State of the Evidence Review on Urban Health and Healthy Weights

K. Raine, J. C. Spence, J. Church, N. Boulé, L. Slater, J. Marko, K. Gibbons and E. Hemphill, State of the Evidence Review on Urban Health and Healthy Weights (Ottawa: CIHI, 2008).

The objectives of the report were to review and synthesize the evidence on:

    • structural and community-level characteristics of urban environments that promote or inhibit the achievement of healthy weights, and
    • effectiveness of interventions to assist urban populations in achieving healthy weights.

The following is an excerpt; the full report is available from the Canadian Institute for Health Information's Canadian Population Health Initiative website:

Main Messages from Urban Environments and Healthy Weights

This review revealed that evidence exists for associations between aspects of the urban environment and behaviours contributing to obesity.

It’s the economy - For individuals, a lower socio-economic status (education level, income, employment), was consistently associated with increased obesity among both adults and children. For instance, lower personal income affects affordability of food which demonstrates the most consistent influence on food consumption. Similarly, individuals living in middle income to high income neighbourhoods are more likely to be physically active than their counterparts in lower income neighbourhoods. Lower income neighbourhoods are also more likely to contain greater access to sources of energy dense foods (e.g., fast foods) and lower access to supermarkets or other stores stocking healthy foods.

    • What this means is that interventions aimed at improving the income and educational status of individuals and families within urban environments may help address disparities in obesity. Also, improving access to healthy food and recreation opportunities in lower income neighbourhoods may help to create a “healthy weight” friendly environment.

School environment key – although schools are not specific to urban areas, studies from interventions performed in schools (e.g., availability of healthy choices in vending machines or point-of-purchase nutrition information) showed evidence for improving eating behaviours. All studies had at least some positive effects on food intake, either increasing healthy food choices or decreasing unhealthy alternatives, though no school interventions significantly affected body weights.

    • What this means is that comprehensive school food policies or educational interventions that promote healthy food choices are likely to have beneficial effects on kids’ eating habits.

Built environment important – the most consistent environmental associations observed for physical activity were elements of the built environment. Hallmarks of walkability (increased residential density, mixed use zoning, and street connectivity) and access to recreational facilities are associated with healthy body weights. People’s perceptions of their built environment are also key.

    • What this means is that walkability of neighbourhoods and access to recreational facilities in and around neighbourhoods can be seen as healthy weight promoting.

Lack of intervention evidence - Very little evidence existed for the effectiveness of interventions in achieving healthy weights in an urban context. More evaluations are needed to take into account natural experiments in urban environments (e.g., does the proliferation of bicycle lanes increase cycling)?

Links (all links will open in new window):