Suburban Sprawl, Waistline Spread

Robin Pelletier will never forget the day she went to meet her 8-year-old daughter, Jessica, at the airport and, to her embarrassment, almost failed to recognize her child. "This flight attendant is walking off the airplane with a little girl, and I'm thinking, 'Omigod, this is not her!'" Robin says. But it was: After a summer at Grammy's up in northern Maine, eating ice cream, watching TV and playing video games, and getting driven around, Jessica had gotten fat.

Pelletier had wanted to spare Jessica the pain and suffering she herself had endured as a "large child"—the last picked for sports teams, the one who wore chubby sizes ordered by mail from Montgomery Ward's. She blames not only ice cream but also her sprawled-out hometown, lacking an interesting, pedestrian-friendly center with places a child could walk to and explore. The long distances between homes and stores, Pelletier remembers, "fostered a culture of inactivity." By the end of high school, Pelletier, at 5' 5", weighed in at 170 pounds; she hit 200 before she was 20. That's partly why, before college, she moved across the country to San Diego, a city that embraced physical fitness; she began walking and biking everywhere. The day her daughter returned from Grandma's, 12 years ago, Pelletier put her back on a daily diet of nutritious food—that, with bicycling, got Jessica back in shape.

Today, the obesity that Pelletier battled has ballooned into a national epidemic. (Obesity is defined clinically as having a body mass index, or BMI, of 30 kilograms per square meter or more; the overweight have a BMI between 25 and 30). The binge at Grandma's is what children now experience in their daily lives: high-calorie school lunches, snack foods and soft drinks, and a rising rate of physical inactivity.

Already, some 60 percent of overweight 5- to 10-year-old children experience at least one associated biochemical or clinical cardiovascular risk factor, such as elevated blood pressure, and 25 percent have two or more factors. The question, "Will parents outlive their children?" is now seriously being asked at obesity conferences, where health practitioners struggle to find ways to stem the bulging tide. In so doing, they've identified another factor driving obesity—the spread-out design of our communities—and how it promotes inactivity and, to some extent, poor diet. "It's harder for kids to walk. And driving and sitting in that fast-food line is more convenient—even if the food does have a higher fat content," says Paulette Mach, a registered dietician with the County Health Department of Manitowoc, Wisconsin, who reports that she's seeing twice as many obese and overweight kids as she did seven years ago.

"Kids are getting fatter and fatter because they're being driven more and more and walking less and less," Thomas Schmid, Ph.D, coordinator of the Active Community Environments (ACES) working group at the Centers for Disease Control and Prevention (CDC), told a meeting of the National Association of Olmsted Parks in Seattle last spring. He cited a 1995 study by the U.S. Department of Transportation, which revealed that non-motorized trips made by children to school declined by more than 40 percent in the past twenty years. The number of commuting trips the average American adult takes on foot each year, too, dropped 42 percent between 1975 and 1995.

Not so long ago—in some places as recently as a generation ago—most people lived in communities that were designed with housing close enough to walk to shopping, entertainment, work and schools. But a post-World War II building boom, driven by a surge in car ownership and housing for returning GIs, and spurred by government subsidies for road construction, home loans and gasoline consumption, has persisted until today. The result has been "sprawl": a pattern of spread-out development without a central core, dependent on car travel. "Sidewalks are often missing. Roadways are designed for vehicular 'throughput' and make foot or bike traffic downright dangerous," writes Neal Peirce, a Washington Post columnist.

Between 1960 and 1997, we've increased the number of vehicle miles we travel by 250 percent, adding more carbon monoxide, nitrogen oxides and volatile organic compounds—components of ozone, or "smog"—to the air. The burning of gasoline and diesel fuel also produces particulates, fine soot particles that get lodged in the lungs.

"Bad air makes lung diseases, especially asthma, worse," writes Richard Jackson, M.D., of the CDC's National Center for Environmental Health, co-author of a 2001 report published by Sprawl Watch Clearinghouse that probes the impacts of sprawl on public health. Atlanta's deliberate 22.5 percent reduction of peak weekday car travel during its 1996 Olympic Games may have also led to 41.6 percent fewer asthma admissions to hospitals during that time, Jackson notes. Also of concern are the psychological stresses of long commutes and reduced family time.

Because one problem feeds another, solutions to sprawl and its health effects are being pursued in the design of both the built environment and our food system.

Working on Solutions

A city needs to provide somewhere to walk, and that's where urban design comes in. Public-health officials such as Schmid and Jackson are urging a closer connection between public health and urban planning, disciplines that once intersected when cities were redesigned to cope with epidemics of infectious diseases like cholera. Now "we need to bring the disciplines back together to design more livable places," says Schmid. At the federal level, the CDC supports "re-engineering activity back into our lives," he says. ACES was started in 2002 to promote walking, bicycling and greater access between housing and public transit, all of which also reduce air pollution by reducing the number of vehicles on the road.

Sprawl swallows farmland, pollutes watersheds and destroys natural resources—forests, prairie, wetlands, coastal ecosystems and wildlife habitat. It detracts from the beauty of our countryside, our quality of life and our health, not least by removing natural areas where we are motivated to hike, swim, watch birds and otherwise be active. Proponents of "smart growth" seek to preserve and renew existing communities rather than expand roads, homes and businesses out into the countryside, and to build higher -density residential areas, leaving more open space. In the dense, compact Seattle neighborhood of Northgate, for example, Steve Clagett recently participated in a "bike to work day." That is not an everyday thing, since he now works a 45-minute bike trip away. "But I can walk to transit centers and the grocery store, while I'm one block from a wild ravine and stream, and all the time I spend jogging and running would otherwise have been spent battling traffic," Clagett says.

Smart growth also means the development of parks and green spaces that promote community and mental health as well as physical activity. Leslie Brown of Seattle recently moved to a new cohousing community, a development where homes are clustered together in order to preserve common open space. There's a wetland area with a pond where children can explore. "The native Pacific frogs there are music to me," she says.

Changes can happen citywide or just a few buildings at a time. Between 1998 and 2000, Enrique Peñalosa, former mayor of Bogotá, Colombia, built 70 miles of bicycle routes and closed several streets to cars, converting them instead into pedestrian malls. Commute times dropped by 20 minutes, and during his citywide car-free days air pollution was cut by 25 percent, Peñalosa says. In 1976, according to Will Toor, mayor of Boulder, Colorado, the city established an urban-growth boundary that would curtail haphazard sprawl and preserve the city's beautiful mountain views. Now the city's rate of bicycling is ten times the national average and "from anywhere in Boulder you can get to recreation as well as walkable, bikable and pleasant downtown neighborhoods," Toor says, adding that he wasn't surprised to find the city also had one of the lowest rates of obesity in the state.

Manitowoc County, Wisconsin, recently voted to renovate an older, in-town school rather than build a larger regional school, farther away, that would have necessitated more car travel.

Healthier School Food

In San Diego, Robin Pelletier is now director of Nutrition Network News, a nonprofit organization that works with schools to encourage healthy eating habits as well as active physical education classes—often the first casualty of underfunded school districts. She's kicking off a "walking school bus" program that gets parents and friends walking with kids, on National Walk to School Day, October 8. She recently helped a school host a "Farm to Market Day," to encourage students to eat fruits and vegetables bought as much as possible from local farmers—thus decreasing the time and fuel from farm to market. In Opelika, Alabama, school officials have started buying fresh vegetables from local farmers, as have school districts in 17 states, The New York Times reported early this year.

Across the country, school districts are beginning to re-evaluate the meals they serve, eliminating fattening junk food and soft drinks in cafeterias and school vending machines. Opelika schools do not serve fried foods; nor do they permit snack- and soft-drink vending machines, or fast-food commercials shown on Channel One. Schools from Appleton, Wisconsin, to San Diego to New York City, the nation's largest, have banned sodas and/or candy and other sugary snacks from vending machines. New York, where 21 percent of sixth-graders are obese, is reducing fat and portion size in school lunches. Some school districts are stocking machines and snack bars with healthy choices, such as sandwiches, salads, bottled water and fresh fruit cups. In Cajon Valley, California, which offers healthy snacks in middle schools, "The students like it so much they are requesting this option at their high schools," Pelletier says. In Maine, Pelletier's home state, legislators recently introduced anti-obesity bills that would cut back on junk food in school vending machines and require chain restaurants to display nutritional information.

As these examples show, while researchers at the national level are setting policy, there's a grass-roots battle against sprawl—of the built environment and our waistlines—taking place at the local level. Smart growth has a human face and brings us closer to our communities. As Leslie Brown says of her clustered housing development, "It feels like a retreat center rather than a typical housing development, and I like to hear the voices and sounds of feet walking past."