Obesity rising in less walkable Ontario neighbourhoods; highly walkable areas see drop in diabetes

Obesity rates in Southern Ontario cities have remained stable for more than a decade in highly walkable neighborhoods but continued to rise in less walkable ones, a new study had found.  Neighbourhoods that were designed to be more walking friendly also experienced a fall in the rate of new cases of diabetes.

The study, led by Dr. Gillian Booth, an endocrinologist and researcher at St. Michael’s Hospital and an adjunct scientist at the Institute for Clinical Evaluative Sciences (ICES), was published today in the journal JAMA.

The study, the largest of its kind, looked at patterns of obesity, diabetes and transportation across 9,000 neighbourhoods with different levels of walkability over a dozen years and involved 3 million people in 15 municipalities in Southern Ontario. The study looked at adults ages 30-64, a group that has experienced a rapid increase in obesity-related conditions, including diabetes.

Previous studies on this topic have been much smaller and most were cross-sectional in their design (focusing on a single time point), meaning they were unable to follow residents over time for their future risk of disease.

“Our study illustrates the important role that neighbourhoods play in keeping us healthy,” Dr. Booth said. “The best designed communities make it easy for people to walk which helps protect them against obesity and diabetes. Neighbourhoods that require people to drive to their schools, stores and leisure facilities are worst off in terms of obesity and diabetes.”

The global increase in obesity is a major health problem. Being overweight increases the chance a person will develop Type 2 diabetes. An estimated 3.4 million Canadians have diabetes, or almost one in 10. Diabetes is a leading cause of vision loss, kidney failure, limb amputations and cardiovascular disease. It’s estimated that diabetes will cost the Canadian healthcare system $16.9 billion each year by 2020.

Despite public health efforts to reduce obesity through diet and exercise, rates of being overweight, obese and developing diabetes remain high. Aside from encouraging healthy eating, an approach gaining interest is to redesign communities to be more walkable, lessening dependence on cars and increasing opportunities for physical activity.

Highly walkable neighbourhoods are those with high population densities and high numbers of destinations within walking distance of residential areas (stores, banks, schools, etc.), along with well-connected streets. The researchers obtained the walkability data from a validated composite index including data from the 2006 Canadian Census and DMTI Spatial Inc. Neighborhoods were then ranked and classified into five groups, from lowest to highest walkability.

Weight trends: In 2001, the first year for which Dr. Booth examined data in this study, the prevalence of being overweight or obese was 10 per cent lower in the most walkable neighborhoods compared to the least walkable (43 per cent vs. 53 per cent).

By 2012, the prevalence of being overweight or obese increased in the three categories of least walkable neighbourhoods, while there was no significant change in areas of higher walkability. The difference in prevalence between the most and least walkable areas widened to 13.5 percentage points (45.5 per cent vs. 59).

Diabetes: In 2001, the number of new cases of diabetes in the most walkable areas was lower than the other areas. By 2012, the rate actually dropped in the two most walkable areas from 8.7 per 1,000 residents to 7.6, while not changing significantly in the least walkable neighbourhoods.

Foot vs. car traffic: Rates of walking, cycling and public transit use remained significantly higher and car use lower in the most walkable neighbourhoods, although the frequency of daily walking or cycling increased only modestly from 2001 to 2011 in highly walkable areas. Leisure time physical activity, diet and smoking patterns did not vary by walkability.

“Association of neighborhood walkability with change in overweight, obesity, and diabetes” was published today in the journal JAMA.

Author block: Creatore MI, Glazier RH, Moineddin R, Fazli GS, Johns A, Gozdyra P, Matheson FI, Kaufman-Shriqui V, Rosella LC, Manuel DG, Booth GL.

This study received funding from the Canadian Institutes of Health Research.

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future healthcare professionals in more than 23 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, and care of the homeless are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Center, which make up the Li Ki Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

The Institute for Clinical Evaluative Sciences (ICES) is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. For the latest ICES news, follow us on Twitter: @ICESOntario

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