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 ATTACHMENT PREVIEW Download attachmentU.S. Childhood Obesity and Climate Change:Moving Toward Shared Environmental Health SolutionsPerry E. Sheffield and Maida P. GalvezABSTRACTThis article focuses on the epidemic of childhood obesity, a significant cause of pediatric morbidity in theUnited States. It begins with a review of the evidence regarding environmental influences on obesity. Thenit draws from that evidence to cite examples of climate change prevention and preparedness efforts thatcould also benefit the obesity problem. Climate change is a global environmental issue predicted to neg-atively impact children’s health. In the United States, many regions are expected to experience worse airquality, increased vector-borne disease, and changes in food availability. Children’s size, developmentalstage, and long life expectancy make them unique when considering health effects from the environment.Furthermore, in the latter part of this century, the children of today will become seniors, a group alsovulnerable to predicted health impacts from climate change. These vulnerabilities will contribute to ex-isting health disparities that are due, in part, to unequal risk factors in communities of color and lowincome. Improved air quality, healthier diets, and increased physical activity are all potential results ofclimate change interventions. Unintended potential negative consequences are also discussed and carefulpre-intervention assessment is emphasized. Interdisciplinary collaborations for research and solutions areneeded for large scale environmental issues such as climate change and their impact on multi-factorialhealth problems including childhood obesity. Carefully selected climate change-related efforts can si-multaneously address current children’s health problems, future population health concerns, and ulti-mately result in more equitable health for all.NEW PEDIATRIC MORBIDITIESWhile childhood infectiousdiseases continue tosignificantly burden parts of the world, they arerapidly becoming eclipsed by the emergence of previ-ously rare and altogether new problems referred to as thenew pediatric morbidities. These are typically chronic con-ditions that persist into adulthood and include obesity,asthma,neurodevelopmentaldisorderslike attention-deficit and hyperactivity disorder (ADHD), childhoodcancers, birth defects, and preterm birth. The portrait ofchildhood conditions in the United States is very differentfrom global pediatric disease but increasingly these newmorbidities are beginning to appear around the worlddue in part to changing global trends in diet, activitylevels, and air quality.2–5Within the United States, sig-nificant disparities exist in children’s health that are relatedto numerous factors including different environmentalexposures. Research shows that environmental factorssuch as the built, or human-made, environment contrib-utes to the rising prevalence of these health problems.Whether considering the built environment or envi-ronmental toxins, children’s size, developmental stage,and long life expectancy make them uniquely vulnerable.Through different mechanisms in different parts of theworld, climate change is creating new environmentalrisks while exaggerating old ones to which children haveincreased vulnerability such as increased heat, changes inoutdoor air quality, rising sea level, and contaminatedwater. Older individuals are also more vulnerable to thesechanges. The children today will be seniors in the latterDr. Sheffield is a research fellow in the Departments of Pre-ventive Medicine and Pediatrics at Mount Sinai School of Med-icine in New York.Dr. Galvez is an assistant professor in the Departments ofPreventive Medicine and Pediatrics at Mount Sinai School ofMedicine.ENVIRONMENTAL JUSTICEVolume 2, Number 4, 2009ªMary Ann Liebert, Inc.DOI: 10.1089=env.2009.0027207Used with permission from Liebert Publications

View the Answerpart of this century. The effects of climate change on bothcurrent and future environmental risks thus will impacttoday’s children throughout their life span.6,7Further-more, climate change is exacerbating already glaring in-ternational disparities in children’s health and is thus anenvironmental justice issue. Environmental justice issuesare defined here as unequal community exposures (che-mical or otherwise) resulting from the actions and deci-sions of persons, institutions, or nations external to thoseexposed communities.Obesity and, increasingly, climate change have been atthe forefront of health concerns, with widespread cover-age in scientific journals, national and international con-ferences, and the media. Yet opportunities for exploringinterdisciplinary approaches to addressing these healthissues have been far fewer. The purpose of this article is toidentify potential co-benefits from climate change inter-ventions on one major U.S. pediatric morbidity, obesity.First, evidence regarding environmental risk factors forpediatric obesity is examined. Then, some select climatechange prevention and preparedness interventions andtheir demonstrated or potential co-benefits for obesity aredescribed. Of note, some diseases such as asthma have amore extensive body of research on environmental riskfactors and quantified studies of co-benefits from climatechange interventions.5,8–14The purpose of this article is toexplore the potential crossover between climate changeinterventions and pediatric obesity, an interface whichhas received considerably less attention. The importanceof this approach lies in its potential ability to break on-going cycles that perpetuate poor health outcomes andon-going injustice.OBESITYAffecting over 15% of children nationally,15–18child-hood obesity is defined as having greater than 95th per-centile for body mass index (BMI, weight in kilogramsdivided by height in meters squared) for a child’s age.While the national average is high, there are communitieswithin the United States, such as East Harlem, New York,where more than 25% of young children are obese. Thusthe burden of this illness is not equally distributed. Ad-ditionally, in communities of color and low income, suchas East Harlem, there is also evidence of unequal chemicaland built environment exposures which are discussed inmore detail later. Lastly, there is emerging evidence re-garding the relationships between these unequal expo-sures and the prevalence of obesity which contribute tothis as an environmental justice issue.19In terms of the consequences of obesity, obese childrenare more likely to have insulin resistance, diabetes, hy-pertension,cancer,gallbladder disease,liverdisease,atherosclerosis, and depression. In addition, adults whowere obese as children have increased mortality regard-less of their adult weight.20Lack of physical activity andhigh calorie diets are known risk factors for obesityamong children in the U.S. Many individual factors alsoinfluence this relationship and are more studied amongadults. Examples include co-morbid conditions and indi-vidualperceptionofsafety.21Thefollowingsectionreviews the evidence on environmental factors and in-terventions that influence physical activity levels and foodhabits.BUILT ENVIRONMENT AND OBESITYThe few existing child-focused studies have shown apositive correlation between physical activity level andtime spent outdoors, residential proximity to recreationalfacilities and parks, availability of adult supervision, im-proved school facilities such as basketball courts, andhousing density.22–24Other studies have shown that in-creased presence of green spaces as measured by satellite-derived greenness measures and geographical informationsystem (GIS)-based neighborhood vegetation measuresare inversely associated with children’s BMI.25,26Thesefactors are considered part of the built environment. Onestudy found that, instead of the physical environment, apositive social environment—higher collective efficacy,more collective socialization of children, more social tiesamong neighbors, and greater perceived neighborhoodsafety—was positively associated with more activity.27For adult studies of obesity, the body of evidence islarger. Multiple studies have documented an associationbetween characteristics of adults’ neighborhoods, physi-cal activity levels and BMI.28Presence of specific neigh-borhood amenities such as walking trails, sidewalks, andbicycle paths are associated with more adults meetingbasic recommendations for physical activity.29,30Streetconnectivity and mixed residential densities are also as-sociated with increased physical activity.31Studies havefurther demonstrated a positive association between obe-sity and increased vehicle miles traveled as a result ofurban sprawl (defined as low density developments sur-rounding urban areas).32,33In an Oregon study, increasedneighborhood fast-food outlets and individual unhealthyeating behaviors were related to weight gain, while betterneighborhood walkability and increased levels of physicalactivity were likely to be associated with maintaining ahealthy weight over time. In this study, walkability wasdetermined by a composite score that included land-usemix, street connectivity, public transit stations, and greenand open spaces.34As we will discuss in more detail later,many of these built environment factors are areas of po-tential intervention that can impact obesity problems aswell as both the causes of and necessary adaptations toclimate change.Environmental interventions and obesityDespite a growing body of evidence supporting anassociation between environmental factors, physical ac-tivity level, dietary quality, and obesity, research gapsremain regarding obesity interventions specifically ad-dressing these factors. For example, few studies demon-strate the effectiveness of community level interventionsto increase access to physical activity resources and thesubsequent impact on childhood BMI or obesity-relatedhealth outcomes.35One review focusing on interventions208SHEFFIELD AND GALVEZ

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