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Diet and physical activity are shaped by multiple and complex pathways, including individual-level factors, social and cultural norms, as well as the environment. In turn, as is well documented, diet and physical activity influence myriad clinical outcomes including obesity—the result of an imbalance caused by physical inactivity and poor nutrition—and its association with health, morbidity, and mortality. In 2017, most of the leading causes of death in the United States, including heart disease, cancers, chronic lower respiratory diseases, cerebrovascular diseases, diabetes, kidney disease, and hypertension1 can be linked to obesity. The trends in leading chronic diseases and associated causes of death in the United States are also seen globally.

There is an impetus among the scientific, medical, and policy communities to devote attention to how characteristics of the environment influence diet and physical activity. This growing concern is, in part, driven by the need to complement individual-level treatments or programs addressing diet and physical activity with policies and environmental interventions that support healthy choices and behaviors for entire populations.2–12 Independent of individual-level factors well known to be associated with health (e.g., income), growing evidence indicates that the environment (including its social and physical dimensions) may influence a person's ability to be physically active13–17 and to consume nutritious and/or nonhealthful foods.18–20 In particular, community-level resources and characteristics of the built environment may influence diet and physical activity through a variety of pathways, and may interact with individual factors (Fig. 185-1). The built environment refers to the physical, human-made space within which humans live, work, and recreate on a day-to-day basis. It includes all of the physical aspects of a person's life, such as the residential and school/work neighborhood environments, infrastructure that supports those places, and physical space. Studies have noted that specific aspects of the built environment are associated with a plethora of biological factors for which diet and physical activity serve as pathways, including glucose levels21 and obesity,22,23 cholesterol levels, triglycerides,24,25 and increased risk for chronic diseases, including cancer, diabetes,26,27 and cardiovascular disease.28,29

FIGURE 185-1

Conceptual frameworks describing how policies and broader community factors influence specific features of the (A) food and (B) physical activity environment, and, in concert with individual- and other community-level characteristics, influence diet and physical activity.

It is increasingly clear that environmental factors play a role in diet and physical activity above and beyond other individual-level characteristics. Crucially, the work of the medical and public health communities, along with other sectors, to alleviate the burden of chronic disease can leverage research on the health effects of the built environment. In addition to providing high-quality medical care within the clinic walls, healthcare providers may seek to broaden the lens to include built environments as part of assessments of patients’ risks, exposures, and vulnerabilities to health outcomes, and in ...

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