Advancing Obesity Solutions Through Investments in the Built Environment Proceedings of a Workshop (2018) / Chapter Skim
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2 The Built Environment, Obesity, and Health
2 The Built Environment, Obesity, and Health
Pages 7-20
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(Karen Glanz) • Interventions to change the food environment have shown mixed results in improving eating behavior or body mass index (BMI)
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A FRAMEWORK FOR INTERVENTIONS The 21st century poses many challenges to human health, including chronic disease, depression, road traffic injuries, air pollution, chronic noise, social isolation, fear of crime, and health inequities, observed Rodrigo Reis, professor of public health, Washington University, St. Louis, Missouri. All of these health challenges can be connected to urban planning, city design, and social policies, he asserted.
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Reis continued by explaining that the framework (see Figure 2-1) identifies eight risk exposures -- traffic, air pollution, noise, social isolation, personal safety, physical inactivity, prolonged sitting, and unhealthy diet -- related to urban and transport planning and design decisions, which it divides into environmental, social, and behavioral categories.
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Reprinted I I I I I Food and health service access from The Lancet, Vol. 388, Billie Giles-Corti, Anne Vernez-Moudon, Social and recreational Rodrigo Reis, Gavin Turrell, Andrew access L
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, which can have a direct health benefit for the people who partake, but can also reduce air pollution, noise, and social isolation and is likely to have other beneficial economic and social effects. Over time, he asserted, the switch to active transport could lead to lower prevalence of obesity and other metabolic risk factors.
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For example, he added, rather than talking about the health benefits of parks, community leaders can emphasize social benefits such as an enhanced environment and safety, and when talking about transportation systems or denser cities, they can describe the benefits in terms of environmental stability, social benefits, safety, and economic benefits. He closed by saying, "Let's think about how we can message the work around urban planning, city design, and health, [taking]
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. He reported that "50 percent of all transit commuters got 100 minutes a week of physical activity walking solely for getting to and from transit," adding that "if this is not a public health intervention, I don't know what is." He further cited a pair of studies examining the
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. He also noted that mixing land uses and mixing increasing residential density were two strategies recommended by the Community Preventive Services Task Force for increasing physical activity (Community Preventive Services Task Force, 2016b)
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. Finally, Rodríguez turned to a study of people living in cities in southern Ontario, Canada, which found that the most walkable neighborhoods had lower rates of obesity than less walkable neighborhoods (Creatore et al., 2016)
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. She explained that the societal-level factors interact with individual factors such as genes, FIGURE 2-2 An ecological framework depicting the multiple influences on what people eat.
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Much of this research is descriptive and correlational, she explained. For example, she said, early findings on the retail food environment suggested that supermarkets produce healthier outcomes relative to fast food restaurants, which contribute to obesity, but more recent research has explored some of the ambiguities of these findings.
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In an evaluation of a large-scale urban corner store intervention, a component of the Communities Putting Prevention to Work initiative, Cavanaugh and colleagues (2014) found that to a modest degree, the environments in intervention stores were healthier, with greater availability of low-fat milk and fresh fruit.
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on interventions to support healthier foods and beverages in schools found positive evidence for meal interventions, fruit and vegetable snack interventions, and multicomponent interventions. However, Glanz added, policies for healthier snacks and interventions for water access do not yet have positive evidence.
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Maybe that is not the only place we should be looking." Glanz concluded by observing that changes in the food environment are inevitably linked to other issues, including food justice and social justice. "I think we can all agree that everyone should have a right to healthy, affordable food, that consumers have a right to know what is in their food when they eat out, [that]
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