Built Environment in Relation
to
Obesity and Physical Activity
Part I
Fuzhong Li, Ph.D.
Oregon Research Institute
Focus
To understand
 the basic terminologies
 the scope of problems related to
overweight/obesity, physical inactivity
To layout
 conceptual framework to the study of
environmental health
Terminology and Definitions
What Is Built Environment?
Encompasses all of the buildings,
spaces, and products created or
modified by people.

For example: buildings (housing, schools,
workplaces); land use (industrial or
residential); public resources (parks,
museums); zoning regulations;
transportation systems.
What is the Built
Environment?
Spatial scales:
Micro
Small
Intermediate
Large
Community Design and Health
Related to land use
Related to automobile
dependency
Related to social
processes
Obesity, physical activity, CVD
Water quantity and quality
Access to green spaces and
parks
Air pollution and asthma
Climate change contribution
 Car crashes
 Pedestrian injuries
Mental health impact
 Social capital
Health equity
Urban Sprawl
Transportation
The Streetscape
Connectivity
Suburban
Development
Air Pollution
Traditional
Neighborhood
Drawing by Duany Plater
Zyberk, in ITE Journal
1989;59:17-18
Key Health Impacts
Built Environment

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Obesity, inactive and unhealthy lifestyle
Motor Vehicle Accidents
Pedestrian / Bicyclist Injuries and
Fatalities
Air Quality

Air Pollution
Contact with Nature

Climate Change
Terminology and Definitions
Body Mass Index (BMI)
Defined: Weight (kg) / height (m)2
Categories:

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Underweight: < 18.5
Normal: 18.5 – 24.9
Overweight: 25 – 29.9
Obesity: 30 or greater
Source: National Heart Lung and Blood Institute
Prevalence of Overweight and
Obesity in the United States
Among adult men, prevalence was
31.1% in 2003-2004, 33.3% in 20052006
 Among adult women, 33.2% in
2003-2004, 35.2% in 2005-2006
 16.3% of children and adolescents
aged 2-19 years were obese

Source: http://www.cdc.gov/nccdphp/dnpa/obesity
Prevalence of Overweight and
Obesity in the United States
(cont.)
Trend

The increase (percentage points) in
obesity and overweight in adults was
faster than in children (0.77 vs. 0.46–
0.49), and in women than in men (0.91
vs. 0.65).
Source: Wang et al. (2008). Obesity.
Prevalence of Overweight and
Obesity in the United States
(cont.)
Projection


by 2030, 86.3% adults will be overweight or
obese; and 51.1%, obese. Black women
(96.9%) and Mexican-American men
(91.1%) would be the most affected. By
2048, all American adults would become
overweight or obese, while black women
will reach that state by 2034.
In children, the prevalence of overweight
(BMI 95th percentile, 30%) will nearly
double by 2030.
Source: Wang et al. (2008). Obesity.
Overweight and Obesity and
Health Risks
Heart disease and stroke
High blood pressure (hypertension)
Diabetes
Certain Cancer (breast, colon)
Gallbladder disease and gallstones
Osteoarthritis
Breathing problems, such as sleep apnea
Terminology and Definitions
Physical Activity
“Bodily movement produced by the
contraction of skeletal muscle that
increases energy expenditure above
the basal level”
Source: USDHHS (1996)
Recommended Physical
Activity Levels - Adults
Moderate-intensity aerobic
(endurance) physical activities (i.e.,
brisk walking, bicycling, vacuuming,
gardening, or anything else that
causes small increases in breath or
heart rate) for a minimum of 30 min on
five days each week
OR
Source: Haskell et al. (2007), Medicine & Science in Sports & Exercise
Recommended Physical
Activity Levels
Vigorous-intensity aerobic
physical activities (i.e., running,
aerobics, heavy yard work, or
anything else that causes large
increases in breathing or heart
rate) for a minimum of 20 min on
three days each week
Source: Haskell et al. (2007), Medicine & Science in Sports & Exercise
Insufficient Physical Activity
Doing more than 10 minutes
total per week of moderate or
vigorous-intensity lifestyle
activities (i.e., household,
transportation, or leisure-time
activity), but less than the
recommended level of activity
Source: http://www.cdc.gov/nccdphp/dnpa/physical/stats/definitions.htm
Inactivity
Less than 10 minutes total per week of
moderate or vigorous-intensity lifestyle
activities (i.e., household, transportation,
or leisure-time activity).
Source: http://www.cdc.gov/nccdphp/dnpa/physical/stats/definitions.htm
Levels of Physical Activity
Source: apps.nccd.cdc.gov/PASurveillance/StateSumV.asp
1988-2007 No Leisure Time
Physical Activity Nationwide
Source: www.cdc.gov/nccdphp/dnpa/physical/stats/leisure_time.htm
Source: http://apps.nccd.cdc.gov/PASurveillance/StateSumResultV.asp
Thailand
Source: Thailand Health Profile – 2004-2006
Yes, I Exercise
All You Can Do
Health Risks of Physical Inactivity


Risk of coronary heart disease
People with inactive and unfit almost twice
as likely to die from heart disease as more
active and fit people
Risk of being overweigh or obese,
Which in turn, associated with certain
cancers, osteoarthritis, and back problems
Risk of developing type 2 diabetes
Risk of lowering bone density - osteoporosis
Certain Cancer
Inactivity, Overweight,
and Health
Evidence links inactivity and overweight with…
Increased mortality
Cardiovascular disease
Cancers
Depression
Gall bladder disease
Osteoporosis
Hypertension
Inactivity
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Overweight
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Built Environment in Relation to
Overweight or Obesity, and Physical
Activity: An Ecologic Model
Individual factors
Genetics
Built environment
Food
Physical activity
consumption
(energy expenditure)
(energy intake)
Social factors
Family and peer
influences
Socioeconomic
characteristics
Source: Powell et al. (www.impacteen.org)
Behaviors
Other individual
characteristics
Environmental factors
Lifestyle/behavioral factors
Behaviors
Socioeconomic
Characteristics
BMI
Economic influences
(cost and access)
Neighborhood safety
(perceived/objective)
Transportation
opportunities
Part II
Research
and
Implications