Greater Greater Washington

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Planners are the new public health officials

Research has linked the growing obesity epidemic to inactivity caused by poor land-use and transportation choices. Transportation and planning professionals are now joining the ranks of public health professionals to find solutions. Across the region, local officials are taking this to heart.


Photo by Jeff Anderson, Wolftrap Elementary, VA.

Obesity is a serious problem in the US. When planners shape land-use or transportation options, they're determining the potential health of the community, because these options affect whether people can choose effective transit or safe walking and bicycle routes.

When the Prince George's community hosted a screening of the four-part HBO Weight of the Nation documentary series earlier this week, the community highlighted this intersection between public health and transportation planning.

Global Solutions President and CEO Dr. Maya Rockeymore, speaking at a panel after the screening, responded to the stark numbers presented in the film. In Baltimore, residents of the Inner Harbor have a life expectancy of 62 years while residents of North Baltimore have a life expectancy of 82 years. "Context controls choice," she said. People need access to parks, transit, safe walking and bicycle routes, and full-service grocery stores to even have the choice to be healthy.

Low-income communities and communities of color have higher rates of obesity and chronic disease. The physical neighborhood of the Inner Harbor contributes to the health disparity in life expectancy. While designed as a walkable community, the neighborhood suffers from vacant houses, streets in need of maintenance and lack of destinations to meet basic needs such as a grocery store. When the physical environment deteriorates, safety becomes an additional issue in neighborhoods.

In the United States, 66% of adults are overweight or obese and nearly 20% of children are obese. Being overweight or obese increases the risk of chronic diseases such as hypertension, high cholesterol, type 2 diabetes, and asthma in both adults and children.

Pamela Creekmur, the Acting Health Officer and Director of the Prince George's County Health Department, explained that Prince George's obesity and physical inactivity rates are higher than other jurisdictions in the greater Washington region. Though Prince George's faces a bigger challenge, all the region's communities have seen a rise in obesity rates, which range between 18 to 34 percent for adults throughout the region.

Part of the cause of this obesity epidemic is physical inactivity. There has been a 300 percent increase in driving to work since 1960. As the documentary explains, in 1969 almost 50 percent of kids walked or biked to school while today only 13 percent of kids do the same.

The lack of exercise by children extends beyond just commuting to and from school. The documentary shows a mom who takes her children to a parking lot because it is the only open space they have to play. This environment isn't hospitable to the kind of physical activity a good park encourages.

Whether it's questions of commuting or questions of parks, transportation and planning professionals make decisions that affect travel and open spaces every day. These decisions need to be viewed as public health decisions.

The Centers for Disease Control and Prevention (CDC), the federal agency charged with health promotion and disease prevention, agrees. It has recognized that transportation policy, street-scale improvements, and access to places suitable for physical activity matter to our health. Among the CDC's recommendations is to participate in Safe Routes to School initiatives and adopt Complete Streets policies.

The Guide to Community Prevention Services, written by an independent group of public health and prevention professionals appointed by the CDC director, outlines several more environmental and policy approaches to provide opportunities for people to be physically active. These include the connectivity of sidewalks and streets, providing places for physical activity such as trails, and street-scale improvement such as street lighting and traffic calming. Such urban design features have been shown to improve some aspect of physical activity by 35 percent, not to mention the accompanying benefits of reduced crime and stress.

Of course, these improvements do not come overnight. After the screening, an elected official and audience members noted that such changes are not easy. After all, parks do not generate tax dollars.

But that does not mean that our environments must stagnate while our health deteriorates. Local communities can bring about change even when the federal government or state government seems stuck. Port Towns Youth Council President Erick Vargas talked about how his group took matters into their own hands by doing an audit of the streets and reporting the problems.

Prince George's County is taking action through a partnership of towns within the county. The Port Towns Community Health Partnership has a policy development team focused specifically on the built environment and nutrition policy to improve options for active living and healthy eating.

The group, which includes the towns of Bladensburg, Colmar Manor, Cottage City, and Edmonston, included a community health and wellness section in the Port Towns sector plan with the goals of providing safe places to walk and exercise and access to nutritious foods. The group is following through on sector plan recommendations to formalize a wellness opportunity zone as part of the zoning code. This would include changes in the built environment, access to healthier foods, and improved environmental stewardship.

Across the Potomac, the Fairfax County Health Department established the Partnership for a Healthier Fairfax, a group of community members and organizations concerned with public health. The Partnership created an environment and infrastructure strategic issues team as one of five teams who will make recommendations for improving health in Fairfax County. The first focus is a on local policy. The team is doing a scan of policies, including transportation and land use, that could be modified to promote a healthier and safer physical environment.

In the Washington region, better transportation and planning decisions can improve our health by increasing our access to efficient transit and space to run, bike, and play. We also create a healthier context for our environmentand as Dr. Rockeymore said, context controls choice. Throughout the region, local groups are working to give more of their neighbors the choice to live healthier lives.

Christine Green is the policy manager for the Greater Washington region Safe Routes to School network. She has a master's degree in city and regional planning from Ohio State University and has worked on neighborhood and transportation issues since 2003. She walks and bikes from her home and office on Capitol Hill. Views and opinions are her own.  

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Baltimore has among the highest rates of IV drug use, heroin addiction, and AIDS in the US. Not to mention one of the highest violent crime rates and high levels of poverty. I would suggest that access to healthcare and ending the cycle of drug addiction and violence is just a bit more important than new sidewalks or parks, which, by the way, will simply become havens for more violence and drugs.

As for "access to nutritious foods" can we please, for once and for all, end this myth of "food deserts." Every single person in this country can access healthy food if they want to. The supermarket in Barrow, Alaska, the northern-most community in the US, not accessible by any roads, has a fresh produce section. No one in Cottage City is going without fruits and vegetables for any reason other than they chose to. There's a Yes Organic Market right on Route 1 in Hyattsville! accessible by any number of bus routes!

Finally, let's stop with this "context controls choice" nonsense. Choice controls choice. You want to exercise, you can exercise. You want your kids to not be obese, get them to participate in activities or turn off the Xbox. Stop relying on bankrupt governments to do all of the work for you.

Take some control of your own life...oh wait, that kind of defeats a lot of the purpose of "urban planning" which is predicated on the idea that planners know more about what you want and need than you do.

by dcdriver on May 18, 2012 1:31 pm • linkreport

" I would suggest that access to healthcare and ending the cycle of drug addiction and violence is just a bit more important than new sidewalks or parks,"

Im not sure why one excludes the other.

"which, by the way, will simply become havens for more violence and drugs."

You want no sidewalks to prevent drug abuse!!!!???? I hardly think that lack of safe sidewalks leads to less drug abuse or violence.

"As for "access to nutritious foods" can we please, for once and for all, end this myth of "food deserts." Every single person in this country can access healthy food if they want to. The supermarket in Barrow, Alaska, the northern-most community in the US, not accessible by any roads, has a fresh produce section. No one in Cottage City is going without fruits and vegetables for any reason other than they chose to. There's a Yes Organic Market right on Route 1 in Hyattsville! accessible by any number of bus routes!"

as with most things, we can make things easier, or harder.

"Finally, let's stop with this "context controls choice" nonsense. Choice controls choice. You want to exercise, you can exercise. You want your kids to not be obese, get them to participate in activities or turn off the Xbox."

My kid is not obese. Im concerned about all the kids who are. And again, you can make things easier, or harder.

" Stop relying on bankrupt governments to do all of the work for you."

A. our govt is not bankrupt B. Many solutions are not that expensive, and could even save money.

"Take some control of your own life...oh wait, that kind of defeats a lot of the purpose of "urban planning" which is predicated on the idea that planners know more about what you want and need than you do."

So, I take that means you are fine with abolition of zoning that limits density? Thats urban planning too, you know.

by AWalkerInTheCity on May 18, 2012 1:40 pm • linkreport

It is amazing how we can find every excuse in the book for why people are getting fat. Blame everyone but the fattie.

Correlation, not causation?

by charlie on May 18, 2012 1:48 pm • linkreport

"There has been a 300 percent increase in driving to work since 1960."

If the increase in driving has been at the expense of public transportation, then the importance of this statistic is drastically reduced. Not much difference between sitting on a bus and sitting in a car.

"As the documentary explains, in 1969 almost 50 percent of kids walked or biked to school while today only 13 percent of kids do the same."

Busing children to mitigate de facto segregation is a worthy policy goal. Of course, planning can help alleviatesuch segregation

by bmv818 on May 18, 2012 1:51 pm • linkreport

If the increase in driving has been at the expense of public transportation, then the importance of this statistic is drastically reduced. Not much difference between sitting on a bus and sitting in a car.

Untrue, transit is much healthier since you are usually going to walk to and from transit and your destinations. Using transit requires a lot more walking than using a car.

by MLD on May 18, 2012 2:02 pm • linkreport

Thank you Walker for your points.

by watcher on May 18, 2012 2:09 pm • linkreport

To give a little more background, the number of children living with in a mile of school has dropped 10% since 1969 but the number of kids 5-14 years old walking and bicycling that distance has gone from 88% to 38%. There are a lot of reasons for this-busy roads between home and school, fear of stranger danger, parents busy schedules. I know busing for desegregation has declined but I cannot find any stats. Kids walking and biking to school not only is an opportunity for physical activity (and associated with higher academic performance) it reduces congestion-parents are shown to be 10-30% of morning drivers.

Also, research has shown that Americans who use transit spend a median of 19 minutes daily walking to and from transit; 29% achieve the recommended 30 minutes of physical activity a day solely by walking to and from transit.

While personal responsibility is part of the equation, it is not the full picture.

by Christine Green on May 18, 2012 2:28 pm • linkreport

I dunno about the premise that a more walkable environment leads to less obesity. I used to think so ... that is before I moved from the burbs to the city center. And the closer I've moved to that city center, the more weight I've gained. Why? Well, the easier it is to just stroll out your door and around the corner for dinner (or lunch or breakfast) the less likely you are to just cook at home. And with all the great restaurants we have around here and with all the tempting choices and 'less than good for you' portions and ingredients, it's not surprising that increased urban = increased obesity ... and regrettably not the other way around!

by Lance on May 18, 2012 2:45 pm • linkreport

"Research has linked the growing obesity epidemic to inactivity caused by poor land-use and transportation choices."

[citation_needed]

by Jimmy Wales on May 18, 2012 2:50 pm • linkreport

Personal responsibility is great but it obviously is not working given that (highly conservative) estimates show that 2/3 of Americans are overweight or obese. Perhaps some people just want to "beat their chests" rather than contribute to help solve the problem?

by Fred on May 18, 2012 3:29 pm • linkreport

MLD wrote:


Untrue, transit is much healthier since you are usually going to walk to and from transit and your destinations. Using transit requires a lot more walking than using a car.

I guess you could call transit healthier since it requires more walking than driving as a means of commuting, but describing transit as "much healthier" is an exaggeration. Walking is a low intensity activity that doesn't expend a lot of calories. A 200 pound individual won't even burn off the calories he took in from the Coke he had at lunch if he walks an extra mile every day.

We need to stop pretending that there's huge benefits to walking .

by Fitz on May 18, 2012 3:36 pm • linkreport

It's a stretch to consider planners as public health officials. That is unless there backgrounds are actually in...public health.

Much like those who develop lung cancer from smoking nasty newports everyday, people are responsible for their own obesity.

by HogWash on May 18, 2012 3:40 pm • linkreport

"Much like those who develop lung cancer from smoking nasty newports everyday, people are responsible for their own obesity."

er, I take it you also are not that familiar with whats meant by PUBLIC health, and how the public health profession approaches disease?

"We need to stop pretending that there's huge benefits to walking ."

except the empirical data suggest that a modest daily walk DOES make a big difference in health outcomes.

by AWalkerInTheCity on May 18, 2012 4:42 pm • linkreport

also Im not sure why you guys think school buses are all about deseg. Fairfax most of the kids take the bus, and theres no bussing for deseg here. They take the bus cause they are too far to walk (or the walk isn't safe, or whatever)

by AWalkerInTheCity on May 18, 2012 4:45 pm • linkreport

"A 200 pound individual won't even burn off the calories he took in from the Coke he had at lunch if he walks an extra mile every day."

but he probably isn't going to drink MORE coke than he would have otherwise. Assume pre walking he drank just enough coke to maintain at 200 lbs. Now add a mile walk every day. Same diet. Suddenly he's got a calorie deficit, and he's losing weight. Not real fast, but eventually he will cease to be obese.

I know whereof I speak on this ;)

by AWalkerInTheCity on May 18, 2012 4:48 pm • linkreport

I saw a stat once that basically since 1969 the percent of schoolkids taking the bus hasn't changed - that basically all of the shift away from walking and biking has been to kids being driven to school by their parents.

by MLD on May 18, 2012 4:53 pm • linkreport

AWalker wrote:

except the empirical data suggest that a modest daily walk DOES make a big difference in health outcomes.

What empirical studies are you referring to? It would be nice if they're not hidden behind a paywall.

Simply adding 20 to 30 minutes of walking to one's daily activities is not going to make a big difference in an individual's health because it is a low intensity activity.

by Fitz on May 18, 2012 4:58 pm • linkreport

It should be possible to design studies to compare unwalkable car-only areas with walkable-bikeable, transit available areas in terms of metrics like obesity, diabetes, heart disease, depression etc. We could control for income, education, race, other possible confounding factors by geo-coding if those data are not included in the data on health by location. My question is: has any really done this rigorously? My intuition is that there is a profound link between sitting most of the time (drive to work, sit at work, drive home, sit at home) and bad health outcomes (including mental), and that getting at least some daily movement (even just standing) as part of commuting can make a huge difference. The anecdotal and trend evidence seems very obvious. But we'll need good studies to respond to the "blame it on fattie" responses from the roadbuilders and fossil fuelers who so like to apologize for our car-only built environment.

by Greenbelt on May 18, 2012 5:02 pm • linkreport

AWalker wrote:

but he probably isn't going to drink MORE coke than he would have otherwise. Assume pre walking he drank just enough coke to maintain at 200 lbs. Now add a mile walk every day. Same diet. Suddenly he's got a calorie deficit, and he's losing weight. Not real fast, but eventually he will cease to be obese.

I don't think that's a reasonable assumption for most individuals, especially those who are currently overweight. The reason that are sky-high levels of overweight and obese individuals in the US is because they're greatly exceeding their daily caloric intake and expenditure needed to maintain their current weight.

by Fitz on May 18, 2012 5:04 pm • linkreport

"The reason that are sky-high levels of overweight and obese individuals in the US is because they're greatly exceeding their daily caloric intake and expenditure needed to maintain their current weight."

then there current weight wouldn't be stable. It would be constantly increasing - your 200 pounder would go up to 300 pounds, 400, etc. Most people hit an equilibrium at some point (because it takes heavier people more calories to do even the most basic things).

by AWalkerInTheCity on May 18, 2012 5:08 pm • linkreport

think about it like this

Calorie intake = x, calories burnt for any given lifestyle is f(w) where w is current weight. Eventually w goes up so that f(w) =x, and at that point w stabilizes. If x is low enough, w is normal weight. If x is too high, w is obese.

Change the lifestyle, and you change the function f(w). so that the equilibrium w for intake f becomes lower.

See its quite simple really.

by AWalkerInTheCity on May 18, 2012 5:11 pm • linkreport


why are some folks unable to use google?

Why are some people unable to understand that when they make a specific claim that the onus is on them to back it up. Using the LMGTFY route is not acceptable because it leads me to believe that you're just parroting talking points.

Sorry if I come off confrontational here, BTW.

by Fitz on May 18, 2012 5:16 pm • linkreport


then there current weight wouldn't be stable. It would be constantly increasing - your 200 pounder would go up to 300 pounds, 400, etc. Most people hit an equilibrium at some point (because it takes heavier people more calories to do even the most basic things).

An adult who weighs 250 to 300 pounds doesn't just end up that way. It happens over time. Most overweight individuals aren't leading lifestyles where simply adding 30 minutes of daily walking is going to have a huge impact in their weight.

by Fitz on May 18, 2012 5:19 pm • linkreport

Hm...the information I can Google quickly estimates that a *just* obese (BMI 30) woman would burn 178 calories and man 207 walking for 30 minutes. Done every day for a year, that could add up to 18 lbs off the woman and 22 lbs off the man, taking them from obese to the mid-range for overweight (BMI 26-27). Another year of walking at their new weight, and chances are they'll be a "normal" weight by the end of year 2.

*I dropped 72 lbs. about 8 years ago, and the only exercise I added to my life was walking. I dropped another 12 immediately upon arriving in DC and beginning to walk more places, even though I was drinking much more than I had before (1. I finally had a job and 2. who doesn't drink like a fish in DC?). I went from bordering on morbidly obese (BMI over 40...I never *quite* made that cut, but I came close) to a being within fractions of "normal" on the BMI scale, and staying there for over 6 years for the full loss including the 12 DC lbs., and over 8 years for the initial drop. I do a lot more exercise-y stuff (for fun) these days, but the walking + a healthy diet took the weight off initially. If someone is *not* burning calories from exercise and then starts burning *any* calories from exercise, it will help. Who cares if it's "not even their lunchtime Coke?" If they don't add ANOTHER Coke to compensate for the exercise, the weight will eventually come off.

by Ms. D on May 18, 2012 5:20 pm • linkreport

"We need to stop pretending that there's huge benefits to walking ."

you made a claim. see the above. You failed to back it up.

I did not advance anything controversial or unusual. The studies have been widely cited in the mainstream press. the burden really shouldn't be on me to prove to you whats widely known in the field.

I WILL admit there are isn't the same consensus on "dense walkable places lead to better health outcomes" we know that walking leads to better outcomes, and we know that dense walkable leads to more walking (all other things being equal) but AFAIK no one has found a good way around all the confounding variables.

by AWalkerInTheCity on May 18, 2012 5:26 pm • linkreport

"An adult who weighs 250 to 300 pounds doesn't just end up that way. It happens over time."

irrelevant. Once they get there, they hit equilibrium where calories in equals calories out. Increase calories out, while holding calories in the same, and they will lose.

have you ever belonged to weight watchers? you might ask them.

by AWalkerInTheCity on May 18, 2012 5:29 pm • linkreport

The thing about public health is that it's not about apportioning blame. I don't care whether any individual should or shouldn't have smoked less or exercised more. I work in public health because I want to create conditions that improve everyone's chances at living a healthy life. Environments that make it easy and enjoyable to incorporate physical activity into everyday life are an important part of that.

I've become hesitant about claiming that healthier built environments will reduce obesity, because obesity has a lot of factors -- and, as Lance points out, walkable environments can mean easier access to less-healthy foods.

What's been extensively demonstrated is that physical inactivity is a risk factor for several chronic diseases, and physical activity has many health benefits. Becoming more active might not lead to weight loss, but it can improve your metabolic health, which reduces your risk for diabetes. Recent research also suggests that regular aerobic workouts can't completely offset the negative effects of long stretches of sitting, and that short, low-impact walks can have metabolic benefits. (Many of these studies are behind paywalls, but NYT's Gretchen Reynolds has a helpful summary of a few studies at http://nyti.ms/JhrVza; .)

It's great to hear about what Port Towns and Fairfax are doing to create healthier environments, and I'd love to see more posts about their projects as they continue.

by Liz on May 18, 2012 5:49 pm • linkreport

But what if we make it easier for people to walk and it doesn't have an incredibly measureable impact on public health and we've made our neighborhoods nicer places to live all for nothing?

by x on May 18, 2012 7:39 pm • linkreport

+1 Liz

Apportioning blame doesn't solve the problem. Yes, fatties are responsible fir being fat and left unto themselves, they will continue being fat and costing the rest lots of $$$ in health care. Not to mention the fact thag fatness has been shown to show the same biologic pattern as a contagion. The more people you know who are fat, the more likely you are to be fat, holding all other variables constant.

The point is that we have to find ways to trick fatties into losing their weight so they stop exerting their externalities on the rest of us. Making walking a pleasant way to get around is a great way to trick them into burning several extra pounds per year of fat.

by Falls Church on May 18, 2012 9:52 pm • linkreport

AWalker wrote:
you made a claim. see the above. You failed to back it up.

Here's research, over a 15 year period, that states in the conclusion "walking may attenuate the long-term weight gain that occurs in most adults." The research also states:

"In summary, this study provides evidence that a higher frequency of walking is accompanied by a reduced weight gain and an increased likelihood of weight loss and weight maintenance over young-to-middle adulthood. That is, each extra 0.5 h/d of walking was associated with an annual reduced weight gain of 1 lb (0.54 kg) or 15 lb over 15 y for women who were heaviest at baseline."

In other words walking is shown to help reduce the rate of gaining weight, but it does not reduce an individual's weight over time. If you're a woman who weighs over 200 pounds, great benefits are reaped from losing weight and not simply slowing the rate at which it's being gained.

Source:
http://www.ajcn.org/content/89/1/19.abstract?ijkey=dbd75d25ae5de106b415a638d99b371e78e93ff7&keytype2=tf_ipsecsha

by Fitz on May 21, 2012 2:37 pm • linkreport

@Fitz- Weight loss is not the only or even the primary health benefit of physical activity. An overweight person who walks at a moderate pace for 150 minutes/week (~21 min/d) has a significantly lower risk of many chronic diseases than a person with the same BMI who is sedentary.

Linked below is a study showing significant benefits of even fewer total minutes of PA.

You're making a critical mistake focusing solely on weight/ weight loss. Physical activity even w/o weight loss significantly improves health. There is ample evidence of this.

If its impossible to walk to school or work even when those destinations are < 1 mile away b/c of the design of the built environment, that has a great impact on opportunity for physical activity on the individual level and on the overall health of a community.

Moderate means you can talk normally but have trouble singing.

http://www.ncbi.nlm.nih.gov/pubmed/21846575
http://archinte.jamanetwork.com/article.aspx?volume=164&issue=8&page=892

by Tina on May 21, 2012 5:19 pm • linkreport

@Tina, the first study is behind a paywall, so it's hard to tell what they controlled for. The second study, except for smoking, doesn't account for lifestyle. Both studies show correlation, not causation.

You're making a critical mistake focusing solely on weight/ weight loss. Physical activity even w/o weight loss significantly improves health. There is ample evidence of this.

If an individual is overweight and they simply add 90 minutes of walking/week and don't see any weight loss then what directly measurable and observable health improvements are they likely to see? If they were formerly sedentary then the added stresses of walking will initially tax them but their bodies will eventually adapt; that is why studies for obeses/overweight individuals show initial reduced weight gain w/in 6 months but lower rates 6 months after.

Is 90 minutes of walking better for overall health than not? Yes, but we need to stop pretending that it adds significantly to one's health, especially for overweight individuals. That requires significant diet and lifestyle changes.

by Fitz on May 22, 2012 7:02 am • linkreport

@Fitz-in health studies the only way to get beyond correlation is with a randomized clinical trial. Please note, the evidence we have that cigarette smoking causes cancer in humans is correlational. There is no causation w/o correlation. In studies of human health there is a lot that goes into causal inference. Its a complex concept that includes correlation.

The second study, except for smoking, doesn't account for lifestyle.

Routine moderate physical activity is an important modifiable lifestyle factor. The dependent variable is the health outcome. IIRC the study controlled for all the usual independent vars.

In any case there are many studies, including a nationwide clinical trial called the Diabetes Prevention Program that repeat this same outcome. The DPP was ended early b/c it was found that modest lifestyle changes of losing ~7% of weight and walking moderately for 150 mins a week was significantly better at preventing progression to diabetes than fancy drugs in people who were pre-diabetic, overweight/Obse and sedentary.

If an individual is overweight and they simply add 90 minutes of walking/week and don't see any weight loss then what directly measurable and observable health improvements are they likely to see?

The improvement to health when a sedentary person adds walking is Significantly reduced risk for many chronic diseases and longer lifespan.

The greatest increase in health improvement is seen when a sedentary person takes up moderate physical activity, e.g. walking 150 mins/week. The dose effect begins to flatten as a person adds more, and more intense activity.

studies for obeses/overweight individuals show initial reduced weight gain w/in 6 months but lower rates 6 months after.

An overweight person who loses ~7% of body weight significantly improves risk for many chronic diseases including impaired glycaemic control and type II diabetes. That means an person who starts out obese (BMI >=30) can lose weight and still be obese and still see significant improvement in long term health outcomes. These improvements are even stronger when modest physical activity is added.

Is 90 minutes of walking better for overall health than not? Yes, but we need to stop pretending that it adds significantly to one's health, especially for overweight individuals. That requires significant diet and lifestyle changes.

Again, you are too focused on drastic weight loss and super intense activity. Important significant improvements are achieved with modest changes.

There is ample evidence of this it is considered causal.

by Tina on May 22, 2012 10:49 am • linkreport

This article's use of Baltimore as an example is questionable at best. Anyone who's ever been to the Inner Harbor knows 1.) it's not really a neighborhood and 2.) it is not full of vacant houses. The bundling of large swaths of any city, whether for the purposes of research or not, is the sort of thought process that causes people to stereotype cities like Baltimore. The Inner Harbor is nice, other parts of Baltimore are not necessarily. To lump them together, however, isn't doing anyone any good. The areas surrounding the Inner Harbor are healthy urban spaces for the most part but they're old and dense and need to be rethought. There are also parts of North Baltimore that, though they are green and have access to parkland are full of vacant houses. Public health issues exist everywhere in major cities, it's foolish to think otherwise.

I understand this is an article about public health but before

by BmoreUrban on May 22, 2012 11:38 am • linkreport

@Tina:

Routine moderate physical activity is an important modifiable lifestyle factor. The dependent variable is the health outcome. IIRC the study controlled for all the usual independent vars.

So is their diet and social interaction, neither of which is accounted for in the 2nd study. More importantly, an individual's diet is a direct function of their weight.

The improvement to health when a sedentary person adds walking is Significantly reduced risk for many chronic diseases and longer lifespan.

Neither of the studies you linked to show that. All they show are associations between existing physical activity and either lifespan or risk of type II diabetes. The study that isn't behind a paywall notes that for overweight individuals their risk for type II diabetes is reduced through weight loss or improved body fat distribution. If you're overweight then increased physical activity must result in loss of weight and/or increasing strength if you want to see health benefits. Walking isn't going to add much physical strength b/c, as I noted earlier, your body will quickly adapt to low stress activity, so if you're not losing weight then you're not really seeing any significant health benefits.

Again, you are too focused on drastic weight loss and super intense activity. Important significant improvements are achieved with modest changes.

My initial comments on walking were in regards to a statement from MLD that transit was "much healthier" (in their words, not mine) b/c there was more everyday walking. There might be fringe benefits to walking, and one might see incentives for increased physical activity, but simply stating "walking everyday using transit is much healthier than not" is nonsense.

by Fitz on May 22, 2012 11:39 am • linkreport

@Fitz, there is a pile of evidence refuting your suppositions.
One more time, modest changes in weight loss (~7% reduction in weight in those who are overweight) and modest physical activity, including walking ~20 minutes a day at a moderate pace significantly improve health outcomes. The author referred to studies indicating that people who live in walkable communities, on average walk 19 mins a day more than those in non-walkable communities and weigh on avg. 6lbs less. thos small differences are enough to improve health outcomes of the community, on the population level.

There is ample of evidence of this from good studies w/ internal and external validity. it doesn't matter how many times you say you don't believe it.

by Tina on May 22, 2012 11:58 am • linkreport

@Tina,

The study I initially linked to this in this post showed that adding 30 minutes of walking per day provided only modest reduction in annual weight gain, not weight loss. If you're overweight, add physical activity to your lifestyle and don't lose weight then there needs to be other measurable benefits. The study on risk to type II diabetes noted that the risks may be lowered with weight loss or gaining muscle strength. Walking will initially help an individual increase some muscle strength but their body will adapt over time.

by Fitz on May 22, 2012 2:01 pm • linkreport

"The study I initially linked to this in this post showed that adding 30 minutes of walking per day provided only modest reduction in annual weight gain, not weight loss"

becuase people tend to add weight as the age. So they end up at a lower weight then they would have if they did not walk.

As for the diabetes study, they speculated about what the intermediate factors may have been. You keep arguing that it couldnt be those intermediate factors - yet the health outcomes were improved. So either the walking was a proxy for some other lifestyle change, or there were other intermediate factors. I see no reason to assume it was not another intermediate factor. Our bodies are complex, and I don't think you can reduce the impact of exercise, which has many biochemical impacts, to only a couple of pathways.

by AWalkerInTheCity on May 22, 2012 2:10 pm • linkreport

If you're overweight, add physical activity to your lifestyle and don't lose weight then there needs to be other measurable benefits.

The measurable benefits are significantly reduced risk for chronic diseases. These are health outcomes measured, for instance, over time in a cohort with a life-table or cox proportional hazard. http://www.statsoft.com/textbook/survival-failure-time-analysis/

These are measurable outcomes.

The study on risk to type II diabetes noted that the risks may be lowered with weight loss or gaining muscle strength. Walking will initially help an individual increase some muscle strength but their body will adapt over time.

What matters is maintaining the routine physical activity. This lifestyle factor measurably, significantly so, contributes to better health outcomes over time compared to if it is not maintained. It doesn't matter if the amount and intensity of PA remain the same.

Again, There is a mountain of evidence. If you don't like these two studies there are others that you may like better. Look in pubmed. Use search words physical activity, risk chronic disease. http://www.ncbi.nlm.nih.gov/pubmed/22564893

by Tina on May 22, 2012 3:13 pm • linkreport

Go Christine!

Nice article.

by Mark Dravillas on May 24, 2012 2:47 pm • linkreport

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