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LETTER TO THE EDITOR |
To the Editor.—
In their statement on the prevention of childhood obesity through increased physical activity,1 the American Academy of Pediatrics Council on Sports Medicine and Fitness and the Council on School Health gave only a passing glance at what may be the elephant in the room (no pun intended). Our reliance on the automobile and our propensity to design our urban environments for cars rather than for people may well be an additional root cause of the obesity epidemic. Any solution to this epidemic requires that this issue be addressed.
The authors acknowledged that addressing the current epidemic of obesity requires work on several fronts, including "making activity-promoting changes in the environment." They are also disquieted by "safety concerns" and "unsafe environments" that inhibit physical activity and suggested that "[c]ommunities designed with green spaces and biking trails help provide ... the means to enjoy ... active lifestyles." However, the majority of their recommendations for controlling or preventing obesity were for active interventions. It is intuitive that active public health measures (eg, boiling water in each household) are less effective than passive ones (eg, water treatment plants).
Our urban design often prohibits the possibility of passive opportunities to exercise. It is too far, too dangerous, or too difficult to walk or bike to school or work. Up to 40% of the space in a city is devoted to automobiles,2 stretching it beyond the physical capacity of pedestrians. Soccer moms do not walk their kids to practice. The automobile city has created sprawl: single-use zoning, with shopping, housing, recreation, and commerce all connected by roads and parking lagoons. One must always drive or be driven from one to the other. The result is that the environment provides a paucity of opportunity to exercise but an overabundance of food, easily obtainable at the drive up window.
The council authors suggested that "[i]t is unlikely that the medical profession alone will be able to solve this serious health problem." As advocates for children we need to begin speaking to city planners, architects, real estate developers, transportation consultants, and city councilors. We must admit to the limited success we have had in either anticipatory guidance or addressing the problems of obese children when they are finally seen in the examination room.
Beyond the obesity issue, there are a multitude of health, social, and environmental problems that can be tempered if we address the problem of automobiles and sprawl. These include cardiovascular and respiratory disease, poverty and segregation, pollution, global warming, and energy conservation. A recent review from the Centers for Disease Control and Prevention articulately summarized the extensive research pertaining to these other issues.3
I suggest that pediatricians inform themselves of the urban design alternatives suggested by initiatives such as Smart Growth and the New Urbanism and consider advocacy for change in the built environment as advocacy for children.
REFERENCES
This article has been cited by other articles:
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  E. B.R. Desapriya, I. Pike, A. Basic, and S. Subzwari Deterrent to Healthy Lifestyles in Our Communities Pediatrics, May 1, 2007; 119(5): 1040 - 1042. [Full Text] [PDF]
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