1. The built environment and obesity: What we know and what we need to know Russ Lopez, MCRP ScD Boston University School of Public Health

2. Past studies: sprawl - obesity Ewing et al (Am J Health Promot. 2003 Sep-Oct;18(1):47- 57) Vadnergrift and Yoked (Health Place. 2004 Sep;10(3):221-9) Lopez (Am J Public Health. 2004 Sep;94(9):1574-9) Sturm and Cohen (Public Health. 2004 Oct; 118(7):488- 96) Kelly-Schwartz, et.al. (J Planning Education Research. In press)

3. Sprawl to obesity: proposed pathways (1) Sprawl results in: –Increased distance to Jobs Schools Food Stores Recreation Facilities –Reduced utility of non-automobile transportation No way to walk/bike to destinations No accessible destinations

4. Sprawl to obesity proposed pathways (2) These cause: –Increased driving –Less walking/biking –Increased stress –More reliance on fast food meals/convenience stores

5. Sprawl to obesity proposed pathways (3) Which leads to: –Less physical activity –Increased calorie consumption And ultimately to obesity

6. Sprawl definition issues Multiple definitions –Density measures –Gradient measures –Land Use measures –Street network measures –Composite measures Does choice of measure influence results? Are better measures needed?

7. Model issues Many of the sprawl – obesity links need additional research Which links are most important? How important is sprawl and the built environment relative to other factors that affect obesity risk?

8. Methodological issues Studies to date are cross sectional Needs include: –longitudinal studies –additional databases –pre/post studies –historical studies

9. Generalizability issues Studies have focused predominately on adults What are the effects on –Children –Elderly –Inner city residents –Non-White people –Low Income people –People with disabilities –Rural areas –Other countries?

10. Application issues Interventions Urban design changes Public education

11. Good news! Many studies are currently underway Important funding available –NIEHS –Robert Wood Johnson

12. Bad news! The sprawl enthusiasts are fighting back Translation of research into policy is lacking The public has not yet taken this knowledge into its collective consciousness

13. Final thoughts Evidence is growing to connect the built environment and obesity, but it is not yet conclusive Greater research is needed to: –Diversify the evidence –Prove the causal pathway –Develop programs/policies for change –Increase our understanding of the effects on other populations

14. For more information Russ Lopez rptlopez@bu.edu http://people.bu.edu/rptlopez /