Lecture 15/16 (Smith & Cummins 2009) Flashcards Preview

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What is suggestively the blame for the rapid rise in obesity rates over the last 30 years (relatively short amount of time)?

Changes in the environments we are exposed to are to blame.


What does this article explore?

Focusing on developed world nations, briefly reviews this emerging 'ecological' perspective in search for causes of obesity.
How aspects of our environment might disrupt 'energy balance' through influencing food consumption and physical activity.


What three hypothesised pathways for environmental risk does the article focus on?

The organisation of built physical space, the social environment and the political environment.


Be overweight or obese is defined as...

having a body mass index (BMI) of 25.0–29.9, or 30.0+


Obesity is also directly associated with other serious health problems such as...

Hypertension, diabetes and osteoarthritis and a wide range of chronic diseases including coronary heart disease and some cancers.


A 2004 report from the UK House of Commons Health Committee (2004) estimates an annual combined obesity-related cost to the economy of...

£3.3–3.7 billion from direct treatment costs and the indirect cost of premature mortality, sickness absence and lost years of productivity.


The conceptual model which underpins this work is one of ‘deprivation amplification' where...

vulnerable populations in deprived neighbourhoods tend to have poorer access to health-promoting ‘resources’ and greater exposure to health-damaging environmental ‘insults’ compared to their wealthier counterparts.


Egger and Swinburn (1997) suggested that three domains of influence are important...

The physical environment, the economic environment and the socio-cultural environment.


ANGELO framework, adapted from Egger and Swinburn (1997).

Features include poor walkability (having characteristics which promote walking as a means of transport or recreation, such as footpaths) and connectivity of residential areas, limited access to leisure facilities, fewer supermarkets and a relatively high accessibility to fast food/takeaway shops (typically franchised outlets where a greater proportion of the menu is high-fat energy-dense food).


What is one of the most commonly identified elements of an obesogenic environment (White 2007)?

Physical proximity to fast food outlets.
More numerous in relatively deprived compared to relatively affluent neighbourhoods.
However, cannot be used as ‘evidence’ that increased access to fast food actually causes obesity.


What is another commonly identified elements of an obesogenic environment (White 2007)?

Access to food for preparation and consumption in the home, usually defined by the distance to a supermarket or grocery store- access a wider range of healthy food.


One important distinction between research undertaken in the USA and elsewhere is the salience of ethnicity as a factor in determining access to food, diet quality and overweight or obesity.

Ethnic residential segregation appears to be a major factor in explaining spatial inequalities in diet. Studies show that African-American neighbourhoods tend to have the worst access to supermarkets and grocery stores and the price and quality of fresh produce and other foods also tends to poorer in black compared to white neighbourhoods.


Work on shopping practices by Williams and Hubbard (2001) has suggested that socio-economically disadvantaged consumers tend to use ‘traditional’ facilities rather than newer stores or shopping centres.

Disadvantaged consumers tended to avoid supermarket provision as it was associated with more affluent consumers and was thus ‘not for them’.


The influence of neighbourhood deprivation on self-reported physical activity has been found to be consistent across developed nations (Jones et al. 2007).

Those who live in deprived neighbourhoods tend to have the lowest levels of physical activity.


Walkable vs less walkable neighbourhoods.

‘Walkable’ neighbourhoods tend to rely more on ‘active’ transport modes such as walking and cycling while residents of less ‘walkable’ and less ‘well-connected’ neighbourhoods have a greater reliance of motorised transport.

Neighbourhoods with the best access to attractive open space were associated with an increase in walking at a recommended level compared to neighbourhoods with the worst access.


The subjective perception of an area may be especially important to parents and children, as it can determine how much time children spend playing outside (Weir et al. 2006)

Therefore, it has been suggested that the measurement of subjective elements of the physical environment (such as safety) should be incorporated into research whenever possible.


The ‘French Paradox’ is one of the best-known illustrations of culture’s role in health and obesity.

The French Paradox is so-called because the French consume a diet which is relatively higher in fat and alcohol, yet maintain a much lower prevalence of obesity than Americans (Wansink et al. 2007).
Wansink et al. (2007) concluded that the French are attuned to individual feelings of satiety, and ended a meal when they felt full. In contrast, American participants more often stopped eating because a drink was finished or a television programme had ended.


Social networks are also emerging as an important determinant of obesity.

One recent study shows that having close relationships with overweight or obese individuals (such as friends, spouses or family members) can increase a person’s risk of obesity (Christakis and Fowler 2007).


Crime, fear of crime and safety are also important mediators in people’s use of space and is a particular problem in urban settings. Concerns over personal safety can reduce community social capital through reductions in social trust and increases in social isolation which results in environmental ‘stress’ (Centers for Disease Control 1999).

Such fears make residents, particularly the elderly and the very young, less likely to use their local environment for physical activity such as walking and playing.

E.g Lopez and Hynes (2006) note that a spate of murders in a Boston neighbourhood caused parents to prevent their children from playing outside.


Environment and Ethnicity

Studies suggest that the greater the segregation of communities along colour lines the more likely residents are to be physically inactive (Litake et al. 2004) and less likely to spend time outdoors (Massey 2004)


For low-income consumers what is attractive?

For low-income consumers, less expensive food options may be more attractive, even if they may exceed dietary guidelines of fat, salt and sugar intake. Cheaper food choices are often a rational economic choice as they maximise calorific intake per penny (Drewnowski 2004).


In Europe, the Common Agricultural Policy promotes

The production of dairy products, with a resulting surplus in high-fat dairy foods recycled into the food chain. Wine and tobacco production is also encouraged, and discourages the production of fruits and vegetables (Elinder 2003).


Non-state actors can further influence the health of residents at a range of different scales. Global commercial policy decisions by trans-national corporations may have (unintended) local health effects. For example...

The introduction of a low-cost menu by MacDonald’s (e.g. the Dollar Menu in the USA and the Poundsaver Menu in the UK) has increased total sales by 33% after a several years of declining revenue. These menus consist entirely of high-fat, high-calorie foods and have an associated marketing campaign that targets those on low incomes, children and ethnic minorities (Warner 2006).