Enviros, what about obesity?

We Americans have gotten fat.  And we’ve done so to an alarming degree.  Sunday’s Washington Post began a five-part series on obesity in children, a particularly serious part of the problem:

“In ways only beginning to be understood, being overweight at a young age appears to be far more destructive to well-being than adding excess pounds later in life. Virtually every major organ is at risk. The greater damage is probably irreversible . . .

“With one in three children in this country overweight or worse, the . . . cumulative effect could be the country's first generation destined to have a shorter life span than its predecessor. A 2005 analysis by a team of scientists forecast a two- to five-year drop in life expectancy unless aggressive action manages to reverse obesity rates. Since then, children have only gotten fatter.

"’Five years might be an underestimate,’ lead author S. Jay Olshansky of the University of Illinois at Chicago acknowledged recently . . .”

Let's move to adult obesity.  Continuing my fascination with maps, I offer two compelling ones below.  The maps come from the federal Centers for Disease Control, though I found them first on the website of the Robert Wood Johnson Foundation, which has done outstanding work in sponsoring research in the field. 

The first map represents the extent of obesity in the United States in 1990.  States in medium blue had 10-14 percent of their population considered obese, defined as a Body Mass Index of 30 or above, or more than 30 pounds overweight for a person standing 5’4”.  States in light blue ("Carolina blue" to Tar Heel fans) had less than 10 percent of their population defined as obese.  No state topped the 14 percent mark:

The second map shows the rate of obesity in states in 2006.  Everything has changed.  Now, no state remains in light or medium blue.  Only a tiny fraction of the country is even in dark blue, representing an obesity rate of 15-19 percent.  Practically the entire country shows obesity rates greater than 20 percent (amber), with much of it greater than 25 percent (red), and two states alarmingly over 30 percent (dark rust).

As the CDC puts it, “These increasing rates raise concern because of their implications for Americans’ health. Being overweight or obese increases the risk of many diseases and health conditions, including the following:

• Hypertension (high blood pressure)
• Osteoarthritis (a degeneration of cartilage and its underlying bone within a joint)
• Dyslipidemia (for example, high total cholesterol or high levels of triglycerides)
• Type 2 diabetes
• Coronary heart disease
• Stroke
• Gallbladder disease
• Sleep apnea and respiratory problems
• Some cancers (endometrial, breast, and colon).”

Heart disease is the leading cause of death in the US, with stroke third.  Diabetes is sixth. 

It has been estimated that the annual cost of overweight and obesity in the U.S. is a staggering 122.9 billion dollars. This represents some $64 billion in direct costs and $58.8 billion in indirect costs, a sum that is comparable to the economic costs of cigarette smoking.  Direct costs include preventive, diagnostic, and treatment services, while indirect costs include the value of wages lost by people unable to work because of illness or disability, as well as the value of future earnings lost by premature death. Obesity and obesity-related conditions or ailments result in at least $62.7 million in doctors’ visits and $39.3 million in lost workdays each year. 

Nonetheless, the mainstream environmental community has remained almost totally inactive on the issue.  This needs to change.

Yes, the issues are complex and the causes not all and probably not mostly environmental, but that is equally true of cancer and asthma, two public health problems that have commanded a lot of attention from the environmental community for decades.

We know that part of the problem with obesity is environmental.  That is because we have created an environment that has become less conducive to physical activity.  An exhaustive study conducted by Rutgers University, Smart Growth America and the Surface Transportation Policy Partnership, and published in the September 2003 issue of the American Journal of Health Promotion, found that people living in counties marked by sprawling land development are likely to walk less and weigh more than people who live in less sprawling counties. In addition, people in more sprawling counties are more likely to suffer from hypertension. These results hold true after controlling for factors such as age, education, gender, and race and ethnicity.

Similarly, another exhaustive, multi-year study of land use, travel behavior and health in metro Atlanta (the SMARTRAQ study, managed by Georgia Tech) found that people who live in neighborhoods with a mix of shops and businesses within easy walking distance are 7 percent less likely to be obese than those living in a mix level equal to the lower regional average.  “Although this difference appears small,” says the report, “the relative decrease in the actual probability of obesity is much greater - approximately 35 percent. A typical white male living in a compact community with nearby shops and services is expected to weigh ten pounds less than a similar white male living in a low density, residential-only cul-de-sac subdivision.” 

SMARTRAQ also found that every additional hour spent in a car each day translated into a 6 percent greater chance of being obese. 

NRDC’s own research in Sacramento found that residents of a walkable smart growth neighborhood reported taking four times as many trips by foot as residents of a sprawling development on the edge of town.

There may be additional environmental factors that contribute to weight gain and obesity.  We don’t know all the answers.  We may not even know all the questions.  But this is our nation's number one public health problem, and it deserves more attention from the environmental community.