Do We Look Fat in These Suburbs?

Garrick and Marshall have also previously found that people who live in more sparse, tree-like communities spend about 18 percent more time driving than do people who live in dense grids. And they die more readily—despite old research that implied otherwise. Studies from the 1950s looked at safety in cul-de-sacs and found, as Marshall put it, “You'll have fewer crashes in the cul-de-sacs. Sure, you're safer if you never leave the cul-de-sac. If you take into account the entire city, your city might be killing more people." I got the impression he could go on about cul-de-sacs.

68 percent of Americans are overweight or obese, which means that someone you know is overweight or obese. Most people don’t get the CDC’s minimum recommended amount of physical activity. Americans spend more time driving every year. So it is logical to conclude, as Garrick and Marshall do in their paper, “The role of the street network and how we put together the bones of our communities should not be overlooked as a potential contributing factor to health outcomes.”

They also found that wide streets with many lanes are associated with high rates of obesity and diabetes. That’s most likely indicative of, as Garrick and Marshall put it, “an inferior pedestrian environment.” Similarly, so-called “big box” stores in a neighborhood indicate poor walkability and are associated with 24.9 percent higher rates of diabetes and 13.7 percent higher rates of obesity.

Dense cities promote walking and biking, so the push for healthier cities fits with the vogue push for active lifestyles—as opposed to gym routines smattered across an indolent existence. Physical activity is not just concerted exercise time and deliberate recreation. It’s about ways of life. For some people, that’s best accomplished by making things inevitably more difficult on themselves in everyday life.

“Taken together these findings suggest a need to radically rethink how we design and build the streets and street networks that form the backbone of our cities, towns, and villages,” Garrick said in a press statement. “This research is one more in a long line that demonstrates the myriad advantages of fostering walkable places.”

"It's nice to make more of these connections,” Marshall told me, tonally foreshadowing the inevitable correlation-is-not-causation caveat, “but it's hard to say that these kinds of neighborhoods cause good health."

It’s true that people who like to walk and bike might be choosing to live in denser neighborhoods, and that may be all there is to this relationship. But on that note, there a lot of people who don't really have a choice where they live. They can't afford to live in the hearts of big grid cities. “A lot of poor people are getting forced out of the walkable urban scene,” Marshall said. In a reversal of the 1950s' “white flight,” many cities are seeing gentrification that is pricing out poor neighborhoods.

Others stranded are kids, who often don't realistically have the option to walk to school. They have to get on a bus.

So are health factors influencing city planning?

"There is a push in that direction, but I still wouldn't say it's really integrated into what people are doing,” Marshall said. “If you're looking to buy a new house, I think very few people are cognizant that there might be long-term health differences between one neighborhood and the other. You might hear about it in terms of things like fracking or living near a highway. The obesity epidemic is becoming a national crisis, but almost nobody connects that with neighborhood design. The connections we're making there are all about food and exercise. But if we build neighborhoods where exercise is part of people's daily routine, you would think that could go a long way."

Indeed. “Life is a bunch of intersections,” I said. But I don’t think he heard me.

Presented by

James Hamblin, MD, is a senior editor at The Atlantic. He writes the health column for the monthly magazine and hosts the video series If Our Bodies Could Talk.

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