Our Waistlines Are Expanding In Sync With Our Car-Dependence

cdc_map.jpgStates with the highest adult obesity rates also tend to be where the fewest people bike or walk to work. Image: CDC

Two reports released last week underscored the increasing severity of America’s obesity epidemic. And the eye-opening findings add to the mounting evidence that stopping the spread of obesity and its attendant health risks will require changes to the nation’s transportation system as surely as it demands altering our diets.

A report from the Centers for Disease Control and Prevention released Tuesday showed the number of obese Americans has increased by 2.4 million since 2007. There are now nine states where more than 30 percent of the population qualifies as obese — up from three states in 2007. (Just ten years ago, no state had obesity levels above 30 percent). 

The following day, Gallup released a ranking of the nation’s most and least obese states as part of a broader index of well-being. By its accounting, a cluster of states in the southeast — West Virginia, Kentucky, Mississippi, Arkansas, and South Carolina — have the highest rates of obesity, while the thinnest states, mainly in the west and New England, tend to have obesity rates about ten percentage points lower.

In the CDC ranking of states (which varies slightly from the Gallup ranking), Colorado and the District of Columbia are the only states with obesity rates under 20 percent, making their rate nearly 15 points lower than the most obese states. Their secret? During a press briefing, the CDC’s Bill Dietz speculated that Colorado’s investment in biking and walking trails, as well as District residents’ frequent use of public transportation, which goes hand in hand with walking and thus burns more calories than driving, are possible factors.

Indeed, if you look at rates of active commuting (walking and biking) in the most and least obese states, a revealing correlation emerges. Three of the five most obese states in the Gallup ranking are also among the five states with the smallest percentage of people who bike to work. At the other end of the spectrum, four of the ten thinnest states are among those where people bike to work most frequently. (The commuting rates come from Census data detailed in this League of American Bicyclists report.)

The relationship seems to hold up when you include walking. People in the five most obese states make about 5.2 percent of all trips by bike or on foot, according to data published recently in a 2010 benchmarking report from the Alliance for Biking and Walking. In contrast, people in the five least obese states made twice as many trips — 10.2 percent of them — by bike or on foot. 

It seems unlikely that you can chalk this all up to coincidence, but it’s worth noting that these are back-of-the-envelope comparisons made without the eye of a trained statistician. And, as Dietz noted in the press briefing, other factors (such as demographic differences) surely play an important role.

For a second opinion, I checked with John Pucher, a Rutgers University planning professor with ample experience crunching these sorts of numbers. The relationship between a lack of active commuting and obesity is absolutely real, Pucher said via email. In fact, Pucher and colleagues have just completed a rigorous study of the relationship in which they examined health and travel data for 14 countries, all 50 U.S. states, and 47 of the 50 largest American cities.

At all three levels, the researchers found a clear negative relationship between active travel and obesity. Differences in transportation choices account for nearly a third of the variation in obesity rate among states, their analysis shows. Since the study hasn’t been published officially, Pucher couldn’t reveal any more specifics at this time. But stay tuned: The full study will come out in the American Journal of Public Health on August 20, and we’ll have more details then.

  • reburton

    Interesting. While it’s plausible that higher obesity rates correlate to less active commuting, I think one also should consider access to “good food.” While I don’t currently have evidence to support the idea, looking at that map, I can believe that areas with higher obesity rates are also areas where the people have relatively little access to (affordable) fresh fruits and vegetables and the like and instead subsist on mostly prepackages things. This could also tie into the demographic differences mentioned by Dietz. Of course, all these problems are certainly interrelated, I’m sure.

  • Colorado has the lowest Obesity rates. Communist plot. Dan Maes to the rescue.

  • J:Lai

    reburton, I think you would need zip code level data to support your assertion. At the state level, I doubt there are significant differences in access to healthy food.

  • Danny G

    Does this data exist on a county-by-county or census tract level? I’d like to see that overlaid with some economic data and commute time data as well, if you’re trying to convincingly tie car dependence to obesity. I support your efforts, and would tend to believe that it is a factor of it, but am holding out for a more unshakable analysis. Keep at it!

  • reburton

    @J:Lai, yeah, that’s fair. Zip code level data would be cool though, both for food and for access to / use of active forms of transit.

  • Access to healthy food is a factor in obesity, as is the ridiculous amount of high fructose corn syrup we consume as a nation, but land use mix (mixing up residential with commercial in a walkable environment) is also critical. See this study:

    http://scienceblogs.com/neurotopia/2010/05/walking_and_obesity_the_city_l.php

    A simple summary of the findings:

    “1) The more the land use is mixed where you are, the less of a probability you have of being obese.

    2) The more you walk, the less probability you have of being obese.

    3) The more time you spend in a car, the MORE probability you have of being obese.”

    Interestingly, land use mix had the strongest correlation with obesity. The study was done in Atlanta, and the statistical correlations hold true for both men and women, and for both whites and African Americans.

    I would also point out the obvious: that the more you are walking and biking, the less time you are spending in a car.

  • Rob B.

    I agree with taomom. I live in the ‘burbs, but have friends with kids the same ages as mine in Manhattan. On our visit this weekend, all we did was walk (and the kids used Razor scooters). We never would have done that in the ‘burbs; places worth going are too far to walk, and no place to stop for food or drink along the way.

    One negative thing about the city: McDonald’s uses land use data to make sure there is a franchise across the street from EVERY elementary school.

  • Doug

    “One negative thing about the city: McDonald’s uses land use data to make sure there is a franchise across the street from EVERY elementary school.” — Subjective. I can think of many schools for which that’s not the case. There really aren’t all that many fast food places in NY by US standards…

    I don’t know that it’s really _access_ to healthy food in all cases. True, for people who simply can’t afford that healthy food, this holds. On the other hand, when I commuted by car and sat at a desk all day and ate crap Chinese food three days a wekk, I put on ten pounds. When I got back to living in the city, I dropped that weight again. (Then I started biking, and I put that back on, but in muscle…)

  • Interestingly enough, the orange states all have constitutional amendments banning same-sex marriage, except West Virginia, which forbids it by law.

    I think some bicycle-riding gay people need to perform an intervention.

  • I dont understand the argument that healthy food is expensive. At the supermarket, it’s usually the fresh fruit and vegetable that is dirt cheap. 5 delicious ears of corn for 99 cents? 2 avocados for a dollar? What exactly is the barrier here?

  • Jass, corn isn’t a healthy food to eat. It has very little nutritional value, and is sugary.

    Green vegetables are by and large expensive in the US. At the supermarkets I go to, good lettuce is about $6-8/pound, bell peppers are $2-5/pound, and so on – generally, the same as or more than red meat. In low-income neighborhoods, they may not exist at all: bodegas don’t have them, and supermarkets only have low-quality versions.

  • Clarence Eckerson Jr.

    Ironically, at 5’9″ 220, I fall in the obese category since the tables do not take dense muscle into account. But still as fit I am, I constantly think that I need to get in better shape. Can’t imagine what a photo of the average American looks like now.

    Bad potential news for NYC: I saw today in the NY Post that there is going to be a Bodega Delivery Conglomerate of sorts where you can get home delivery of stuff directly to your home by your local corner store (milk, soda, candy, etc). I think it is a bad idea and one of the reasons why I am not way overweight. IF I get a hankering for something at 10 PM, that means I have to get dressed and go walk to get it, which at least means a 2 to 8 block walk. Better yet, sometimes the walk makes me just say, I’ll just forget it. But now, I can just call and say, “Bring me by seven KitKat bars and a bucket o’ ice cream!”

  • Ben

    There’s been a lot of Copenhagen love on this blog of late. One thing I noticed when I visited there last year is that I hardly saw a single obese person. Most people there look healthy and lean and fit.
    Danish food is reasonable, but they do have enormous breakfasts, including, yes, “danishes.” But I think all of those morning breakfast calories are burned on the pedals all day.

    But returning to the states for a bit…I think as we think about how to get more low-income and minority folks involved in bicycling, there is quite a bit of concern in those communities about obesity and asthma rates. Getting kids of all ethnicities and income levels on bikes to go to school is a great way of encouraging healthier living.

  • You don’t need to go to Copenhagen for this. The Upper East Side – the densest, most walkable, richest urban neighborhood in the country – has 7% obesity.

  • I think the key word regarding the low rates of obesity on the UES is “richest”–there is an inverse correlation between levels of wealth and obesity.

    As for the argument about healthy food being expensive, I believe the problem is one of caloric density. If you have a very stretched food dollar and you are trying to feed a family, you can get far more caloric bang for your buck by buying highly processed foods than buying a few fruits and vegetables.

  • Also, I believe the orange states are among the poorest in the nation–another link between poverty and obesity.

  • dave

    i moved from nyc to denver about a year ago. i work with a ridiculous number of triatheletes and ultramarathoners. but when i ride my bike a couple miles across town to meet them at a bar everyone is shocked. i think people are thin here because of recreational exercise not active transportation.

  • MarkE

    “i moved from nyc to denver about a year ago. i work with a ridiculous number of triatheletes and ultramarathoners. but when i ride my bike a couple miles across town to meet them at a bar everyone is shocked. i think people are thin here because of recreational exercise not active transportation.”

    Active transportation often provides a stepping stone to or the base for greater athleticism. This pattern is self-reinforcing just as is driving/obesity/poor nutrition.

  • =v= I love this map, coming as it does on the jackbooted heels of Dan Maes’ revelation that bicycling prepares cities for U.N. takeover. He’s just trying to save his beloved Colorado from the velorutionary fate that has apparently befallen D.C.

  • Yankee Doodle

    So it isn’t my imagination! When I first traveled to the South, I was BLOWN AWAY by the number of REALLY FAT people down there. In southern California you see people like that once in awhile, and you remember it because it really stands out. But in the South – Raleigh, Atlanta, whatever – it seems every other person is like that. What is happening to our country?

  • DSL

    urbanis came close to hitting it – these are poor, poor states. But what no one else has keyed in on, is that these states also have the lowest literacy rates. When my dad applied for his OK driver’s license, he passed the written test with 100%. The administrator didn’t make him do the driving portion, because he said usually he has to read the written exam to folks. And they sign their license by making their mark. If my dad passed the written with 100%, he reckoned he could probably drive.

    I read somewhere once that 1 in 5 Americans can’t read (20%!), and I remember thinking, I can’t think of one single (adult) person I know who can’t read.

    Besides access/location/bike paths/commute options – there has to be a major education component. If you can’t read, how can you read the label?

  • While literacy is an important social good, illiteracy cannot explain why Washington DC, which has an extremely high illiteracy rate (36% in 2007 compared to national average of 21%), also has one of the very lowest obesity rates in the nation. Washington D.C. also has high poverty and high income disparity. 55% of its citizens are African Americans, a group that, nationally, has the highest obesity rates, and yet Washington DC has low obesity. Washington may very well have higher obesity rates than some other dense, walkable cities, but when compared to richer, more literate suburbs and exurban areas, it does very well.

  • Urbanis, you’re right that it’s important that the UES is rich. However, the density is important as well. In New York City, the rich suburban parts have obesity rates above city average. The fattest borough is the Bronx, but SI ranks second (Queens is third, Brooklyn is fourth). And in most of the US, inner cities have lower obesity rates than the suburbs, despite being generally poorer. The exception to the rule is the South, where city/suburb income disparities are very large and the cities aren’t too walkable to begin with.

  • I encourage you to rethink your strategy of advancing a perfectly laudable agenda (increased community, walking/transit over gas-based vehicles, etc.) on the backs of fat people. You do none of us any good with your “obesity” ooga-booga routine.

    Here’s an article that explains one very powerful confounding variable that should lead anyone who values science over stereotype to rethink the weight=health assumption:

    http://www.wired.com/magazine/2010/07/ff_stress_cure/1/

    The stress of living as social pariahs, targets of discrimination, and government-funded hate campaigns surely endangers fat people’s health and could account for correlations (not causations!) between higher weights and morbidity/mortality.

    Another powerful confounding variable: fitness level. I recommend Glenn Gaesser, PhD, for proof that fitness leads directly to improved health and longevity with or without weight loss. (And we all know that weight loss is temporary, weight regain almost inevitable, and weighty cycling linked to higher risk of illness and early death!)…
    http://www.hcs.harvard.edu/~epihc/currentissue/fall2003/gaesser.pdf

    If a public health policy targets identity instead of behavior, it’s not a public health message, it’s a public hate message. Saying, “Don’t be fat!” when the real goal is nutrition/fitness for everyone is akin to saying, “Don’t be gay!” when the real goal is safer sex practices for everyone. It’s prejudice-promoting, not health-promoting.

  • Maryjane Heyer

    Marilyn, it’s hardly surprising that we target fat people for our health problems. Last I heard, the Red Cross still doesn’t want gay men to give blood.

    http://www.bloodbook.com/donr-requir.html

    Everybody knows straight people (and women) can’t get AIDS. (/sarcasm) Just like thin people can’t get high blood pressure or cholesterol or arthritis.

  • castroclone

    Maryjane, I don’t think Marilyn is speaking up because she’s surprised that people say dumb things about obesity. I think she’s (perhaps too indirectly) trying to suggest that saying dumb things about obesity is a bad idea.

    I agree. It’s not good public policy to hide behind the very popular topics of dieting and obesity when trying to advocate for a good result.

    For example, we should spend more money on school lunches because too many children are hungry (which is a bad thing in and of itself) and, additionally, because hungry children cannot concentrate in math class (which will have bad results later on down the line).

    But we don’t say that because we are afraid of being called “liberal” or “tax and spend.” So we say we need more money for school lunches because otherwise the kids will get fat on hamburgers and french fries. It’s a way of leveraging popular sentiment to get the result one wants.

    In the case of “obesity” this tactic gets a good policy result by disparaging an unpopular group–and by reinforcing negative (and likely incorrect) stereotypes.

    This is not a price I am willing to pay to get good public policy. I think Marilyn did the right thing by commenting on this article and suggesting that Streetsblog take a little more honest approach (with less stereotyping and name calling) to stopping automobile dependency and sprawl.

  • flp

    so, Streetsblog, as admirable as reduced driving is, would you rather have swarms of waif-thin, ridiculously selfish and airheaded heroin-chic wanna-be models weaving aimlessly through bicycle traffic as they attempt to juggle their handhelds, pomeranians and attention-getting quotient? please!

  • flp

    oh, and they would be somehow maneuvering their 1500 dollar pashley “dutch” bikes freshly plucked from one of the cutesy bike boutiques sprouting up in tribeca, soho and west village.

  • Jack

    A great deal of the citizens of New England or the West Coast will look at a graph like this and unfortunately think things like, “Oh those silly fat southerners”, or “they don’t have access to fresh fruits”. Honestly, those sentiments are silly, and frankly offensive. I’m a southerner, and I’ve lived for quite some time in New England. I also spend time regularly on the west coast. The reason why people in those places walk more is partially due to the fact that the (a) can and (b) have to. The cities are (or rather were) built with pedestrian traffic in mind. A lot of the cities in the red region of this graph were built, rebuilt, or flourished along with auto traffic. At the time, this was considered A Good Thing™. We know better now. Yes, even we poor, illiterate southerners know better. But short of a complete rebuild of cities, and the taxpayer approval of expensive public transit infrastructure, we’re stuck driving for almost anything. It may surprise some of the commenters to learn that many people in the parts of this nation stricken by suburban sprawl hate it. We debate it. We comment on it. But there’s no magic wand to fix it.

  • JamesR

    My understanding of Colorado’s low obesity rate is that the state has a disproportionately high number of semi-pro and elite athletes who live there for part or all of the year due to the favorable climate and ability to train year-round and at high altitude. Colorado well-known as the endurance sports capital of the United States for these reasons.

    Marilyn, your post makes no sense. You cannot be physically fit and obese. Overweight? Sure. But if we define obesity as a BMI of 30 or greater, and fitness as a state in which one has a healthy body composition, muscular endurance, and cardiovascular condition, then if you’re obese, you’re not fit, then the two states are clearly mututally exclusive.

    flp, put your straw man away and come back with a cogent argument next time.

  • The stress of living as social pariahs, targets of discrimination, and government-funded hate campaigns surely endangers fat people’s health and could account for correlations (not causations!) between higher weights and morbidity/mortality.

    Um, no. The public health concerns about obesity are what produced those campaigns, not the other way around. Even today, the way people who actually research public health talk about it involves a long chain of causation, most of which involves variables about which there’s no visible social stigma. Nobody knows how high your blood cholesterol is, and unless you get tested, neither do you. Conversely, everyone thinks that dietary fat is bad, but by itself not correlated with any heart disease, because dietary fat is not the same as body fat.

  • You’re right in one sense, Alon Levy. The only thing anyone can diagnose by looking at a fat person is their own level of weight-based stereotype and prejudice.

    The correlational data linking higher weights with morbidity/mortality do not prove causation. Epidemiology can only track multiple variables across populations. People who conduct and publish so-called “obesity” research are often paid consultants to weight-loss or diet drug companies. They refuse to consider data on any of the likely powerful confounding variables — SES, stress, fitness level, history of dieting and weight cycling, barriers to medical care, poor quality medical care, disrimination — that fat people are likely to encounter and that are also known to influence morbidity/mortality.

    Furthermore, correlations between being fat and having higher risk of illness/death are weak. In even cherry-picked data, researchers only come up with a doubling of risk and sometimes only that in sub-cohorts. In epidemiology, doubling or such risks is a barely significant finding. By comparison, people who smoke tobacco have 300 TIMES the mortality risk of someone who does not smoke, from lung cancer alone.

    There are any number of science-minded people who have reviewed the very same data that the public health finger-waggers look at and have concluded that “obesity” ooga-booga is a dangerous, costly scam. They have created a name for the paradigm shift they recommend. It’s called Health At Every Size.

    The tenets of Health At Every Size include celebrating weight diversity, loving your own body whatever you weigh, and taking good care of your body with enjoyable and sustainable good nutrition and fitness habits. Behavior, not BMI, are the goals.

    One of the leading propononents of Health At Every Size, Linda Bacon, PhD, writes about how the HAES paradigm supports health, social justice, AND sustainable food/environment practices like the ones you argue for here!

    If you can’t hear it from a proud fat person, I suggest you read Linda’s very accessible yet data-driven book, “Health At Every Size: The Surprising Truth About Your Health.”

    She also conducted and published a fabulous study comparing the HAES approach to the traditional weight-loss approach, with dramatic findings. (Dieting caused harm and yielded no lasting weight loss. The HAES approach inspired participants to continue eating better and exercising more even at 2-year follow-up. HAES participants were healthier and happier, lost no weight.)

    Other HAES proponents whose work you might enjoy include…
    Glenn A. Gaesser, PhD, author of “Big Fat Lies: The Truth About Your Weight and Your Health”
    Jon Robison, PhD, editor of several WELCOA publications on HAES
    Deb Burgard, PhD, co-author of “Great Shape: The First Fitness Guide for Large Women”
    Paul Campos, law prof, author of “The Obesity Myth”
    Eric Oliver, PhD, author of “Fat Politics”

    Oh, here’s one last, fun data nugget from Steve Blair, MD, who gathered fitness and health data on more than 75,000 people at the Cooper Institute for Aerobics Research. He found that thin people who were sedentary had four times the mortality risk of fatter people who were moderately fit. (He defined and measured fitness the way scientists do, with treadmill and VO2 max testing.)

    I can’t resist offering just one other fabulous bit of data crunching. In Deb Burgard’s analysis of readily available weight/health data, if you assume that thin people are healthy and fat people are unhealthy, you will be wrong 30% of the time, about both fat and thin people’s health status. Do you really want to cling to a stereotype that makes you look foolish so predictably?

  • I forgot to include the link to the abstract for Linda’s excellent piece of research:
    http://www.adajournal.org/article/S0002-8223(05)00322-6/abstract

  • Happily for us, fat people don’t need your permission, JamesR, to be either fat OR fit!

  • People who conduct and publish so-called “obesity” research are often paid consultants to weight-loss or diet drug companies. They refuse to consider data on any of the likely powerful confounding variables — SES, stress, fitness level, history of dieting and weight cycling, barriers to medical care, poor quality medical care, disrimination — that fat people are likely to encounter and that are also known to influence morbidity/mortality.

    Again, you’re getting the history of obesity research wrong. First, people figured out it was unhealthy. Then dieting became a fad. You’re also generalizing American attitudes to obesity to other parts of the world; while obesity is always correlated with morbidity, in some parts of the world people think fat is beautiful. Third, much of the research about poor nutrition or dieting is controlled experiments – for example, the research about cholesterol levels. And fourth, talking about consultants to dieting companies is stupid in a world dominated by McDonald’s and big agribusiness; are you so sure that the experts you listen to didn’t get their funding from companies that have an interest in stuffing you?

    And I’m glad you can quote a few experts as well as a lawyer who don’t think that obesity is unhealthy. I could probably quote two orders of magnitude more experts who do.

  • Most studies focus too much on event exercise – going to the gym for x hours a week, riding on the treadmill for x miles. The real downfall of our collective health is a lack of incidental exercise; not being able to walk to the store for a gallon of milk may wind up killing us all.

    Having just gone car free in Baltimore, it’s crazy how much healthier I feel and how much fat I’ve lost. My commute is barely 2 miles and the nearest grocery store, which I usually walk to, is only 6 blocks away. Put exercise back into daily routines with better urban planning and transportation options, and that solves at least part of the problem.

  • The South shall rise again! Just give me a minute to get up, the lever on my La-Z-Boy is all jammed again for some reason.

  • castroclone

    I could probably quote two orders of magnitude more experts who do.

    As I posted previously, this sort of discussion is silly. Apparently Alon thinks his experts are bigger than Marilyn’s experts. Therefore he should win. And I happen to think that I should win, because I have more frends on the internet than both of them put together.

    The goal is to get people to drive less. Trying to leverage popular sentiment about dieting and weight loss to acheive that goal simply degrades the level of dialogue about that subject.

  • inconvenient_truth

    You know what’s great about this graph? It puts to the lie the assertion that obesity is just about where the Black people are at. Chocolate City rates with pasty-white Colorado…

    I would say high heat in the summer has something to do with the lifestyle choices that lead to obesity, but that wouldn’t explain why Nevada is doing better than Missouri. I would say “The Fanny Farmer Cookbook” but if that were the case, Illinois would certainly not be spared.

    I wonder if someone could create a “sprawl” heatmap (by Census boundaries or counties) and compare it to an obesity heatmap of the same.

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