As concern deepens over the nation's rising obesity rate, the battle of the bulge is becoming more than just a duel between diets and workout regimens. Now it's an environmental issue.
Researchers say land-use patterns, especially suburban sprawl, are making Americans fat by fostering a drive-everywhere lifestyle at the expense of physical activity.
With two of every three adults overweight and nearly one in three excessively so, some health officials and city planners contend that changing the way we get around may be as crucial to slimming down as changing the way we eat.
"We aren't going to get rid of elevators or McDonald's, but we can take small steps over time to combat inactivity," says James Hill, director of the Center for Human Nutrition at the University of Colorado Health Sciences Center. "Ultimately, changing our environment is our only hope, but it's going to take decades to get there."
The link between fitness and the environment has been underscored by recent research showing that people who live in a typical car-oriented suburb tend to be fatter than residents of more compact, higher-density areas.
"There are a lot of factors involved," says Lawrence Frank, a landscape architect at the University of British Columbia and co-author of a book on the subject published last year. "Some are physical, and some are social. But the evidence is starting to show that there is a relationship between urban design and people's health."
In one key study, strengthened by subsequent research on a larger population, Frank and his colleagues found that the obesity rate among white men in the Atlanta area was markedly higher in areas with less than two homes per acre than in areas with four or more. By comparison, the residential areas of Denver's fledgling Stapleton community will have roughly 12 dwelling units per acre.
Advocates say there are many ways to integrate physical activity into everyday life, from placing parking lots farther from buildings and making stairways more accessible to providing signals at crosswalks and widening bike paths so people will feel safer using them.
Other options include limiting the length of city blocks and requiring that they be split by walkways to create more direct routes for pedestrians to use in navigating neighborhoods.
Many planners also espouse more mass transit, such as metro Denver's proposed FasTracks project, on grounds that people who ride buses or trains tend to use cars less and walk more, if only while going to and from the station.
A further catalyst is a formal network of pedestrian routes, such as one proposed in Denver to "help increase pedestrian activity over time by providing a safe and inviting environment."
One of the seven goals of the plan, submitted in April and now awaiting approval by the City Council, is to support public health.
American corporations, concerned that bulging waistlines of employees are affecting their bottom lines, have tended to address the issue by providing wellness centers and weight- loss counseling.
But some are starting to embrace changes in the physical environment as well. Sprint Corp., for example, has explored the idea of slowing down elevators to make using the stairs more attractive, says Ron Goetzel, director of the Institute for Health and Productivity Studies at Cornell University.
"More companies are realizing that the health of their employees is not just an individual issue," says Goetzel, who is also vice president of the Metstat Group.
Hill, one of the the nation's foremost experts on obesity, encourages businesses to become involved by changing the workplace environment to include "walking meetings" and 15- minute "walking breaks."
Either can help people achieve the federally recommended fitness goal of 30 minutes of moderate exercise five days a week.
The idea of building activity into everyday routines has taken on new urgency as politicians and government officials struggle to address the health- care challenges posed by the nation's ballooning obesity rate.
With more than 15 percent of the adult residents of every state classified as obese, public health authorities warn that millions face higher risks of diabetes, heart attacks, arthritis, cancer and other obesity-related disorders over the next generation.
Obesity is defined as a body- mass index of 30 or above, which translates as roughly 20 percent more than the normal weight recommended for one's height.
One prime advocate of community planning as a way to combat the problem is the National Institute of Environmental Health Sciences, which brought together some 500 community planners, architects, traffic engineers and public health officials for a three-day conference in Washington last week.
The issue also will be addressed at a "Summit on Obesity" this week by Time magazine and ABC News with Peter Jennings as host.
The sold-out gathering in Williamsburg, Va., will dovetail with the publication of a Time issue devoted to what it calls the "obesity crisis."
Attendees in Washington last week focused on multi-use developments, which combine pedestrian-friendly residential areas with nearby shops, schools and office complexes.
Such compact communities - metro Denver's Stapleton, Lowry and Belmar developments are good examples - have long been praised for helping to reduce auto use, cut energy consumption and improve air quality.
Now their broad sidewalks, bike trails and greenways are being heralded as weapons in the battle against obesity.
"This has really snowballed in the last couple of years," says Susan Handy, a transportation and community planning expert at the University of California at Davis.
"Researchers have realized that just telling people to go to the gym doesn't work," she says. "You need to help build exercise into their daily lives."
In essence, says Rich McClintock of the Livable Communities Support Center, a program of the Denver-based Center for Regional and Neighborhood Action, "what this all comes down to is creating more destinations that people can and want to walk to or bike to, and making it safe and convenient to do so."
One recent convert to the more active lifestyle is Ralph Carson, 52, a federal employee who moved to the Lowry neighborhood a few months ago.
For 16 years, he commuted 45 minutes each way by car between an apartment in Lakewood and his job at the Air Reserve Personnel Center on the former air base. Now he goes to and from the office in about half the time - on foot.
"It's just over a mile to where I work, and everything I need is within walking distance," he says.
"There's a restaurant where I like to have breakfast, a barber shop, a liquor store, even an Albertson's," he says. "And they're getting ready to put in a medical center I can get to in an emergency."
Carson has lost some weight as a result of the extra exercise he's been getting, but the main difference, he says, is that "I seem to have a lot more energy than I used to."
So far, it's unclear whether less spread-out neighborhoods simply attract people who would be more active anyway, or whether "if you plopped down a sedentary person in such a neighborhood, they would change their behavior," notes Handy, the UC-Davis researcher.
But many planners are convinced that whatever their preferences are, people will walk when opportunities knock.
In hopes of proving the theory, Frank and his colleagues are seeking grant money to survey the residents of newly established communities such as Stapleton, with an eye to comparing the levels of fitness and activity when people first move in to levels recorded a year or two later.
The housing industry, which would bear the brunt of any fitness-oriented land-use mandates, generally supports the concept of more "livable" design, "but that's because there's a demand for it, not because we're interested in the social engineering aspect," says Clayton Traylor, a vice president of the National Association of Home Builders.
Traylor faults anti-obesity advocates for emphasizing Stapleton-style urban in-fill projects while ignoring more conventional developments such as Highlands Ranch.
"The fastest-growing types of activity-friendly development are in suburban and exurban small towns," he says. "There needs to be space in the dialogue for these kinds of communities, because the reality is that 80 percent of the population in the home-buying market (is) looking for suburban single- family homes."
One source of support for further research is the Robert Wood Johnson Foundation, which has awarded $16.5 million in grants to 25 projects across the country - including one at Stapleton - to show how community design can be used to promote healthier lifestyles.
"Basically, what's happened is that we have engineered physical activity out of our lives. We have 'drive-up' everything," says Helen Thompson, head of the Active Living Partnership at Stapleton.
"Meanwhile, we have food everywhere - in our cars, at work, in front of the TV - and our bodies still store excess calories as fat," she says. "So there's no surprise that we're getting heavier.
"But we can do things in our environment to make it more conducive to physical activity and encourage people to burn off a few of those extra calories."
source: http://www.denverpost.com/cda/article/print/0,1674,36%257E11676%257E2182931,00.html 1jun04
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