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ST. PAUL, Minn. - Obesity is usually blamed on diet or genetics, but now there's something else to fault: where you live.
A national report released Thursday draws a link, for the first time, between people living in areas with the most urban sprawl and the likelihood of being overweight and having high blood pressure.
It's harder to get daily exercise in sprawling suburbs and exurbs, where homes are spread-out and few destinations are in easy walking or biking distance. In compactly built communities, there are more opportunities to walk or bike to the grocery store, work or school, the report said.
Obesity, which is linked to many chronic diseases, has become a national epidemic, with nearly 65 percent of the adult population overweight and almost one in three people obese. That's one reason why many health professionals called "Measuring the Health Effects of Sprawl" a landmark report that clearly shows how community design can affect public health.
"We're finding a lot of developments are engineering physical activity out of people's lives," said Nico Pronk, vice president of HealthPartners' Center for Health Promotion.
In Minnesota, A committee convened by the Minnesota Health Department has been studying strategies of land and transportation planning that promote good health.
Investigators at the University of Minnesota will embark on a two-year study next year to examine the design of 36 neighborhoods in St. Paul and its suburbs, and its link to the activity of people in those places.
Loretta Masloski is a Weight Watchers leader who works with people in the Twin Cities area. One meeting location is in Isanti County, which the report ranked as having the most sprawl in the area.
"I could see where not having all the `advantages' city folks have to get around without a car might be an excuse for people out here to not be moving around," she said.
She hasn't found that to be the case, though. Masloski sees people working around the limitations of their physical surroundings.
"We find ways to add more steps," she said. That could include walking around the office during a lunch break or doing yard work. "Any kind of movement really benefits a person."
Masloski, who lives outside Zimmerman, Minn., enjoys walking but has to drive two miles into town to do so. Where she lives, on Highway 169, is "like the autobahn," she said.
Still, researchers computed - based on national averages, not actual numbers for the counties - that a hypothetical adult standing 5 feet, 7 inches tall in Isanti County would be expected to weigh 1.17 pounds more than the same person (factoring out age, race, gender, diet and other characteristics) living in Ramsey County, which was ranked as having the area's least sprawl.
It's a small difference, but researchers say it's still valuable information.
The most dramatic weight difference can be seen between the most sprawling county, Geauga County (outside Cleveland), and the least, New York County (Manhattan). A person living in Geauga County would be expected to weigh 6.3 pounds more than the identical person in New York County.
"The real significance is that it's the first national study that finds the way we build our communities may be having a negative impact on health," said Barbara McCann, an author of the report. "We're facing a situation where people living in sprawling places walk less and weigh more."
The study, which was based on research by urban planning and public health researcher, examined 448 counties and more than 200,000 people across the nation. It also determined that in the 25 most sprawling counties, the average rate of high blood pressure was 25 per 100, compared with a rate of 23 per 100 in the 25 least sprawling counties. Researchers found weak links between diabetes and coronary heart disease with urban sprawl.
One example shows how little many people walk in a day. HealthPartners runs a program called 10,000 Steps, which encourages people to do just that each day. But when people begin the program, when they're most likely still in their usual routine, they average 3,500 to 4,000 steps a day.
The degree of sprawl doesn't affect whether people get any exercise in their leisure hours, the study found. People in sprawling and compact areas were equally likely to report they had ran, golfed, gardened or exercised in some way during the past month.
But the kind of physical activity studied in the report looked at "active living," a way of life that integrates physical activity into daily routines, like climbing stairs instead of taking an elevator.
Beyond looking at housing density, the report also studied the degree to which streets form a grid that provides alternate routes; a lack of direct routes discourages people from walking, the report said.
"The medical community is recognizing exercise is not always easy to accomplish when you don't have sidewalks and the streets are so busy a child can't cross to get bread," said Lee Ronning, president of 1000 Friends of Minnesota, a group working to control sprawl.
The report urges communities to consider growth and design patterns more closely. It suggests cities should, among other things, invest in sidewalks and bike paths, consider traffic-calming designs, create safe routes to schools and build transit-orientated development.
There's also a significant cost to obesity, said Michael Huber, director of cardiovascular health initiatives for BlueCross BlueShield of Minnesota.
The Centers for Disease Control and Prevention estimate that 10 percent of all health care costs might be attributed to obesity and being overweight. The Minnesota Health Department found that in 2000, almost a half-billion dollars in state health care costs were for diagnoses associated with physical inactivity and obesity, Huber said.
Beyond cities' role in urban design, there's also the matter of convincing people to get out of their cars and get around in an alternate fashion. But there has been research that shows that people do walk and bike more when there are sidewalks and bike paths available, McCann said.
"It will come down to educating people that this simple act of walking to some destinations everyday can really help your health," she said.
A full copy of Measuring the Health Effects of Sprawl can be found at www.smartgrowthamerica.org.
For tips on easy ways to stay active, see www.beactiveminnesota.org/myactivity.asp.
(c) 2003, Saint Paul Pioneer Press (St. Paul, Minn.). Distributed by Knight Ridder/Tribune News Service.