Comparing Childhood Obesity Prevalence in Relation to Neighborhood Recreational Area Availability Using Harmonized National and Regional Data

Abstract Background/Objectives Natural and built environment is an important factor of children’s physical activity and weight status. This study investigated the relationship between the availability and type of recreational areas and school children’s weight status, using national and regional levels, to inform community-tailored interventions. Subjects/Methods A cross-sectional analysis using harmonized data (N = 626) from the Hellenic National Nutrition and Health Survey (HNNHS) and Health4EUkids studies of children aged 7–13 years old. Recreational area availability was tabulated in national and regional areas. The probability of overweight and obesity was estimated following multinomial logistic regression analysis to investigate the likelihood of children with overweight or obesity by total recreational areas available and by type. All statistical analyses were performed using STATA 18.0 (Texas Ltd.). Results Overweight and obesity prevalence was 25.2% and 15.3% in total, with obesity rates being slightly higher in the regional sample compared to the national (17.6% and 13.1%, respectively). Patterns of area type and distribution differed between national and regional areas. Total recreational area access (≥ 2 areas) was associated with lower overweight/obesity prevalence (38.3% vs. 56.5% for 0–1 areas, p = 0.030), with sports-center availability linked to a 7% reduction in obesity probability. No significant effect was found with park presence alone. Conclusions Increased neighborhood recreational area availability, particularly sports centers, was associated with lower obesity risk among Greek children, with notable regional differences, highlighting the need for localized infrastructure distribution. Further studies should address obesogenic elements such as food outlet proximity and utilize larger regionally stratified samples for robust spatial analysis.