Tuesday, July 28, 2009

How to fight obesity: ride a bike

It shouldn't come as a surprise that one consequence of creating a car-dependent society is the lack of opportunities for most people to get exercise on a daily basis. When most of our transportation dollars are spent building roads for cars, there is very little available for more active modes of transportation like walking and biking. One result: we spend $147 billion a year treating the obese.

That is the finding of a recently released Centers for Disease Control report entitled Annual Medical Spending Attributable To Obesity. A startling finding is that "obesity rates increased by 37 percent between 1998 and 2006 (from 18.3 percent to 25.1 percent of the population)".
The take-home message is that without a strong and sustained reduction in obesity prevalence, obesity will continue to impose major costs on the health system for the foreseeable future. And although health reform may be necessary to address health inequities and rein in rising health spending, real savings are more likely to be achieved through reforms that reduce the prevalence of obesity and related risk factors, including poor diet and inactivity. These reforms will require policy and environmental changes that extend far beyond what can be achieved through changes in health care financing and delivery.
What environmental changes are needed? The CDC provides some guidance in a Morbidity and Mortality Weekly Report published this week entitled Recommended Community Strategies and Measurements to Prevent Obesity in the United States. The report lists specific recommendations for preventing obesity. Number 17 is Communities Should Enhance Infrastructure Supporting Bicycling

Enhancing infrastructure supporting bicycling includes creating bike lanes, shared-use paths, and routes on existing and new roads; and providing bike racks in the vicinity of commercial and other public spaces. Improving bicycling infrastructure can be effective in increasing frequency of cycling for utilitarian purposes (e.g., commuting to work and school, bicycling for errands). Research demonstrates a strong association between bicycling infrastructure and frequency of bicycling.


Longitudinal intervention studies have demonstrated that improving bicycling infrastructure is associated with increased frequency of bicycling (104,105). Cross-sectional studies indicated a significant association between bicycling infrastructure and frequency of biking (p<0.001) (103,106,107).

Suggested measurement

Total miles of designated shared-use paths and bike lanes relative to the total street miles (excluding limited access highways) that are maintained by a local jurisdiction.

This measurement captures the availability of shared-use paths and bike lanes, as defined by the American Association of State Highway and Transportation Officials, relative to the total number of street network miles in a community. The numerator of this measurement includes both shared-use paths and bike lanes. The denominator of this measurement is limited to paved streets that are maintained by city/local government, and excludes limited access highways. Although no estimated standard exists for this measurement, data collected from local governments reporting on this measurement can lead to establishment of a standard.

103. Troped PJ, Saunders RP, Pate RR, et al. Associations between self-reported and objective physical environmental factors and use of a community rail-trail. Prev Med 2001;32:191--200.

104. Macbeth AG. Bicycle lanes in Toronto. ITE Journal 1999;69:38--46.

105. Staunton CE, Hubsmith D, Kallins W. Promoting safe walking and biking to school: the Marin County success story. Am J Public Health 2003;93:1431--4.

106. Dill J, Carr T. Bicycle commuting and facilities in major U.S. cities: if you build them, commuters will use them. Transportation Research Record 2003;1829:116--23.

107. Nelson A, Allen D If you build them, commuters will use them: association between bicycle facilities and bicycle commuting. Transportation Research Record 1997;1578:79--83.
How does Fairfax rate based on the suggested measurement of (bike lanes and shared use paths)/(total lane miles)? You be the judge: We have about 20 miles of bike lanes and 6,000 miles of roads for a bike lane infrastructure index of 0.00333. We rate much better on the shared use path index, but many of those trails are in poor condition or do not connect to other trails.

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