slide1 n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Obesity and the built environment Obesity Issues Program National Press Foundation University of Colorado at Denver PowerPoint Presentation
Download Presentation
Obesity and the built environment Obesity Issues Program National Press Foundation University of Colorado at Denver

Loading in 2 Seconds...

play fullscreen
1 / 33

Obesity and the built environment Obesity Issues Program National Press Foundation University of Colorado at Denver - PowerPoint PPT Presentation


  • 24540 Views
  • Uploaded on

Obesity and the built environment Obesity Issues Program National Press Foundation University of Colorado at Denver. Janne Boone-Heinonen, PhD, MPH Assistant Professor of Epidemiology Oregon Health & Science University Penny Gordon-Larsen, PhD Professor of Nutrition

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Obesity and the built environment Obesity Issues Program National Press Foundation University of Colorado at Denver' - atalo


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
slide1

Obesity and the built environmentObesity Issues ProgramNational Press FoundationUniversity of Colorado at Denver

Janne Boone-Heinonen, PhD, MPH

Assistant Professor of Epidemiology

Oregon Health & Science University

Penny Gordon-Larsen, PhD

Professor of Nutrition

University of North Carolina at Chapel Hill

April 30, 2013

Key reference

Boone-Heinonen J, Gordon-Larsen P. Am J Prev Med. 2012;42(5): e37-46.

session objectives
Session objectives
  • Conceptual framework for research on the built environment and obesity
  • Overview of the evidence: examples of studies on key built environment features
      • Diet
      • Physical activity
  • Issues to consider when evaluating built environment research

Challenges of studying how the built environment effects obesity

  • What is on the horizon?
slide4

What is an obesogenic environment?

What aspects of the environment support this…

…as opposed to this?

the built environment
The Built Environment

“Consists of the neighborhoods, roads, buildings, food sources, and recreational facilities in which people live, work, are educated, eat, and play”

  • Sallis & Glanz 2006 Future Child

Also known as: “neighborhood environment”, “obesogenic environment”, “physical environment”, “physical activity environment”, “food environment”

Key references

Sallis JF, Glanz K. Future Child. Spring 2006;16(1):89-108.

Saelens BE, Sallis JF, Frank LD. Ann Behav Med. Spring 2003;25(2):80-91.

Saelens BE, Handy SL. Med Sci Sports Exerc. Jul 2008;40(7 Suppl):S550-566.ç

o besity related policy strategies
Obesity-related policy strategies

White House Task Force on Childhood Obesity (Let’s Move!)

Recommendation 5.13: Increase the number of safe and accessible parks and playgrounds, particularly in underserved and low-income communities.

Recommendation 4.2: Local governments should be encouraged to create incentives to attract supermarkets and grocery storesto underserved neighborhoods.

Los Angeles Ordinance #180103

…prohibit the establishment of new fast food restaurants in South Los Angeles that will be effective for 365 days…

White House Task Force on Childhood Obesity Report to the President: http://www.letsmove.gov/white-house-task-force-childhood-obesity-report-president

LA Ordinance: http://cityplanning.lacity.org/Code_Studies/Misc/FastFoodInterim.pdf; Sturm & Cohen. Health Aff. 2009;28(6): w1088-w1097

supermarkets a source of affordable fresh produce
SupermarketsA source of affordable, fresh produce?

Likelihood of meeting dietary guidelines among adults with 1+ supermarkets in their neighborhood, relative to no supermarkets

Photo: examiner.com

ARIC Study. Census tract-defined neighborhoods. Adjusted for other types of food stores, food service plans, income, and education.

Morland et al. Am J Public Health. 2002;92:1761-1767

food deserts
Food deserts?
  • Access to Affordable and Nutritious Food – Measuring and Understanding Food Deserts and Their Consequences: Report to Congress. Administrative Publication No. (AP-036) 160 pp, June 2009
    • Few households live in food deserts
    • Most low-income households shop for food outside their neighborhoods
    • Transportation barriers

Food desert (USDA definition)

Low‐income census tract where either a substantial number or share of residents has low access to a supermarket or large grocery store

Food swamps?

Prof. Donald Rose, Tulane University

Access to healthy andunhealthy foods may influence diet

http://www.npr.org/blogs/thesalt/2013/03/13/174112591/how-to-find-a-food-desert-near-you

Map from: USDA Food Atlas

food swamps easy a ccess to affordable calorie dense food
Food swampsEasyaccess to affordable, calorie dense food?

Fast food restaurants

Convenience stores

fast food restaurants a source of affordable high calorie foods
Fast food restaurantsA source of affordable, high calorie foods?

Greater BMI in women living in areas with greater fast food restaurant density

For 5’ 4” person:

BMI of 29.0 = 169 pounds

BMI of 29.3 = 171 pounds

Women’s Health Initiative. Fast food density per 1,000 persons w/in 1.5 miles of home. Adjusted for birth cohort, race/eth, education, marital status, income, urbanicity, population density, availability of grocery stores, neighborhood SES

Dubowitz et al. Obesity. 2012;20(4):862-71

other retail food outlets of interest
Other retail food outlets of interest

Farmers markets

Vegetable and produce markets

Small grocery stores

Supercenters

slide13

Walkability/Urban sprawl

Supporting walking and cycling for transportation?

Suburban development, many cul-de-sacs

Well-connected urban development with mixed land uses

Obesity & The Environment

The University of North Carolina at Chapel Hill

example walkability urban sprawl
Example: walkability/urban sprawl

Graded increase in likelihood of performing 30+ minutes/day of moderate-intensity physical activity with greater walkability index

Photo: http://christophgielen.com/christoph_gielen.html

SMARTTRAQ. 1-km network buffers. Adjusted for gender, age, education, ethnicity.

Frank et al. Am J Prev Med. 2005;25(2S2):117-125

r ecreation facilities settings for exercise
Recreation facilitiesSettings for exercise

Greater proportion reporting physical activity 1+ times per week with greater density of recreational resources

MESA. Euclidean buffers. Adjusted for gender, age, income, race/ethnicity, study site, perceived neighborhood violence.

Diez Roux et al. Am J Public Health. 2007;97:493-499.

1 why do you live where you live
1. Why do you live where you live?

Who lives on Main Street?

?

Main street

Walk to the store

Preference to walk to the store

Who lives in the suburbs?

?

Suburbs

Walk to the store

Downtown commute

Budget constraints

do supermarkets lead to healthier diets another look with data that follows people over time
Do supermarkets lead to healthier diets?Another look with data that follows people over time

Supermarkets

Diet Quality

Assess changes in diet quality related to changes in supermarket availability, analyzed in two different ways:

Comparable to prior studies: expected findings

Focusing on changes over time: relationship no longer apparent

WHY?

Complex decisions about where to live

Purposeful placement of supermarkets

CARDIA Study. Supermarkets per 100,000 population. Adjusted for individual-level sociodemographics and census tract-level poverty.

Boone-Heinonen, et al. Arch Int Med. 2011;171(13):1162-1170

2 does the built environment effect everyone equally
2. Does the built environment effect everyone equally?

Percent increase in likelihood of meeting dietary guidelines in the presence of 1+ supermarkets in the census tract of residence (versus no supermarkets)

Differences in associations are observed for numerous aspects of the food and physical activity environments

ARIC Study. Adjusted for other types of food stores, food service plans, income, and education.

Morland et al. Am J Public Health. 2002;92:1761-1767

3 what is a neighborhood consider
3. What is a neighborhood?Consider…

How far will you walk…

…to the park?

…for coffee?

How far will you drive…

…to the gym?

…to the grocery store?

…for a burger?

neighborhood buffers
Neighborhood buffers

Also: ZIP codes, Census Tracts, Census Block Groups

slide22
2 & 3. The way we should define neighborhoods may vary by gender, income, race/ethnicity, urbanicity, and others

*

Fast food restaurants

Relationship only found in low-income men, within 2 miles of homes

WHY?

Why not low-income women?

Why not high-income men?

Why only close to home?

Photo: http://trimet.org

CARDIA Study. Fast food restaurants per 10,000 population. Adjusted for individual-level sociodemographics and census tract-level poverty.

Boone-Heinonen, et al. Arch Int Med. 2011;171(13):1162-1170

4 what else is in your neighborhood teasing apart complex neighborhood environments
4. What else is in your neighborhood?Teasing apart complex neighborhood environments
  • Density (walkability) may be important for physical activity
  • Many aspects captured by urbanicity
  • Alternative built environment measures:
    • Resources per 10,000 population
    • Resources per mile of road
    • Ratios of healthy/unhealthy resources
5 many diet physical activity and health outcomes
5. Many diet, physical activity, and health outcomes

Fast food restaurants

Supermarkets

Physical activity settings

slide26
Approaches for looking at multiple diet, physical activity, and health outcomes: complex statistical modeling

Fast food restaurants

Supermarkets

Physical activity settings

what is a healthy food resource
What is a “healthy” food resource?
  • Other features of interest
  • Specific type (Chipotle vs. Burger King)
    • Non-traditional outlets
  • Types of foods sold (fresh produce vs. candy)
  • Quality of foods sold (“fresh” vs. “not-so-fresh” fresh produce)
  • Affordability (“food mirage”*)

Traditional convenience store

Village Market (Portland, OR)

Photo: Rebecca Koffman, The Oregonian

*Noelle Dobson, Oregon Public Health Institute

many steps between neighborhood availability and diet
Many steps between neighborhood availability and diet

Environmental factors

Individual factors

Availability of supermarket

Proximity

Transportation

Time constraints

Preferences: cultural, dietary

Travel to supermarket

Availability

In-store marketing

Food placement

Preferences

Locate food items

Select & purchase food items

Affordability

Quality

Financial constraints

Preferences

Prepare food items

Skills

Preferences

Time constraints

(other neighborhood food options)

Consume food items

Preferences

slide31

Policy approaches to influencing

dietary Intake and physical activity

Adapted from Popkin BM, unpublished

does the built environment effect
Does the built environment effect ________?
  • Where would you rather…
    • Walk to dinner?
    • Go for a jog?
  • Why?
  • (narrow) Sidewalks
  • Shade
  • Low traffic
  • Parks for recreation
  • Cul de sacs for play
  • (wide) Sidewalks
  • Shade
  • Dense, diverse (short distances)
  • Public transportation
  • Limited/expensive parking
slide33

Biological & Demographic

Age, sex, race/ethnicity, SES, genes

Psychological

Beliefs, preferences, emotions, self-efficacy, intentions,

pros, cons, behavior change skills, body image,

motivation, knowledge

Social/Cultural

Social support, modeling, family factors,

social norms, cultural beliefs, acculturation

Organizational

Practices, programs, norms, & policies in schools, worksite,

Health care settings, businesses, community orgs

Physical Environment

Access to & quality of foods, recreational facilities, cars,

sedentary entertainment; urban design,

transportation infrastructure

Policies/Incentives

Cost of foods, physical activities, & sedentary behaviors;

incentives for behaviors; regulation of environments

An Ecological Model of Diet, Physical Activity, & Obesity

Influences

Behaviors

Health

Outcomes

Eating

Dietary patterns,

nutrient intake

Sedentary

Behaviors

TV, computer use,

driving

Body Weight,

Fat, &

Distribution

Energy Balance

Physical Activity

Recreation,

transportation,

occupation,

domestic

Risk Factors,

CVD,

Diabetes,

Cancers,

Costs

Developed for the NHLBI Workshop: Predictors of Obesity, Weight Gain, Diet, and Physical Activity; August 2004, Bethesda MD