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Kaid Benfield’s Blog

5 graphs and 4 photos tell the story on obesity, diabetes & walking

Kaid Benfield

Posted March 28, 2012

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  Bentonville, Arkansas (courtesy of Steve Davis)

Perhaps the single most alarming public health trend in the United States today is the dramatic rise in overweight and obesity, bringing serious risks of heart disease, diabetes and other consequences leading to life impairment and premature death.  This is bad enough as it is, but I contend that it is particularly unfortunate that we do not sufficiently recognize the extent to which these trends are caused by environmental factors, particularly the shape of our built environment.

The graphs tell the story.  Start by looking at the dramatic rise in US obesity over a 14-year period.:

  obesity by state, 1994 and 2008 (by: Centers for Disease Control & Prevention)

The problem is especially acute in America, where the combined share of overweight and obese residents is now well over 60 percent, ranking first among 22 nations represented in this graph from the OECD:

  rates of overweight and obesity, 2004 (by: OECD via Choices)

Now consider the trend in the rate of diabetes:

  trend in diagnosed diabetes (by: CDC)

One of the nation's foremost experts in environmental health, Dr. Richard Jackson, has eloquently reminded us of the seriousness of this problem, which he highlights in a documentary series shown on PBS.  Now consider the correlation between obesity and diabetes:

  trends in diabetes and obesity (via Medscape Education)

An excellent (though unsigned) article in Medscape Education summarizes why this should be a major concern:

"Type 2 diabetes is a serious problem, not only in our country but also throughout the world. In the United States, probably more than 30% of individuals above the age of 60 years have diabetes (most of which is type 2 diabetes) or impaired fasting glucose. The most recent data support having 21 million people with diabetes in this country with millions not knowing that they have this disease. In general, for every two individuals who have been diagnosed with diabetes, there is another person out there with the disease who is not yet aware of having this condition. More than 2,500 cases of diabetes are diagnosed every single day.

"Diabetes is the leading cause of nontraumatic amputations, eye disease, kidney disease, and a major factor in the development of cardiovascular disease. Cardiovascular disease is the number one cause of death in our patients with diabetes."

(The article continues with a very good exposition of the relationship of diabetes and obesity to ethnicity.)  Overall, the risk for death among people with diabetes is about twice that of people without diabetes of similar age.

Now, correlate the problem of the alarming rise in these problems with a serious lack of physical activity in the US.  Here is a graph from National Geographic showing what shares of the population in 17 countries walk or bicycle to purposeful destinations:

  shares of population walking or bicycling (via National Geographic)

So:  we Americans are first in obesity, and last in everyday exercise.  While I won't argue that lack of walking or other everyday exercise is the sole cause of weight-related health problems - we all know the issues with nutrition, for example - the correlation is too strong to discount.

Why don't Americans walk more?  Because, as Dr. Howard Frumkin, another of our leading experts on environmental health, puts it in a fantastic presentation, "we have engineered walking and bicycling out of our communities" with community design oriented almost exclusively to driving.  (With Andrew Dannenberg, Frumkin and Jackson co-authored the recent Making Healthy Places, published by Island Press.)

We have, in effect, made getting around by foot or bicycle the most dangerous and least attractive option, though some brave souls risk their safety to walk or bicycle despite the hostility of the environment.  Want some examples?  Here you go:

  (courtesy of Complete Streets Coalition)

  (courtesy of Complete Streets Coalition)

  just outside a DC area Metro station (courtesy of Cheryl Cort)

For more, see the links at the bottom of this post.

There are many remedies available to us, including "complete streets," which fortunately are gaining favor in planning offices around the country.  The research also points us in the direction of better street connectivity, neighborhoods with shops in close proximity to homes, and the presence of sidewalks and transit stops.  My post yesterday featured a two-minute video on steps cities can take.  Let's do it.

Related posts:

Move your cursor over the images for credit information.

Kaid Benfield writes (almost) daily about community, development, and the environment.  For more posts, see his blog's home page.  Please also visit NRDC’s Sustainable Communities Video Channel.

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Jennifer MartinMar 28 2012 01:57 PM

Never mind the facts about how obesity is more prevalent among socioeconomic classes, people who might not have the time to walk because they're working 3 jobs, or don't live in a neighborhood safe enough to walk. Never mind that diabetes affects thin AND fat people (yes, including type 2!), but we only care about preventing fatness and eliminating fat people, and naturally thin folks get a pass.

I agree we need to get better food and movement options to all people, but this post is eliminationist rhetoric, not about making the world a better place for all earthlings.

Kaid @ NRDCMar 28 2012 02:45 PM

Actually, I and the organization I work for, as well as the sources I cite, advocate action in all of the areas you mention (and that I hope you are working on). Every public health problem is multi-faceted and requires many solutions. This happens to be the one I am expert in, and thus where I can play a small role in bringing it to the attention of the public.

Martha McDonaldMar 28 2012 03:35 PM

Great article and charts! Dr. Richard Jackson speaks often about this same subject, and he has also written a couple of books. The most recent is Building Healthy Communities.

Kaid @ NRDCMar 28 2012 04:02 PM

Thanks. Actually, I think Dick's newest book is called Designing Healthy Communities.

AlitaMar 29 2012 09:15 AM

I heartily agree with the overall spirit of this blog entry. I *definitely* agree that we as a nation are getting heavier and more unhealthy and that the physical environment is a key part of that. Heck, I used to live in a very dense Seattle neighborhood (didn't even own a car!) and now find myself in a town in North Carolina with no crossing signals or crosswalks, and it sucks. I have to drive to get somewhere where I can go running, and that's sad.

I only have one tiny quibble: I believe that the "the U.S. rise in obesity from 1994 to 2008" graphic at the top should come with the acknowledgment that BMI categories were recalculated in 1998, thereby making many people "overweight" almost overnight. The graphic does not mention BMI, but it relies on CDC data and therefore, I assume, is based on BMI rates for each state.

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