Transcript Research?

Research?
?
THE QUESTION
Can the built environment make
us fat?
by fostering unhealthy lifestyles such as physical
inactivity, automobile dependency, and poor diet?
Density
Land Use
Transportation Infrastructure
Urban & Architectural Design
Aesthetics
Safety
BUILT
ENVIRONMENT
PHYSICAL
Activity
Transportation
Household
Leisure & Recreation
Work-related
OBESITY
Quality of Life
Cardiovascular Diseases
Diabetes
Respiratory Diseases
Cancers
Depression
Aging
Our Behaviors…
60+% of US adults (BRFSS) and 60+% of global
population (WHO) are not regularly active. In the US,
active transport (walk & bike) to school among 5 to
18 years reduced from 42% in 1969 to 16% in 2001
(CDC).
Walking to school
Active Transport to School
Among Youth 5 to 18 Years of Age
http://www.cdc.gov/nccdphp/dnpa/kidswalk/t
hen_and_now.htm
Walking-Friendly
Walking-Hostile
Location
Distance
Accessibility
Frontage Streets
Sidewalk
Center
28% within ½ mile
All directions
Local streets
Complete with trees
Street pattern
Grid-like with small blocks
Land Use
Primarily residential
Periphery
13% within ½ mile
Only 2 access points
Highway and arterials
Incomplete with no trees
Grid-like and cul-de-sacs with
super blocks
Commercial and office uses
with large parking lots
Los Angeles: The architecture of four
ecologies (Banham, 1971)
Drive-through voting
draws early voters in
Southern California
(AP Photo/Mark Avery,
Oct. 21, 2008)
AP Photo/Mark Avery, Oct. 21, 2008)
http://www.treehugger.com/files/2008/10/bike-thru-banking.php
Empirical Evidence
The Link Between Built Environment and
Lifestyle Physical Activity
A Few Findings on Health Benefits of Walking
and Biking
• Sesso and colleagues (1999) found that walking more than 10 blocks
everyday resulted in a 33 % reduced cardiovascular disease risk.
• LaCroix et al (1996) observed that the increased hours of walking is
related with reduced rate of cardiovascular disease hospitalization.
• Oja and colleagues (1998) reported that daily walking and bicycling to
work improves the cardio-respiratory and metabolic fitness of
previously inactive adults and health beneficial.
• Pollock et al (1978) also concluded that moderate to high energy cost
activities such as running, jogging, walking, and bicycling, show a
significant increase in cardio-respiratory fitness.
A Few Findings on Health Benefits of Walking
and Biking
Lifestyle interventions (i.e., walking and bicycling), compared to
structured intervention (i.e., exercise program and health club
activities), are
– more likely to induce long-term lifestyle changes
– effective for currently sedentary people
– more cost effective
(i.e., Dunn et al., 1999; Owen and Bauman, 1992; Sevick et al., 2000)
Correlates of Overall or Recreational Physical
Activity
Objective Measures:
– Geographic location (levels of
urbanization, coastal location, etc.)
– Age of the
neighborhood/housing
(neighborhood design)
– Density
– Destination (physical activity
facilities, shops, etc.)
– Streets (sidewalks, safety, route
quality and barriers)
Perceived Measures:








Land use mix
Accessibility
Convenience
Safety
Route quality
Barriers (distance, etc.)
Aesthetic/visual quality
Etc.
Lee C and Moudon AV (2004). Physical activity and environment research in the health field: Implications for urban
and transportation planning practice and research. Journal of Planning Literature, 19(2), 147-181.
Correlates of Transportation Behaviors (mode
choice, VMT, non-motorized mode use, etc.)
• Density
• Land use mix
• Infrastructure design
• Transit service
• Neighborhood design
• Safety
• Topography
• Visual quality
• Etc.
Environments that support Walking
The 3Ds+R
R3
–Destination
–Distance
–Density
–Route
Area
R1
Area
Lee C, Moudon AV (2006). 3Ds+R: Land use and
urban form correlates of walking. Transportation
Research D, 11(3), 204-215.
#
# Destination
R2
Origin
Destination
How far do people walk?
Number
Walked
Minutes
Taken
Estimated
Kilometers
Estimated
Miles
Grocery Stores
280
12.36
0.99
0.62
Retail-Service Facilities
(excluding Grocery Stores)
331
12.98
1.04
0.65
Walking or Jogging Trails
114
8.38
0.67
0.42
Parks, Areas near Lakes,
Creeks, or Waterways
149
10.25
0.82
0.51
Gyms or Fitness Centers
16
8.69
0.70
0.43
Walking to
(n=608)
Seattle, WBC Survey
Where people walk to?
Younger Adults
N=213
Grocery store*
Non-fast food restaurant
Café or coffee shop
Convenience store
Drug store
Bank
Post office
Video store
Clothing store
Book store
Fast food restaurant
Library
Hardware store
Theaters and movie theater
Dry cleaners
Religious institution
Rank
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
%
46.0
31.0
30.5
29.1
28.6
22.5
18.3
16.0
15.0
15.0
13.1
7.5
7.5
6.1
3.8
Seattle
Older Adults
N=65
Rank
2
4
7
1
3
4
14
6
15
14
8
11
12
12
9
%
43.1
27.7
21.5
60.0
33.8
27.7
7.7
23.1
15.4
6.2
18.5
12.3
10.8
10.8
15.4
Seattle, WBC Survey
Where people walk to?
Food Stores &
Restaurants
Other Stores
Services
Destinations (n=89)
Grocery store
Convenience Store
Fast Food restaurant
Non Fast Food restaurant
Hardware Store
Salon/ Barber Shop
Bingo / Party Supply
Garage Sale
Post Office/Mailbox / Postal services
Community Center
Bus / Transit Stop
Elementary School
Religious Institution
Day Care
El Cenizo, TX
N
41
3
2
1
4
3
2
4
40
38
30
28
16
1
Percent
46.1%
3.4%
2.2%
1.1%
4.5%
3.4%
2.2%
4.5%
44.9%
42.7%
33.7%
31.5%
18.0%
1.1%
Where do people go for “recreational” walking?
Younger Adults
N=311
Rank
%
Street
Park
Trail
Gym
Mall
1
2
3
4
5
63.0
52.1
34.7
14.1
4.2
Older Adults
N=127
Rank
%
1
2
3
4
5
66.9
43.3
25.2
10.2
7.9
Seattle, WBC Survey
What are the barriers to walking?
El Cenizo, TX
N=89
1. Unattended dogs
SWUTC survey
Personal
No.
%
33
Environ mental
No.
%
37.1%
2. No parks or recreations places
31
34.8%
3. No benches or places to rest
27
30.3%
4. No interesting places to walk
25
28.1%
5. No trees or shade
24
27.0%
6. Distances to places are too great
19
21.4%
6. No sidewalks or no continuous sidewalks
19
21.4%
6. No safe places to walk nearby
19
21.4%
9. No interesting architecture
17
19.1%
10. No crosswalks or pedestrian signals
15
16.9%
10. No shopping locations nearby
15
16.9%
12. Not enough lighting at night
14
15.7%
12
13.5%
10
11.2%
13. Lack of time
13
14.6%
14. No walking paths or trails nearby
15. Fear of being robbed/ attack/ assaulted
16. Traffic is traveling too fast on roads I need to walk along
11
12.4%
What are the environmental factors that can help
people walk or walk more?
Seattle
Younger Adults
N=264
Older Adults
N=86
Rank
1
%
57.6
Rank
1
%
55.8
Closer to other interesting places to walk to
2
54.9
2
50.0
Closer to or more walking trails / paths
3
54.2
5
41.9
Interesting architecture or landscape to look at
4
52.7
3
45.3
Closer to park and recreation facilities
Closer to shopping places
More trees along streets
Benches and other places to rest
Longer crosswalk signals
5
6
7
8
9
45.8
44.7
38.3
28.4
20.8
4
6
8
6
8
44.2
37.2
27.9
37.2
27.9
Good lighting at night
Seattle, WBC Survey
Assessments:
Examples of objective measures of the built
environment
Audit
Geographic Information System
Other Relevant Measurement Tools
•
•
•
•
Global Positioning System
Ecological Momentary Assessment
Photography & Video Recorder
Infrared Motion Sensor (indoor)
S
ummary
Activity Friendly Community as a
Strategy to Reduce Obesity:
Modifiable environmental factors
Land Use
Destination
Distance
Street and Transport Infrastructure
(Adopted from Lee and Moudon 2005)
Site Design
Pedestrian & Bicycle Facilities
Recreational
Facilities
Visual Quality
Architecture
Urban
Design & Amenity
Safety!
Safety!
Safety!
Changes in Major Food Sources of Energy From Snacking:
Young Adults Aged 19-29
1994-96
Desserts
15.7
Total 15.7
1977-78
23.0
23.0
Sweetened
Beverages
1994-96
11.6
15.7
0.1
Regular Soft Drinks
1977-78
3.9
Diet Soft Drinks
Fruit Drinks
0.1 2.1
12.1
14.3
Alcoholic
Beverages
1994-96
8.7
12.5
3.1
Beer
1977-78
Liquor
7.8
0.6
Wine
1.4
0.8
10.0
1994-96
Milks
3.2
5.8
2.6
Skim
1977-78
0.01
½%
3.3
Whole
5.4
0.1
8.8
Salty
Snack Foods
1994-96
1.5
11.5
1977-78
10.0
Low Fat Snack Foods
0.6
High Snack Foods
5.3
5.9
0
5
10
15
Percent of Energy from Snacking
Zizza et al 2001 Prev Med 32:303
20
25
Portion Sizes for Selected Foods for Individuals
Aged 2 and Older, USA 1977-1998
20
19.9
18
1977-78
16
1989-91
16.8
15.1
1994-98
Ounces
14
13.1
12.6
11.3
12
10
8
5.7 5.9
6
5.8
7.1
6.2
6.1
6.3
6.7
4.5 4.5 4.8
4
2
8.0
7.4 7.3
7.0
3.1
1.0
3.5 3.6
1.4 1.6
0
Salty Snacks
Desserts
Soft Drinks
Fruit Drinks
French Fries Hamburgers Cheeseburgers
Pizza
Mexican Food
Nielsen & Popkin 2003 JAMA 289:450-453.
Trends in Total Energy Intake: The Proportion of
Energy by Food Source for US Adolescents
Aged 12-18
14
13
'77-78
'89-91
'94-96
10
10
10
10
99
8
8
7
6
6
5
5
4
44
4
4
2
22
2
2
4
33
3
3
2
22
11
111
000
2
2
22
1
0
0
High fat
lunchmeats &
hotdogs
med & high fat
beef & pork
Low & med fat
milk
Mexican
Pizza
Cheeseburgers
Hamburgers
French fries
Alcohol
Fruit drinks
Soft drinks
Candy
Desserts
0
Salty snacks
Percentage of total daily kcal
12
Nielsen et. Al. (2002). Obesity Research 10: 370-378.
Trends in Total Energy Intake by Location, 1977- 96
Ages 12-18
80
'77-78
'89-91
Ages 19-29
'94-96
80
74
71
67
68
60
60
60
40
40
31
25
19
17
20
20
11
5
0 0 1
3
5
6
9 8
3 2
14
8
6
8
5
3
1 1 1
1 0 1
3
6
Other
School
Rstrnt/fast food
Store eaten out
at Home
Vending
Other
School
Rstrnt/fast food
Store eaten out
0
at Home
0
Vending
Percentage
53
Nielsen et. Al. (2002). Obesity Research 10: 370-378.
Trends in Beverage Consumption Between 1977 and 2001
(the % of total daily calorie intake from each beverage for all
Americans aged 2 and older)
Percentage of daily calorie intake
10
1977-78
1999-01
8.0
8
7.0
6
5.0
4
3.5
2.8
2.2
1.7
1.6
2
0.8 0.9
2.0
1.1
0.5 0.3
0
Coffee
and tea
Soft drinks Fruit drinks
Alcohol
Milk
Other milk Fruit juice
bev
Source: Source:Nielsen & Popkin 2004 Am J Prev Med 27: 205-10.
*All changes significant at the 0.01 level between 1977-78 and 1999-2001
Trends in the Mean Percentage of Consumers, Mean Servings/Day,
and Mean Portions of Specific Beverages
% Consumers
Servings
90
Portions (ounces)
3.5
79.0
80
76.0
25
21.0
3.0
3.0
20
67.4
70
61.4
2.4
2.5
60
2.2
2.0
50
2.0
15
13.6
11.7
40
1.5
10.9
10
30
1.0
20
5
0.5
10
0
0.0
1977-78
1994-96
0
1977-78
1994-96
Calorically-Sweetened beverages
1977-78
1994-96
Milk beverages
Source: Source:Nielsen & Popkin 2004 Am J Prev Med 27: 205-10.
Percentage of total daily calories
Trends in Sweetened Beverages and Milk Consumption
by Location 1977-96. (Each figure represents the % of total daily
calorie intake by location and meal type for each year)
1977-78 Total sweetened bev
1977-78 Total milk
10
1994-96 Total sweetened bev
1994-96 Total milk
8.0
8
7.1
6.5
6
5.0
3.9
4
4.1
3.9
2.6
1.7
2
0
0.2 0.3 0.1 0.0
Vending
0.3
Ate at home
0.7
0.3 0.1
Store eaten out
0.6
0.3 0.1
Restaurant/fast
food
Total of
beverages
Source: Source:Nielsen & Popkin 2004 Am J Prev Med 27: 205-10.
U.S. Beverage Consumption in 1999-2001: What proportion
of our calories come from each type of beverage?
Soft drinks
Fruit juice
Other milk beverages
Fruit drinks
Alcohol
Percentage of total daily kcal
from each beverage
25
0.3
0.9
20
0.3
0.5
0.3
2.7
Milk
Coffe and tea
0.3
1.0
4.8
1.6
0.3
1.2
3.8
4.9
3.5
2.0
15
8.3
2.6
5.0
10
2.2
2.5
3.4
5
1.6
2.4
3.9
9.8
7.0
0.6
1.1
1.2
4.6
1.2
6.9
5.0
3.0
0
All ages
2-18 yr olds
19-39 yr olds
40-59 yr olds
60+ yr olds
Source:Nielsen & Popkin 2004 Am J Prev Med 27: 205-10.
Level 1: Water
• Water-essential for life
• For average person with 2200 kcal per day: 16-24
ounces or more per day but this could provide all
beverage needs of about 98 ounces
• Needed for adequate hydration
• Dehydration: impaired cognition, moodiness, physical
work performance, increased risk of bladder, colon,
breast cancer
Level 2: Tea and Coffee
• Tea and Coffee – selected benefits on chronics, no adverse
health effects in terms of obesity and chronic diseases. The
only issue is for high added cream and sugar such as for
gourmet coffees
• Tea: animal work strong for tea’s protective role against
selected cancers; unclear benefits in humans. Potential
health benefits of flavonoids in tea are unclear
• Coffee: mild antidepressant, some evidence lowers risk of
Type 2 diabetes
• Caffeine: 400 mg limit. 32 ounce limit coffee [150 mg
caffeine limit if pregnant]
Level 3: Low Fat and Skim Milk and
Soy Beverages
• Skim Milk – unclear benefits on weight gain and bone
density and fractures. Range of meta-analyses and one
recent 48-week trial show no benefits for weight loss.
Important benefits as protein source for child linear
growth. Also major provider of calcium and vitamin D
• Adult milk intake may adversely affect several chronic
diseases (prostate cancer, ovarian cancer)
• Current consumption patterns indicate milk products are
important contributors of many key nutrients
Level 4: Noncalorically-Sweetened Beverages
• High sweetness in these beverages holds the possibility
that consumption of these sweet beverages may
condition a preference for sweetness
• Animal work suggests that altering the ability of the
sensory properties of food to predict the caloric
consequences of consuming that food may impact
energy regulation and body weight
Level 5: Caloric Beverages with Some Nutrients
• Fruit juices: high in energy content, contribute limited
nutrients. IOM states that two-thirds of all fruit intake
should be from fruit. Limit to 4-8 ounces/day
• Vegetable juices: fewer calories, significant amounts of
sodium
• Whole milk: Saturated fats are not needed beyond
infancy
Level 5: Caloric Beverages with Some Nutrients
(continued)
• Sports drinks – reduced energy density over soft drinks,
helpful for hydrating endurance athletes, provides small
amounts of key minerals
• Alcohol – only the ethanol benefit is clear. Moderate
intake (1 drink-women, 2 for men) linked with reduced
mortality, CVD, type II diabetes
Level 6: Calorically-Sweetened Beverages
• Calorically-sweetened beverages are associated with
increase dental cares, Type II diabetes and weight gain
• Animal and human research show a potential
relationship with weight gain but the data are not
conclusive yet
What is the proportion of energy from beverages a
person should consume?
• Today 21% of kcal from beverages. Need to reduce this
level
• Current food composition means about 81% of our
water needs must come from beverages. This varies
with fruit and vegetable intake patterns
• IOM and USDA present one acceptable meal pattern for
person with 2200 kcal needs. Only needs 14% of kcal
from beverages. This is 2849 ml
or 98 ounces
IOM Ideal Meal Layout of Beverages for Man with
2200 kcal Intake
• The size of beverage needs varies based on diet [e.g.,
fruit and vegetables contain water], individual needs
• Individuals can readily live with no kcal in diet from
beverages
• Clearly some people can also live with very high caloric
intake from beverages but the hope is to reduce
considerably the average American’s % of energy from
beverages to 5-15% from the current 20% and higher
level
Recommendations
• Two options: the panel’s suggested beverage pattern.
10% of energy from beverages
[or less]
• Acceptable Beverage pattern (14% of energy from
beverages)
Average Beverage Intake Patterns for U.S.
Adults Aged 19 and Older, 1999-2002
a. Fluid Ounces Consumed
b. Kcal Consumed per day
Total 114 FL OZ
Total 464 KCALS
NONCALORICALLYSWEETENED
BEVERAGES
(5 FL OZ)
CALORICALLYSWEETENED
BEVERAGES
(20 FL OZ)
CALORIC BEVERAGES
WITH SOME NUTRIENTS
(15 FL OZ)
LEVEL VI
CALORICALLYSWEETENED
BEVERAGES
(211 KCALS)
LEVEL V
LEVEL IV
LEVEL VI
LEVEL III
LOW FAT MILK
(3 FL OZ)
TEA/COFFEE,
UNSWEETENED
(15 FL OZ)
WATER
(46 FL OZ)
LEVEL II
LEVEL I
NONCALORICALLYSWEETENED
BEVERAGES
(1 KCALS)
TEA/COFFEE,
UNSWEETENED
(11 KCALS)
WATER (0 KCALS)
CALORIC BEVERAGES
WITH SOME NUTRIENTS
(213 KCALS)
LOW FAT MILK (29 KCALS)
LEVEL V
LEVEL IV
LEVEL III
LEVEL II
LEVEL I
Suggested and Acceptable Beverage Consumption Patterns for a Person with a
2200 kcal Energy Requirement per Day
CALORICALLY
SWEETENED
WITH
NUTRIENTS
a. Suggested Pattern
(10% of energy from beverages)
b. Acceptable Pattern
(14.% of energy from beverages)
Total 98 FL OZ
Total 98 FL OZ
ALCOHOL (BEER)
(0 FL OZ)
FRUIT JUICES
(4 FL OZ)
LEVEL VI
LEVEL V
LOW FAT MILK
(16 FL OZ)
NONCALORICALLYSWEETENED
BEVERAGES
(0 FL OZ)
CALORICALLY-SWEETENED
BEVERAGES
WITHOUT NUTRIENTS
(0 FL OZ)
CALORICALLY-SWEETENED
BEVERAGES
WITHOUT NUTRIENTS
(0 FL OZ)
TEA/COFFEE,
UNSWEETENED
(28 FL OZ)
WATER
(50 FL OZ)
LEVEL IV
LEVEL III
LEVEL II
ALCOHOL
(BEER)
CALORICALLY
SWEETENED (12 FL OZ)
WITH
FRUIT
NUTRIENTS
JUICES
(8 FL OZ)
NONCALORICALLYSWEETENED
BEVERAGES
(12 FL OZ)
LEVEL VI
LEVEL V
LEVEL IV
LOW FAT MILK (6 OZS)
LEVEL III
TEA/COFFEE,
UNSWEETENED
(36 FL OZ)
LEVEL II
LEVEL I
WATER
(24 FL OZ)
LEVEL I
Footnote: The Panel suggests a range for each level of beverage that is from 100% water to: Water 20-50 fl oz/d; tea and coffee (unsweetened) 0-40 fl oz/d
(can replace water; caffeine is a limiting factorup to 400 mg/d or about 32 fl oz/d of coffee); low fat and skim milk and soy beverages 0-16 fl oz/d;
noncalorically-sweetened beverages 0-32 fl oz/d (could substitute for tea and coffee with the same limitations regarding caffeine); caloric beverages
with some nutrients: 100% fruit juices 4-8 fl oz/d, alcoholic beverages 0-1 drink per day for women and 0-2 drinks per day for men, whole milk 0 fl
oz/d; calorically sweetened beverages 0-8 fl oz/d.