Built Environment in Relation to Obesity and Physical Activity

1. Built Environment in Relation to Obesity and Physical Activity Part I Fuzhong Li, Ph.D. Oregon Research Institute

3. Focus • To understand • the basic terminologies • the scope of problems related to overweight/obesity, physical inactivity • To layout • conceptual framework to the study of environmental health

4. Terminology and DefinitionsWhat Is Built Environment? • Encompasses all of the buildings, spaces, and products created or modified by people. • For example: buildings (housing, schools, workplaces); land use (industrial or residential); public resources (parks, museums); zoning regulations; transportation systems.

5. What is the Built Environment? • Spatial scales: Micro Small Intermediate Large

6. Related to land use Related to automobile dependency Related to social processes Obesity, physical activity, CVD Water quantity and quality Access to green spaces and parks Air pollution and asthma Climate change contribution  Car crashes  Pedestrian injuries Mental health impact  Social capital Health equity Community Design and Health

7. Urban Sprawl

9. Transportation

10. The Streetscape

11. Connectivity

12. Suburban Development Air Pollution Traditional Neighborhood Drawing by Duany Plater Zyberk, in ITE Journal 1989;59:17-18

13. Key Health Impacts • Built Environment • Obesity, inactive and unhealthy lifestyle • Motor Vehicle Accidents • Pedestrian / Bicyclist Injuries and Fatalities • Air Quality • Air Pollution • Contact with Nature • Climate Change

14. Terminology and DefinitionsBody Mass Index (BMI) • Defined: Weight (kg) / height (m)2 • Categories: • Underweight: < 18.5 • Normal: 18.5 – 24.9 • Overweight: 25 – 29.9 • Obesity: 30 or greater Source: National Heart Lung and Blood Institute

15. Prevalence of Overweight and Obesity in the United States • Among adult men, prevalence was 31.1% in 2003-2004, 33.3% in 2005-2006 • Among adult women, 33.2% in 2003-2004, 35.2% in 2005-2006 • 16.3% of children and adolescents aged 2-19 years were obese Source: http://www.cdc.gov/nccdphp/dnpa/obesity

16. Prevalence of Overweight and Obesity in the United States (cont.) • Trend • The increase (percentage points) in obesity and overweight in adults was faster than in children (0.77 vs. 0.46–0.49), and in women than in men (0.91 vs. 0.65). Source: Wang et al. (2008). Obesity.

17. Prevalence of Overweight and Obesity in the United States (cont.) • Projection • by 2030, 86.3% adults will be overweight or obese; and 51.1%, obese. Black women (96.9%) and Mexican-American men (91.1%) would be the most affected. By 2048, all American adults would become overweight or obese, while black women will reach that state by 2034. • In children, the prevalence of overweight (BMI 95th percentile, 30%) will nearly double by 2030. Source: Wang et al. (2008). Obesity.

18. Overweight and Obesity and Health Risks • Heart disease and stroke • High blood pressure (hypertension) • Diabetes • Certain Cancer (breast, colon) • Gallbladder disease and gallstones • Osteoarthritis • Breathing problems, such as sleep apnea

19. Terminology and DefinitionsPhysical Activity “Bodily movement produced by the contraction of skeletal muscle that increases energy expenditure above the basal level” Source: USDHHS (1996)

20. Recommended Physical Activity Levels - Adults • Moderate-intensity aerobic (endurance) physical activities (i.e., brisk walking, bicycling, vacuuming, gardening, or anything else that causes small increases in breath or heart rate) for a minimum of 30 min on five days each week OR • Source: Haskell et al. (2007), Medicine & Science in Sports & Exercise

21. Recommended Physical Activity Levels • Vigorous-intensity aerobic physical activities (i.e., running, aerobics, heavy yard work, or anything else that causes large increases in breathing or heart rate) for a minimum of 20 min on three days each week • Source: Haskell et al. (2007), Medicine & Science in Sports & Exercise

22. Insufficient Physical Activity • Doing more than 10 minutes total per week of moderate or vigorous-intensity lifestyle activities (i.e., household, transportation, or leisure-time activity), but less than the recommended level of activity Source: http://www.cdc.gov/nccdphp/dnpa/physical/stats/definitions.htm

23. Inactivity • Less than 10 minutes total per week of moderate or vigorous-intensity lifestyle activities (i.e., household, transportation, or leisure-time activity). Source: http://www.cdc.gov/nccdphp/dnpa/physical/stats/definitions.htm

24. Levels of Physical Activity Source: apps.nccd.cdc.gov/PASurveillance/StateSumV.asp

25. 1988-2007 No Leisure Time Physical Activity Nationwide Source: www.cdc.gov/nccdphp/dnpa/physical/stats/leisure_time.htm

26. Source: http://apps.nccd.cdc.gov/PASurveillance/StateSumResultV.asp

27. Thailand Source: Thailand Health Profile – 2004-2006

28. Yes, I Exercise

30. All You Can Do

31. Health Risks of Physical Inactivity • Risk of coronary heart disease • People with inactive and unfit almost twice as likely to die from heart disease as more active and fit people • Risk of being overweigh or obese, • Which in turn, associated with certain cancers, osteoarthritis, and back problems • Risk of developing type 2 diabetes • Risk of lowering bone density - osteoporosis • Certain Cancer

32. Inactivity, Overweight, and Health Evidence links inactivity and overweight with…

33. Built Environment in Relation to Overweight or Obesity, and Physical Activity: An Ecologic Model Individual factors BMI Environmental factors Genetics Built environment Economic influences (cost and access) Neighborhood safety (perceived/objective) Transportation opportunities Socioeconomic Characteristics Other individual characteristics Lifestyle/behavioral factors Food consumption (energy intake) Physical activity (energy expenditure) Behaviors Behaviors Social factors Family and peer influences Socioeconomic characteristics Source: Powell et al. (www.impacteen.org)

34. Part IIResearchand Implications