Monthly Archives: August 2017

Would Walkable Sidewalks Keep Us Thinner?

A few weeks ago on a trip to a picture perfect Vermont town, we asked the proprietor of our B&B if we could walk to the concert that night.

“You can, sure… it is less than a mile, but it will be dangerous walking home in the dark. There are no sidewalks and no street lights,” she told us.  So we drove, despite feeling silly at using the car for such a short distance, but happy we had done so when we left the concert. Ground fog was adding to the darkness in concealing the road, and we were sure we would not have felt safe walking back up the hilly, winding route.

The next day, we chatted about the lack of sidewalks and street lights with our hostess. She told us that daytime walking on the roads was manageable in the non-snow months, but not in the winter; the snow banks reduced the width of the roads and eliminated any possibility of stepping off the pavement.  “See, there’s is no side of the road to stand on when a pick-up truck comes speeding down the mountain….no one walks; it’s just too easy to be hit.”

There is no lack of activities in Vermont to provide opportunities to exercise, even if taking long walks in the winter is not one of them (Unless it is on a packed snow trail.) But unlike the quick convenience of going out the door to take a walk when sidewalks (plowed, of course) do exist, the lack of sidewalks in suburban or rural areas makes this simple activity difficult to carry out.

For the exercise committed, there are, of course, numerous opportunities to engage in physical exercise regardless of weather or environment. Not so for those who prefer being sedentary and are unlikely to seek out opportunities to move. In an episode of a television program focused on finding a house to buy, the client announced that she was too old (she was in her fifties) to buy a house with stairs. “Too much walking, “she told her realtor. Not surprisingly, the community in which she was house hunting had no sidewalks. If this woman had been advised to walk for her health and weight, she would have had a ready excuse. “Where? There is no place to walk where I live!”

No one has to be told about the rising incidence of obesity. Simply looking around confirms its prevalence, although the effects such as diabetes, back & leg pain, as well as the increased risk of certain types of cancer are silent.  One obvious culprit is that we eat too much, in part because portion sizes of just about everything have increased. Another fault lay in that we no longer live a lifestyle readily allowing us to burn off those excess calories. When physical activity was unavoidable in order to earn a living and maintain a household, a large caloric intake provided the fuel for the constant physical activity.  Now caloric intake has remained the same, or most likely increased, while physical activity has become optional for the most of us most of the time.

Because they eliminate a source of calorie use, might the absence of walkable sidewalks be a contributing factor to the continuous rise in obesity? The Journal of the American Medical Association (“JAMA”) published a study in 2016 showing that residents living in walkable urban neighborhoods had a slower increase in obesity and diabetes than those living in less walkable ones.  For this specific research, almost 9,000 urban neighborhoods in southern Ontario were studied over more than 11 years.  This study’s “Walkability Index” was based on safety of the sidewalks, the residential and commercial density, cross walks at intersections, schools, coffee shops, banks, and other retail establishments which might be walkable destinations.  People living in the walkable neighborhoods, and New York City is another example; they use sidewalks not only to get to their routine destinations like work, stores and restaurants but as places for urban hikes. These city dwellers may spend an entire day outside, hiking and exploring different parts of their city. The seemingly limitless places to walk allow them to do so.

However, it’s important to note the benefits of walking by city dwellers are not available to residents of towns such as the one we visited in rural Vermont. The population density is too low to justify the expense of sidewalks, and indeed many of roads are not even paved. Of course there are numerous places to hike, but this activity is not only seasonally limited, but also limited to people whose stamina and age enable them to climb mountain trails.

Perhaps the answer is to emulate many European cities which have set aside parkland filled with paved paths for walking. From my limited experience of these parks which I have seen in Holland, France and Germany, they are usually filled with walkers early in the day and then especially in the summer, after dinner. Benches are numerous for those who need to rest or just admire a view.  Strolling through one of these walking parks has the additional advantage of allowing members of a community to see and talk with each other. People often walk in small groups, or stop and greet others coming in the opposite direction. When so many members of a neighborhood are out walking?  It is easy to see this activity as a routine and healthful aspect of the day.

Eating less to prevent weight gain and/or lose weight is difficult because potential temptation lurks in the next meal. Walking may not compensate entirely for excess calories, but it can have a positive effect on preventing weight gain… unless of course, one walks to the doughnut shop.

Cite: Association of Neighborhood Walkability With Change in Overweight, Obesity, and Diabetes. Creatore M, Glazier R, Moineddin R.  JAMA  2016, 315; 2211-2220

The Covert Bullying of Obese Adults

When I congratulated a friend on her promotion to the head of a non-profit organization, she smiled and then told me it almost did not happen. “I learned that someone on the board did not want me to get the position and campaigned actively against me,” she told me.

“Why?” I asked. “You were obviously the front-runner.”

“Because I am fat,” she replied. “He told everyone on the board that he would not hire anyone who was fat. At least he is not criticizing my competence, only my size.”

But she was wrong.

The board member was likely not rejecting her solely because he believed her size or shape might affect her stamina in wearing the hats of an administrator, fundraiser, and creative director of a mid-size organization. He may have believed that her obesity reflected a deficit in her overall ability. A review of many studies of employer attitudes toward obese workers presented evidence that obese people are thought to have less leadership potential than normal-weight individuals. The obese are viewed as lazy, undisciplined, slow, unmotivated, and incapable of advancing to positions of responsibility. Thus my friend, whose resume indicated an unusually strong record of leadership and creativity in a previous position, could have been judged as inferior on these traits simply because she was fat.

Had she been male and obese, her size may not have been considered a detriment unless the job required physical skills that were difficult to perform because of weight. But an obese woman whose job requires some visibility—while fundraising, representing the organization at meetings, or giving presentations—might be passed over because of her appearance.

Had she failed to win the position, a claim that she was being discriminated against would have had no legal impact in the state in which she worked. The state of Michigan and some cities, including San Francisco and the District of Columbia, have outlawed employment discrimination against the obese.

Proving that a job is not offered or advancement not received because of size discrimination is very difficult. The board member did not publicly announce the reason for his opposition to anyone, but secretly told other members of the search committee. Happily, there were leaks, and eventually everyone in the organization knew and so did she. But even though he wished to deprive her of the position because of her weight, there was little she could do about it. What real proof did she have?

Obese employees face the same type of discrimination that smokers do, although 29 states prohibit the non-hiring of smokers. However, one justification of the employment discrimination against smokers is based on health risks to the smoker and thus increased medical costs to the employer. Other reasons include leaving the work site to smoke in a designated area, although this is a weaker argument since breaks for everyone are often built into the workday.

Many assume that the smoker, or indeed the obese individual, could quit or lose weight if he or she wanted to. Thus discrimination against these groups is sometimes justified by the belief that it’s their fault.

An article in the New England Journal of Medicine refutes the argument that smokers irresponsibly raise healthcare costs because they don’t want to stop smoking. What is rarely understood, except by ex-smokers, is how hard it is to break the addiction to nicotine. Surveys have shown that 69 percent of smokers want to quit but are unable to do so.

Losing weight and maintaining weight loss is similarly difficult, and the same uninformed attitudes persist. “Just stop eating so much and start exercising!“ (As if they hadn’t tried to do so.) The reasons for gaining weight are so varied and often so psychologically complex that simplistic solutions make about as much sense as trying to prevent the oceans from rising by stacking sandbags on a beach. I have a neighbor who gained a substantial amount of weight while she was on large doses of prednisone to reduce inflammation, and a distant relative who gained 125 pounds on a combination of antidepressants and mood stabilizers. Would they be unemployable?

The laws protecting the obese from workplace discrimination are insufficient or nonexistent. Children bullied on the playground may have more protection, because sometimes there is a teacher who can intervene. No one is watching or reprimanding the adult bully who refuses to hire or promote someone who is overweight.