Does living in the suburbs make you fat?

It’s timely to revisit my earlier discussion of obesity because there’ve been a few studies released recently, like this one, that find residents of low density neighbourhoods are fatter and generally less healthy than those who live in higher-density areas. This is often framed as attributable to car-oriented lifestyles vs walkable lifestyles, and as the suburbs vs the inner city.

There’s good evidence that suburbanites are on average fatter than inner city residents. But correlation is not causation, and households aren’t randomly distributed across cities. The favoured explanation that it’s all down to density, so that if the residents of inner city Fitzroy and outer suburban Mernda swapped houses the former would get fat and the latter would shed the kilos, doesn’t necessarily follow.

An alternative explanation is suburbanites aren’t fatter because they live in the suburbs, but because people who are more likely to be fat self-select into the suburbs. Conversely, people who are likely to be thin self-select into denser neighbourhoods like the inner city. Changes in urban form will accordingly have little if any impact on obesity.

Observers of Australian cities who argue that density and walkability affect obesity usually compare the inner city with the suburbs. But the two populations are not the same. For example, compared to suburban populations, inner city residents are more likely to be young, single, have no dependants, have a higher level of education and enjoy a higher income.

It’s easier to be thin when you’re young, haven’t had a baby, don’t have kids badgering you for fast food, are well informed about nutrition, can afford good food and have the time to cook. These sorts of factors are more likely to explain why on average inner city residents are thinner, not the fact they live at higher densities (I’ve expanded on this line of thinking before, herehere and here).

There are good reasons to pursue higher densities in Australia’s major cities, but addressing obesity isn’t one of them. It’s unlikely tightening the belt on sprawl will have much, if any, impact on the average BMI of Australians.

This fascinating study published in the leading Journal of Urban EconomicsFat city: questioning the relationship between urban sprawl and obesity, supports the alternative explanation. The research team, which included internationally prominent academics Henry OvermanDiego Puga and Mathew Turner, examined changes in the geographic location of 6,000 respondents in the US between 1978 and 1994.

They had access to a remarkable data base which, among other important variables, provided the precise street addresses, height and weight of respondents at intervals over a 16 year period. They tracked changes in the location of individuals and constructed measures of the neighbourhood density and walkability of each address.

As expected, the authors found residents of more sprawling neighbourhoods are indeed heavier on average than people who live in less sprawling neighbourhoods (although they found this applied to men but not women). However, their results strongly suggest urban sprawl does not cause weight gain:

Rather, people who are more likely to be obese (e.g., because they do not like to walk) are also more likely to move to sprawling neighborhoods (e.g., because they can more easily move around by car). Of course the built environment may still place constraints on the type of exercise that people are able to take or the nature of the diet that they consume. The key point is that individuals who have a lower propensity to being obese will choose to avoid those kinds of neighborhoods.

They say they found “no evidence that neighborhood characteristics have any causal effect on weight”.

The authors are aware their conclusions contradict the received wisdom. However, they point out their findings are consistent with other studies showing that sorting rather than causation is the primary mechanism that drives observed differences within cities on many socioeconomic variables. They conclude:

It follows immediately from our results that recent calls to redesign cities in order to combat the rise in obesity are misguided. Our results do not provide a basis for thinking that such redesigns will have the desired effect, and therefore suggest that resources devoted to this cause will be wasted. The public health battle against obesity is better fought on other fronts.

And equally, the battle for higher densities, improved public transport and shorter commutes is also better fought on other fronts. Of course this is a US study so the usual caution in extrapolating from another culture to Australia should be exercised – I’ve discussed the relationship between obesity and urban form and infrastructure in the Australian context on a number of occasions before (see links above and also hereherehere, and here).

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