We’re not as shapely as we used to be and it appears that slackin’ and poor nutrition are the culprits. But being labeled the “most obese county in the state,” ironically, is leading us to some interesting new places.
Most people might know that when it comes to obesity rates, Hawaii does pretty well compared to the rest of the country. In fact, according to the Center for Disease Control (CDC), only Colorado and Connecticut were less obese in 2007. But, according to Hawai`i State Director of Health Chiyome Fukino, M.D., “From 1990 to 2006, Hawaii’s obesity rate more than doubled from 9.1 percent to 20.6 percent. This equates to approximately 196,300 obese adults.”
So, what if you’re a Skinny Bones Jones? Just because you may not have a weight problem, doesn’t mean the problem isn’t affecting you. In fact, there’s tons of data saying, “Care.” Through taxes, everyone with a job in Hawaii contributed to the $140 million in medical care in 2005 for preventable hospital charges–pertaining to disease related to inactivity, obesity and poor nutrition–according to the state Department of Health (DOH).
Various studies have found that employees are less productive and even show up less if they’re overweight. Of course this means consumers end up paying more for products or services. Why? Because employers usually tack the costs that they’re paying on health care on to the retail price. For example, General Motors has reported that for them, this cost is roughly $2000 per car that they sell, which is more than the cost of the steel to build it.
And maybe the best reason to care is that, according to an analysis published in the March 17, 2005 issue of the New England Journal of Medicine, the current generation may be the first generation not to outlive their parents, due to health issues relating to our current lifestyle.
In 2007, Maui County won the award for highest obesity rate (24.1 percent of adults) in the state. Molokai was second in the state for most obese area at 35.4 percent. Nanakuli/Waianae, in Honolulu County, took the cake in 2007 with a whopping 40 percent.
These figures may be misleading though. Here’s why. All studies point to physical activity as the overweight miracle cure. The Department of Health defines physical activity as at least 60 minutes a day, five days a week for children and at least 30 minutes a day, five days a week for adults. But, according to the Physical Activity and Nutrition Survey of 2008, published by the DOH, the most physically active ethnicity in Hawaii is “Whites” followed by “Native Hawaiians.” Filipinos and Japanese were the least physically active during the study period of 2003-2005. Yet, Native Hawaiians–who when surveyed as middle-schoolers, get the best nutrition compared to other ethnicities– are overwhelmingly the most statistically obese people in Hawaii. One may notice a kink in the logic train here.
So, perhaps the definition of “obese” could shed light on this question. It is loosely defined as a weight range given a certain height. Whether the weight is bone, muscle, fat, or huge hair, is not taken into account. According to the CDC, “As a result, some people, such as athletes, may have a BMI (body mass index) that identifies them as overweight even though they do not have excess body fat.” For example, Arnold Schwarzenegger was classified as obese when he was in top competitive form.
In 1996, the Surgeon General’s Report on Physical Activity and Health concluded we should get at least 30 minutes of exercise per day for health reasons (currently the recommendation for children is double that of adults).
We’ve been doing a terrible job of heading this recommendation ever since. “Childhood obesity, rising for more than two decades, appears to have hit a plateau, a potentially significant milestone in the battle against excessive weight gain among children,” said a May 28, 2008 article in the New York Times (“Hint of Hope as Child Obesity Rate Hits Plateau”); but the article goes on to say hopes shouldn’t glimmer too brightly. They’re not sure if this plateau is significant or just a temporary lull in the climbing rates.
Of course, there is hope. In fact, by failing to win the battle against obesity, new, more successful strategies are coming to light.
There is a growing body of evidence that says people living in activity-friendly neighborhoods have a 35 percent lower risk of obesity. They’re healthier, and it makes sense. Essential trips like going to school or to the market done on foot or by bicycle means more physical activity without even blocking out time for the gym or track. Other studies actually show that people who move to denser areas, where things like schools, work and shops are within walking distance, lose weight if they take advantage of the opportunity to leave their car behind.
Of course there’s always another side to the story. A University of Toronto study from April 19, 2007 concluded thinner people choose to live in denser areas, so it just seems like activity friendly communities effect obesity.
Still, the former argument is winning the war of ideas. And the Hawaii DOH is now on board. Funded by Tobacco Settlement money, the Healthy Hawaii Initiative (HHI) was formed by the DOH in 1999. They deal with healthy lifestyle issues like nutrition, smoking cessation and physical activity.
The rubber met the sidewalk when the Maui County Physical Activity and Nutrition Coalition (another offshoot of the DOH), represented by Sandra McGuiness, formed a couple months ago. The Coalition will focus on making Maui County healthier through initiatives in the built environment, health care system, work sites and schools.
Between June 2 and June 5 the 17 members–community representatives with backgrounds in health care, politics, education, etc.– met with representatives from the Mayor’s office, Maui’s state representatives, county council members, representatives from the University of Hawaii, Maui Memorial Hospital, Parks and Recreation and Alexander and Baldwin, in five community workshops.
Dr. Mark Fenton, host of the Public Broadcast System program “America’s Walking”, a Massachusetts Institute of Technology graduate and national expert on creating activity-friendly communities was a keynote speaker at HHI forums on Maui, Lana‘i and Moloka‘i.
Fenton extols the idea of activity-friendly communities with biking trails and safe pedestrian thruways, where one can walk places to get things done on foot, rather than driving. Fenton spoke about an additional benefit to these types of communities–ones specifically designed for pedestrian and bicyclist safety–that he calls the “free-range kid”. This is a kid parents can let out in the neighborhood to play saying, “Just be home by dinner time,” without worrying for his or her safety. Of course, it’s more likely than these kids will get the Surgeon General’s recommended 60 minutes of physical activity per day while romping outside with friends and siblings.
Other Maui groups are acting on their support of the idea of activity friendly communities for their own reasons. For example, a developer in downtown Paia is promoting a mix of businesses designed to foster greater pedestrian travel through the town. In this way, his lessees see more foot traffic, and business is better for everyone.
In Wailuku, Market Street is going through a rehab, and groups are pushing for mixed-use zoning. Mixed-use zoning would bring the possibility of having a structure that has shops, office space and residential sections. The idea behind it is that people can work, play and live in the same area with little need for driving.
Sustainability groups like Maui Tomorrow advocate density rather than sprawl for a variety of reasons. It gets people out of cars, decreases pollution and dependence on foreign energy and decreases development in open space.
Likewise, the County Planning Department’s Maui Island Plan, released in April, calls for growth in the form of density and mixed-use in existing urban areas versus increased sprawl. Projects like Ma’alaea Mauka, Olowalu Town, Kaanapali 2020 and the joint A&B/ML&P project at Hali’imaile would be nixed if county council adopts the plan.
Fenton says, “To really impact physical activity, we’re not just taking about more playing fields, basketball and tennis courts…not even about more parks and purely recreational trails, though they also have great merit.” He says essential trips, like traveling to school, work, or to the market, must be more convenient on foot. Areas must be connected via safe walkways and bikeways.
So where are these ideas already in place? One spot is in Lana‘i City (obesity rate of 23.2 percent.) In Lanai City, one can walk to the park, doctor’s office or grocery store. Upper Wailuku, Lahaina and Paia town are similar. This is probably because plantation villages were designed to work when everyone didn’t have a car.
But can existing car-centric neighborhoods change? Here Fenton presents interesting methods he’s seen work in other areas. For example, to make walk-thru neighborhoods, some municipalities are buying houses at the ends of cul-de-sacs. They then add a permanent easement for a through-path and sell the home back into the private sector. Or, to ease the costs of adding pedestrian friendly features like sidewalks or medians on streets, other areas wait until other work like pavement improvement or sewer repairs are necessary in order to kill two birds with one stone and reduce costs. Finally, Fenton suggests adjusting zoning to allow for at least a corner store.
As new ideas are being introduced, older ones are already happening in Maui:
A&B has two mixed-zoning projects on the drawing board.
Maui Greenways is pushing for bikeways throughout Kihei.
Na‘Pu‘uwai (the Hawaiian Health Care System) gives employees extra time after lunch for a walk. Visit www.healthyhawaii.com or www.sbwi.org/employers.asp for more information.
Patsy Mink Northshore Heritage Park and open space is one of the mayor’s goals for the land between Kanaha county beach park and Ho‘okipa. Visit www.northshorepark.org/index.php for more information.
And the Hawaii Department of Education began implementing a new wellness policy this year in all Hawaii schools. The policy includes more healthful school lunches and more frequent PE class and recess.
Fenton reminded the Maui County forums that better designed communities cannot be the only solution. Programs and new policies must complement them. For example, Lana‘i City is already activity-friendly, but citizens still have high levels of disease. Fenton reported that while on Lanai, he noticed that many people drove their children, instead of walking the four blocks to school.
Hence, one goal of the Maui Physical Activity and Nutrition Coalition is to encourage employers and schools to make decisions with health goals in mind. They will also push to get activity-friendly policies and ordinances worked into the General Plan.
And so there is hope, according to health advocates in Maui. Coalition coordinator McGuiness says, “This is a very exciting time.” As Maui continues to grow, it is beginning to pro-actively plan its future. And these choices could make us all feel better. MTW