Urban Sprawl Contributes to Obesity, Study Finds
Residents of counties that contain large amounts of urban sprawl walk less, weigh more and are at a greater risk of developing high blood pressure, according to a study published in the September issue of the American Journal of Health Promotion, USA Today reports (Fackelmann, USA Today, 8/29). The study is the first large-scale, national study to link sprawl with negative health outcomes and to quantify them (Petersen, Wall Street Journal, 8/29). The study was led by Reid Ewing of the University of Maryland's National Center for Smart Growth and funded by Smart Growth, which opposes sprawl, and the Robert Wood Johnson Foundation, a health philanthropic organization (Hymon, Los Angeles Times, 8/29). Ewing and colleagues analyzed data from about 206,992 U.S. adults surveyed between 1998 and 2000 by the Behavioral Risk Factor Surveillance System, an ongoing CDC survey. The researchers calculated a "sprawl index" for 448 counties in the nation's largest metropolitan areas, which are home to about 67% of the population, using information about population density, block size, street patterns and other factors from the Census Bureau and other federal sources. Researchers then related the sprawl index to community residents' amount of time spent walking; weight; and rates of high blood pressure, diabetes and heart disease. Researchers accounted for confounding factors such as education, race, ethnicity, smoking habits and fruit and vegetable consumption (Stein, Washington Post, 8/29).
The study found that for every 50-point increase in sprawl score, the average resident weighed one additional pound, walked 14 minutes less each month, was 10% more likely to be obese and was at a 6% greater risk of having hypertension. No statistically relevant link was found between sprawl and either heart disease or diabetes. In Geauga County, Ohio, which is located outside Cleveland and is the nation's most sprawling county, the average resident weighs 6.3 pounds more than the average resident of the least sprawling county, New York, which includes Manhattan, and a Geauga County resident is 29% more likely to have high blood pressure (Wall Street Journal, 8/29). The difference in incidence of hypertension between the most and least compact counties was roughly equivalent to that between non-smokers and smokers (Libit, Baltimore Sun, 8/29). The study also found that people in the 25 most sprawling counties walk 191 minutes each month on average, compared with an average of 254 minutes a month among people who live in the 25 densest counties.
"If these results hold up, then building compact communities will become a public health imperative, given our obesity epidemic," Ewing said (Washington Post, 8/29). Former Maryland Gov. Parris Glendening (D), who is now president of the Smart Growth Leadership Institute, said, "Unfortunately, with sprawl, we are designing obesity and high blood pressure and heart attacks and asthma right into our lives" (Baltimore Sun, 8/29). However, some researchers say that urban sprawl is a minor factor contributing to the higher obesity rate. Samuel Staley, president of the Buckeye Institute for Public Policy Solutions, said, "What this is saying to me ... 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? There are small changes in behavior that can get the same outcomes" (Washington Post, 8/29).
In related news, the New York Times on Friday looked at the increasing demand for bariatric procedures, which shrink the stomachs of people who are severely obese, and some insurers' reluctance to pay for the procedure, which costs $25,000 on average. Last year, 80,000 surgeries were performed -- an increase of more than 40% over the number of procedures performed in 2001 -- and consulting firm Frost & Sullivan estimates that about 120,000 surgeries will be performed this year. The number of people who are eligible for the surgery based on NIH standards is increasing by an estimated 10% to 12% each year. However, insurers and employer health plans are concerned about the procedure's costs, and some often delay approvals. Medicaid programs in several states have also been reluctant to pay for bariatric procedures, according to physicians. For example, at the University of California - Davis, Medicaid patients are put on a 12-year waiting list, Dr. Bruce Wolfe, a bariatric surgeon and professor of surgery, said (New York Times, 8/29). CBS "Evening News" reported Friday on the increasing demand for bariatric surgery (Pitts, "Evening News," CBS, 8/29). The segment includes comments by Lenox Hill Hospital Surgeon Marina Kurian and is available online in RealPlayer.This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.