The WSJ Health Blog is running a post on Mississippi's State Health Officer's work to reduce the state's obesity rate, the worst int he country. The blog adopts a kind of cynical, tongue-in-cheek,"check out this Southern simpleton" kind of approach. Too bad Elva Ramirez didn't Google the subject of obesity interventions.
Mississippi has several interventions under way, but the data shows neither clinical nor public health interventions work very well.
Obesity is subject to health disparities by race and by economic status and these effects appear to be independent. The worst off are First Nations and Latinos, whose obesity-related mortality is higher. It also turns out inner city African-American neighborhoods have more fast-food restaurants than wealthy "white" areas and are exposed more heavily to high-fat food advertising. One of the most interesting associations (not a causal relationship, for those of you who are still awake) is the effect of infrastructure. The accessibility of sidewalks and safe areas to walk, stores within walking distance, public transportation and exercise facilities or parks can all impact obesity rates in a any given environment. This is frequently referred to as the built environment.
So the NIH is supporting a program to investigate how the built environment influences obesity. Obesity experts have approached our facility with a proposal to participate in a couple of grants and they tell me that the two areas which will likely yield the best future outcomes are interventions that empower patients and interventions that alter the built environment.
But that's just an opinion.
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One advantage of the subway/train system here in Tokyo is that you have to walk for at least 20minutes a day up and down stairs. Even that minimal amount of exercise has an effect... America has become too much of a car culture. Maybe as population density in cities increases alternative transport that doubles as exercise will become more prevalent.
I think it will turn out to be more than just the availability of safe sidewalks and nearby shops.
Inner-city residents normally have public transit available and those are neighborhoods where car ownership is more an option than a requirement.
I go more for the social nature of obesity.
Yoyoyo, You are 100% right. I have wondered if we could correlate car use with obesity rates. This first came up when a friend moved from Atlanta to New York City and asked me what I noticed... "There are very few fat people," he pointed out. Public transit encourages walking!
Roseag, I agree that social determinants are important, but obesity is paradigmatic of the interaction between multiple biological, behavioral, social and environmental factors.
So, if inner city African Americans and poor Hispanics jumped off a cliff would we then blame the cliff?
Yes, obesity has multiple causes including decreased physical activity, the abundant availability of cheap and fast food, increased time demands of the modern lifestyle, bad parenting, etc. etc.
Neither America's car culture nor cheap and fast food availability is going to go away any time soon. As with tobacco and alcohol products, the best way to combat this modern disease is with education and awareness.
Chris, I wouldn't want to push this analogy too far, but if the cliff wasn't there, nobody would be able to jump off.
:-)
Seriously, you are 100% right, awareness and education are step one. Business and marketing are experts at influencing and altering people's behavior. Thinking of the social, environmental and psychological components of the behavior open the door to more than just education.
Obesity is becoming a paradigm of the new "biopsychosocial" and I think we will hear more about novel approaches to prevention.
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