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Obesity Presumption #6: Built Environment Promotes Obesity

Continuing in the discussion of obesity myths, presumptions and facts published in the New England Journal of Medicine, Presumption #6 states that:

“The built environment, in terms of sidewalk and park availability, influences obesity.”

This idea, is based on the very “common-sense” notion that neighborhood-environment features may promote or inhibit physical activity, thereby affecting obesity rates.

However, as the authors point out, virtually every study showing any relationship between built environments (and not all have) are observational in nature – and correlation does not prove causation. Indeed, there is certainly no dearth of confounders regarding those who chose to live where, which could easily account for any positive findings (or lack thereof).

Thus, although this is a most attractive and logical appearing hypothesis, the data to support it is far less than the researchers (and policy makers) working in this area would have us believe.

This is not to say that walkable neighbourhoods, children playgrounds, promotion of bicycle paths, parks, mixed land use, etc. would not have countless important benefits both for the kids and adults living in these spaces.

In fact, I stand firm in support of building “healthy” communities, which can only flourish in environments built for that purpose.

On the other hand, I would neither expect obesity rates to go up or down in such an environment – obesity is far too complex a problem to expect any major impact from such a measure.

Edmonton, AB


  1. Your series brings home just how “wicked” a problem obesity can be.

    As I read your posts, I feel more and more that perhaps improvements in a number of areas (a more walking friendly environment, eating more fruits and veg, eating breakfast, stress reduction, breastfeeding, better physical activity programs in schools, etc. etc.) ARE the answer–just not the answer to obesity. They are factors that help us become a healthier society.

    All these societal shifts and more will make us healthier as a population and will perhaps bring more of us closer to (but not precisely at) the middle of the weight bell curve. In other words, although there may be fewer extremely thin or morbidly obese people and more people will be healthier (BP, cholesterol, etc.), overweight and obesity will not be eliminated. It’s better to be healthy, weight-stable and be at Stage 0 or 1 on the EOSS rather than vainly striving to become something your body just won’t accept–at least in the long-term.

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  2. I suspect that local crime rates are much more important!

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  3. There’d be less crime if there were more people out of the streets. Read Jane Jacob’s “Death and Life of Great American Cities.”

    I agree 100% with Dr. Sharma, and I would take it a step further. Building healthier communities isn’t about obesity. It’s a worthwhile end in itself, because it will make everyone’s life better. And guess what? There will be people of all sizes living in those healthier communities, and it would be really nice if those who are larger than average could ride bikes and walk down the street without insults being shouted at them from cars and without getting the side-eye from other pedestrians.

    Unfortunately, I have a feeling that making “stopping obesity” a motivator to create healthier communities will just encourage the haters and make fat people feel as if they’re not welcome to participate in those communities.

    After all, people who live in healthy communities should be healthy, and healthy is the same thing as thin! /sarcasm.

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  4. While I agree obesity is a complex issue and the relationship between the built environment and obesity requires further research, cities should be working towards developing more compact, mixed use and walkable communities.

    The built environment can promote physical activity through active transportation by providing sidewalks and bike lanes, placing shops and other amenities close to residential development, requiring a grid or modified grid street pattern to reduce travel distances, and reducing parking availability. In addition to promoting active transportation, the built environment can increase the safety of travel through traffic calming measures and provision of bicycle and pedestrian facilities, improve air quality by reducing the number of cars on the road, and provide opportunities for social interaction and recreation.

    As per their websites, several municipalities and countries are recognizing the correlation between the built environment and health, including the Canadian government, the government of British Columbia and Ontario, Alberta Health Services, the City of Toronto, etc.

    Also a recent Australian study found: “for every local shop, residents’ physical activity increased an extra 5-6 minutes of walking per week. For every recreational facility available such as a park or beach, residents’ physical activity increased by an extra 21 minutes per week.”

    I would welcome further research in this area.

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