- Rates of overweight and obesity have increased dramatically in the US over the past few decades, with over 2/3 of American adults now overweight and about 1/3 obese. - This epidemic is primarily due to lifestyle and environmental changes that have led to poor nutrition habits like increased fast food consumption and sugary drinks, as well as less physical activity due to more sedentary jobs and communities designed around automobile use. - Community design features like walkability, mixed land use, and access to transit and active transportation can significantly impact physical activity levels and obesity rates by supporting healthier lifestyle choices.

1. Health and Community Design

2. Overweight is Epidemic Rates in Adults 2/3rds of American adults are overweight In 1991 rates were 45% (almost 50% increase in 15 yrs) (

3. Obesity Trends* Among U.S. Adults BRFSS, 1985 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14%

4. Obesity Trends* Among U.S. Adults BRFSS, 1989 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14%

5. Obesity Trends* Among U.S. Adults BRFSS, 1993 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

6. Obesity Trends* Among U.S. Adults BRFSS, 1997 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20

7. Obesity Trends* Among U.S. Adults BRFSS, 2000 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20

8. (*BMI  30, or ~ 30 lbs overweight for 5’4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) Obesity Trends* Among U.S. Adults BRFSS, 2002

9. Obesity Trends* Among U.S. Adults BRFSS, 2004 No Data <10% 10%–14% 15%–19% 20%–24% ≥25% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

10. OBESITY Risk Factors for the Chronic Disease Cardiovascular Stroke Endocrine Orthopedic Pulmonary Hepatic Psychosocial

11. Leading Causes of Obesity Poor Nutrition: Taking in too many calories Inactivity: Burning off too few calories

12. Poor Nutrition Fast Food Five-fold increase since 1970 1/3 of US kids eat daily Super-size me Portion sizes Sugars and Refined Flours Soda consumption has doubled in 20 years Processed Foods Higher in calories, fat and salt Irregular Meal Patterns

13. Physical Inactivity 25% of adults are sedentary 60% of adults not active enough 78% of kids don’t meet physical activity requirements. Electronic Media & Kids 5 ½ hrs/day 2 hrs more if computer/TV in room

14. Percentage of Trips in Urban Areas Made by Walking and Bicycling: North America and Europe 1995

15. The disappearing walk to school Only 10% of these trips are made by walking and bicycling 1 in 4 trips made by 5-15 year olds are for the journey to and from school Of school trips one mile or less, about 28% are walk-based and less than 1% are bike-based

16. 20% to 30% of morning peak traffic is parents driving kids to school

17. Increasing Vehicle Travel

18. Explaining the Epidemic Not genetic or biological changes Lifestyle and environmental changes

23. Improving Health through Community Design

24. Traffic Calming

25. Street Lighting

26. Improving Street Crossings

27. Compact/ Mixed Use Development

28. Attractive Street Design

29. Street Design & Connectivity

30. Transit-Oriented Development

31. Community Design/ Health Links San Diego study: 70 minutes more physical activity/week among residents in walkable neighborhood; 35% vs. 60% overweight 6 lb weight difference in sprawling vs. compact counties King County study: 5% increase in neighborhood’s “walkability index” correlated with 32% increase in active transportation; 0.23 point reduction in BMI

32. Expanding our Roles and Vision Urban planners, Transportation Engineers and Architects: Have a critical role in public health ************** Public Health needs to appreciate the built environment influences public health as much as vaccines or water quality .

33. The Public Health Impacts of the Built Environment Physical activity Obesity Chronic disease Access to healthy foods Pedestrian injuries/death Crime & violence Senior independence & mobility Water quality & quantity Mental health Health disparities Asthma & respiratory disease

34. Acute Asthma Events Among Children and Youth During the 1996 Summer Olympic Games Data Source Type of Asthma Event Mean No. of Events Per Day % Change Baseline Period* Olympic Period+ GA Medical Claims Emergency care and hospitalizations 4.23 2.47 -41.6 HMO Emergency care, urgent care and hospitalizations 1.36 0.76 -44.1 Emergency Departments Emergency care and hospitalizations 4.77 4.24 -11.1 GA Hospital Discharges Hospitalizations 2.04 1.65 -19.1

35. Best Practices

36. King County, Washington King County pursues aggressive “ smart growth: strategies: Land Use- combating sprawl and building healthier communities. Public transportation- getting more people onto leaner, greener busses. Environmental management- turning waste into energy Clean energy future- stimulating climate-friendly fuel and technology markets for a prosperous, sustainable economy. Ron Sims, King County Executive

37. Health & Transportation departments collaborated Commissioned study on health/transportation links The first Comprehensive Plan with physical activity/health as a goal and policies in the Urban Form and Transportation Elements Health as a General Plan Goal in King County, WA Seattle, Washington

38. Los Angeles County LAC Public Health and Regional Planning Directors have agreed to have their staff work collaboratively on General Plan Policies supporting healthy, livable communities have been incorporated into the Draft Preliminary General Plan Review/revise zoning ordinances to ensure they are in support of new general plan Public Health input into proposed new developments at Regional Planning’s subdivision committee meetings and EIR reviews

39. What Can Cities Do? Include health objectives in general plans Add a health element to the general plan Get Public Health input projects and updates Update zoning codes to allow compact, mixed use Update street design standards Dedicate/Increase funds for active transportation

40. Integrate Health into General Plan Health as explicit goal Provide comprehensive definition of health Link health and policies that support walkable, livable communities and smart growth

41. Models in California Chula Vista Richmond Chino

42. Integrate Health into Specific Plans Master Plan Redevelopment Plans Downtown Plans

43. California Assembly Bill 437 Authorizes the county health officer to provide assistance to cities and counties with local land use planning and transportation planning processes as they relate to public health.