Overweight? Blame your ZIP code
Property value beats income and education as obesity predictor
By JENNIFER LANGSTON
The neighborhoods around Green Lake have P-patches, destination parks, crosswalks, corner groceries and one of the densest concentrations of farmers markets in the city.
Those niceties account for some of the most sought-after real estate in Seattle and some of the city’s least obese residents.
University of Washington researchers recently found wide disparities in obesity rates among King County ZIP codes. The rates range from less than 10 percent in parts of central Seattle and Bellevue to more than 25 percent in some south county neighborhoods.
The strongest predictor of obesity rates wasn’t income or education but property values, the study found. Each additional $100,000 in median home value for a ZIP code corresponded with a drop in obesity of 2 percentage points.
It’s further evidence, experts say, that weight isn’t solely about individual behavior and that the environment you live in matters.
“If you have this mind-set that obesity has to do with the individual alone, then ZIP codes or areas really should not come into this. But they do, big-time,” said Adam Drewnowski, director of the UW Center for Obesity Research.
The study, which used data from surveys of nearly 9,000 county residents over multiple years, suggests areas where public health agencies should focus, and what kinds of programs may be unlikely to work.
“If people are concentrated in a neighborhood with no grocery store and little access to fresh fruits, this is not the place to go in and say, ‘Eat nine servings of fresh fruits and vegetables and play a bit of tennis.’ Get a grip,” Drewnowski said. “The strategies need to be targeted and sensitive.”
In less affluent areas, a lack of access to fresh produce, health insurance or nutritious groceries that are affordable likely influence obesity rates, experts said.
People often use limited money to buy cheap, calorie-dense foods rather than more nutritious fruits and vegetables, said Paul Haas, resource development director for Solid Ground, which works on hunger issues in the region.
“It’s something that’s counterintuitive to a lot of folks, how people with a greater level of food insecurity and who struggle with hunger are at a greater risk of obesity,” he said.
A coalition plans to lobby the Legislature next year for money that would allow food banks to buy more fresh food from local farmers, Haas said.
With at least three Seattle farmers markets in danger of losing their homes to redevelopment projects, some City Council members want to consider lowering street closure or park fees to help markets move to public property.
When it comes to exercise, there’s a big difference between wealthy neighborhoods with nice sidewalks and places where graffiti, broken windows, interrupted routes, crime or other deterrents make walking unappealing, said Rebecca Deehr, interim executive director of Feet First, a pedestrian advocacy group.
It’s spearheading efforts around the city to make walking less daunting — from bird-dogging developers to designing good pedestrian links to organizing “walking school buses” that connect groups of students and parents going to the same school.
In neighborhoods where cars have the run of the road, community intersection projects that paint a huge radiating sun or labyrinth on the asphalt give drivers a psychological cue that they should slow down.
“It says this community is invested and involved,” she said.
Access to healthy food
Standing a block off Aurora Avenue near Bitter Lake, two public health employees tick off the food choices within their line of sight — doughnut shop, Kentucky Fried Chicken, Ivar’s.
They’re in ZIP code 98133, where obesity rates are higher than 20 percent. Median single-family home prices last year were $140,000 less than the Green Lake ZIP code directly south.
“The No. 1 thing is that everyone should have access to fresh produce they can afford. Right now we have big gaps,” said Erin MacDougall, program manager for Public Health — Seattle & King County’s Healthy Eating and Active Living initiative.
She’d like to see cities establish standards for access to affordable healthy food, in the same way that they track proximity to open space or bus stops.
Linden Avenue itself looks different than it did at the bottom of Phinney Ridge. It lacks sidewalks on one side, crosswalks, a white center line or much of anything to separate cars from people.
One elderly woman struggles to load a personal grocery cart into a car parked on the side of the road, with traffic whizzing by her open door.
Another woman picking dust-covered blackberries nearly falls on the crumbling asphalt as brambles catch her diabetes socks.
Hannah Avessuck, who lives in a new apartment building for active seniors, points to the buckled, bumpy sidewalks on the good side of the road. Complications from diabetes make it hard for her to negotiate crummy, meandering sidewalks.
“They’re just horrible, especially for people who are on canes,” she said. “Sometimes my feet don’t clear these lumps. It definitely hinders some people from walking.”
Sidewalks and street trees may be added as properties are redeveloped, under a recent proposal by Mayor Greg Nickels that would require smaller projects to comply with those rules. But gaps will exist for a long time.
Anne Bikle, an environmental planner for Public Health, said it’s important that things such as open space, gardens and decent pedestrian connections don’t get bargained away in the development process.
People intuitively grasp that food choices affect their health. The profound influence of the built environment is less obvious, she said.
“They feel like there’s less within their power to do anything about it,” she said. “It’s become so invisible to society, and so common to not have a sidewalk or a street tree that they don’t see anything wrong with a Linden Avenue anymore in some communities.”
Teaching fellow residents
In Rainier Valley, another Seattle neighborhood with higher obesity rates, people such as Leatha Bailey are feeling more empowered these days.
She leads tours at the local Safeway store of the bread, dairy and frozen food aisles, teaching fellow residents how to read nutritional labels.
It’s part of a broad effort throughout Rainier Valley to promote nutrition and physical activity through culturally relevant programs. That includes working with local and ethnic restaurants to offer healthy menu options, senior exercise programs and community cooking classes.
“I didn’t know how to read labels. I really didn’t,” said Bailey, who never realized that the whole grain bread she bought had low fiber and sweeteners such as high fructose corn syrup.
“I thought I was buying healthy stuff because it looked good.”
A single-serving low-fat strawberry banana yogurt, for instance, can hide more calories than a mint chocolate chip ice cream sandwich or Little Debbie oatmeal cake.
Rose Motola was surprised to learn that one of her husband’s favorite cereals, Kellogg’s Raisin Bran, had more sugar, more sodium and less protein than Kellogg’s Frosted Mini Wheats.
“That’s terrible — no wonder he likes that,” she said to the group assembled in the cereal aisle, poring over boxes.
David Solet, a Public Health epidemiologist and co-author of the recent UW study, said individual choices and predispositions obviously play important roles in health issues such as obesity.
But he’s encouraged to see a growing body of research that might get communities thinking about other strategies to narrow health disparities.
“In my mind, too often this issue is sort of one of individual blame,” he said. “And I think the most effective interventions that public health can mount and have been pushing are … the social and community-level things we can do.”
TO LEARN MORE
For more information on the Healthy and Active Rainier Valley Coalition, visit goto.seattlepi.com/r979.
P-I reporter Aubrey Cohen contributed to this report. P-I reporter Jennifer Langston can be reached at 206-448-8130 or firstname.lastname@example.org.