Dissecting and influencing Obesogenic environments: Urban Design

1. Physical Activity and Nutrition Research Unit Dissecting and influencing Obesogenic environments:Urban Design Professor Boyd Swinburn Physical Activity and Nutrition Research Unit School of Health Sciences Deakin University Melbourne Australia

2. Physical Activity and Nutrition Research Unit Outline The obesity pandemic & current approaches Ecological view of obesity Some education/motivation strategies Obesogenic environments ANGELO framework Specific settings: schools, neighbourhoods, transport networks, buildings Other priorities

3. Physical Activity and Nutrition Research Unit Increasing obesity prevalence

4. Physical Activity and Nutrition Research Unit Current approaches to obesity Perceived causes Lifestyle (eating and physical activity choices) Genetic background Perceived solutions Education (to individuals and populations) Diets and various ‘magic bullet’ treatments Drugs / surgery Research effort Potential genetic causes (? drugs, identify at risk individuals) Treatment options (diet, exercise, drugs)

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6. Physical Activity and Nutrition Research Unit Education / motivation interventions EXAMPLES: Australian Physical Activity Guidelines Green Prescriptions – written exercise prescriptions from GPs (NZ) TravelSmart – household marketing of alternative transport options (WA)

7. Physical Activity and Nutrition Research Unit PA guidelines Think of movement as an opportunity not an inconvenience Move every day in as many ways as possible Put together at least 30 minutes of moderate intensity activity on most days If you can, do some vigorous exercise a few times a week

8. Physical Activity and Nutrition Research Unit Green Prescriptions(Swinburn et al 1998, Am J Publ Health) RCT of written vs verbal advice on PA N=491, F/U 6 weeks Both increase PA, GRx > verbal advice At 11 months, 59% maintained ? PA After GP detailing ~50% GPs using GRx in 1999 52% maintaining ? PA after 6 months

9. Physical Activity and Nutrition Research Unit Transport – South Perth trial Household marketing of alternative options for transport in South Perth (good public transport services) 97 fewer ‘car as driver’ trips, 75 more as ‘active transport’ Net effect: Walk + bicycle ?~30 minutes/week www.travelsmart.transport.wa.gov.au

10. Physical Activity and Nutrition Research Unit Environments Obesogenic environments = “the sum of influences that the surroundings, opportunities or conditions of life have on promoting obesity in individuals or populations” Obesogenic = “promoting obesity” Leptogenic = “promoting leanness” Setting = places where people gather Sector = Broader systems, industries, services (state, federal, international)

11. Physical Activity and Nutrition Research Unit Obesogenic Environments Fundamental drivers of obesity epidemic Built on some natural human preferences (eg easy, convenient, value for money, fast, low effort) Most dominant driver is profit motive Making environments more ‘leptogenic’: Drivers are mainly policy and social changes Environment/public governance movements allies Aim to achieve small changes in large volume activities (eg transport, stairs, recreation)

12. Physical Activity and Nutrition Research Unit Strengths of environmental solutions Address underlying causes Sustainability Embeds in structures and systems Embeds in social norms Health equity Can influence the ‘hard-to-reach’ Less language dependent Effectiveness Often very cost-effective Influences ‘default’ behaviours Minimises message distortions

13. Physical Activity and Nutrition Research Unit ANGELO Framework(Analysis Grid for Environments Linked to Obesity)

14. Physical Activity and Nutrition Research Unit Uses of ANGELO Used with stakeholders for scanning environments for obesogenic elements Needs analysis ? ANGELO Problem identification ? ANGELO Strategy development Intervention Evaluation Shifts the focus upstream Robust (tested in NZ, Australia, Pacific Islands, Middle East)

15. Physical Activity and Nutrition Research Unit Example – Schools (PA)

16. Physical Activity and Nutrition Research Unit Driving children to school(Christchurch NZ - C O’Fallon, 1999) 77% of people with primary school children drove them to school 4+ days/week 54% live <2km from school Reasons for travel by car to school 35% road safety 28% distance 16% already going to work

17. Physical Activity and Nutrition Research Unit School setting Physical (what is available?) Outdoor space, indoor space, gym, equipment, PE in curriculum, sports teams, non-competitive activities, coaching, walking bus, safe routes to school, traffic calming/reduction, skilled teachers Economic (what are the financial factors?) Costs to students: playing some sports, travel Budgets: school funding allocation for PE, sports, grounds, facilities

18. Physical Activity and Nutrition Research Unit Schools setting (contd) Policy (what are the rules?) School policies/rules on transport (eg cycling) to school, PE in curriculum, equipment use, participation in sports (students and teachers) Socio-cultural (what are the attitudes, beliefs, perceptions and values?) School ethos on sports, participation, exercise Perceptions of safety of walking/cycling to school Beliefs about PA and classroom learning Beliefs about causes of obesity, school role in health promotion

19. Physical Activity and Nutrition Research Unit Sectors related to schools Education system Policies on PE requirements in curriculum Funding for space, facilities School transport systems Local government Provision of footpaths, cyclepaths, playing fields Traffic laws (eg stopping for buses) Transport sector Provision of traffic calming measures

20. Physical Activity and Nutrition Research Unit Prioritising process An ANGELO workshop with stakeholders identifies many potential obesogenic elements Need to prioritise elements on basis of: Changeability (how amenable is it to change?) Relevance (how much of a problem in this population?) Impact (how much will it affect population PA levels?) May lead to action, further research, further consultation

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22. Physical Activity and Nutrition Research Unit Brief examples Neighbourhoods Active recreation locally Transport Networks Active transport = walking, cycling, public transport (13 min walking per PT trip vs 2 min per car trip) Buildings Incidental activity (mainly use of stairs)

23. Physical Activity and Nutrition Research Unit Neighbourhoods(parks, open spaces, recreation facilities) Physical Availability, access, quality, facilities, lighting Economic Costs to users, local govt budget allocations Policy Green space requirements in suburbs, ‘policy orientation’ towards participation, car-free areas Socio-cultural Perceptions of safety, community value/ownership of spaces, cultural attitudes to exercise

24. Physical Activity and Nutrition Research Unit Access to recreation facility versus use(Odds ratio compared to top quartile of access)

25. Physical Activity and Nutrition Research Unit Transport networks Physical Extent of and access to networks and services for cars, public transport, cycling, walking Urban design – mixed use, density, corridors Economic Costs of public transport vs car Direct – fares vs car, gas, parking, tolls, insurance etc Indirect – environmental costs Budget allocations/subsidies for car vs PT infrastructure

26. Physical Activity and Nutrition Research Unit Transport networks (contd) Policy Funding formulae for transport infrastructure Traffic laws, by-laws Socio-cultural ‘Car culture’ among citizens, transport bureaucracy, and politicians Advertising the ‘car dream’ Belief in technological solutions ‘Road ownership’

27. Physical Activity and Nutrition Research Unit Buildings (stairs) Physical Visible, accessible, attractive, promoted Economic Added building costs to include accessible stairs Policy Fire and security regulations Socio-cultural Attitudes of public to stair use (inconvenience or opportunity), perceptions/attitudes of architects

28. Physical Activity and Nutrition Research Unit Other priority issues Children and adolescents Difficulty of losing weight in adulthood More intervention options Opportunity to influence adults through children Monitoring and surveillance Connect with policy, funding, education, advocacy Indicators versus total picture Sentinel sites (‘guinea pig’ populations) Brings intersectoral action to manageable size

29. Physical Activity and Nutrition Research Unit The built environment - conclusions Fundamental but neglected links to obesity Can be scanned and prioritised for interventions Interventions are: Complementary to public education Concordant with sustainability/ environmental protection efforts Priorities: Children, monitoring, sentinel sites, high volume PA Desperately need well-evaluated wins