Why Kids Don’t Walk To School

For today’s kids, walking or biking to school has become the exception rather than the rule.

A study by Anna Price and colleagues, published in the Journal of School Health, now explores the perceptions of school administrators in South Carolina regarding the factors that influence childrens’ active travel to school.

According to their survey of 314 school and district leaders of elementary and middle schools, the two most commonly raised issues were concerns about the safety of crossing streets (54%) and the availability of sidewalks (54%).

Additional factors included distance to school (46%), traffic volume (42%), parental attitudes (27%), traffic speed (27%), neighborhood condition (24%), and student attitudes (10%).

Some respondents also expressed concerns about liability issues related to students’ active travel to school.

Overall, the survey left no doubt about the considerable concerns of schools administrators about the safety of students while walking to school.

Based on these findings, the researchers suggest that active travel to school may be increased by addressing the (perceived?) safety of street crossing and the number of sidewalks, and by educating school and district leaders about liability and safety issues related to students walking to school.

If my readers can think of other barriers or novel ideas how to address them, I’d certainly love to hear them.

Edmonton, Alberta

Price AE, Pluto DM, Ogoussan O, & Banda JA (2011). School Administrators’ Perceptions of Factors That Influence Children’s Active Travel to School. The Journal of school health, 81 (12), 741-748 PMID: 22070505


Use of Light Rail Transit Can Reduce Obesity Risk

As an enthusiastic supporter and user of public transit, I have long suggested that promoting the availability and use of public transportation could go a long way in promoting physical activity and fitness, especially among those who have little time, interest or energy to invest in recreational physical activity.

Simply put, if public transportation is the most efficient way to get from A to B, then more people will spend more time on their feet irrespective of any interest in or motivation for physical activity.

But can the use of public transportation really have a measurable impact on body weight?

This question was addressed by J MacDonald and colleagues from the University of Pennsylvania, who, in a paper just published in the American Journal of Prventive Medicine, examined the impact of light rail transit (LRT) use on BMI and physical activity.

Data were collected on individuals before (July 2006-February 2007) and after (March 2008-July 2008) completion of an LRT system in Charlotte, North Carolina and BMI, obesity, and physical activity levels were calculated for a comparison of these factors before and after LRT construction.

Data were adjusted for differences in baseline characteristics among LRT and non-LRT users.

Over the course of the study, the use of LRT to commute to work was associated with an average 1.18 reduction in BMI and an 81% reduced risk of becoming obese over time.

Obviously, body weight is only one possible benefit of being more active. It remains to be seen if the use of LRT (or other efficient modes of public transportation) may also help improve or prevent other conditions known to be positively associated with decreased physical activity including hypertension, dyslipidemia, diabetes, arthritis, depression, and perhaps even certain cancers.

Nevertheless, as the authors note, “The results of this study suggest that improving neighborhood environments and increasing the public’s use of LRT systems could provide improvements in health outcomes for millions of individuals.

Thus costs for the construction and promotion of efficient public transit can potentially translate into very significant savings in health care costs (not to mention carbon footprint).

I, for one, can certainly attest to the fact that the recent expansion of the Edmonton LRT system to my neighborhood has markedly increased my number of daily steps (while actually saving time (and money) on my daily commute).

Edmonton, Alberta

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MacDonald JM, Stokes RJ, Cohen DA, Kofner A, & Ridgeway GK (2010). The effect of light rail transit on body mass index and physical activity. American journal of preventive medicine, 39 (2), 105-12 PMID: 20621257


Is Active Transport the Solution to Canada’s Fitness Dilemma?

Yesterday’s news was all about the new report on the declining fitness and increasing fatness of Canadians.

Although the role of physical activity to combat excess weight remains disputable, there is absolutely no doubt that increased physical activity is the key to better physical fitness (at any weight!).

So how do we get Canadians moving?

Probably not by demanding that they exercise more – indeed, we could probably easily plot the increase in gyms, fitness clubs, joggers, and sales of home exercise equipment vs. the increase in obesity and get a straight line that leaps right off the top of our chart.

Somehow I very much doubt that throwing even more gyms, fitness clubs or exercise equipment at the problem is likely to make any difference whatsoever.

Not that these facilities or gadgets are not effective when used; it is just that they are only (and probably only ever will be) used by such a small fraction of the population (mostly younger, female and affluent) that their use will probably never have a noticeable impact on public health.

If we want Canadians as a population to be more active, we will have no choice but to address some of the key factors that have led to this dramatic reduction in physical activity: automation and built environments that promote car dependency.

As pointed out by James Woodcock and colleagues from the UK in a recent article in The Lancet:

“Creation of safe urban environments for mass active travel will require prioritisation of the needs of pedestrians and cyclists over those of motorists. Walking or cycling should become the most direct, convenient, and pleasant option for most urban trips.

An increase in the safety, convenience and comfort of walking and cycling, and a reduction in the attractiveness of private motor vehicle use (speed, convenience, and cost) are essential to achieve a modal shift.”

Based on their modeling of the impact of increasing active transportation in London, UK and New Delhi, India, together with the known benefits of increased physical activity, the authors conclude that:

“Increase in the distances walked and cycled would lead to large health benefits. Largest health gains would be from reductions in the prevalence of ischaemic heart disease, cerebrovascular disease, depression, dementia, and diabetes.”

Are these changes likely to occur across Canada anytime soon? Probably not!

Can we perhaps get Canadians to be fitter by hoping that they’ll now all get on their treadmills at the end of their eight hour working days and hour-long commutes? Don’t hold your breath!

Do you drive a car, complain about poor roads, expensive parking, and simply hate those pesky pedestrians and cyclists?

Then YOU are the cause of Canada’s fitness dilemma.

Edmonton, Alberta


Airline Seat Saga Continues

Regular readers of these pages will recall my previous comments on the recent Canada Supreme Court ruling on the accommodation of severely obese passengers on Canadian airlines (for previous comments click here and here).

This policy resulted in Air Canada now requiring obese patients to present a doctor’s note 48-72 hrs before travel if they wish to be accommodated on two seats (click here for the forms Air Canada requires passengers to fill out – see page 5 of the form). 

While creating more work for doctor’s who have to fill out the form (with rather simple measurements that almost anyone can take) and creating embarrassment for all involved, at least this policy does ensure that large patients are accommodated without extra charge: one passenger – one fair – it’s only fair!

Yesterday, United Airlines took the other view and announced that it would begin charging large individuals for two seats. In doing so, United now joins the other four major airlines (Delta, US Airways, Continental, and Southwest), which have already been charging large travelers for an extra seat.

As expected, there are a host of people who think that this is only fair (which is probably why the airlines can get away with this policy). I have previously made my views on this clear: this policy is discriminating and feeds into the widespread notion that obesity is simply a self-inflicted condition resulting from poor choice, completely avoidable by eating less and moving more.

As long as this simplistic view of obesity prevails, we are still a long way off from treating obesity for what it is – just another complex chronic condition (like diabetes, asthma or heart disease) that results from complex interactions between sociocultural, biomedical, genetic and/or iatrogenic factors in our obesogenic environment.

I have yet to meet someone who “chooses” to be fat.

Edmonton, Alberta


Supersizing Air Ambulances

Yesterday, I predicted that this year we will continue seeing concerns about and services for individuals with extreme obesity. 

Perfectly on cue, the Government of New South Wales (Australia) announced that they have put out a tender for larger air ambulances that will allow transportation of patients weighing upto 260 Kg (up from the current 140 Kg). The larger planes will cost an additional $10 Mill per plane.

Given the importance of air ambulances for transporting patients from geographically dispersed remote parts of Canada to urban centres, I wonder how we are dealing with this issue in Canada. Given the high prevalence of obesity in rural communities, I would not be surprised if our air ambulances are faced with a very similar problem.

I assume that this is only the first of a whole series of news stories that we will be seeing from around the world regarding the need to “supersize” everything from public seating, hospital beds, commodes and doctors’ scales to ambulances and amusement park rides.

I predict a good year for the “bariatric” industry.

Edmonton, Alberta