Built Environment in Relation Built Environment in Relation to to

Obesity and Physical ActivityObesity and Physical Activity

Fuzhong Li, Ph.D.Fuzhong Li, Ph.D.

Oregon Research InstituteOregon Research Institute

Part I

FocusFocus

To understand To understand the basic terminologiesthe basic terminologies the scope of problems related to the scope of problems related to

overweight/obesity, physical inactivity overweight/obesity, physical inactivity

To layout To layout conceptual framework to the study of conceptual framework to the study of

environmental healthenvironmental health

Terminology and DefinitionsTerminology and DefinitionsWhat Is Built Environment?What Is Built Environment?

Encompasses all of the buildings, Encompasses all of the buildings, spaces, and products created or spaces, and products created or modified by people. modified by people. For example: buildings (housing, schools, For example: buildings (housing, schools,

workplaces); land use (industrial or workplaces); land use (industrial or residential); public resources (parks, residential); public resources (parks, museums); zoning regulations; museums); zoning regulations; transportation systems. transportation systems.

What is the Built What is the Built Environment?Environment?

Spatial scales:Spatial scales:

Micro Small Intermediate Large

Community Design and HealthCommunity Design and Health

Related to land useRelated to land use

Related to automobile Related to automobile dependencydependency

Related to social Related to social processesprocesses

Obesity, physical activityObesity, physical activity, , CVDCVDWater quantity and qualityWater quantity and qualityAccess to green spaces and Access to green spaces and parksparks

Air pollution and asthmaAir pollution and asthmaClimate change contributionClimate change contribution Car crashesCar crashes Pedestrian injuriesPedestrian injuries

Mental health impactMental health impact Social capitalSocial capitalHealth equityHealth equity

Urban Sprawl

TransportationTransportation

The Streetscape

Connectivity

Traditional Neighborhood

Suburban Development

Drawing by Duany Plater Zyberk, in ITE Journal 1989;59:17-18

Air Pollution

Key Health ImpactsKey Health Impacts Built EnvironmentBuilt Environment Obesity, inactive and unhealthy lifestyleObesity, inactive and unhealthy lifestyle Motor Vehicle AccidentsMotor Vehicle Accidents Pedestrian / Bicyclist Injuries and FatalitiesPedestrian / Bicyclist Injuries and Fatalities

Air QualityAir Quality Air PollutionAir Pollution

Contact with NatureContact with Nature Climate ChangeClimate Change

Terminology and DefinitionsTerminology and DefinitionsBody Mass Index (BMI)Body Mass Index (BMI)

Defined: Weight (kg) / height (m)Defined: Weight (kg) / height (m)22

Categories: Categories: Underweight: < 18.5Underweight: < 18.5 Normal: 18.5 – 24.9Normal: 18.5 – 24.9 Overweight: 25 – 29.9Overweight: 25 – 29.9 Obesity: 30 or greaterObesity: 30 or greater

Source: National Heart Lung and Blood InstituteSource: National Heart Lung and Blood Institute

Prevalence of Overweight and Prevalence of Overweight and Obesity in the United StatesObesity in the United States

Among adult men, prevalence was Among adult men, prevalence was 31.1% in 2003-2004, 33.3% in 2005-31.1% in 2003-2004, 33.3% in 2005-20062006

Among adult women, 33.2% in Among adult women, 33.2% in 2003-2004, 35.2% in 2005-20062003-2004, 35.2% in 2005-2006

16.3% of children and adolescents 16.3% of children and adolescents aged 2-19 years were obeseaged 2-19 years were obese

Source: http://www.cdc.gov/nccdphp/dnpa/obesity

Prevalence of Overweight and Prevalence of Overweight and Obesity in the United States Obesity in the United States

(cont.)(cont.)

TrendTrend The increase (percentage points) in The increase (percentage points) in

obesity and overweight in adults was obesity and overweight in adults was faster than in children (0.77 vs. 0.46–faster than in children (0.77 vs. 0.46–0.49), and in women than in men (0.91 0.49), and in women than in men (0.91 vs. 0.65). vs. 0.65).

Source: Wang et al. (2008). Obesity.

Prevalence of Overweight and Prevalence of Overweight and Obesity in the United States Obesity in the United States

(cont.)(cont.) ProjectionProjection by 2030, 86.3% adults will be overweight or obese; and by 2030, 86.3% adults will be overweight or obese; and

51.1%, obese51.1%, obese. Black women (96.9%) and Mexican-. Black women (96.9%) and Mexican-American men (91.1%) would be the most affected. American men (91.1%) would be the most affected. By By 2048, all American adults would become overweight or 2048, all American adults would become overweight or obeseobese, while black women will reach that state by 2034., while black women will reach that state by 2034.

In children, the prevalence of overweight (BMI 95th In children, the prevalence of overweight (BMI 95th percentile, 30%) will nearly double by 2030.percentile, 30%) will nearly double by 2030.

Source: Wang et al. (2008). Obesity.

Overweight and Obesity and Overweight and Obesity and Health RisksHealth Risks

Heart disease and strokeHeart disease and stroke

High blood pressure (hypertension)High blood pressure (hypertension)

DiabetesDiabetes

Certain Cancer (breast, colon)Certain Cancer (breast, colon)

Gallbladder disease and gallstonesGallbladder disease and gallstones

OsteoarthritisOsteoarthritis

Breathing problems, such as sleep apneaBreathing problems, such as sleep apnea

Terminology and DefinitionsTerminology and DefinitionsPhysical ActivityPhysical Activity

““Bodily movement produced by the Bodily movement produced by the contraction of skeletal muscle that contraction of skeletal muscle that increases energy expenditure above increases energy expenditure above the basal level”the basal level”

Source: USDHHS (1996)Source: USDHHS (1996)

Recommended Physical Recommended Physical Activity Levels - AdultsActivity Levels - Adults

Moderate-intensity aerobic (endurance) Moderate-intensity aerobic (endurance) physical activities (i.e., brisk walking, physical activities (i.e., brisk walking, bicycling, vacuuming, gardening, or bicycling, vacuuming, gardening, or anything else that causes small anything else that causes small increases in breath or heart rate) for a increases in breath or heart rate) for a minimum of 30 min on five days each minimum of 30 min on five days each week week

OROR

Source: Haskell et al. (2007), Medicine & Science in Sports & Exercise

Recommended Physical Recommended Physical Activity LevelsActivity Levels

Vigorous-intensity aerobic Vigorous-intensity aerobic physical activities (i.e., running, physical activities (i.e., running, aerobics, heavy yard work, or aerobics, heavy yard work, or anything else that causes large anything else that causes large increases in breathing or heart increases in breathing or heart rate) for a minimum of 20 min on rate) for a minimum of 20 min on three days each weekthree days each week

Source: Haskell et al. (2007), Medicine & Science in Sports & Exercise

Insufficient Physical ActivityInsufficient Physical Activity

Doing more than 10 minutes Doing more than 10 minutes total per week of moderate or total per week of moderate or vigorous-intensity lifestyle vigorous-intensity lifestyle activities (i.e., household, activities (i.e., household, transportation, or leisure-time transportation, or leisure-time activity), but less than the activity), but less than the recommended level of activityrecommended level of activity

Source: http://www.cdc.gov/nccdphp/dnpa/physical/stats/definitions.htm

InactivityInactivity

Less than 10 minutes total per week of Less than 10 minutes total per week of moderate or vigorous-intensity lifestyle moderate or vigorous-intensity lifestyle activities (i.e., household, transportation, activities (i.e., household, transportation, or leisure-time activity).or leisure-time activity).

Source: http://www.cdc.gov/nccdphp/dnpa/physical/stats/definitions.htm

Levels of Physical ActivityLevels of Physical Activity

Source: apps.nccd.cdc.gov/PASurveillance/StateSumV.asp

1988-2007 No Leisure Time 1988-2007 No Leisure Time Physical Activity NationwidePhysical Activity Nationwide

Source: www.cdc.gov/nccdphp/dnpa/physical/stats/leisure_time.htm

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

ThailandThailand

Source: Thailand Health Profile – 2004-2006

Yes, I ExerciseYes, I Exercise

All You Can DoAll You Can Do

Health Risks of Physical InactivityHealth Risks of Physical Inactivity

Risk of coronary heart diseaseRisk of coronary heart disease People with inactive and unfit almost twice People with inactive and unfit almost twice

as likely to die from heart disease as more as likely to die from heart disease as more active and fit peopleactive and fit people

Risk of being overweigh or obese, Risk of being overweigh or obese, Which in turn, associated with certain Which in turn, associated with certain

cancers, osteoarthritis, and back problemscancers, osteoarthritis, and back problems

Risk of developing type 2 diabetesRisk of developing type 2 diabetes

Risk of lowering bone density - osteoporosisRisk of lowering bone density - osteoporosis

Certain CancerCertain Cancer

Inactivity, Overweight, Inactivity, Overweight, and Healthand Health

InactivityInactivity OverweightOverweight

Increased mortalityIncreased mortality Cardiovascular diseaseCardiovascular disease CancersCancers DepressionDepression Gall bladder diseaseGall bladder disease OsteoporosisOsteoporosis HypertensionHypertension

Evidence links inactivity and overweight with…

Built Environment in Relation to Built Environment in Relation to Overweight or Obesity, and Physical Overweight or Obesity, and Physical

Activity: Activity: An Ecologic ModelAn Ecologic ModelIndividual factors

Genetics

Socioeconomic Characteristics

Other individual characteristics

Social factors

Family and peer influences

Socioeconomiccharacteristics

Food consumption (energy intake)

Physical activity (energy expenditure)

Source: Powell et al. (www.impacteen.org)

BMI Environmental factors

Built environment

Economic influences (cost and access)

Neighborhood safety (perceived/objective)

Transportation opportunities

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Lifestyle/behavioral factors

Part IIPart II

ResearchResearch and and

ImplicationsImplications