Is the environment causing obesity? Taking action to reverse an epidemic Rebecca E. Lee, PhD Texas Obesity Research Center Department of Health and Human Performance University of Houston Houston, Texas USA http://www.hhp.uh.edu/obesity
Outline Ecologic Model of Obesity Case 1. Neighborhood Streets Case 2. Physical Activity Resources Case 3. Food Environment Conclusions
Billions of US Dollars Estimated Costs of Obesity 160 140 120 100 80 60 40 20 0 1998 2008 Finkelstein EA, Trogdon JG, Cohen JW, Dietz W. Annual medical spending attributable to obesity: payerand service-specific estimates. Health Aff (Millwood). 2009;28(5):w822 w831, pmid:19635784.
What is causing all this obesity?
Obesogenic Environment? Obese + Genic = Something that creates or leads to obesity Obesity is a complex system of policies, built environment, food supply, marketing, media, societal context, social networks, individual behavior, biologic predispositions and genetics.
Forces of Change Technology, Globalization Macro-Environment Policies, Institutionalized Norms, Weather Micro-Environment Work, School, Home Meso/Exo-Environment Travel, Social Relationships Obesity Biology Genetics Ecologic Model of Obesity Lee RE, McAlexander KM, Banda JA. Reversing the Obesogenic Environment. Champaign, IL: Human Kinetics; 2011.
Individual Choices?
Outline Ecologic Model of Obesity Case 1. Neighborhood Streets Case 2. Physical Activity Resources Case 3. Food Environment Conclusions
Defining Neighborhoods Residences of HIP Houston Participants Geographic Information Systems (GIS) Boundaries 160652 120098 150481 100034 120125 150478 150504 150477 100045 100058 140324 110013 150533 140316 150395 160571 160643 140235 130248 140343 140300 130171 150351 130255 130177140304 160553 150456 150367 150353 150510160669 150345 130251160565 140338 160656 160591 120090 150484 160618 160684 160603 150488 140286 100040 130166 150507 120205 120202 140294 150361 100035 140309 160583 160633 160628 100053 100063 110052 160593 140282 150532 100037 110020 100069 150337 130036 100039 160687 130149 100062 160530 100061 110064 160678 150543 130276 160470 130203 150346 130165160638 130192 140287 160632 160541 110038 130237 160658 100044 100029 130274 150523 130273 120110 130147 160680 140079 160675 110014 160689 160619 160564 150368 160548 140307 110012 110058 140290 120100 160547 140280 140269 130148 130168 120077 140332 130275 160602 110002 160637 160512 110060140319 110006 110019 160544 160471 160563160608 100003 160679 160582 150482 160665 120088 110015130099 110063 120223130092 130097 160630 160358 150531 130128 100030 130231 110008 110001 140291 140308 150518 100017 140306160667 120220 120109 160568 100071 130230 130232 100047 150366 140289 120229 110016140299 110051 130083 160551 100038 120124 160549 150490 130162 120222 110037 100012 150394 150342 150359 140339 110049 160594 130226 130091 140285 100050 120272 130278 130245 130170 150315 120108 130137 140349 140326 100051 100004 100001 140221 100049 110044 100032 100007100008 130236 150505 140199 150362 110029 160527 120111 150540 120256 140333 130144 120129 140312 130145 130185 160654 150224 150473 150341160627 140325 140301 140297 110061 120086 140281 100022 140295 130233 100041 100026 160586 110032 150506 110004 150458 160646 110048 130175 130240 100060 120270 Buffers Streets Census geography School Locations 160370 110062 140260 100023 160545 110005 160629 130178 140323 110046 5 120089 130213 0 160620 130133 Legend 10 20 Kilometers Created for Health is Power Research Project Fall 2007 Participant Residences Highway 800 m buffer Arterial 400 m buffer Parmenter BM, McMillan T, Cubbin C, Lee RE. Developing Geospatial Data Management, Recruitment, and Analysis Techniques for Physical Activity Research. Urban and Regional Information Systems Association Journal. 2008; 20(2): 13-19. 160365
Defining Neighborhoods Radial buffer All arterials 25% of residentials Street segments 800 meters 400 meters McMillan TM, Cubbin C, Parmenter B, Medina AV, Lee RE. Neighborhood sampling: how many streets must an auditor walk? 2010, 7:20 http://www.ijbnpa.org/content/7/1/20
Neighborhood Assessment Pedestrian Environment Data Scan (PEDS) McAlexander KM, Mama SK, Medina AV, O'Connor DP, Lee RE. Concordance and correlates of direct and indirect built environment measurement among minority women. Am J Health Promot, 2011. In press.
Clifton KJ, Livi Smith A, Rodriguez D. The Development and Testing of an Audit for the Pedestrian Environment. Landscape and Urban Planning. 2007, 80(1-2):95-110.
PEDS Data Pedestrian sidewalk connections Traffic speed limit Vehicle lanes Safety for walking Attractiveness for walking Safety for bicycling Attractiveness for bicycling Lee RE, Mama SK, McAlexander KP, Adamus H, Medina AV. Neighborhood factors and physical activity in African American public housing residents. J Phys Act Health. 2011 Jan;8 Suppl 1:S83-90.
Neighborhood and Physical Activity Slower posted speed limits associated with more physical activity among low income African Americans living in public housing in Houston Lee RE, Mama SK, McAlexander KP, Adamus H, Medina AV. Neighborhood factors and physical activity in African American public housing residents. J Phys Act Health. 2011 Jan;8 Suppl 1:S83-90.
Lee RE, Mama SK, Medina AV, Ho A. Neighborhood Factors Influence Physical Activity Among Community Dwelling African American and Hispanic or Latina Women. Paper presented at the Active Living Research Conference, San Diego, CA, 2011. Neighborhood Attractiveness People who live in neighborhoods that are attractive for bicycling tend to do more physical activity
Lee RE, Mama SK, Medina AV, Ho A. Neighborhood Factors Influence Physical Activity Among Community Dwelling African American and Hispanic or Latina Women. Paper presented at the Active Living Research Conference, San Diego, CA, 2011. Combining Individual Approaches and Environment? Women participating in a physical activity intervention who lived in neighborhoods with more crossing aids and traffic control devices increased their physical activity, while those in the comparison did not.
Neighborhood Streets Programs to increase physical activity are more effective in supportive neighborhoods More supportive neighborhoods can help reduce obesity Lee RE, Mama SK, Medina AV, Ho A. Neighborhood Factors Influence Physical Activity Among Community Dwelling African American and Hispanic or Latina Women. Paper presented at the Active Living Research Conference, San Diego, CA, 2011.
Outline Ecologic Model of Obesity Case 1. Neighborhood Streets Case 2. Physical Activity Resources Case 3. Food Environment Conclusions
Physical Activity Resources Lee RE, Mama SK, Banda JA, Bryant LG, McAlexander KP. Physical activity opportunities in low socioeconomic status neighbourhoods. J Epidemiol Community Health. 2009 Dec;63(12):1021.
Physical Activity Resources As gyms per square mile increased, energy expenditure increases for low income, but not for high income women As gyms and parks per square mile increased in low SES neighborhoods, number of moderate physical activities increased Lee RE, Cubbin C, Winkleby M. Contribution of neighborhood SES and physical activity resources to physical activity among women. J Epi Comm Health. 2007 Oct;61(10):882-90.
Physical Activity Resources Physical Activity Resource Assessment (PARA) Lee RE, Booth KM, Reese-Smith JY, Regan G, Howard HH. The Physical Activity Resource Assessment (PARA) instrument: evaluating features, amenities and incivilities of physical activity resources in urban neighborhoods. Int J Behav Nutr Phys Act. 2005. 14;2:13.
http://hhp.uh.edu/undo
Physical Activity Resources Lee RE, Booth KM, Reese-Smith JY, Regan G, Howard HH. The Physical Activity Resource Assessment (PARA) instrument: evaluating features, amenities and incivilities of physical activity resources in urban neighborhoods. Int J Behav Nutr Phys Act. 2005. 14;2:13.
Most common resources were parks, schools, community resources Wide variability in resource availability Many, many more incivilities in low SES neighborhoods Lee RE, Booth KM, Reese-Smith JY, Regan G, Howard HH. The Physical Activity Resource Assessment (PARA) instrument: evaluating features, amenities and incivilities of physical activity resources in urban neighborhoods. Int J Behav Nutr Phys Act. 2005. 14;2:13.
Physical Activity Resources More physical activity resources of better quality may increase likelihood of meeting physical activity recommendations. The greater the amenities and fewer the incivilities in the local physical activity resources, the lower the prevalence of obesity among residents. McAlexander KM, Banda JA, McAlexander JW, Lee RE. Physical activity resource attributes and obesity in low-income African Americans. J Urban Health. 2009 Sep;86(5):696-707.
Outline Ecologic Model of Obesity Case 1. Neighborhood Case 2. Physical Activity Resources Case 3. Food Environment Conclusions
Food Environment Food Stores Assessment (FSA) Restaurant Assessment Tool (RAT) http://hhp.uh.edu/undo
Food Store Assessment http://hhp.uh.edu/undo Lee RE, Heinrich KM, Medina AV, Regan GR, Reese-Smith JY, Jokura Y, Maddock JE. A picture of the healthful food environment in two diverse urban cities. Environ Health Insights. 2010; 4: 49 60.
Store Types in Low SES Neighborhoods Most commonly available stores were convenience and liquor stores Lee RE, Heinrich KM, Medina AV, Regan GR, Reese-Smith JY, Jokura Y, Maddock JE. A picture of the healthful food environment in two diverse urban cities. Environ Health Insights. 2010; 4: 49 60.
Store Types in Low SES Neighborhoods Convenience stores and liquor stores sell convenience foods Lee RE, Heinrich KM, Medina AV, Regan GR, Reese-Smith JY, Jokura Y, Maddock JE. A picture of the healthful food environment in two diverse urban cities. Environ Health Insights. 2010; 4: 49 60.
% Stores and Fresh Produce 100 Percent of Neighborhoods with Stores Selling Fresh Produce 90 80 70 60 50 40 30 Low SES High SES Most lower SES neighborhoods had only one store that sold fresh produce 20 10 0 Fruit Vegetables Lee RE, Heinrich KM, Medina AV, Regan GR, Reese-Smith JY, Jokura Y, Maddock JE., 201Lee RE, Heinrich KM, Medina AV, Regan GR, Reese-Smith JY, Jokura Y, Maddock JE. A picture of the healthful food environment in two diverse urban cities. Environ Health Insights. 2010; 4: 49 60.
Price US$ Price of Products 12 10 8 6 4 2 0 Cost of Buying 6 Pounds of Mixed Produce Supermarkets Small Groceries Farmers' Markets Convenience Cost of buying one pound each of apples, carrots, green peppers, onions, oranges, and tomatoes 32% more expensive to shop at convenience stores compared to farmers markets Lee RE, Heinrich KM, Medina AV, Regan GR, Reese-Smith JY, Jokura Y, Maddock JE., 201Lee RE, Heinrich KM, Medina AV, Regan GR, Reese-Smith JY, Jokura Y, Maddock JE. A picture of the healthful food environment in two diverse urban cities. Environ Health Insights. 2010; 4: 49 60.
Retail Point of Purchase Supermarkets and farmers markets increase access to fruits and vegetables Challenging to maintain healthful dietary habits depending on neighborhood of residence Lee RE, Heinrich KM, Medina AV, Regan GR, Reese-Smith JY, Jokura Y, Maddock JE., 201Lee RE, Heinrich KM, Medina AV, Regan GR, Reese-Smith JY, Jokura Y, Maddock JE. A picture of the healthful food environment in two diverse urban cities. Environ Health Insights. 2010; 4: 49 60.
Outline Ecologic Model of Obesity Case 1. Neighborhood Case 2. Physical Activity Resources Case 3. Food Environment Conclusions
Obesogenic Neighborhoods? Obesogenic refers to something that fosters obesity Many neighborhoods, particularly in low SES areas, obesogenic People who reside in deprived neighborhoods often report less physical activity and poorer dietary habits and greater obesity Context is important for determining behavior, health and supporting individually targeted obesity control efforts
What can we do? Larger, more representative and longitudinal studies Better coordination between practitioner recommendations and neighborhood realities Policy changes that foster health promoting neighborhoods Relatively simple changes can make a lifetime of difference
Questions?
Rebecca Lee Health & Human Performance University of Houston Garrison Gymnasium 104 3855 Holman Rd Houston, TX 77004 USA http://www.hhp.uh.edu/undo releephd@yahoo.com