Diabetes in society
Preventing diabetes
avenues and alleyw
and cities as exerci
Avi Friedman
The global obesity epidemic is already staggering –
and it keeps on growing. In Canada, for example,
one person in five is overweight and nearly one
in 10 is obese – a two-and-a-half-fold increase
over the past two decades. Moreover, obesity
rates among children in Canada have almost
tripled in the past 30 years. Our societies are
transforming previously healthy children into
generations of adults who in future decades will
suffer widespread chronic ill-health and overpopulate hospital wards. Efforts to curb the trend
have been largely unsuccessful. Avi Friedman
looks at the environmental factors associated with
the rise in obesity in suburban areas and calls for
coherent and realistic steps to provide healthful
surroundings for young people in particular.
A recent New York Times article suggested that in the USA, despite attempts
by some states to tax soft drinks, promote farm stands, require healthier
school meals and mandate caloric information in fast-food restaurants, rates
of obesity are still growing. The article
goes on to report that an estimated 72.5
million adults are obese (according to
recent data published by the Center
for Disease Control and Prevention).
Obesity costs the US healthcare system
a whopping 147 billion USD every year.1
The medical consequences are well
documented. Overweight and obese
people run a five-fold risk of developing type 2 diabetes and have greater
risk of hypertension, gallbladder disease
and certain cancers. The overall risk of
mortality increases two and half times.2
The rise of the effort-free ‘modern’
lifestyle
So why do waistlines keep expanding?
The common tendency is to blame
people’s poor dietary choices, made
worse by their inactivity. Only recently
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March 2011 • Volume 56 • Issue 1
Diabetes in society
in the
ays – homes
se machines
has attention been given to a critical
issue: our built environment has been
progressively altered to curtail physical
activity, even among those who wish
to be active. Over the past century, we
have planned communities, built homes
and welcomed lifestyles that allow us to
live and work while burning fewer and
fewer calories.
Our built environment
has been progressively
altered to curtail
physical activity, even
among those who
wish to be active.
The motor vehicle and suburbia stand
out as principal culprits of our effortfree habits. Some 65% of all North
Americans live in suburban or rural
locations, where nearly all work, shopping, social, educational and entertainment-related activities require every
member of the household to use a private car. We have reduced walking to a
bare minimum.
March 2011 • Volume 56 • Issue 1
Urban planning, sedentarism
and social alienation
Low residential
density, the mark
of most new suburbs, creates a
situation where
basic services
and amenities
that could potentially get
people active
are not economically viable. There are
not enough passengers
to justify the provision of public transport and not enough
shoppers to support a corner
grocery store, for example. In
terms of the public health implications of town planning
decisions, things have gone
from bad to worse.
their traditional location in the heart
of the neighbourhood to the outskirts
where they can be accessed more easily
by residents of several communities –
by car. That means that pupils can no
longer reach school with a short walk
or an easy bike ride. Unfortunately also,
the school time allocated to physical
activity has also been sharply reduced.
In Canada, this stands at one hour per
week, far less than that needed to allow
a child to burn the number of calories
appropriate to their age and stage of
physical development.
Small play
areas near
homes have
also found
their way into
the municipal
waste basket.
Once again, in the
name of efficiency,
developers argued
that there is no
longer a need for
back lanes where
children once
played and through
which they safely
reached a friend
in a neighbouring
home. Numerous
small play yards,
known as ‘parkettes’,
have been replaced by a huge
playing field, to
which children have to
In the name of efficiency, schools have
been relocated from
DiabetesVoice 39
Diabetes in society
be driven. Play itself has been morphed
into regimented leagues with strict
schedules. Spontaneity, unfortunately,
has been sucked out of children’s play.
It is no wonder that watching television and playing computer games has
replaced outdoor play. Studies suggest
that watching television is the primary
leisure activity among young people in
North America – an average of up to 2.5
hours a day. Significantly also, some of
this time includes watching advertising
for high-calorie foods.3
In terms of the public
health implications
of town planning
decisions, things have
gone from bad to worse.
Another casualty of contemporary suburban planning was the pavement or sidewalk. Since no one walks, some argued,
why even bother to provide for pedestrians? Children, older people and parents
pushing a pram were forced to share the
road with motorists, often putting their
lives at risk. Stepping out for a simple
healthy walk became uncomfortable.
No need to lift a finger – at work or
at home!
Our work places have not fared much
better. Whereas in the early decades of
the 20th century the manufacturing and
agricultural sectors were the principal
employers, service jobs now account
for the lion’s share of all employment
in the developed world and increasingly in developing countries. The work
environment offers little opportunity
for physical activity. Workplaces are
reached by private cars; a lift is likely to
be the first thing that one sees entering
an office building lobby. Hard-to-find
stairs have been shoved aside and made
to function only in case of emergency.
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March 2011 • Volume 56 • Issue 1
Diabetes in society
At home, physical activity has also experienced a sharp decline. When asked, most
people will rather reside in a dwelling
with fewer stairs, limiting a dose of essential healthy exercise. Many families have
acquired effort-free tools, like mechanized lawn mowers or snow blowers. The
kitchen has become a store for mechanical devices and electrical utensils which
have replaced domestic manual labour.
We are spending fewer and fewer calories
outside as well as inside the workplace.
We are spending fewer
and fewer calories
outside as well as
inside the workplace.
An urban planning response to obesity
So, how should we encourage people
to become active? The simple answer
is to recast in our built environment
the features that, over the past half a
century, have been taken out. Homes
and cities must be regarded as exercise
machines. Several strategies need to be
placed at the top of planning agendas.
Higher- and medium-density communities of greater than 62 units per hectare
(25 units per acre) need to be encouraged. It has been demonstrated repeatedly
that urban dwellers are more active than
their suburban counterparts. Once higher
density communities have been built,
commerce will also become economically
viable. Efficient public transit must be
part of every community. Frequent buses
during rush hours, covered shelters and
clearly displayed schedules may encourage motorists to leave their cars behind
and use public transit.
Taking back the streets
Pedestrians and cyclists must be given
priority in all road designs. Slowing traffic,
changing the road surface and enlarging
pavements are some of the means to help
March 2011 • Volume 56 • Issue 1
make streets people-friendly. Walkable
communities need to allow residents
to reach every spot in a comfortable
10-minute walk. Bicycles for rent, a growing practice around the world, need to be
part of the day-to-day activity of every
neighbourhood. It has been demonstrated
that obesity rates among children decline
when (bicycle) riding time increases.
Homes should be built next to or facing play yards so that parents are able
to keep a watchful eye on their children.
Whenever possible, schools should be
placed at the centre of the community
and their recreational areas open to the
public. Community urban agricultural
gardens need to become a valued feature of public green spaces. In addition
to growing nutritional food, residents
can be active tending to their gardens.
When squares and parks are planned,
they can be equipped with adult exercise
machines. The municipality can appoint
a fitness instructor and schedule for those
who wish to engage in group activities.
The practice of planning neighbourhoods
with identical large, single-family homes
should be avoided; mixed types of dwellings can accommodate all sorts of residents – young and old. Children should
be able to take a leisurely stroll or bike
ride to visit their grandparents’ home.
Officials are finally
recognizing the
link between poor
urban planning
and its unhealthy
consequences.
A master plan for healthy living
The tide is beginning to turn. Elected and
public health officials are finally recognizing the link between poor urban planning and its unhealthy consequences. In
recent years, I have consulted established
towns and designed new ones based on
the principles of active living. In Stony
Plain, Alberta, Canada, we configured a
‘master plan’ for healthy living. Organic
models of growth ensure that the town
centre could be reached by walking or
safe cycling from every home. Pavements,
bike paths and traffic-calming features
are an integral part of every street. Places
for commerce have been allocated in
every neighbourhood. A new civic square
that functions as a neighbourhood meeting place has been introduced in front
of the town hall. Free shuttle buses that
reach all neighbourhoods have been proposed and a series of green open spaces
have been connected to provide a secondary, more leisurely way of moving
around. Mixed types of dwellings, some
with commerce on their ground floor,
are now an urban reality.
It takes time to bring about changes in
town planning. Convincing elected officials about the need to invest in health
promotion is not simple. However, we
must work with urgency to make our
case. If we fail to do so, the consequences
for people, their communities and nations will be costly – economically, socially and in terms of human suffering.
Avi Friedman
Avi Friedman is a Professor of Architecture
at McGill University in Montreal, Canada,
and is the President of Avi Friedman
Consultants, Inc. His latest book, A Place
in Mind: The Search for Authenticity was
published by Vehicule Press. He can be
reached at [email protected].
References
1 S inger N. Fixing a World that Fosters Fat.
The New York Times 2010; 22 August: 3.
2 W
illet WC, Dietz WH, Colditz GA. Guidelines for
Healthy Weight. N Engl J Med 1999; 341: 427-34.
3 L
arson RW. How US Children and Adolescents
Spend Time: What It Does (and Doesn’t) Tell Us
About Their Development. Current Directions
in Psychological Science 2001; 10: 160-4.
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