Active Living

Background

Proper nutrition and physical activity are key to reducing risks for chronic disease and cancer as well as maintaining a healthy weight. The District is one of the fittest cities in the U.S. and according has the second lowest obesity rate in the nation (22.9% in 2017) [1]. Despite this, obesity rates in the District vary greatly by race, socioeconomic status, and geographic location. Disparities in this area are persistent with 36.3% of African American adults in the District experiencing obesity and Wards 7 and 8 well above both the District and national figure.

It is important to recognize that Body Mass Index (BMI) is often the standard by which health care providers assess the health of individuals, and subsequently use it as the basis for planning health improvements. However, BMI is a poor proxy for general health and health behaviors because it fails to account for differences in body composition, fitness levels, and nutritional differences that are predictive of health and longevity [2]. Emerging best practices for obesity prevention expand the focus on individual factors to the environmental and social contexts of peoples’ lives to influence the social/structural determinants of health [2]. 

The DC Healthy People 2020 goal for this topic is:

1.  That chronic disease risk is reduced through the consumption of healthful diets and daily physical activity to achieve and maintain a healthy body weight.

Physical Activity

The evidence is clear that physical activity fosters normal growth and development, can reduce the risk of various chronic diseases, and can make people feel better, improve their quality of life, and help them sleep better. Some health benefits start immediately after activity, and even short bouts of physical activity are beneficial [3]. 

In 2017, 75.7% of adults in the District participated in physical activities or exercises in an average month. However, disparities persisted across racial/ethnic demographics, whereas 63.6% of Latinxs and 66.2% of Black District residents reported that they had exercised in the past month [1].

"Dancing in the streets, Anacostia River Festival," Payton Chung, CC BY-SA 2.0

Regular physical activity can help children and adolescents improve cognitive performance, improve cardiorespiratory fitness, build strong bones and muscles, control weight, reduce symptoms of anxiety and depression, and reduce the risk of developing health conditions such as heart disease, type 2 diabetes, high blood pressure, and cancer [3].

In 2017, 28.4% of high school students and 25.1% of middle school students in the District did not exercise or participate in physical activity at least one day in a usual week [4]. Only 34% of high school students report physical activity for at least an hour a day 4 or more days a week [4].

I have a patient who was experiencing bullying at school. It was severe, he had repeated concussions from physical assaults. His family was able to get him transferred to a new school, but he was traumatized from his experiences. He's since had depressive episodes that led to binge eating. There's a clear connection to mental health and nutrition/obesity 

-Community Physician

Percentage of high school students who reported physical activity for at least 60 minutes per day, by race and sex

Source: DC YRBS 2017

Nutrition

In 2017, 31.1% of adults and 17.1% of high school adolescents in the District ate fruit less than once a day and 12.3% of adults and 24.5% of high school adolescents ate vegetables less than once a day. Among high school students, 30.7% of students had fast food three or more days in a usual week. Students who were overweight were less likely though to eat fast food on this frequent basis [4].

In 2017, only 23.9% of high school students in the District ate breakfast every day during a usual week. High school students who ate breakfast more frequently were less likely to be overweight, after accounting for other demographic factors [4]. 

Lesbian, gay, and bisexual high school students were more likely to report going hungry than their heterosexual peers, after accounting for other demographic factors. Middle school students who reported going hungry were more likely to have lower grades, after accounting for other demographic factors [4]. 

Increasing opportunities for exercise and access to healthy foods in neighborhoods, schools, and workplaces can help children and adults eat healthy meals and reach recommended daily physical activity levels [6]. In 2018, there were 73 community gardens, 134 school gardens, 62 farmers markets and 18 urban farms in the District. Food access and security is a continued challenge the District is working to address, and moving forward it will be important to collect data on the experiences of people experiencing homelessness, veterans, and both children and adults with special needs to more equitably improve food access. 

Assets & Resources

• Produce Plus program

Community Food Guide by Ward

Kids Enjoying Exercise Now: provides one-on-one recreational activities to children, teens, and young adults with developmental and physical disabilities at no cost to participants or their families.

Physical Activity Guidelines

2015-2020 Dietary Guidelines for Americans

Promising Practices & Policies:

• NWP-I Adopt use of health impact assessments for new and existing construction or improvement projects to ensure safe communities that promote healthy living and physical activity.

• NWP-II Incorporate best practices to improve healthy food offerings in schools.

• NWP-III Plan for walkable, bikeable, mix-use neighborhoods that encourage and promote physical activity.

• NWP-IV Encourage development of full-service grocery stores in food deserts and augment offering of healthy, affordable foods at corner stores.

Citations & Additional Data Resources

1. DC BRFSS 2017

2. Dodgen L, Spence-Almaguer E. Beyond Body Mass Index: Are Weight-loss Programs the Best Way to Improve the Health of African American Women? Prev Chronic Dis. 2017

3. CDC. Physical Activity Basics. 2019.

4. DC YRBS 2017

5. DC Food System Assessment. 2019. 

6. County Health Ranking. Diet and Exercise. 2019


Photo Credits

"Scenes from Shaw, Washington, DC USA", Ted Eytan, CC BY-SA 2.0

Courtesy of Allison Shelley/The Verbatim Agency for American Education: Images of Teachers and Students in Action

"Community Garden" by Paul Goddin, CC BY-NC 2.0