Hilary T. Box, PharmD- Mercer University College of Pharmacy
The National Health and Nutrition Examination Survey estimated that 69% of US adults were overweight or obese in 2011-2012 resulting in an increase in diabetes prevalence from 15% in the late 1970’s.1-2 Diabetes prevalence has increased from less than 4% in 1990 to 8.3% in 2012.3-4 It is thought that neighborhoods have shifted towards sprawling, car-oriented communities that discourage walking with heavy reliance on motorized transportation. However, it has been shown that neighborhoods with high population density, well-connected streets, and high number of destinations within walking distance of residential areas have higher rates of walking and bicycling for transportation.5-6
|Title: Association of Neighborhood Walkability with Change in Overweight, Obesity, and Diabetes|
|Design||Time-series analysis (2011-2012) N= 8,777|
|Objective||To examine whether walkable urban neighborhoods are associated with a slower increase in overweight, obesity, and diabetes than less walkable ones|
|Study Groups||Using annual provincial health care and biennial Canadian Community Health Survey data for adults (30-64 yrs) living in Southern Ontario cities|
Neighborhood walkability was derived for each dissemination area with a validated composite walkability index.
The index includes four equally weighted components: population density (number of persons per square kilometer), residential density (number of occupied residential dwellings per square kilometer), walkable destinations (number of retail stores, services [eg, libraries, banks, community centers], and schools within a 10-minute walk), and street connectivity (number of intersections with at least three converging roads or pathways).
The prevalence of overweight and obesity was estimated for each quintile of neighborhood walkability with self-reported data from the Canadian Community Health Survey, which is a series of cross-sectional nationally representative health surveys of Canadians aged 12 years and older and is conducted by Statistics Canada.
Administrative health data collected from April 1, 2001, to
March 31, 2013, were used to calculate the annual incidence of diabetes within each quintile of neighborhood walkability.
|Duration||January 1, 2001 to December 31, 2012|
|Primary Outcomes Measure||Annual prevalence of overweight, obesity, and diabetes incidence, adjusted for age, sex, area income, and ethnicity|
|Baseline Characteristics||Walkability Quintiles|
|1 (Least Walkable)||2||3||4||5 (Most Walkable)|
|No. of neighborhoods||1,757||1,757||1,757||1,759||1,747|
|Pop per neighborhood, median (IQR)||551
|Nonwhite ethnicity, %||23.9||27.8||31.0||30.6||26.3|
|Socioeconomic indicators, %|
|Poverty , %||11.2||13.9||17.1||21.3||25.1|
|Retail Indicators, %|
gyms, no per
|Built Environment Characteristics|
|Walkability Score, median (range)||10.1
|Mean distance to nearest park, m||3,224||3,207||3,182||3,169||3,186|
|Results||Prevalence of Overweight and Obesity|
|Quintile||Change in Prevalence, %||95% CI, %||p value|
|1 vs 5||43.3 vs 53.5||-13.5- -6.8||<0.001|
|Quintile||Absolute change of Adjusted Annual Incidence of Diabetes||95% CI, %||p value|
|1 vs 5||-1.7||-2.8- -0.7||0.001|
|Adverse Events||Common Adverse Events: none|
|Serious Adverse Events: none|
|Percentage that Discontinued due to Adverse Events: none|
|Study Author Conclusions||In Ontario, Canada, higher neighborhood walkability was associated with decreased prevalence of overweight and obesity and decreased incidence of diabetes between 2001 and 2012.|
Many other factors can contribute to the incidence of overweight, obesity, and diabetes including genetics, personal health motivation, and lack of health education. Thus, further research is necessary to assess whether the observed associations are actually causal.
- Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA. 2014;311(8):806-814.
- Fryar CD, Carroll MD, Ogden CL; National Center for Health Statistics, Centers for Disease Control and Prevention. NCHS health e-stat: prevalence of overweight, obesity, and extreme obesity among adults: United States, trends 1960-1962 through 2009-2010. http://www.cdc.gov/nchs/data/hestat/obesityadult/
- Geiss LS,Wang J, Cheng YJ, et al. Prevalence and incidence trends for diagnosed diabetes among adults aged 20 to 79 years, United States,1980-2012. JAMA. 2014;312(12):1218-1226.
- Nichols GA, Schroeder EB, Karter AJ, et al;SUPREME-DM Study Group. Trends in diabetes incidence among 7million insured adults,2006-2011: the SUPREME-DM project. Am J Epidemiol. 2015;181(1):32-39.
- Sallis JF, Cerin E, Conway TL, et al. Physical activity in relation to urban environments in 14 cities worldwide: a cross-sectional study. Lancet. doi:10.1016/S0140-6736(15).
- Saelens BE, Handy SL. Built environment correlates of walking: a review. Med Sci Sports Exerc. 2008;40(7)(suppl):S550-S566.