Dissecting and influencing Obesogenic environments: Urban Design

1
Dissecting and influencing Obesogenic
environmentsUrban Design

• Professor Boyd Swinburn
• Physical Activity and Nutrition Research Unit
• School of Health Sciences
• Deakin University
• Melbourne
• Australia

2
Outline

• The obesity pandemic current approaches
• Ecological view of obesity
• Some education/motivation strategies
• Obesogenic environments
• ANGELO framework
• Specific settings
• schools, neighbourhoods, transport networks,
  buildings
• Other priorities

3
Increasing obesity prevalence
4
Current approaches to obesity

• Perceived causes
• Lifestyle (eating and physical activity choices)
• Genetic background
• Perceived solutions
• Education (to individuals and populations)
• Diets and various magic bullet treatments
• Drugs / surgery
• Research effort
• Potential genetic causes (? drugs, identify at
  risk individuals)
• Treatment options (diet, exercise, drugs)

5
Ecological model for obesity
Influences
Environment
Biology
Behaviour
Energy in (fat) Energy out (PA)
Equilibrium fat stores

Physiological adjustments
X
Moderators
Mediators
Swinburn et al Prev Med 1999
6
Education / motivation interventions

• EXAMPLES
• Australian Physical Activity Guidelines
• Green Prescriptions written exercise
  prescriptions from GPs (NZ)
• TravelSmart household marketing of alternative
  transport options (WA)

7
PA guidelines

• Think of movement as an opportunity not an
  inconvenience
• Move every day in as many ways as possible
• Put together at least 30 minutes of moderate
  intensity activity on most days
• If you can, do some vigorous exercise a few times
  a week

8
Green Prescriptions(Swinburn et al 1998, Am J
Publ Health)

• RCT of written vs verbal advice on PA
• N491, F/U 6 weeks
• Both increase PA, GRx gt verbal advice
• At 11 months, 59 maintained ? PA
• After GP detailing
• 50 GPs using GRx in 1999
• 52 maintaining ? PA after 6 months

Minutes per week 74 136 76 157
9
Transport South Perth trial

• Household marketing of alternative options for
  transport in South Perth (good public transport
  services)
• 97 fewer car as driver trips, 75 more as
  active transport
• Net effect Walk bicycle ?30 minutes/week
• www.travelsmart.transport.wa.gov.au

• Walk ? 49
• Bicycle ? 14
• Public T ? 12
• Car as driver
• 97
• Car as passenger
• ? 21

Total trips 1160
10
Environments

• Obesogenic environments the sum of influences
  that the surroundings, opportunities or
  conditions of life have on promoting obesity in
  individuals or populations
• Obesogenic promoting obesity
• Leptogenic promoting leanness
• Setting places where people gather
• Sector Broader systems, industries, services
  (state, federal, international)

11
Obesogenic Environments

• Fundamental drivers of obesity epidemic
• Built on some natural human preferences (eg easy,
  convenient, value for money, fast, low effort)
• Most dominant driver is profit motive
• Making environments more leptogenic
• Drivers are mainly policy and social changes
• Environment/public governance movements allies
• Aim to achieve small changes in large volume
  activities (eg transport, stairs, recreation)

12
Strengths of environmental solutions

• Address underlying causes
• Sustainability
• Embeds in structures and systems
• Embeds in social norms
• Health equity
• Can influence the hard-to-reach
• Less language dependent
• Effectiveness
• Often very cost-effective
• Influences default behaviours
• Minimises message distortions

13
ANGELO Framework(Analysis Grid for Environments
Linked to Obesity)
Swinburn et al Prev Med 1999
14
Uses of ANGELO

• Used with stakeholders for scanning environments
  for obesogenic elements
• Needs analysis ? ANGELO
• Problem identification ? ANGELO
• Strategy development
• Intervention
• Evaluation
• Shifts the focus upstream
• Robust (tested in NZ, Australia, Pacific Islands,
  Middle East)

15
Example Schools (PA)
16
Driving children to school(Christchurch NZ - C
OFallon, 1999)

• 77 of people with primary school children drove
  them to school 4 days/week
• 54 live lt2km from school
• Reasons for travel by car to school
• 35 road safety
• 28 distance
• 16 already going to work

17
School setting

• Physical (what is available?)
• Outdoor space, indoor space, gym, equipment, PE
  in curriculum, sports teams, non-competitive
  activities, coaching, walking bus, safe routes to
  school, traffic calming/reduction, skilled
  teachers
• Economic (what are the financial factors?)
• Costs to students playing some sports, travel
• Budgets school funding allocation for PE,
  sports, grounds, facilities

18
Schools setting (contd)

• Policy (what are the rules?)
• School policies/rules on transport (eg cycling)
  to school, PE in curriculum, equipment use,
  participation in sports (students and teachers)
• Socio-cultural (what are the attitudes, beliefs,
  perceptions and values?)
• School ethos on sports, participation, exercise
• Perceptions of safety of walking/cycling to
  school
• Beliefs about PA and classroom learning
• Beliefs about causes of obesity, school role in
  health promotion

19
Sectors related to schools

• Education system
• Policies on PE requirements in curriculum
• Funding for space, facilities
• School transport systems
• Local government
• Provision of footpaths, cyclepaths, playing
  fields
• Traffic laws (eg stopping for buses)
• Transport sector
• Provision of traffic calming measures

20
Prioritising process

• An ANGELO workshop with stakeholders identifies
  many potential obesogenic elements
• Need to prioritise elements on basis of
• Changeability (how amenable is it to change?)
• Relevance (how much of a problem in this
  population?)
• Impact (how much will it affect population PA
  levels?)
• May lead to action, further research, further
  consultation

21
(No Transcript)
22
Brief examples

• Neighbourhoods
• Active recreation locally
• Transport Networks
• Active transport walking, cycling, public
  transport (13 min walking per PT trip vs 2 min
  per car trip)
• Buildings
• Incidental activity (mainly use of stairs)

23
Neighbourhoods(parks, open spaces, recreation
facilities)

• Physical
• Availability, access, quality, facilities,
  lighting
• Economic
• Costs to users, local govt budget allocations
• Policy
• Green space requirements in suburbs, policy
  orientation towards participation, car-free
  areas
• Socio-cultural
• Perceptions of safety, community value/ownership
  of spaces, cultural attitudes to exercise

24
Access to recreation facility versus use(Odds
ratio compared to top quartile of access)
Giles-Corti Soc Sci Med 2001
25
Transport networks

• Physical
• Extent of and access to networks and services for
  cars, public transport, cycling, walking
• Urban design mixed use, density, corridors
• Economic
• Costs of public transport vs car
• Direct fares vs car, gas, parking, tolls,
  insurance etc
• Indirect environmental costs
• Budget allocations/subsidies for car vs PT
  infrastructure

26
Transport networks (contd)

• Policy
• Funding formulae for transport infrastructure
• Traffic laws, by-laws
• Socio-cultural
• Car culture among citizens, transport
  bureaucracy, and politicians
• Advertising the car dream
• Belief in technological solutions
• Road ownership

27
Buildings (stairs)

• Physical
• Visible, accessible, attractive, promoted
• Economic
• Added building costs to include accessible stairs
• Policy
• Fire and security regulations
• Socio-cultural
• Attitudes of public to stair use (inconvenience
  or opportunity), perceptions/attitudes of
  architects

28
Other priority issues

• Children and adolescents
• Difficulty of losing weight in adulthood
• More intervention options
• Opportunity to influence adults through children
• Monitoring and surveillance
• Connect with policy, funding, education, advocacy
• Indicators versus total picture
• Sentinel sites (guinea pig populations)
• Brings intersectoral action to manageable size

29
The built environment - conclusions

• Fundamental but neglected links to obesity
• Can be scanned and prioritised for interventions
• Interventions are
• Complementary to public education
• Concordant with sustainability/ environmental
  protection efforts
• Priorities
• Children, monitoring, sentinel sites, high volume
  PA
• Desperately need well-evaluated wins