is the environment causing obesity? taking action to ... · macro-environment policies,...

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

Estimated Costs of Obesity

0

20

40

60

80

100

120

140

160

1998 2008

Bill

ions o

f U

S D

olla

rs

Finkelstein EA, Trogdon JG, Cohen JW, Dietz W. Annual medical spending attributable to obesity: payer-

and 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 ChangeTechnology, Globalization

Macro-Environment Policies, Institutionalized Norms, Weather

Micro-EnvironmentWork, School, Home

Meso/Exo-EnvironmentTravel, Social Relationships

Obesity

BiologyGenetics

Ecologic Model of Obesity

Lee RE, McAlexander KM, Banda JA. Reversing the Obesogenic

Environment. Champaign, IL: Human Kinetics; 2011.

Individual Choices?

Outline





• Conclusions

Defining Neighborhoods

• Geographic

Information

Systems (GIS)

• Boundaries

–Buffers

–Streets

–Census geography

–School Locations

#

#

#

#

#

#

#

#

##

#

#

###

#

#

#

# ## ####

#

#

##

#

#

##

###

##

##

# # ##

# #

#

##

#

# ##

## #

##

# ##

##

##

#

#

##

#

#

###

# ##

#

##

# #

##

# ##

###

##

#

#

##

#

##

#

#

#

#

#

#

##

##

#

# ####

## #

#

#

#

########

##

##

#

##

#

##

###

##

##

## ###

##

##

#

##

###

###

### #

###

###

##

###

###

# ###

##

##

#

# #

## ##

##

#

#

##

##

#

#

# #

#

##

## #

#

#

##

##

#

### #

#

# #

#

#

#

#

##

#

#

##

###

#

## #

#

##

###

## #

### #

# # #

#

#

#

#

#

#

#160620

130226

120089

110046

130133

130213

140323

160365130178120077

100023130168130148

120108

160629110005

160545

100003 160608160563

140260

120088

160548

140307110012

160512

160358

140319110060

110006

160544

160471

110019

110062

130092120223

140269

130231

140280

160665

160637110002

160689

160658110038

100044

110014

160568

150368140290

120100

110058

110051

110008

150482160675

160680

160619

140079

130147

160602110063

160582

160541

150518

130237

120229

160679

130203

160564

150531100030

160630130275

160632

100071

150315120111

100029

160470

150346

130162120222

140332

130099110015130185

150523130274130273

140308

130128

120110

150342

160547

130083130097

160527

140291

130170130276

150543150394

160549

150490 160638130192

130165

100038140289

110001

130245 150366

130232

120220

100047

120124

100012

140221100001

160667140306

140299

130230

120109

110016100017

160551

140287

110037

140325

140301

160594

120129

100062

130145

130278

130149

100039160678

150359140339

110049

110044

120272

100051

100004

150224160687

110029

160627150341140285

100050160654

140326

110064

150540

100008100007

140312

140295

100061

110061

150362

150337

130036

150473

140199

130144

140297

130091

140349

110020

100069

160530

100049

100037

150505

100032100022

140333 130137

130236160586

150532

140281

100041

120256

120086100026

100063160593

140282

120270

100060

160646110052

150506

130233

100053130175

150458

110004

110032

110048160628

160633

100035

140294120202

160583

140309

130240150361

150507

130166

120205

100040

140286160618

160603

150488160684

150484

160591120090

160656

140338

160669150510

150481

160565130251

100058

150353

150345

150477

150395

150504

150478

160553150456

150367

140304130177100045

150351

130255

110013

120125100034

140316

150533

160571

140343

140300

130171

160652

140324

120098

130248

140235

160643

160370

¯

Created for Health is Power Research Project Fall 2007

Residences of HIP Houston Participants

0 10 205 KilometersLegend

# Participant Residences

Highway

Arterial 400 m buffer

800 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.

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

400 meters

800 meters

Defining Neighborhoods

• Radial buffer

• All arterials

• 25% of residentials

• Street segments

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

ActivitySlower 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.

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




Outline





• 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.


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 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

Most common resources were parks,

schools, community resources

Wide variability in resource availability

Many, many more incivilities in low SES

neighborhoods





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


• Case 1. Neighborhood



• Conclusions

Food Environment

• Food Stores Assessment (FSA)

• Restaurant Assessment Tool (RAT)


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.

Food Store Assessment


Store Types in Low SES

Neighborhoods

Most commonly available stores were

convenience and liquor stores




Store Types in Low SES

Neighborhoods




Convenience stores and liquor stores sell

convenience foods

Stores and Fresh Produce

Percent of Neighborhoods with Stores Selling Fresh Produce

0

10

20

30

40

50

60

70

80

90

100

Fruit Vegetables

%

Low SES

High SESMost lower SES

neighborhoods

had only one store

that sold fresh

produce

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 of Products

Cost of Buying 6 Pounds of Mixed Produce

0

2

4

6

8

10

12

Farmers' M

arkets

Sm

all Groceries

Superm

arkets

Convenience

Price U

S$

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




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




Outline


• Case 1. Neighborhood



• 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

[email protected]

is the environment causing obesity? taking action to ... · macro-environment policies,...

Documents