Journal Issue: Childhood Obesity Volume 16 Number 1 Spring 2006
Lessons Learned and Challenges
Changing the built environment to increase children's physical activity for recreation and transportation, to improve access to healthful foods, and to reduce access to less healthful foods can help provide long-term solutions to the childhood obesity epidemic. Unlike the often-transitory effects of motivational and educational approaches to addressing obesity, changes in behavior prompted by changes in the built environment should be long lasting. Although research generally links aspects of the built environment with physical activity and eating behaviors, most data are from studies of adults, and findings to date are unable to pinpoint which specific variables would have the greatest effect on childhood eating, physical activity, and obesity. Nevertheless, we can draw some lessons from the studies to date and offer some tentative policy recommendations. Given the urgency of the childhood obesity epidemic, we cannot wait for optimal evidence and must instead base actions on the best available evidence.79
Children of all ages need and want places to play. To support the diversity of their physical activities, they need many types of recreational facilities, both public and private, near their homes and schools. To remedy the relative scarcity of such facilities in low-income neighborhoods, policymakers must ensure that these facilities are more equitably distributed.
Adults who live in walkable communities are more physically active and less likely to be overweight than those who do not. A few studies suggest that adolescents living in walkable neighborhoods may be more active and more likely to walk to school than their counterparts in unwalkable communities, but more studies of youth are needed. Combining physical improvements to enhance the safety of routes to school with activities that promote walking and cycling appears to increase active commuting to school. Improving the safety of roads, sidewalks, and crosswalks may reduce parental concerns about traffic danger and encourage more active transportation among children.
Low-income and minority neighborhoods not only have less access to healthful foods but also may face higher food costs. Evidence linking access to healthful foods with dietary intake in children is limited; more studies should be a high priority. But enough studies document inequitable access to healthful foods to justify corrective efforts. With obesity rates among low-income children and adults much higher than those among well-to-do citizens, there is a strong rationale for grassroots efforts, public-private partnerships, and even public subsidies of healthful food sources in targeted areas.80 Increasing the number of healthful, affordable food choices in a variety of food outlets is a complementary strategy that may be largely driven by commercial considerations. In this instance, public pressure and consumer demand can make a difference.