FABB Blog

According to a July 7th Stanford Medicine News article, "An examination of national health survey results suggests that inactivity, rather than higher calorie intake, could be driving the surge in obesity. Inactivity rather than overeating could be driving the surge in Americans' obesity, according to a study by a team of Stanford University School of Medicine researchers. (Obesity, Abdominal Obesity, Physical Activity, and Caloric Intake in U.S. Adults: 1988-2010) Examining national health survey results from 1988 through 2010, the researchers found huge increases in both obesity and inactivity, but not in the overall number of calories consumed.

"'What struck us the most was just how dramatic the change in leisure-time physical activity was,' said Uri Ladabaum, MD, associate professor of gastroenterology and lead author of the study. 'Although we cannot draw conclusions about cause and effect from our study, our findings support the notion that exercise and physical activity are important determinants of the trends in obesity.'..."

Yes, let’s have an honest discussion about being the “fattest people in the world.” Every day, “decision makers” make transportation infrastructure and planning decisions that favor cars over people, decisions that make walking and biking—walking or biking to real public transit options, to work, to school, to the store—come to seem more and more…radical. It is indeed time we took responsibility for these and for the full range of consequences they entail. Let’s take some personal responsibility and make sure we as a society make the decisions that instead favor people over cars, favor transportation infrastructure built around the human scale.

I appreciated the information given in Kathleen Parker’s May 9 op-ed column, “Eating our way into a disaster.” It did, however, only consider one side to the thinness issue by discussing caloric input of high-glycemic food. I’m a 49-year-old woman, 5-foot-6 and 113 pounds. I eat and drink whatever I want, taking in more than 2,000 calories a day. I’m able to maintain my low body weight because I gave up driving two years ago in disgust over the BP oil spill disaster.

I ride my bike for all of my personal transportation, typically cycling 150 miles a week. The mileage I previously covered in a heavy, gas-powered car is now provided by my leg muscles; I burn a lot of food.

While most people are filling up their gas tank, I’m filling up my plate, including lots of bread and potatoes. Americans indeed eat too much food and eat too thoughtlessly. Yet, if they would get out of their cars, and walk or cycle instead, they wouldn’t be so fat.

Margaret Wohler, Alexandria

People are significantly fatter in countries, states, and cities where car use is more common. Mass transit use, on the other hand, is correlated with lower obesity. But there has been scant evidence that public transportation actually causes widespread weight loss — until now. A study of residents in Charlotte, N.C., found that users of the city’s new light rail system were 81 percent less likely to become obese, and reduced their Body Mass Index by an average 1.18 points — the equivalent of 6.45 pounds for a person 5’5″ tall. The study appears in the American Journal of Preventive Medicine.

RESULTS: Countries with the highest levels of active transportation generally had the lowest obesity rates. Europeans walked more than United States residents (382 versus 140 km per person per year) and bicycled more (188 versus 40 km per person per year) in 2000.

DISCUSSION: Walking and bicycling are far more common in European countries than in the United States, Australia, and Canada. Active transportation is inversely related to obesity in these countries. Although the results do not prove causality, they suggest that active transportation could be one of the factors that explain international differences in obesity rates.

"This is the future of America," said Linda Van Horn, a professor of preventive medicine at Northwestern University who heads the American Heart Association's Nutrition Committee. "These data really confirm the seriousness of our obesity epidemic. This really is an urgent call for health-care providers and families to take this issue seriously."

The take-home message is that without a strong and sustained reduction in obesity prevalence, obesity will continue to impose major costs on the health system for the foreseeable future. And although health reform may be necessary to address health inequities and rein in rising health spending, real savings are more likely to be achieved through reforms that reduce the prevalence of obesity and related risk factors, including poor diet and inactivity. These reforms will require policy and environmental changes that extend far beyond what can be achieved through changes in health care financing and delivery.

Overview

Enhancing infrastructure supporting bicycling includes creating bike lanes, shared-use paths, and routes on existing and new roads; and providing bike racks in the vicinity of commercial and other public spaces. Improving bicycling infrastructure can be effective in increasing frequency of cycling for utilitarian purposes (e.g., commuting to work and school, bicycling for errands). Research demonstrates a strong association between bicycling infrastructure and frequency of bicycling.

Evidence

Longitudinal intervention studies have demonstrated that improving bicycling infrastructure is associated with increased frequency of bicycling (104,105). Cross-sectional studies indicated a significant association between bicycling infrastructure and frequency of biking (p<0.001) (103,106,107).

Suggested measurement

Total miles of designated shared-use paths and bike lanes relative to the total street miles (excluding limited access highways) that are maintained by a local jurisdiction.

This measurement captures the availability of shared-use paths and bike lanes, as defined by the American Association of State Highway and Transportation Officials, relative to the total number of street network miles in a community. The numerator of this measurement includes both shared-use paths and bike lanes. The denominator of this measurement is limited to paved streets that are maintained by city/local government, and excludes limited access highways. Although no estimated standard exists for this measurement, data collected from local governments reporting on this measurement can lead to establishment of a standard.

103. Troped PJ, Saunders RP, Pate RR, et al. Associations between self-reported and objective physical environmental factors and use of a community rail-trail. Prev Med 2001;32:191--200.

104. Macbeth AG. Bicycle lanes in Toronto. ITE Journal 1999;69:38--46.

105. Staunton CE, Hubsmith D, Kallins W. Promoting safe walking and biking to school: the Marin County success story. Am J Public Health 2003;93:1431--4.

106. Dill J, Carr T. Bicycle commuting and facilities in major U.S. cities: if you build them, commuters will use them. Transportation Research Record 2003;1829:116--23.

107. Nelson A, Allen D If you build them, commuters will use them: association between bicycle facilities and bicycle commuting. Transportation Research Record 1997;1578:79--83.