Obesity -- Enabled by the Suburbs at a Heavy Cost

By Karen O'Keefe

Sprawl can be described as: a population widely dispersed in low-density residential development; rigid separation of homes, shops and workplaces; a lack of distinct, thriving activity centers, such as strong downtowns or suburban town centers; and a network of roads marked by large block size and poor access from one place to another.

For a number of years, there have been voices in the suburban development wilderness saying that there is something wrong with a land planning process and development system that would, for example, supplant giant chunks of a wonderful place like the Florida Everglades with large-tract developments of suburban homes, strip malls, office parks and the many other abysmal accoutrements of American suburbs.

With the advent of the Congress for the New Urbanism and the smart growth movement, the voices sounding alarms are becoming stronger. But today they are still not loud enough to awaken a sleeping public to the fact that changes are necessary in the very essence of the way we live.

Many people, like author James Kunstler and architect/planner Léon Krier (see profile, "Léon Krier"), predict that, in time, the suburban mainframe will collapse on itself and Americans will have no choice about changing how they design new towns, rehab old ones and prioritize refilling abandoned city cores. Sprawl residents will pull themselves out from under the rubble of these bloated places and begin anew.

It would be good if the development system could change before towns are abandoned or reduced to economic and cultural tragedy.

In this new series, "Why the Suburbs Have to Go," we begin a close-up examination of the causes and the effects of many different elements of sprawl. Each of the elements bears upon other elements naturally and it has taken a giant hodge-podge of things to get into the mess we are in today. However, we see a great benefit in looking at some of the individual pieces that add up to the morass.

In future issues, we will examine energy, transportation, environment, economy and many other topics. We welcome ideas from readers.

Our first article in the series looks at obesity, poor health and the density of the built environment.


Fat is weighing heavily on the minds of Americans these days. In the news, close behind information about the war in Iraq and terrorism, is news about weight, health and ill-health, diabetes and carbohydrates.

Also gaining more attention are the healthcare-related economic repercussions of fat, a multi-billion dollar and growing albatross borne by society members, fat and thin alike.

The links between physical activity and health outcomes are well established. In 1996, concurrent with the U.S. surgeon general's "Report on Physical Activity and Health," hundreds of research studies were amassed providing evidence that said the greater the activity level, the better the health. Today it is common knowledge, both on microcosmic (after a walk, for example) and macroscopic levels (research): More physical activity usually means better health.

How active are Americans today? In recent years, the Robert Woods Johnson (RWJ) foundation, the largest philanthropic organization devoted exclusively to health and health care in the United States, has committed over $70 million to promote healthy living.

RWJ information about activity is troubling:

• Almost two-thirds of the U.S. adult population is overweight;

• Almost one in three adults is obese;

• Seventy-four percent of U.S. adults do not get enough physical activity to meet public health recommendations;

• About one in four U.S. adults remains completely inactive during their leisure time.

• Excess weight and physical inactivity are reported to account for over 300,000 premature deaths each year, second only to tobacco-related deaths among preventable causes of death.

Today, there is growing interest across many professional disciplines in how physical inactivity, obesity and related chronic health problems (including but not limited to: two kinds of diabetes, hypertension, colon cancer, osteoarthritis, osteoporosis and coronary heart disease) are affected by environmental factors.

One factor is the structure or the type of the density of the built environment.

The question is: Is there a relationship between density and health?

The answer is: yes.

The first national study to show a clear association between the type of place people live and their activity levels, weight and health, "The Relationship Between Urban Sprawl and Physical Activity, Obesity and Morbidity (RBUSPA)" conducted by Reid Ewing, Tom Schmid, Richard Killingsworth, Amy Zlot and Stephen Raudenbush, was published in the September 2003 issue of the American Journal of Health Promotion.

The research project's specific purpose was to determine the relationship, if any, between urban sprawl, health and health-related behaviors.

On April 26, 2004, at a session at a session of the American Planning Association's annual meeting, Barbara McCann, writer and policy expert on the impact of the built environment, public health and quality of life, and Reid Ewing, Ph.D., presented a report they coauthored aimed at making the RBUSPA more accessible to the general public. Their report is entitled "Measuring the Health Effects of Sprawl: A National Analysis of Physical Activity, Obesity and Chronic Disease."

Although the study's many other factors need to be considered and much more research is required on issues around obesity and physical activity, RBUSPA (controlling for such factors as age, education and race and ethnicity) is the first to definitely find:

• that people living in counties marked by sprawling development are likely to walk less and weigh more than people living in less sprawling counties,

• people in more sprawling counties are more likely to suffer from hypertension - the odds of having hypertension are 6 percent higher for every 50 point increase in the degree of sprawl,

• a 50 point increase in the degree of sprawl on the county sprawl index was associated with a weight gain of just over 1 pound for the average person,

• people in the most sprawling areas are likely to weigh 6 pounds more than people living in the most compact counties.

Encompassing 206,992 adults from 448 counties and 83 metropolitan areas, the study revealed that urban form could be significantly associated with some forms of physical activity and some health outcomes.

Along with much other referenced research, RBUSPA authors noted a salient study that found that urban and suburban residents living in homes built before 1946 were more likely to walk long distances with some frequency than those living in newer homes. This result was attributed to the greater likelihood of sidewalks, denser interconnected streets and a mix of business and residential uses.

The authors added that, assuming their findings hold true, health practitioners can improve public health by advocating for more compact development patterns: "Over the past several decades, we have engineered much of the physical activities out of our daily lives. Now our task is to understand how opportunities for physical activity can be revived."


Researchers' Biographies:

Reid Ewing, Ph.D. currently works as a research professor at the National Center for Smart Growth at the University of Maryland in College Park where he is associate professor of urban studies and planning. He previously served at Rutgers University as research professor and director of the Alan M. Voorhees Transportation Center.

Barbara McCann is a consultant in Washington, D.C., and the former director of information and research at Smart Growth America.