Book Review: Obesogenic Environments

Obesogenic environments: complexities, perceptions and objective measures. (2010), Lake,Amelia A, Townshend,T.G, Alvanides,Seraphim, Wiley-Blackwell.

“When you design streets solely for cars, people die as a result. The underlying conditions that are responsible for those deaths are rarely or never challenged. The victims often get blamed for their own injuries or deaths.”i

The above quote refers to the case of Raquel Nelson, a US Atlanta-area mother who was recently convicted of vehicular homicide. But not for driving a motor vehicle. She was crossing a busy road with three children when her 4-year-old son was struck by a car and killed. The road did not have adequate pedestrian crossing facilities.

Such examples highlight the impact that the design of our built environment can have on our lives. But for some readers, linking street design, road deaths and obesity may seem unwarranted. However, the growing levels of obesity in the United Kingdom suggest that the design of our streets, neighbourhoods and cities are helping to kill us – maybe a little slower but just as surely.

The Health Survey for England (HSE) data shows that nearly 1 in 4 adults, and over 1 in 10 children aged 2-10, are obese. In 2007, a Government-commissioned Foresight report predicted that without actions being taken, 60% of men, 50% of women and 25% of children would be obese by 2050.ii

The likely health consequences of the rise in obesity levels have also been well documented. The US Surgeon General Richard Carmona stated, “because of the increasing rates of obesity, unhealthy eating habits and physical inactivity, we may see the first generation that will have a shorter life expectancy than their parents”. Obesity has been linked to various chronic diseases, such as type 2 diabetes, cardiovascular disease, osteoarthritis, and certain types of cancer. In 2000, poor diet and lack of physical activity were indicated as the second highest causes of preventable death in the United States; just behind tobacco.iii Unfortunately, where the US has led, the United Kingdom and other countries are following.

There are many well-documented factors that influence obesity. At the simplest level, obesity is caused by not doing enough physical activity and eating too much food. But obesity is actually an extremely complex issue. Our built environment and how it encourages, or prevents, us from making healthy lifestyle choices is now recognised as an under-researched area.

For all those not familiar with the term, “obesogenic environment” refers to “an environment that promotes gaining weight and one that is not conducive to weight loss” within the home or workplace.iv Or put another way an obesogenic environment is one that makes it difficult for people to include physical activity in their everyday lives.

As Tim Townshend, one of the book authors, commented:

“We need to think seriously about what kind of environment we are creating for ourselves and have a sensible debate about what’s acceptable and what’s not in our towns and cities. Health needs to be back on the town planning agenda before it’s too late.”

The government and the food industry are keen to stress individual responsibility for health, diet and planning issues. They are also very keen on ‘light touch’ and ‘self’ regulation for the food and drinks industries. The “market”, it would appear, knows what is best for us and gives us what we want.

But the built environment and food policy are too important to be left to the market and to individual “choices”. The current situation is that the unhealthy option is the easy one. Society has to create environments where people are encouraged and supported to take the healthier options.

The book has fourteen chapters (*) which provide an introduction to obesity and its implications for health and wellbeing, and also cover key themes such as eating behaviours and food environments, physical activity and the environment, the urban environment, methods, policy and future research directions. By bringing together many disciplines including nutrition and dietetics, policy, epidemiology, environmental sciences, medical sciences, town planning and urban design, transport, geography and physical activity, this book helps demonstrate the multidisciplinary approach to public health needed to reshape our built environment to encourage and support people to make healthy food, transport and lifestyle choices.

As co-editor, Dr Amelia Lake, commented “Our research shows that it is as much the responsibility of an urban designer as it is a nutritionist to reverse the obesity trend.”.

This book is not an easy read and not for the general reader. However, one of its strengths is that it helps demonstrate that obesity, just like road deaths, cannot be blamed on individual responsibility. There is such a thing as society and we needs to work collectively to plan better and healthier environments.

Pete Abel
20/2/2012.

* Book chapters
An International Perspective on Obesity and Obesogenic Environments;
Towards Transdisciplinary Approaches to Tackle Obesity;
Walkability, Neighbourhood Design and Obesity;
Availability and Accessibility in Physical Activity Environments;
Defining and Mapping Obesogenic Environments for Children;
Objective Measurement of Children’s Physical Activity in the Environment: UK Perspective;
Physical Activity and Environments Which Promote Active Living in Youth (USA);
Active Travel; Greenspace, Obesity and Health: Evidence and Issues;
Eating Behaviours and the Food Environment;
Food Policy and Food Governance – Changing Behaviours;
Neighbourhood Histories and Health: Social Deprivation and Food Retailing in Christchurch, New Zealand, 1966-2005;
Environmental Correlates of Nutrition and Physical Activity: Moving Beyond the Promise;
Obesogenic Environments: Challenges and Opportunities.

Endnotes

ii Foresight (2007) Tackling Obesities: Future Choices – Project report. London: Government Office for Science, 2nd edition. www.dh.gov.uk/en/Publichealth/Obesity/index.htm

ivSwinburn, B., Eggar, G., & Raza., F. (1999). Dissecting obesogenic environments; the development and application of a framework for identifying and prioritizing environmental interventions for obesity. Preventive Medicine, 29(6), 563-570.

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