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Study Links Obesity to Urban Sprawl

washingtonpost.com

Suburbia USA: Fat of the Land?
Report Links Sprawl, Weight Gain

By Rob Stein
Washington Post Staff Writer
Friday, August 29, 2003; Page A03

Suburban sprawl appears to be contributing to the nation's obesity epidemic, making people less likely to walk and more likely to be overweight, researchers reported yesterday.

In the first comprehensive examination of whether suburbs spreading across the U.S. landscape are affecting Americans' health, the researchers studied more than 200,000 people in 448 counties, producing the first concrete evidence supporting suspicions that sprawl is aggravating the nation's growing weight crisis.

People who live in the most spread-out areas spend fewer minutes each month walking and weigh about six pounds more on average than those who live in the most densely populated places. Probably as a result, they are almost as prone to high blood pressure as cigarette smokers, the researchers found.

"There are lots of other reasons why we should work to contain sprawl," said Reid Ewing of the University of Maryland's National Center for Smart Growth, who led the study. "This could be another important reason."

Skeptics said that the effect of sprawl on health appears to be relatively modest even in the most extreme comparisons, and hardly justifies restricting growth.

"I don't think sprawl is close to being the boogeyman," said Samuel R. Staley, president of the Buckeye Institute for Public Policy Solutions, a Columbus, Ohio, think tank. "We're not finding that we can look at land use as a principal tool or lever for dealing with public health issues."

Health experts have become increasingly alarmed by the rapidly rising number of Americans who are overweight or obese. More than two-thirds of adults are overweight and nearly 1 in 3 is obese.

The spread of isolated subdivisions with large lots -- which make walking or bicycling to stores, schools or churches difficult and sometimes even dangerous -- has been cited as one possible cause, but there has been little direct evidence and no national data. The new findings are likely to be used by advocates of tightly controlled growth around the country, including locally.

"There is a lot of circumstantial evidence that sprawl is related to health," Ewing said in a telephone interview. "This is certainly the first national study to make the direct connection between the built environment and health."

Ewing and his colleagues analyzed data collected about 206,992 U.S. adults between 1998 and 2000 by the Behavioral Risk Factor Surveillance System, an ongoing federal survey. Using data from the Census Bureau and other federal sources about population density, block size, street patterns and other factors, the researchers calculated a "sprawl index" for 448 counties in the largest metropolitan areas nationwide, where two-thirds of the population resides, including the Washington region.

The index ranged from a low of 63 for the most sprawling county -- Geauga, Ohio, just outside Cleveland -- to a high of 352 for the densest -- New York City.

Frederick County in Maryland, with a sprawl index of 87.09, was rated as the most sprawling county in the Washington area, according to the analysis. The least sprawling is Fairfax County, which got a score of 117.81.

The researchers then related the degree of sprawl to time spent walking, weight, high blood pressure, diabetes and heart disease. They also accounted for factors that could confuse the issue, such as education, race and ethnicity, smoking, and fruit and vegetable consumption.

For every 50-point increase in the sprawl index, residents are likely to walk 14 fewer minutes a month during leisure time, the researchers reported in a paper released yesterday by the American Journal of Health Promotion, which along with the American Journal of Public Health dedicated its upcoming issue to sprawl and health. People who live in the 25 most sprawling counties walk an average of 191 minutes a month, compared with 254 minutes a month among those living in the 25 densest counties.

People in more sprawling counties are also likely to have a higher body mass index (BMI), a standard measure of weight. A 50-point increase in the degree of sprawl was associated with an average weight gain of a little more than one pound per person, researchers found.

While researchers found no association between sprawl and diabetes or heart disease, they did find that people who live in the least sprawling areas had a 29 percent lower risk of developing high blood pressure than those in the most sprawling areas.

"If these results hold up, then building compact communities will become a public health imperative, given our obesity epidemic," Ewing said.

Not everyone agrees.

"There is no question that obesity is a serious health problem facing our nation today," said Jerry Howard of the National Association of Home Builders (NAHB) in a statement. "However, NAHB rejects the argument . . . that the choices people make about where they live can actually cause them to become obese. The study's findings simply do not support this contention."

Richard Jackson, senior adviser to the director of the federal Centers for Disease Control and Prevention in Atlanta, said the findings provide evidence that the "built environment" can influence health, although it is not necessarily the most important factor.

"I think that planners, builders, architects and zoning agencies need to realize that they are also public health officials," Jackson said. "They influence the health of the community in profound ways, perhaps more than the doctor who's giving out pills."

Staley, of the Buckeye Institute, agreed that sprawl may affect health, but said it is a relatively minor factor. People may be willing to live in places that make them a little more prone to gain weight to get the benefits of open space, he said.

"What this is saying to me, sitting on my half-acre with my kids playing outside and riding their bikes, is that if I want to reduce my hypertension and lose a couple of pounds, do I want to give up my house, or do I want to go to McDonald's less?" said Staley. "There are small changes in behavior that can get the same outcomes."

© 2003 The Washington Post Company

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