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
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•
•
•
•
Ecologic Model of Obesity
Case 1. Neighborhood Streets
Case 2. Physical Activity Resources
Case 3. Food Environment
Conclusions
Estimated Costs of Obesity
160
140
Billions of US Dollars
120
100
80
60
40
20
0
1998
2008
Finkelstein EA, Trogdon JG, Cohen JW, Dietz W. Annual medical spending attributable to obesity: payerand 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 Change
Technology, Globalization
Macro-Environment
Policies, Institutionalized Norms, Weather
Micro-Environment
Work, School, Home
Meso/Exo-Environment
Travel, Social Relationships
Obesity
Biology
Genetics
Ecologic Model of Obesity
Lee RE, McAlexander KM, Banda JA. Reversing the Obesogenic
Environment. Champaign, IL: Human Kinetics; 2011.
Individual Choices?
Outline
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•
•
•
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Ecologic Model of Obesity
Case 1. Neighborhood Streets
Case 2. Physical Activity Resources
Case 3. Food Environment
Conclusions
Defining Neighborhoods
Residences of HIP Houston Participants
• Geographic
Information
Systems (GIS)
• Boundaries
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– Buffers
– Streets
– Census geography
– School Locations
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Legend
10
20 Kilometers
Created for Health is Power Research Project Fall 2007
#
Participant Residences
Highway
800 m buffer
Arterial
400 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.
160365
Defining Neighborhoods
•
•
•
•
Radial buffer
All arterials
25% of residentials
Street segments
800 meters
400 meters
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
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):95110.
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
Activity
Slower 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.
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.
Neighborhood Streets
• Programs to increase
physical activity are
more effective in
supportive
neighborhoods
• More supportive
neighborhoods can
help reduce obesity
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.
Outline
•
•
•
•
•
Ecologic Model of Obesity
Case 1. Neighborhood Streets
Case 2. Physical Activity Resources
Case 3. Food Environment
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.
Physical Activity Resources
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 Resources
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
Physical Activity Resources
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.
Most common resources were parks,
schools, community resources
Wide variability in resource availability
Many, many more incivilities in low SES
neighborhoods
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.
Physical Activity Resources
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
•
•
•
•
•
Ecologic Model of Obesity
Case 1. Neighborhood
Case 2. Physical Activity Resources
Case 3. Food Environment
Conclusions
Food Environment
• Food Stores Assessment (FSA)
• Restaurant Assessment Tool (RAT)
http://hhp.uh.edu/undo
Food Store Assessment
http://hhp.uh.edu/undo
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.
Store Types in Low SES
Neighborhoods
Most commonly available stores were
convenience and liquor stores
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.
Store Types in Low SES
Neighborhoods
Convenience stores and liquor stores sell
convenience foods
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.
Stores and Fresh Produce
Percent of Neighborhoods with Stores Selling Fresh Produce
100
90
80
Low SES
High SES
70
%
60
50
40
30
Most lower SES
neighborhoods
had only one store
that sold fresh
produce
20
10
0
Fruit
Vegetables
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
12
Price US$
10
8
6
4
2
0
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e
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ie
en
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pe
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et
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ar
'M
ro
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s
er
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al
Sm
rm
Fa
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
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.
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
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.
Outline
•
•
•
•
•
Ecologic Model of Obesity
Case 1. Neighborhood
Case 2. Physical Activity Resources
Case 3. Food Environment
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
releephd@yahoo.com