Getting to the roots of obesity: why surroundings may matter
There Colin Rehm stood, on a commercial strip in Auburn, an area with the highest rate of obesity in King County. He had mapped it in his...
Seattle Times reporter
There Colin Rehm stood, on a commercial strip in Auburn, an area with the highest rate of obesity in King County. He had mapped it in his research, but it was another thing entirely to see this fast-food frenzy in person.
More than a dozen chain restaurants stretched out for a mile, from Denny's to Dairy Queen to Domino's. A discount grocer sold trays of cookies and packets of pastries for a dollar.
"I've never seen such good deals for unhealthy food," said Rehm, of the University of Washington's Exploratory Center for Obesity Research.
Across King County, researchers such as Rehm are studying everything from the clusters of fast-food restaurants to the number of run-down sidewalks, trying to explain high rates of obesity. And the Exploratory Center is right in the thick of it, one of only two federally funded programs in the country that are looking at how economics and the environment affect obesity.
King County's obesity rate has more than doubled in the past two decades, reaching about 18 percent of the population last year. Genetics alone can't explain it, public health officials say. And urging better individual behavior hasn't worked. So many experts are focusing now on access — both to healthy foods and to exercise — and what can be done to improve it.
Public Health-Seattle & King County has spent the past year working with academics and architects, city planners and transportation experts as part of a new Overweight Prevention Initiative. Their focus is on policy change, from bringing healthy options into the workplace to expanding hours for exercise at local schools. The county Board of Health is set to vote Friday on whether to support the initiative's plan.
"There's not going to be any one answer," said Shelley Curtis, a nutrition outreach and food policy manager for the Children's Alliance, a statewide child advocacy group. "The forces that we need to reckon with are powerful and difficult to change."
More than half of King County residents are considered either overweight or obese. A new survey by Public Health has found the highest obesity rates are in South King County.
Obesity prevention action plan
The King County Board of Health is set to vote Friday on recommendations from the county Overweight Prevention Initiative, designed to address the rising rates of overweight and obese adults.
1. Promote healthy eating and active living, including reducing families' TV time.
2. Help school districts implement nutrition and physical-activity policies.
3. Enhance employers' efforts to promote wellness programs, starting with schools and King County workers.
4. Encourage breastfeeding-friendly policies at work places and child-care facilities because breastfeeding reduces children's risks of becoming overweight later.
5. Support guidelines and policies that promote nutrition standards, appropriate portion sizes and health-food choices.
6. Support "Safe and Active Routes to Schools and Transit" programs.
7. Support greater use of private and public facilities for exercise.
8. Support the completion of pedestrian and bicycle links.
9. Promote standards of active-community design.
10. Promote evidence-based practices and evaluate and disseminate the results.
Overweight Prevention Initiative site: www.metrokc.gov/health/overweight/index.htm.
Exploratory Center for Obesity Research at the University of Washington: http://depts.washington.edu/uwecor/.
To calculate your body mass index: www.nhlbisupport.com/bmi/bmicalc.htm
Obesity is defined by a body mass index, or BMI, of more than 30. BMI is a commonly used height and weight comparison.
About 28 percent of Auburn residents are considered obese, and 26 percent of Federal Way residents fit that description. South King County also has higher rates of chronic conditions that can come from obesity, such as diabetes and heart disease.
"It's hard to understand the enormity of what's coming down the pike," said Dr. Ben Danielson, medical director of the Odessa Brown Children's Clinic in the Central Area. "It's not going to be solved with some education and a few trainings."
Apples or frozen pizza?
Angela Davis knows all about healthy food. Her problem is getting it.
She can't find the money sometimes for fresh produce or lean meat. Not when she's living on disability benefits. Not if she wants to pay the rent.
"It's frustrating," said Davis, 42, whose 13-year-old daughter is obese. "I feel my children deserve to have what the rest of society is having."
Obesity affects people of all income levels, but poor people face more hurdles in trying to stay healthy, said Adam Drewnowski, director of the Exploratory Center.
For starters, healthy food costs more. The price of produce has skyrocketed in the past two decades, according to a study by the Rand Corporation. At the same time, the price of sweets and soft drinks has stayed about the same.
Junk food is just a better deal, packing more calories per dollar than most healthy food, Drewnowski has found.
"You've got five dollars for dinner," he said. "Are you going to buy fresh apples or frozen pizza?"
Only the federal government can address food prices, by offering subsidies for fruit and vegetables, for example, or using the food-stamp system to give incentives to buy better food, the researchers say.
Nonetheless, the county is trying to make healthy food more available in local neighborhoods. A nutrition task force has come up with a slew of ideas, from offering more vouchers for farmers' markets to providing more produce to local food banks.
Researchers are also looking at the so-called "food environment" in King County. Rehm, for example, has been mapping fast-food restaurants, convenience stores and grocery stores. The theory is that in low-income neighborhoods it's easier to buy unhealthy food than to seek out healthy alternatives.
That theory, along with so many others, has yet to be proven. Obesity is a complicated epidemic, experts say, with roots in everything from education to motivation. Living first in the Central Area, and now in South Seattle, Davis said she sometimes has struggled to find a low-cost grocery store. Even when she finds one, she said, it's tough to afford the fruits and vegetables there.
Now that her son has gone to college, she has lost eligibility for food stamps, making the problem worse, she said.
"I end up not paying a lot of my bills, to make sure that my kids have what they're supposed to be eating," said Davis, a student at Seattle University.
Her daughter's health depends on that sacrifice. The girl is under a doctor's care now and enrolled in a fitness program through The Austin Foundation, which helps get young people involved in fitness. Davis is a parent representative with the foundation.
But without healthy food, the plan will fall flat.
Make it walkable
Play outside for an hour. Walk around the block a few times. Do something small every day, Dr. Odette Sueda tells her patients — anything to help you lose weight.
Up to a half of Sueda's patients at the Columbia Public Health Center in South Seattle are obese. Some of them can't afford bus fare to a community center, she said, let alone sports equipment. Outdoor exercise is sometimes the only option they have, Sueda said. But when she suggests it, parents sometimes resist. They talk about hypodermic needles in the grass, or parking lots with broken glass, or strangers roaming around, looking like a threat.
Inside the center on a recent morning, the walls were warm with color. Children had written the word "healthy" on the bulletin board, in many different languages, from Spanish to Somali. But there were two bullet holes in the front window, Sueda said, fresh from the previous weekend.
The county's anti-obesity initiative is attempting to deal with fears of crime by recommending longer hours for schools and community centers so residents can exercise indoors. It's also trying to expand a "Safe Routes to School" program, a partnership with the police department to get more kids walking.
A local pedestrian group called Feet First has been working on "walking audits" with residents in Seattle and South King County, documenting everything from faded crosswalks to missing sidewalks, then taking that information to city officials. Their work has already inspired Seattle's Department of Transportation to move some neighborhoods to the top of lists for improvements.
It's all part of a new focus on "walkability." Most people will simply not set aside a half hour, three times a week for exercise, the researchers say. So it's crucial that the streets themselves encourage activity, in their appearance and their design.
A recent King County study found that people will walk around their neighborhoods more if sidewalks and streets are connected, and shops and parks are located nearby. Some of the older city neighborhoods, such as Capitol Hill, already fit that description — and the obesity rate there is the lowest in the county, at 7 percent.
"If you create environments where it's easier to choose the healthy option, people will choose the healthy option," said Dr. Jim Krieger, of Public Health.
The Seattle Housing Authority has adopted that concept, turning some of its housing projects into national models for active living.
In the Delridge neighborhood, the old High Point project is a sprawling community of beaten-down barracks. The wide streets encourage speeding cars. The sidewalks are broken. Crime has been a serious concern. But block by block, the project is being transformed into mixed-income housing. New houses are painted in reds and greens and yellows, with windows and porches that look out on shared lawn where children play. Streets are narrow, sidewalks are wide, and landscaping serves as a buffer between them.
There are plenty of new amenities within walking distance, including a library and a public health center. And the city is trying to lure a large grocery store there soon.
It's all just good, healthy design, said Tom Phillips, the project director. It's not so much a step forward, he says, but a step back — to a time when communities were not built around the car.
Cara Solomon: 206-464-2024 or firstname.lastname@example.org
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