The built environment and obesity: What we know and

what we need to know

Russ Lopez, MCRP ScD

Boston University School of Public Health

Past studies: sprawl - obesity

• Ewing et al (Am J Health Promot. 2003 Sep-Oct;18(1):47-

57) • Vadnergrift and Yoked (Health Place. 2004

Sep;10(3):221-9)

• Lopez (Am J Public Health. 2004 Sep;94(9):1574-9) • Sturm and Cohen (Public Health. 2004 Oct; 118(7):488-

96)

• Kelly-Schwartz, et.al. (J Planning Education Research. In press)

Sprawl to obesity: proposed pathways (1)

• Sprawl results in:– Increased distance to

• Jobs

• Schools

• Food Stores

• Recreation Facilities

– Reduced utility of non-automobile transportation• No way to walk/bike to destinations

• No accessible destinations

Sprawl to obesity proposed pathways (2)

• These cause:

– Increased driving– Less walking/biking– Increased stress– More reliance on fast food meals/convenience

stores

Sprawl to obesity proposed pathways (3)

• Which leads to:

– Less physical activity– Increased calorie consumption

• And ultimately to obesity

Sprawl definition issues

• Multiple definitions– Density measures– Gradient measures– Land Use measures– Street network measures– Composite measures

• Does choice of measure influence results?

• Are better measures needed?

Model issues

• Many of the sprawl – obesity links need additional research

• Which links are most important?

• How important is sprawl and the built environment relative to other factors that affect obesity risk?

Methodological issues

• Studies to date are cross sectional

• Needs include:– longitudinal studies– additional databases– pre/post studies– historical studies

Generalizability issues

• Studies have focused predominately on adults• What are the effects on

– Children– Elderly– Inner city residents– Non-White people– Low Income people– People with disabilities– Rural areas– Other countries?

Application issues

• Interventions

• Urban design changes

• Public education

Good news!

• Many studies are currently underway

• Important funding available– NIEHS– Robert Wood Johnson

Bad news!

• The sprawl enthusiasts are fighting back

• Translation of research into policy is lacking

• The public has not yet taken this knowledge into its collective consciousness

Final thoughts

• Evidence is growing to connect the built environment and obesity, but it is not yet conclusive

• Greater research is needed to: – Diversify the evidence– Prove the causal pathway– Develop programs/policies for change – Increase our understanding of the effects on other

populations

For more information

Russ Lopez

rptlopez@bu.edu

http://people.bu.edu/rptlopez/