Obesity, Urbanization, and Food Access in Wisconsin: The Intersection of Healthcare Provider Access and Population Health Outcomes

Background. Social determinants of health (SDOH) are widely linked to obesity, but effects may depend on local structural conditions. We examined whether SDOH act uniformly or vary by urbanization and community profile in Wisconsin. Methods. We conducted a cross-sectional ecological study of 833 ZIP codes (72 counties) from 2019–2023. Obesity prevalence was derived from electronic health records. Predictors covered education, transportation, housing, household composition, insurance, income and poverty, and demographic specific food access. Analyses used a multi-level urbanization classification, bivariate associations to identify universal versus context dependent patterns, and UMAP with clustering to derive community archetypes. Results. Obesity prevalence increased in all cohorts. Urban Underserved communities rose by just over eight percentage points, Urban Advantaged by about three, and rural cohorts formed an intermediate band. Education was the only consistently protective factor across all strata, with stronger inverse associations in urban settings, whereas most other SDOH appeared context dependent. Food access associations are concentrated in specific subgroups, children in low access areas (r = 0.39), low-income populations (r = 0.39), and households without a vehicle (r = 0.36), with asymmetric racial patterns. UMAP revealed eight community archetypes spanning 42.6% to 53.7% obesity prevalence, indicating that structural profiles aligned more closely with burden than geography alone. Conclusions. Relationships between SDOH and obesity were not uniform. Education behaved as a protective indicator, while most determinants varied by urbanization and community structure, supporting context matched strategies that prioritize high risk subgroups and tailor interventions to community archetypes.