Going the Extra Mile for Action Against Diabetes And Overweight By Wendy Landman & Steven E. Miller Only one can of soda, about 150 extra calories a day, can cause the overweight suffered by 60% of Americans. On the other hand, adding half-an-hour of walking per day can reduce body weight by up to 7 pounds a year. Our expanding waistlines already cost us an estimated $93 - $117 billion each year in treatment fees and another $56 billion in lost productivity. But the most painful costs of overweight are the associated epidemics of diabetes, heart disease, several kinds of cancer, osteoarthritis, cataracts, and more. Diabetes is particularly widespread and devastating because it corrupts the body's most basic functions, potentially leading to heart disease, stroke, blindness, amputations, organ failure, and more. Today, one in three US newborns are likely to become diabetic, including nearly half of AfricanAmerican and Hispanic children. Doctors already know that increased physical activity can help prevent and treat diabetes. Some doctor's now write "prescriptions" to get out and regularly walk, bicycle, or exercise. Increasing physical activity is not only healthy, but makes people feel more in control of their lives. It is good medicine for patients and for neighborhoods. More people out walking and biking reduces traffic, creates business for neighborhood stores, and contributes to public safety. However, most people don't follow their doctor's advice to get up and move, and some doctors are suggesting that we skip the life-style advice and start immediately prescribing medication, even for pre-diabetics. This would increase our pharmaceutical dependency. Instead of more medications, we need to set up effective, locally-based programs that provide the personal supports and community environments that help people to walk and bike in their neighborhoods. This is particularly important for the low-income communities statistically most at risk of obesity and diabetes. Boston Public Health Commission's STEPS program, with WalkBoston as its walking advisor, has shown that people walk more when they walk together and become empowered to ask local agencies for walking improvements. Northeastern University's Sport in Society program runs the East Boston Play Across Boston youth program, in collaboration with the Harvard Prevention Research Center, which has proven the value of embedding physical activity programs within a Community Health Center to facilitate the involvement of the whole family - an essential strategy for maintaining changes in diet and physical activity. Research shows that people are more likely to get moving when their neighborhoods are "pedestrian friendly" - with traffic lights that provide ample time to cross streets, traffic that is not moving too fast, and sidewalks clear of trash, in good repair, with
appropriate lighting and busy with other people. Biking is more likely when there are bike lanes and convenient bike parking. To move from prescription to practice we need to put all the pieces together. We need to hire local people, place them in neighborhood health centers, and train them to provide individual support to potential walkers and act as advocates with city agencies. Half their time should be spent helping people walk more, the other half should be spent working with the municipal transportation department to make sure sidewalks, crossing signals, crosswalks, and bike lanes are in place; with the public works department to make sure walking and biking routes are in good condition; with community police officers to make sure walking routes are reassuringly patrolled during scheduled times; and with nearby businesses to create local promotions. To work, this kind of program must be intensely local and fully integrated with the health services of the neighborhood clinic. It has to be in place long enough to become part of the daily fabric of neighborhood life. And it has to be regularly evaluated to help refine its components to ensure maximum impact. It might seem easier to simply dispense pills, or cheaper to set up quick programs that address only one part of the full spectrum of support that is needed. But they won't work by themselves. The Strategic Plan for Obesity Prevention developed by the Harvard School of Public Health and the New England Coalition for Health Promotion and Disease Prevention (NECON) for the New England Governor's Council correctly points out the complex interplay of factors that must be addressed to effectively stem the growing epidemic of overweight and its resulting chronic diseases. Prescribing more physical activity, from walking to biking to aerobics, is an excellent starting point. Now we have to create a community environment that will help the medicine go down. Wendy Landman is Executive Director of WalkBoston Steven E. Miller co-chairs the Healthy Weight Initiative of the Harvard School of Public Health Nutrition Department's Nutrition Round Table