Current Efforts Related to Public Health and The Built Environment FHWA Efforts, Complexity, and Overwhelming Stressor Hypothesis David Belluck, Ph.D

Current Efforts Related to Current Efforts Related to Public Health and The Built Public Health and The Built

EnvironmentEnvironment

FHWA Efforts, Complexity, and FHWA Efforts, Complexity, and Overwhelming Stressor HypothesisOverwhelming Stressor Hypothesis

David Belluck, Ph.D.David Belluck, Ph.D.

FHWAFHWA

Washington, D.C.Washington, D.C.

FHWA Efforts on the Built FHWA Efforts on the Built Environment and Public HealthEnvironment and Public Health

FHWA is expending considerable FHWA is expending considerable resources in the field of infrastructure and resources in the field of infrastructure and public health.public health.

Three of these efforts will be described Three of these efforts will be described today.today.

FHWA's Transportation Planning & Physical FHWA's Transportation Planning & Physical Activity Project.Activity Project.

FHWA’s upcoming publication FHWA’s upcoming publication “What Works: “What Works: Transportation and Public Health.”Transportation and Public Health.”

FHWA is working with CDC to assess whether FHWA is working with CDC to assess whether transportation facilities can be evaluated for transportation facilities can be evaluated for health impacts. health impacts.

FHWA Efforts on the Built FHWA Efforts on the Built Environment and Public HealthEnvironment and Public Health

FHWA Transportation Planning & FHWA Transportation Planning & Physical Activity ProjectPhysical Activity Project

Initiative to help transportation planners and USDOT understand potential links between transportation planning and physical activity.

FHWA Transportation Planning & FHWA Transportation Planning & Physical Activity Project Physical Activity Project

Main activities to Date:

Meetings with public health stakeholders

Annotated Bibliography - Released in 2004

Experts Peer Roundtable - January 2004

Roundtable Proceedings - Released in 2004

FHWA Portland RoundtableFHWA Portland Roundtable

Transportation and public Transportation and public health professionals health professionals discussed opportunities discussed opportunities and strategies to include and strategies to include health and activity goals health and activity goals within the transportation within the transportation planning process. planning process. Lesson learned from this Lesson learned from this multidisciplinary effort will multidisciplinary effort will be used in producing be used in producing “What Works: “What Works: Transportation and Public Transportation and Public Health.”Health.”Photo: Photo: http://lists.village.virginia.edu/sixties/Graphics/Covers/http://lists.village.virginia.edu/sixties/Graphics/Covers/cover_Lessons.JPEGcover_Lessons.JPEG

First Steps at Multidisciplinary First Steps at Multidisciplinary ApproachApproach

““What Works: What Works: Transportation & Public Transportation & Public Health” is an important Health” is an important first step to bring together first step to bring together health professionals and health professionals and transportation transportation professionals to work on professionals to work on the problem of active the problem of active transport, active living, and transport, active living, and public health. public health.

What Works: Transportation & What Works: Transportation & Public HealthPublic Health

Sherry Ways (FHWA) and I will shortly put together a final Sherry Ways (FHWA) and I will shortly put together a final Statement of Work to hire a contractor to work with FHWA, Statement of Work to hire a contractor to work with FHWA, along with public and private sector partners, to develop along with public and private sector partners, to develop consensus themes and select consensus photographs to consensus themes and select consensus photographs to show how transportation may contribute to improved public show how transportation may contribute to improved public health to work for the public good. health to work for the public good. It will initially be an Internet document with the potential for It will initially be an Internet document with the potential for hard copy publication. hard copy publication. Here is an example of how the publication could look: Here is an example of how the publication could look:

ComplexityComplexityThe subject of obesity causation and control is very The subject of obesity causation and control is very complex. There are many potential causes.complex. There are many potential causes.

Scientists and physicians are having a very difficult time Scientists and physicians are having a very difficult time getting a firm hold on all the pieces to the puzzle and getting a firm hold on all the pieces to the puzzle and figuring out how they relate to one another.figuring out how they relate to one another.

Currently no unifying theory about why obesity control Currently no unifying theory about why obesity control interventions have not met expectations (i.e. obesity still interventions have not met expectations (i.e. obesity still increasing). increasing).

The importance of transportation infrastructure as a cause The importance of transportation infrastructure as a cause of obesity is unclear as demonstrated by the next slides.of obesity is unclear as demonstrated by the next slides.

Purported Causes of ObesityPurported Causes of Obesity

Carbohydrate intake increaseCarbohydrate intake increase

Chemical toxinsChemical toxins

Children’s purchasing powerChildren’s purchasing power

CultureCulture

Early dieting in response to media induced Early dieting in response to media induced body imagesbody images

Eating less meals at homeEating less meals at home

EnvironmentEnvironment


GeneticsGenetics

High birth weightHigh birth weight

Increase in sedentary behaviorsIncrease in sedentary behaviors

Limited freedom to walkLimited freedom to walk

Lipostatic system set-point set at Lipostatic system set-point set at inappropriate levelinappropriate level

Lowered food costs Lowered food costs

Media messages Media messages


Obesogenic food environmentObesogenic food environmentParental eating behaviors and weight statusParental eating behaviors and weight statusParental feeding behaviorParental feeding behaviorParental smokingParental smokingPhysical activity reductionPhysical activity reductionPregnancyPregnancyPrenatal over-nutritionPrenatal over-nutritionPrepared foodsPrepared foodsProductivityProductivitySleep duration, shortSleep duration, short


Socioeconomic status (a complex Socioeconomic status (a complex multidimensional construct)multidimensional construct)Sugar sweetened beveragesSugar sweetened beveragesTechnological changeTechnological changeTechnological innovationTechnological innovationTelevision viewing increasesTelevision viewing increasesWalking and biking less to schoolWalking and biking less to schoolWestern lifestyle adoptionWestern lifestyle adoption


Given the number and complexity of obesity Given the number and complexity of obesity causation factors, it is difficult to point to any one causation factors, it is difficult to point to any one of these factors alone, or in combination, and of these factors alone, or in combination, and definitively rank them in order of importance.definitively rank them in order of importance.

In fact, no such scientifically validated list In fact, no such scientifically validated list currently exists.currently exists.

What is the Role of Transportation and What is the Role of Transportation and the Built Environment in Obesity the Built Environment in Obesity

Causation?Causation?Recent papers have Recent papers have focused on the focused on the relationship of sprawl relationship of sprawl on obesity.on obesity.These papers have These papers have linked sprawl to linked sprawl to lessened physical lessened physical activity.activity.They have They have hypothesized that hypothesized that transportation and the transportation and the built environment are a built environment are a primary cause of primary cause of inactivity.inactivity.


Causation?Causation?The implication of this The implication of this and other sprawl and other sprawl studies is that a lack studies is that a lack of sprawl translates of sprawl translates into more active living into more active living (e.g. walking), less (e.g. walking), less obesity and lower obesity and lower weights, and better weights, and better general health. general health. Graphic: Graphic: http://www.mp3.com.au/img/artist/Implicationhttp://www.mp3.com.au/img/artist/Implication%209_RESIZED.jpg%209_RESIZED.jpg


Causation?Causation?New York City has over New York City has over nine million residents and nine million residents and ranks as the city with the ranks as the city with the least amount of sprawl in least amount of sprawl in the 83 metropolitan areas the 83 metropolitan areas studied by Smart Growth studied by Smart Growth America. America. New York City has a high New York City has a high residential density factor, residential density factor, mix of homes, jobs and mix of homes, jobs and services, strong town services, strong town centers and downtowns, centers and downtowns, and accessible street and accessible street networks.networks. Photo: http://en.wikipedia.org/wiki/New_York_CityPhoto: http://en.wikipedia.org/wiki/New_York_City


Causation?Causation?New York City New York City boroughs had the boroughs had the lowest sprawl lowest sprawl statistics in the nation statistics in the nation (Ewing and McCann (Ewing and McCann September 2003). September 2003). Question: Question: Does A Does A Lack of Sprawl In New Lack of Sprawl In New York City Translate York City Translate Into A Model of Into A Model of Obesity Control?Obesity Control?Photo: Photo: http://www.tourbec.info/voyage/popup_image.php?http://www.tourbec.info/voyage/popup_image.php?pID=117&image=0pID=117&image=0

Is NYC A Good Built Environment Model Is NYC A Good Built Environment Model for Obesity Control?for Obesity Control?

Public health data Public health data from NYC suggests from NYC suggests that a relative lack of that a relative lack of sprawl does not mean sprawl does not mean that NYC may not be that NYC may not be an appropriate model an appropriate model of obesity control of obesity control through infrastructurethrough infrastructure..Graphic: Graphic: http://www.richardsilverstein.com/tikun_olamhttp://www.richardsilverstein.com/tikun_olam/obesity.jpg/obesity.jpg


In 1996 prevalence of In 1996 prevalence of severe overweight in severe overweight in second and fifth grade second and fifth grade school children was school children was higher in NYC higher in NYC compared to the rest compared to the rest of the state.of the state.Numerous NYC studies Numerous NYC studies highlight obesity highlight obesity problem in children problem in children and adults.and adults.


According to Wilson According to Wilson (August 2003) “…almost (August 2003) “…almost half (43 percent) of the half (43 percent) of the children in New York City's children in New York City's public elementary schools public elementary schools are overweight to some are overweight to some extent, and a quarter extent, and a quarter qualify as obese. Hispanic qualify as obese. Hispanic children had nearly double children had nearly double the obesity rates of white the obesity rates of white and Asian children (31 and Asian children (31 percent versus 16 and 14 percent versus 16 and 14 percent, respectively). percent, respectively). African-American children African-American children fell in the middle, with a 23 fell in the middle, with a 23 percent obesity rate.”percent obesity rate.”


The New York City The New York City Department of Health Department of Health and Mental Hygiene and Mental Hygiene (2003, July 2003) (2003, July 2003) reports that between reports that between 1991 and 2001 1991 and 2001 obesity levels doubled obesity levels doubled in the United States in the United States with New York City with New York City adults being slightly adults being slightly less than the national less than the national average.average.

ConclusionsConclusions

In contrast to the In contrast to the implications of some sprawl implications of some sprawl studies, NYC may not be a studies, NYC may not be a good model for built good model for built environment and obesity environment and obesity control based on actual control based on actual obesity statistics in the obesity statistics in the literature.literature.Additional built Additional built environment and obesity environment and obesity research is required before research is required before firm relationships can be firm relationships can be established sufficient to established sufficient to support large scale support large scale infrastructure interventions.infrastructure interventions. Graphic: Graphic: http://www.ci.nyc.ny.us/html/doh/html/survey/survey.htmhttp://www.ci.nyc.ny.us/html/doh/html/survey/survey.htmll

What Could Be the Underlying What Could Be the Underlying Reasons for Obesity Increases?Reasons for Obesity Increases?

We have seen that We have seen that there are numerous there are numerous competing hypothesis competing hypothesis to explain the to explain the continuing obesity continuing obesity epidemic.epidemic.I would like to provide I would like to provide you with a working you with a working hypothesis that might hypothesis that might make sense to explain make sense to explain what we are seeing in what we are seeing in the field and technical the field and technical literature.literature.Graphic: Graphic: http://www.cis.gsu.edu/~dstraub/Research/ACIT-APIT/quehttp://www.cis.gsu.edu/~dstraub/Research/ACIT-APIT/question.gifstion.gif

““Overwhelming Stressor Overwhelming Stressor Hypothesis”Hypothesis”

I am currently working on a paper to initiate I am currently working on a paper to initiate discussion on the “Overwhelming Stressor discussion on the “Overwhelming Stressor Hypothesis.” Hypothesis.”

This paper does not currently represent FHWA This paper does not currently represent FHWA policy.policy.

This paper is designed to investigate the many This paper is designed to investigate the many reasons for obesity and to try and figure out why reasons for obesity and to try and figure out why it keeps increasing in the United States.it keeps increasing in the United States.

Logic Of Obesity Causation: A Logic Of Obesity Causation: A HypothesisHypothesis

People are exposed to People are exposed to numerous controllable numerous controllable (escapable) and (escapable) and uncontrollable stressors uncontrollable stressors (inescapable).(inescapable).

Coping with multiple Coping with multiple stressors results in chronic stressors results in chronic stress and fatigue.stress and fatigue.

Chronic stress and fatigue Chronic stress and fatigue result in consumption of result in consumption of readily available and readily available and inexpensive energy rich inexpensive energy rich foods.foods.Graphic: Graphic: http://www.marxists.org/reference/archive/hegel/triads/lohttp://www.marxists.org/reference/archive/hegel/triads/logic.gifgic.gif

Logic Of Obesity Causation: A Logic Of Obesity Causation: A HypothesisHypothesis

Over time, people gain weight, become Over time, people gain weight, become overweight and obese.overweight and obese.

People coping with overwhelming stressors hear People coping with overwhelming stressors hear public health messages to exercise more and eat public health messages to exercise more and eat a balanced diet and nutritious foods.a balanced diet and nutritious foods.

They just cannot act on these messages because They just cannot act on these messages because they are drowned out by more pressing concerns.they are drowned out by more pressing concerns.


My working hypothesis is that the current My working hypothesis is that the current prevention intervention model (education and prevention intervention model (education and motivation) has not worked because it targets a motivation) has not worked because it targets a symptom (i.e. individual weight control) and not symptom (i.e. individual weight control) and not the core problem, overwhelming stressors.the core problem, overwhelming stressors.

If this hypotheses is correct, then a If this hypotheses is correct, then a complex complex systems approachsystems approach is needed to replace the is needed to replace the individual centered approachindividual centered approach currently in use. currently in use.

Evidence: Controllable and Evidence: Controllable and Uncontrollable StressUncontrollable Stress

People are exposed to People are exposed to numerous controllable numerous controllable (escapable) and (escapable) and uncontrollable uncontrollable (inescapable) (inescapable) stressors (e.g. work, stressors (e.g. work, time, economic, time, economic, social, family, etc.) social, family, etc.) (Anisman and Merali 1999)(Anisman and Merali 1999)

Photo: www.secondhand-Photo: www.secondhand-mobilephones.co.uk/images/work_stress.jpgmobilephones.co.uk/images/work_stress.jpg


U.S. Department of U.S. Department of Defense study shows Defense study shows that high levels of that high levels of stress occur at work stress occur at work and home. and home. Figure: www.defenselink.mil/news/Mar2004/040308-Figure: www.defenselink.mil/news/Mar2004/040308-D-6570C-012.jpgD-6570C-012.jpg

Evidence: Men and Women Often Evidence: Men and Women Often Deal With Stress in Different WaysDeal With Stress in Different Ways

UU.S. Department of .S. Department of Defense study shows Defense study shows that men and women that men and women are stressed in are stressed in different ways.different ways.

Figure: www.defenselink.mil/news/Mar2004/040308-D-Figure: www.defenselink.mil/news/Mar2004/040308-D-6570C-012.jpg6570C-012.jpg


Workplace stress Workplace stress results from an results from an awareness of not awareness of not being able to cope being able to cope with the demands of with the demands of their work their work environment with environment with associated negative associated negative emotional response. emotional response. ((www.acc.co.nz/injury-prevention/safe-at-workwww.acc.co.nz/injury-prevention/safe-at-work/worksafe/action/hazard-management/people/worksafe/action/hazard-management/people/stress//stress/))

Figure: Figure: www.defenselink.mil/news/Mar2004/040308-www.defenselink.mil/news/Mar2004/040308-D-6570C-014.jpgD-6570C-014.jpg

Evidence: Longer Working Evidence: Longer Working HoursHours

According to a study According to a study by the National Sleep by the National Sleep Foundation, the Foundation, the average employed average employed American works a 46-American works a 46-hour work week; 38% hour work week; 38% of the respondents in of the respondents in their study worked their study worked more than 50 hours more than 50 hours per week. per week. ((www.libraryspot.com/know/workweek.htmwww.libraryspot.com/know/workweek.htm))

Figure: www.jr.co.il/humorpic/jr-wweek.jpgFigure: www.jr.co.il/humorpic/jr-wweek.jpg


Workers in the United Workers in the United States put in the States put in the longest hours (among longest hours (among industrialized nations) industrialized nations) on the job, nearly on the job, nearly 2000 hours per capita 2000 hours per capita in 1997, and in the in 1997, and in the period from 1980, the period from 1980, the annual working hours annual working hours in the US has been in the US has been steadily rising. steadily rising. ((

www.twnside.org.sg/title/steady-cn.htmwww.twnside.org.sg/title/steady-cn.htm))


The long working The long working hours of workers in hours of workers in the US (rising trend) the US (rising trend) and Japan (declining and Japan (declining trend) is in sharp trend) is in sharp contrast with those of contrast with those of European workers, European workers, who are progressively who are progressively working fewer hours working fewer hours on the job.on the job. ((

www.twnside.org.sg/title/steady-cn.htmwww.twnside.org.sg/title/steady-cn.htm))

Evidence: Stress Leads to Evidence: Stress Leads to FatigueFatigue

Fatigue is one of the Fatigue is one of the common outcomes of common outcomes of stress and can have a stress and can have a serious impact on serious impact on health.health. ((

www.acc.co.nz/injury-prevention/safe-at-workwww.acc.co.nz/injury-prevention/safe-at-work/worksafe/action/hazard-management/people/worksafe/action/hazard-management/people/stress//stress/))

Figure: Figure: www.1001cartes.com/perso/images_perso/fatigue.jpgwww.1001cartes.com/perso/images_perso/fatigue.jpg

Evidence: Stressors That Influence Evidence: Stressors That Influence Weight GainWeight Gain

““Urban and suburban Urban and suburban designs that designs that discourage walking discourage walking and other physical and other physical activities. activities. (Hill and Peters 1998)(Hill and Peters 1998)

Figure: Figure: http://tigger.uic.edu/depts/ahaa/imagebase/maclean/ahttp://tigger.uic.edu/depts/ahaa/imagebase/maclean/aerials1/85.JPEGerials1/85.JPEG


Reduced access and Reduced access and affordability in some affordability in some communities to fruits, communities to fruits, vegetables, and other vegetables, and other nutritious foods. nutritious foods. (Hill and (Hill and

Peters 1998)Peters 1998)

Decreased opportunities Decreased opportunities for physical activity at for physical activity at school and after school, school and after school, and reduced walking or and reduced walking or biking to and from biking to and from school. school. (Hill and Peters 1998)(Hill and Peters 1998)

Figure: www.neon-signs.com/neon-shop/food-and-Figure: www.neon-signs.com/neon-shop/food-and-beverages-signs.htmbeverages-signs.htm


Competition for leisure Competition for leisure time that was once time that was once spent playing outdoors spent playing outdoors with sedentary screen with sedentary screen time-including time-including watching television or watching television or playing computer and playing computer and video games. video games. (Hill and Peters 1998)(Hill and Peters 1998)

Figure: Figure: http://uk.oneworld.net/penguin/pollution/couch_potato.http://uk.oneworld.net/penguin/pollution/couch_potato.gifgif


An environment that An environment that promotes excessive food promotes excessive food intake (food availability and intake (food availability and portion size, high-fat diets, portion size, high-fat diets, passive overeating, limited passive overeating, limited access to low fat/energy access to low fat/energy density foods), and density foods), and discourages physical activity discourages physical activity (transportation, technology, (transportation, technology, no mandatory physical no mandatory physical education in schools, education in schools, environments not conducive environments not conducive to physical activity). to physical activity). (Hill and Peters (Hill and Peters 1998)1998)

Figure: www.edgeworks.us/illustrations/images/473-Figure: www.edgeworks.us/illustrations/images/473-Couch-Potato-Female.jpgCouch-Potato-Female.jpg

Evidence: Coping Results in Evidence: Coping Results in Chronic Stress and FatigueChronic Stress and Fatigue

Coping with multiple Coping with multiple stressors results in stressors results in chronic stress and chronic stress and fatigue.fatigue.

Stress is our reaction to Stress is our reaction to events, environmental events, environmental or internal, that tax or or internal, that tax or exceed our adaptive exceed our adaptive resources.resources. ((

www.texmed.org/cme/phn/psb/stress.aspwww.texmed.org/cme/phn/psb/stress.asp))

Figure: Figure: www.extension.umn.edu/distribution/familydevelopment/Imageswww.extension.umn.edu/distribution/familydevelopment/Images/DE2465-logo.gif/DE2465-logo.gif


Stress is an internal Stress is an internal process that occurs when a process that occurs when a person is faced with a person is faced with a demand that is demand that is perceived perceived to exceed the resources to exceed the resources availableavailable to effectively to effectively respond to it, and where respond to it, and where failure to effectively deal failure to effectively deal with the demand has with the demand has important and undesirable important and undesirable consequences.consequences. ((www.texmed.org/cme/phn/psb/stress.aspwww.texmed.org/cme/phn/psb/stress.asp))

Figure: www.texmed.org/images/stressors.gifFigure: www.texmed.org/images/stressors.gif


The Stress Process The Stress Process

1.1. Stress leads to emotional Stress leads to emotional response. response.

2.2. Person selects a coping Person selects a coping response. response.

3.3. If effective, relaxation of If effective, relaxation of arousal. arousal.

4.4. If ineffective, arousal If ineffective, arousal increases, resulting in increases, resulting in strain. strain.

5.5. Unresolved stress leads Unresolved stress leads to burnout.to burnout.

((www.texmed.org/cme/phn/psb/what_is_stress.aspwww.texmed.org/cme/phn/psb/what_is_stress.asp))

Figure: www.jwolfe.clara.net/Humour/WorkStress.htmFigure: www.jwolfe.clara.net/Humour/WorkStress.htm

Evidence: Stress and Fatigue Result in Evidence: Stress and Fatigue Result in Consumption of Energy Rich FoodsConsumption of Energy Rich Foods

Families often Families often minimize food costs minimize food costs and acquisition and and acquisition and preparation time, preparation time, resulting in frequent resulting in frequent consumption of consumption of energy dense energy dense convenience foods convenience foods that are high in that are high in calories and fat.calories and fat. ((National National

Academy of Sciences 2005)Academy of Sciences 2005)

Figure: Figure: www.aperfectworld.org/clipart/food_dining/pizza.gifwww.aperfectworld.org/clipart/food_dining/pizza.gif

Evidence: Weight Gain Over Evidence: Weight Gain Over TimeTime

Over time, people gain Over time, people gain weight, become overweight weight, become overweight and obese.and obese.

In 1991 four States had In 1991 four States had obesity prevalence rates of obesity prevalence rates of 15-19 percent and no States 15-19 percent and no States above 20 percent.above 20 percent.

In 2003 (see figure to the In 2003 (see figure to the left) 31 States had rates of left) 31 States had rates of 20-24 percent, and four 20-24 percent, and four States had rates more than States had rates more than 25 percent.25 percent.Figure and last two bullets: Figure and last two bullets: www.cdc.gov/nccdphp/dnpa/obesity/trend/maps/obesity_trewww.cdc.gov/nccdphp/dnpa/obesity/trend/maps/obesity_trends_2003.pdfnds_2003.pdf

Lots of Health MessagesLots of Health Messages

Examples of messages:Examples of messages:

1)1) Active play: encourage Active play: encourage your child to get moving your child to get moving every day;every day;

2)2) Memorable mealtimes: Memorable mealtimes: take time to eat together take time to eat together and talk with your family; and talk with your family;

3)3) Television viewing: limit Television viewing: limit television viewing to one television viewing to one hour per day;hour per day;

Figure: Figure: www.infonet.st-johns.nf.ca/providers/nhhp/newswww.infonet.st-johns.nf.ca/providers/nhhp/newsletter/spring00/10_Tom.gifletter/spring00/10_Tom.gif

Lots of Health MessagesLots of Health Messages

4) Drink more water: serve 4) Drink more water: serve water at snacks;water at snacks;

5) Eat more fruits and 5) Eat more fruits and vegetables: offer your vegetables: offer your child 5 fruits and child 5 fruits and vegetables each day; and vegetables each day; and

6) Active families: play with 6) Active families: play with your kids.your kids.

((http://nature.berkeley.edu/cwh/activities/fitwic%20VA.shtmlhttp://nature.berkeley.edu/cwh/activities/fitwic%20VA.shtml))

Questionable effect Questionable effect on obesity increases on obesity increases over time.over time.Figure: Figure: www2.wgbh.org/mbcweis/ltc/leadpois/CARROTS.GIFwww2.wgbh.org/mbcweis/ltc/leadpois/CARROTS.GIF

Hierarchy of NeedsHierarchy of Needs

People hear these messages, People hear these messages, but may not be able to act on but may not be able to act on them because they are them because they are drowned out by more pressing drowned out by more pressing concerns.concerns.

If you are struggling to meet If you are struggling to meet basic security needs at the basic security needs at the bottom of the pyramid, you bottom of the pyramid, you will not be able to focus on will not be able to focus on self actualization near the top self actualization near the top of the pyramid that includes of the pyramid that includes taking care of your health taking care of your health through better nutrition, through better nutrition, exercise, rest and health care.exercise, rest and health care.Figure: www.deepermind.com/maslow3.pngFigure: www.deepermind.com/maslow3.png

Basic NeedsBasic Needs

Only when more basic Only when more basic needs are met can a needs are met can a person move on to person move on to higher level behaviors higher level behaviors that would result in that would result in weight control or weight control or weight loss.weight loss.

Figure: Figure: www.friedenspaedagogik.de/images/service/basic_neewww.friedenspaedagogik.de/images/service/basic_needs_400.jpgds_400.jpg


It is my working hypothesis It is my working hypothesis that the current prevention that the current prevention intervention model intervention model (targeted at individual (targeted at individual education and motivation) education and motivation) has not worked because it has not worked because it targets a symptom (i.e. targets a symptom (i.e. individual weight control) individual weight control) and not the core problem, and not the core problem, overwhelming stressors.overwhelming stressors.

Figure: Marketing/Education Figure: Marketing/Education www.tandl.vt.edu/VTE/MEheader.gifwww.tandl.vt.edu/VTE/MEheader.gif

Figure: Motivation: Figure: Motivation: www.ag.ch/wov/index.htm?/wov/wov.htmwww.ag.ch/wov/index.htm?/wov/wov.htm


If this hypothesis is correct, If this hypothesis is correct, researchers will need to move researchers will need to move from current individually from current individually oriented solutions that have oriented solutions that have not achieved obesity control not achieved obesity control in the United States to in the United States to systems oriented solutions systems oriented solutions that have a better chance of that have a better chance of working to achieve their working to achieve their desired outcome as has been desired outcome as has been indicated in the recent indicated in the recent literature on the subject.literature on the subject.

This means that many uni-This means that many uni-dimensional approaches will dimensional approaches will need to be supplanted by need to be supplanted by multi-disciplinary approaches.multi-disciplinary approaches.

Figure: www.complex-systems.com/cscovers.jpgFigure: www.complex-systems.com/cscovers.jpg


This hypotheses intuitively explains the inability of past population level public health interventions control obesity and stop or reverse the growing obesity epidemic.

This hypothesis is supported by current behavioral and other scientific information found scattered in the peer reviewed literature.

ConclusionsConclusionsObesity causation and control are complex subjects.Obesity causation and control are complex subjects.

Current scientific knowledge is insufficient to provide definitive Current scientific knowledge is insufficient to provide definitive answers.answers.

The role of the built environment in obesity causation is unclear.The role of the built environment in obesity causation is unclear.

People have numerous opportunities for recreation and to make People have numerous opportunities for recreation and to make healthy eating choices.healthy eating choices.

More research is needed to identify clear cause and effect More research is needed to identify clear cause and effect relationships sufficient to identify those built environment factors relationships sufficient to identify those built environment factors that actually result in healthier communities.that actually result in healthier communities.

The current education/motivation paradigm does not work to The current education/motivation paradigm does not work to control obesity.control obesity.

ConclusionsConclusions

A replacement paradigm is needed.A replacement paradigm is needed.

The overwhelming stressor hypothesis is proposed.The overwhelming stressor hypothesis is proposed.

It intuitively explains field observations and is It intuitively explains field observations and is supported by technical literature.supported by technical literature.

It is based on common sense and scientific evidence.It is based on common sense and scientific evidence.

What Works and other FHWA initiatives will address What Works and other FHWA initiatives will address built environment and public health issues through the built environment and public health issues through the use of sound science, research, and partnerships.use of sound science, research, and partnerships.

Documents

Current Efforts Related to Public Health and The Built Environment FHWA Efforts, Complexity, and Overwhelming Stressor Hypothesis David Belluck, Ph.D