.2020.113037","article-title":"Ecosyndemics: the potential synergistic health impacts of highways and dams in the Amazon","volume":"295","author":"PS Tallman","year":"2022","journal-title":"Soc Sci Med"},{"issue":"10173","key":"pone.0354964.ref018","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1016\/S0140-6736(18)32822-8","article-title":"The global syndemic of obesity, undernutrition, and climate change: the lancet commission report","volume":"393","author":"BA Swinburn","year":"2019","journal-title":"Lancet"},{"issue":"1","key":"pone.0354964.ref019","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1186\/s12942-020-00235-z","article-title":"Deep phenotyping meets big data: the Geoscience and hEalth Cohort COnsortium (GECCO) data to enable exposome studies in The Netherlands","volume":"19","author":"GECCO Consortium","year":"2020","journal-title":"Int J Health Geogr"},{"issue":"1","key":"pone.0354964.ref020","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1186\/s12966-022-01270-8","article-title":"Development of an objectively measured walkability index for the Netherlands","volume":"19","author":"TM Lam","year":"2022","journal-title":"Int J Behav Nutr Phys Act"},{"key":"pone.0354964.ref021","doi-asserted-by":"crossref","first-page":"101494","DOI":"10.1016\/j.lanepe.2025.101494","article-title":"Association between the Dutch Obesogenic Built-environmental CharacterisTics (OBCT) index and 14-year cardiovascular disease incidence: a population-based cohort study of 4.4 million adults","volume":"59","author":"P Meijer","year":"2025","journal-title":"Lancet Reg Health Eur"},{"key":"pone.0354964.ref022","volume-title":"Documentatie Sociaaleconomische statusscores van particuliere. huishoudens op 1januari. (SESWOA);","author":"Statistics Netherlands","year":"2026"},{"issue":"1","key":"pone.0354964.ref023","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1002\/oby.23610","article-title":"Development of a neighborhood obesogenic built environment characteristics index for the Netherlands","volume":"31","author":"TM Lam","year":"2023","journal-title":"Obesity (Silver Spring)"},{"issue":"3","key":"pone.0354964.ref024","article-title":"mice: multivariate imputation by chained equations inR","volume":"45","author":"van Buuren S","year":"2011","journal-title":"J Stat Soft"},{"key":"pone.0354964.ref025","first-page":"021","article-title":"Weightedcluster library manual: a practical guide to creating typologies of trajectories in the social sciences with R","volume":"024","author":"M Studer","year":"2013","journal-title":"LIVES Working Papers"},{"key":"pone.0354964.ref026","volume-title":"Leaflet: creative Interactive Web Maps with the JavaScript\u2018Leaflet\u2019 Library.","author":"J Cheng","year":"2025"},{"key":"pone.0354964.ref027","volume-title":"A language and environment for statistical computing. R Foundation for Statistical Computing","author":"R Core Team","year":"2021"},{"key":"pone.0354964.ref028","article-title":"An upper bound of the silhouette validation metric for clustering","author":"HD Str\u00e4ng","year":"2025","journal-title":"arXiv"},{"issue":"1","key":"pone.0354964.ref029","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1007\/s10994-020-05896-2","article-title":"Interpretable clustering: an optimization approach","volume":"110","author":"D Bertsimas","year":"2020","journal-title":"Mach Learn"},{"issue":"1","key":"pone.0354964.ref030","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1177\/00027162251345666","article-title":"Preventing crime at places: the importance of recognizing that places exist within a broader social context","volume":"714","author":"T Hodgkinson","year":"2024","journal-title":"The ANNALS of the American Academy of Political and Social Science"},{"issue":"3","key":"pone.0354964.ref031","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1111\/1745-9133.12585","article-title":"The impact and policy relevance of street lighting for crime prevention: A systematic review based on a half\u2010century of evaluation research","volume":"21","author":"BC Welsh","year":"2022","journal-title":"Criminology & Public Policy"},{"key":"pone.0354964.ref032","doi-asserted-by":"crossref","first-page":"101765","DOI":"10.1016\/j.ssaho.2025.101765","article-title":"Contextualizing crime as an environmental stressor on mental health in urban communities - A scoping review","volume":"12","author":"Q He","year":"2025","journal-title":"Social Sciences & Humanities Open"},{"key":"pone.0354964.ref033","doi-asserted-by":"crossref","first-page":"105954","DOI":"10.1016\/j.envint.2020.105954","article-title":"Air pollution, physical activity and health: a mapping review of the evidence","volume":"147","author":"M Tainio","year":"2021","journal-title":"Environ Int"},{"key":"pone.0354964.ref034","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/j.ypmed.2016.02.002","article-title":"Can air pollution negate the health benefits of cycling and walking?","volume":"87","author":"M Tainio","year":"2016","journal-title":"Prev Med"},{"issue":"1","key":"pone.0354964.ref035","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/s12942-024-00376-5","article-title":"Identifying obesogenic environment through spatial clustering of body mass index among adults","volume":"23","author":"KYY Wong","year":"2024","journal-title":"Int J Health Geogr"},{"key":"pone.0354964.ref036","doi-asserted-by":"crossref","first-page":"04029","DOI":"10.7189\/jogh.11.04029","article-title":"Psychological distress, cardiometabolic diseases and musculoskeletal pain: a cross-sectional, population-based study of syndemic ill health in a Dutch fishing village","volume":"11","author":"MN Slagboom","year":"2021","journal-title":"J Glob Health"},{"key":"pone.0354964.ref037","doi-asserted-by":"crossref","first-page":"108606","DOI":"10.1016\/j.envres.2019.108606","article-title":"The effect of short-term exposure to the natural environment on depressive mood: a systematic review and meta-analysis","volume":"177","author":"H Roberts","year":"2019","journal-title":"Environ Res"},{"key":"pone.0354964.ref038","doi-asserted-by":"crossref","first-page":"103218","DOI":"10.1016\/j.healthplace.2024.103218","article-title":"Urban densification in the Netherlands and its impact on mental health: an expert-based causal loop diagram","volume":"87","author":"MA Beenackers","year":"2024","journal-title":"Health Place"},{"issue":"10034","key":"pone.0354964.ref039","doi-asserted-by":"crossref","first-page":"2207","DOI":"10.1016\/S0140-6736(15)01284-2","article-title":"Physical activity in relation to urban environments in 14 cities worldwide: a cross-sectional study","volume":"387","author":"JF Sallis","year":"2016","journal-title":"Lancet"},{"issue":"10431","key":"pone.0354964.ref040","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1016\/S0140-6736(23)02750-2","article-title":"Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults","volume":"403","author":"NCD Risk Factor Collaboration (NCD-RisC)","year":"2024","journal-title":"Lancet"},{"key":"pone.0354964.ref041","doi-asserted-by":"crossref","first-page":"100375","DOI":"10.1016\/j.metop.2025.100375","article-title":"Obesity: prevalence, causes, consequences, management, preventive strategies and future research directions","volume":"27","author":"SK Ahmed","year":"2025","journal-title":"Metabol Open"},{"issue":"4","key":"pone.0354964.ref042","doi-asserted-by":"crossref","first-page":"2169","DOI":"10.1007\/s00394-020-02367-1","article-title":"Ultra-processed food consumption and risk of obesity: a prospective cohort study of UK Biobank","volume":"60","author":"F Rauber","year":"2021","journal-title":"Eur J Nutr"},{"issue":"9","key":"pone.0354964.ref043","doi-asserted-by":"crossref","first-page":"1825","DOI":"10.1016\/j.socscimed.2007.05.036","article-title":"Understanding and representing \u201cplace\u201d in health research: a relational approach","volume":"65","author":"S Cummins","year":"2007","journal-title":"Soc Sci Med"},{"issue":"4","key":"pone.0354964.ref044","doi-asserted-by":"crossref","first-page":"619","DOI":"10.2105\/AJPH.2016.303097","article-title":"On the distinction--or lack of distinction--between population health and public health","volume":"106","author":"AVD Roux","year":"2016","journal-title":"Am J Public Health"},{"issue":"5","key":"pone.0354964.ref045","doi-asserted-by":"crossref","first-page":"1172","DOI":"10.1016\/j.healthplace.2012.05.006","article-title":"The local food environment and diet: a systematic review","volume":"18","author":"CE Caspi","year":"2012","journal-title":"Health Place"},{"issue":"4","key":"pone.0354964.ref046","doi-asserted-by":"crossref","first-page":"4354","DOI":"10.3390\/ijerph120404354","article-title":"Mental health benefits of long-term exposure to residential green and blue spaces: a systematic review","volume":"12","author":"M Gascon","year":"2015","journal-title":"Int J Environ Res Public Health"},{"key":"pone.0354964.ref047","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1016\/j.envres.2018.06.030","article-title":"The health benefits of the great outdoors: a systematic review and meta-analysis of greenspace exposure and health outcomes","volume":"166","author":"C Twohig-Bennett","year":"2018","journal-title":"Environ Res"},{"key":"pone.0354964.ref048","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1146\/annurev.publhealth.26.021304.144708","article-title":"Urban health: evidence, challenges, and directions","volume":"26","author":"S Galea","year":"2005","journal-title":"Annu Rev Public Health"},{"key":"pone.0354964.ref049","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.addbeh.2017.05.005","article-title":"The relationship between social desirability bias and self-reports of health, substance use, and social network factors among urban substance users in Baltimore, Maryland","volume":"73","author":"CA Latkin","year":"2017","journal-title":"Addict Behav"},{"issue":"1","key":"pone.0354964.ref050","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1186\/s12942-017-0097-5","article-title":"Estimating the prevalence of 26 health-related indicators at neighbourhood level in the Netherlands using structured additive regression","volume":"16","author":"J van de Kassteele","year":"2017","journal-title":"Int J Health Geogr"},{"issue":"5","key":"pone.0354964.ref051","doi-asserted-by":"crossref","DOI":"10.1136\/jech.2007.064287","article-title":"Associations of neighbourhood greenness with physical and mental health: do walking, social coherence and local social interaction explain the relationships?","volume":"62","author":"T Sugiyama","year":"2008","journal-title":"J Epidemiol Community Health"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0354964","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T17:58:23Z","timestamp":1786730303000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0354964"}},"subtitle":[],"editor":[{"given":"Floris","family":"Vermeulen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,8,14]]},"references-count":51,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8,14]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0354964","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,14]]}}}