Highlights of Obesity and the Built Environment: Improving Public Health Through Community Design

Kristin Richardson

Disclosures

August 24, 2004

In This Article

The Perfect Storm

"We've created the perfect storm for obesity," James Hill, MD,[1] University of Colorado Health Sciences Center, Boulder, told conference participants in one of the keynote addresses. Our genes tells us "to eat whatever food is available and that we don't need to be active to rest," sophisticated technologies allow us to get through the day without being physically active, and, in this country, it is acceptable to have food everywhere and to eat almost anywhere. Frankly, Dr. Hill asserted, "It's surprising to me that in this environment anybody can avoid being obese."

Dr. Hill, however, is optimistic about the possibilities for change. He urged listeners to broaden their thinking and to incorporate the commercial environment, the policy environment, and the social/cultural environment in their model of the built environment. He also emphasized that people interested in creating change must think concretely and "paint the picture" of what the desired changes would look like. Most important, we must look to the future rather than the past. We can't go back in time and become hunter-gatherers, and we aren't going to get rid of the automobile -- we must go forward, work together, and "do something that hasn't been done before," he said.

Dr. Hill's picture of the future is expressed in the program "America on the Move,"[2] a nonprofit organization that he cofounded. The program is based on small changes, incentives rather than disincentives, and the involvement of the individual, the government, and the private sector. The first goal of America on the Move is to stop weight gain; currently, adults in the United States gain 1 to 2 pounds per year. The organization recommends that people get a pedometer and take an extra 2000 steps per day, and also to make a second behavior change that will save 100 calories each day. This change could be as simple as drinking a glass of water instead of a sugary soda. Dr. Hill sees these small changes as "the first rung on the ladder of self-efficacy." But, ultimately, the sustainability of these individual changes will depend on the environment, so small changes must be made in the built, commercial, and policy environments as well. For example, when we plan new communities, we should build sidewalks and bike paths. Small changes in the commercial environment might include producing ads with popular cartoon characters promoting healthy foods rather than junk foods, and encouraging restaurants to print an offer on the menu to wrap up one quarter of each dinner for tomorrow's lunch. Changes in the policy environment could include a worksite bill of rights that would give each worker 20 minutes each day when the computers go blank and they are encouraged to walk. While these changes may appear small when taken individually, big cultural movements go forward on small steps, and Dr. Hill cited the example of the smoking-cessation and recycling movements as models for success and hope.

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