Can Urban Design Help Solve the Obesity Crisis?

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Numerous studies and “fittest city” rankings have found that the cities and neighborhoods with the highest levels of easy walkability were also those that had the lowest rates of obesity.

A new urban design movement known as New Urbanism has developed with the goals of promoting healthier and more environmentally-friendly cities, and recent data has shown that this movement can impact rates of overweight and obesity as well.

What Makes a Neighborhood Walkable?

The term “neighborhood walkability” refers to how likely it is that you are able to walk to local shops, schools, and parks in your own neighborhood. Features like sidewalks and bike lanes facilitate this, and so does the ready availability of a diversity of businesses within walking distance.

What Is the Current State of Neighborhood Walkability?

In developed nations, most adults have adopted a modern sedentary lifestyle that is associated with a relatively low level of ongoing physical activity.

The amount of physical activity recommended by most national and international guidelines is at least 30 minutes of moderate-intensity physical activity for at least 5 days per week. However, more and more research has shown that staying active throughout the day is one of the best ways to prevent chronic diseases like heart disease, diabetes, stroke, and cancer.

Studies have shown that most adults don’t even meet the minimum daily recommendation for physical activity, much less the recommendation for staying active throughout the day. And further research has shown that conveniences of our modern lifestyle, like travel by car and desk jobs, combine to make us more sedentary and, in turn, contribute to the obesity epidemic.

What Is New Urbanism?

As noted above, New Urbanism is a contemporary urban planning movement that has among its goals the promotion of healthier and more environmentally-friendly cities and urban areas.

As noted at, “designing great places for the comfort and enjoyment of the pedestrian is one of the most important aspects of New Urbanism.”

The New Urbanism movement aspires to creating cities “with entire networks of car-free streets, known as pedestrian cities.” Thus, with its emphasis on elements that make cities friendly to pedestrians and encourage walking for most everyday destinations, New Urbanism planning can make higher rates of physical activity a normal part of the daily routine.

Proponents of New Urbanism note that “being able to walk to a mix of shops, restaurants, newsstands, coffeehouses and open-air markets within car-free neighborhoods and work centers delivers the highest quality of life.”

Some have even called for entire urban districts to become solely pedestrian, with direct connections to a train line for longer-distance transportation.

What Is the Active Design Movement?

With similar goals as New Urbanism, Active Design is, according to the Center for Active Design, “an evidence-based approach to development that identifies urban planning and architecture solutions to support healthy communities.”

Again, this is an application of the idea to design neighborhoods, communities, and even individual buildings such that people are encouraged to be more active in their daily lives—as with the principles of neighborhood walkability, for instance.

Interestingly, Active Design was inspired not only by the obesity epidemic, but by infectious-disease epidemics of eras past. As noted by the Center for Active Design, Active Design builds on the “precedent of design impacting public health in the 19th century as recognized by the massive reduction in the spread of infectious diseases.”

In the 19th century, alleviating the crowding and poor sanitation associated with tenements and other substandard housing designs resulted in an impressive reduction in infectious diseases such as tuberculosis, cholera, typhoid, and others.

It is hoped that, by using the latest health research, similar design principles can be applied in the contemporary era in the fight against obesity.

How Can This Help With the Obesity Epidemic?

What are known as active modes of travel—walking or cycling, for example—have greater potential health benefits than driving a car, and greater potential to prevent obesity.

In one study that looked at self-reported commuting mode (categorized as private transport, public transport, and active transport) in over 15,000 residents of the United Kingdom, those who traveled to work using active and public modes of transport had significantly lower body mass index (BMI) than those who used private transport. (Private transport may include driving one’s own car and car pooling, for example.)

Not only did those who walked or cycled all or part of the way to work--as one might do by necessity when using public transit--have lower BMIs, but they also had lower percentages of body fat compared to those who got to work using their own private cars. Both men and women were found to reap the benefits of a more active mode of transportation.

Another study that looked at over 100,000 people living in urban and suburban Ontario, Canada, categorized neighborhoods based on the Street Smart Walk Score®, which the study authors describe as a “composite measure of neighborhood walkability.”

Based on this Walk Score®, researchers placed neighborhoods based on postal codes into one of five walkability categories, “ranging from very car-dependent to ‘Walker’s Paradise.’” Study participants who lived in the very car-dependent areas were found to have significantly higher odds of being overweight or obese as compared with those who inhabited “Walker’s Paradise” areas.

Furthermore, residents of “Walker’s Paradise” areas reported walking more for utilitarian rather than leisure reasons—walking to get groceries, for instance, rather than just out for a stroll. These residents were found to weigh an average of 3.0 kg (6.6 lbs.) less than those who lived in the very car-dependent areas.

In a follow-up to the Canadian study, researchers reported in the Journal of the American Medical Association (JAMA) that higher rates of neighborhood walkability were associated with lower rates of overweight and obesity as well as a decreased incidence of diabetes during the years studied (2001 to 2012). The researchers noted that further studies are needed to explore and confirm the effects of Active Design principles and neighborhood walkability on diseases like obesity and diabetes.

Other research has suggested that blood pressure and aerobic fitness are improved in people who live in walkable neighborhoods. Indeed, the simple activity of daily walking is one of the lifestyle changes that are known to improve blood pressure.

And research has borne out other health benefits of a daily 30-minute walk: in the Nurses’ Health Study, for instance, those who walked briskly or otherwise achieved moderate-intensity exercise for at least 30 minutes every day had a low risk of sudden cardiac death during 26 years of follow up.

Global Examples of Walkable Cities

According to the New Urbanism site, both Venice, Italy and Copenhagen, Denmark are excellent examples of “great pedestrian cities.”

Among major world cities, Venice has the largest pedestrian street network that is totally free of cars.

Copenhagen’s traditional main street, Stroget, was turned into a pedestrian thoroughfare 40 years ago, and since then, city planners have continued to work to transform the city from being car-oriented to being more pedestrian-oriented.

Steps that Copenhagen planners have taken to achieve this transformation include converting more streets into pedestrian-only thoroughfares, turning parking lots into public squares, promoting cycling as a major mode of transportation, and building to a scale that is “dense and low,” meaning low-rise, densely spaced buildings are favored.

These steps exemplify principles of New Urbanism, which aims to create and restore “walkable, diverse, compact towns and cities that enable a higher quality of life by offering new choices for living,” as noted by the New Urbanism site.

Among cities in North America, those with the highest Walk Scores include the U.S. cities of New York City (score of 89), San Francisco (86), Boston (81), Philadelphia (78), and Miami (78).

In Canada, those with the highest Walk Scores were the cities of Vancouver (with a score of 78), Toronto (71), and Montreal (70).

In the United States, the most transit-friendly cities also tended to be those with the highest Walk Scores, emphasizing the favorable effect that urban design and city planning can have on walkability. For instance, rated New York, San Francisco, Boston, the District of Columbia, and Philadelphia as the 5 most transit-friendly cities.

San Francisco and Boston also ranked in the top five bike-friendly cities.


Chiu M, Shah BR, Maclagan LC, et al. Walk Score and the prevalence of utilitarian walking and obesity among Ontario adults: a cross-sectional study. Health Rep 2015;26:3-10.

Chiuve SE, Fung TT, Rexrode KM, Spiegelman D, et al. Adherence to a low-risk, healthy lifestyle and risk of sudden cardiac death among women. JAMA 2011; 306:62-69.

Creatore MI, Glazier RH, Moineddin R, Fazli GS, Johns A, Gozdyra P, et al. Association of neighborhood walkability with change in overweight, obesity, and diabetes. JAMA. 2016;315(20):2211-2220.

Flint E, Cummins S, Sacker A. Associations between active commuting, body fat, and body mass index: population based, cross sectional study in the United Kingdom. BMJ 2014;349:g4887.

Hallal PC, Andersen LB, Bull FC, Guthold R, Haskell W, Ekelund U; Lancet Physical Activity Working Group. Global physical activity levels: surveillance progress, pitfalls, and prospects. Lancet. 2012;380(9838):247-257.

Lordan G, Pakrashi D. Do all activities “weigh” equally? How different physical activities differ as predictors of weight. Risk Anal 2015 May 20.

Physical Activity Guidelines for Americans. United States Department of Health and Human Services.

Rundle AG, Heymsfield SB. Can walkable urban design play a role in reducing the incidence of obesity-related conditions? JAMA. 2016;315(20):2175-2176.

Thornton CM, Conway TL, Cain KL, Gavand KA, Saelens BE, Frank LD, et al. Disparities in pedestrian streetscape environments by income and race/ethnicity. SSM Popul Health. 2016;2:206-216.

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