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«The impact of environmental factors in explaining exercise and eating behavior. Master of Science in Cultural, Social and Community Psychology ...»

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Steffen Sæternes

The impact of environmental factors in explaining

exercise and eating behavior.

Master of Science in Cultural, Social and Community Psychology

Department of Psychology


Norwegian University of Science and Technology

Trondheim 2013


I have received assistance throughout the time I have worked with my master thesis,

and I would like to take this opportunity to thank them.

First I would like to thank Mons Bendixen who was of great help in assisting the layout, language and professional tips the last couple of weeks. I would like to thank Kyrre Svarva for help on the questionnaire development for the online program select survey, and Dagfinn Refseth for the making the questionnaire accessible for students on Innsida.

My initial supervisor who moved to Germany, Ellen Matthies, also deserves appreciation for guiding me toward the right direction.

Lastly, my sincerest gratitude goes out to Idalill Udnes for helping me with SPSS and data analysis and my friends who helped to motivate me and proofread the final product.

Steffen Sæternes The effects of local environmental factors on exercise behavior and eating habits.

Abstract The purpose of this overview was to determine which local environmental factors had the best predictive capabilities of exercise and eating behavior, and also which ones could be used for possible intervention programs and research. There are too many undefined factors which have made it hard for researchers to know which one to implement; in addition it is hard to interpret the studies that have been conducted.

There are promising factors that appear, such as accessibility to supermarkets, convenience of facilities, aesthetics and beach access. Nonetheless, it is not possible to draw any causal relationship between the local environmental factors and exercise- or eating behavior because there has not been carried out any good longitudinal studies with good definitions of the local environmental factors that control for confounding variables. For future research, it is important to have good definitions of the local environmental factors in order to determine the actual effects they have on exerciseand eating behavior.

In recent decades, the population has changed in ways that makes it easier to use of vehicles to get around. In everyday life most of us are inactive far more than we are in activity. We sit on our way to work (drive or public transport), we sit at work, and some even sit while working out. This has become the norm as fewer jobs require manual labor and more jobs are performed in front of a computer or behind a service desk. These changes have reduced the average amount of energy expenditure in the population, while the energy intake has remained stable. The stable intake could perhaps be surprising in a time were the media are often reporting the negative effects of fast-food and finished products (Cutler, Glaeser & Shapiro, 2003). There is reason to believe that this also applies to Norway, as Norwegians have gained weight over the last decades (Statistisk sentralbyrå, 2009). We can however see that there was less candy among the youth of Norway in 2008 than 2005, so it seems we might be on our way to a healthier society.

The current requirements for physical activity is half an hour per day according to the Norwegian Institute of public health (Anderssen & Andersen, 2004).

Unfortunately, large amounts of the Norwegian population do not meet the requirements of half an hour/day of exercise (Dillern, Pedersen & Jenssen, 2012). This is unfortunate as physical exercise is associated with several of positive health outcomes, ranging from mental to physical health (Casaburi, et al., 1997; Martinsen, 1990; Vanhees et al., 2012; Warburton, Nicol, & Bredin, 2006). Among the negative outcomes of not being physically active is obesity. Obesity is associated with considerable negative physical and mental health problems (Papas et. al., 2007). This article will focus on the local environment, and how this plays a role in physical activity.

Over 60 years ago, the first preventative program in the United States was initiated. In 1952 (Nestle & Jacobson, 2000) the American Heart Association tried an approach were they created guidelines for individuals on how to reduce energy intake and increase energy expenditure. While being an important step, we can’t say that it hasn’t had any effect, and the bottom line is that quite a lot of people are overweight and not physically active enough (Menifield, Doty & Fletcher, 2008).

Obesity is a complicated problem influenced by genetic, physiological, psychological, social and environmental factors (Popkin, Duffey & Gordon-Larsen, 2005). Among the main individual factors is energy intake, and the fact that a higher energy intake than output is likely to result in weightgain (Chirico & Stunkard, 1960;

Douthwaite, 1936; Hoelzel, 1945; Turk et. al., 2009).

In order to prevent obesity, we can either focus on individuals, or on the population. It is impossible to point at one factor that is responsible for the obesity problem. The government should focus on a number of areas in actualizing a healthier society, these areas include pricing of healthy foods (Horgen & Brownell, 2002), media interventions (Nestle & Jacobson, 2000), educational system, behavioural interventions, and environment interventions (Popkin et al., 2005). I will give an overview over these different areas of research and look at intervention methods in society that are likely to bring positive health outcomes, arguing for the built environment and its possible positive effects.

Obesogenic environments In order to be successful at preventing obesity, it is important to be able to point out the typical obesogenic environments, i.e. environment that promotes less physical activity and unhealthier eating (Swinburn, Egger & Raza, 1999), as well as find the important factors for determining physical activity. Studies of obesogenic environments have been conducted but there is so far no consensus on the defining elements. Therefore it is hard to define, this article however will use a definition provided earlier. More specifically, obesogenic environments are environments that are built up such that it promotes less physical activity and unhealthier eating (Swinburn et. al., 1999). This of course entails a whole lot of complex areas of research that are probably not the same within different cultures and may also even vary across countries and might even be seasonal in some countries. For this article, we will focus on the parts of the obesogenic environment that are likely to bring positive physical activity changes within the community.

Why population-focus?

In order to be successful at preventing obesity, it is logical to not only treat what we see, but also the reason for what we see. We know that the reasons are many (Popkin et al., 2005), and that some of these are more have a greater effect than others, but why should we try to focus populations rather than individuals when it comes to promoting physical activity?

Individually-based interventions are successful within a one-year period (Apfelbaum et. al., 1999); however after 5 years the effect seems to have had no effect (Wadden, Sternberg, Letizia, Stunkard & Foster, 1988). Even if they were successful at maintaining weight-loss for the rest of their life, we would still be treating only one person. This is unfortunate, as it would be very time-consuming and costly to treat everyone individually; also, individual interventions are not likely to provide population-wide change (Sallis, Bauman & Pratt, 1998).

Population-based interventions It should be much better to move the focus to a medium in which we can get change within a population. We already named these interventions, such as media interventions (Nestle & Jacobson, 2000), educational system, and environment intervention (Popkin et. al., 2005). All these are probably places where interventions could be successful if done correctly. These are all arguably part of an obesogenic environment.

Educational interventions. Several studies have indicated that educational interventions might have an effect on treating obesity (see Summerbell et. al., 2005).

As Summberbell and colleagues points out, these seem to be very sensitive to how they are implemented, and the setup of the intervention. The results aren’t quite convincing either, as there are quite a lot of research that are disagreeing with the effect that has been shown. Determining the long-term and population-wide effects of these types of interventions is difficult. Maybe if an intervention that was based on families in their homes,, it could have better effect. There are also studies showing no effect on an educational-based intervention (Shaya, Flores, Gbarayor & Wang, (2008), and especially not on physical activity (Sahota et. al., 2001).

Media interventions. There are some measures that can be taken in the media in order to promote physical activity. Norway already has advertisements on the benefits of a healthy lifestyle and being physically active. There are certainly not many promoting an unhealthy lifestyle. Also, when it comes to physical activity, a review from 1998 concluded that there was no long-lasting effect in mass-media interventions (Marcus, Owen, Forsyth, Cavill & Fridinger, 1998). There must also be shown criticism towards those type of commercials, as they are likely to disturb the body image of the population, and especially youth (Derenne & Beresin, 2006).

Environment interventions. In order to produce a population-wide change, it is reasonable to look at the environment. There are several different ways to look at the environment, and an obesogenic environment consists of many factors, such as;

supermarket accessibility, recreational facilities accessibility, pricing of food, etc.

Interventions on this level have been shown to have positive effect (Kegler, Swan, Alcantara, Feldman & Glanz, 2013; Sallis et. al., 1998). However weaknesses in this method are also apparent, as there is problem in defining different factors within environmental research (Kirk, Penney & McHugh, 2010). Nevertheless, this might be the area that has the most promise in bringing population-wide change without having unwanted negative effect on individuals. In this article, we’re interested in the factors in the obesogenic environment that deals with physical activity and eating habits; these include access to exercise possibilities, opportunities, safety and aesthetics (Bauman et al, 2012; Humpel, Owen & Leslie, 2002).

Physical environment Physical activity In finding determinants of physical activity and behavior, the physical environment is an interesting area of research. Earlier research has studied mostly individual factors or non-environmental factors, some with more success than others.

There are a number of factors that are known to consistently predict physical activity level, these include age, health status, self-efficacy and previous physical activity (Bauman et. al., 2012; Rasmussen & Laumann, 2013). In recent decades environmental determinants have been included as well.

There are a lot of different environmental determinants that has been studied over the years, and a meta-analysis from 2005 assessed 138 different determinants (Duncan, Spence & Mummery, 2005). Depending on the definition of environmental factors, the number could be much higher or lower.This meta-analysis employed a liberal definition and included things such as unattended dogs and sidewalks. The environmental determinants that are related to the physical or built environment are the ones that are interesting for this article. It’s reasonable to say that not all of the determinants are either good at predicting physical activity or not. The fact is that these determinants are too complex to only be classified as either having a relationship, or not. Therefore, I classified the physical environment determinants of physical activity in three groups based on their relationship to physical activity (Figure 1).

Figure 1 Physical environment for determining physical activity

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These groups are fairly easy to understand. If an environmental determinant ends up in the “No relationship with PA”-box it means that I could not find any previous studies that showed a significant relationship between that environmental factor. If in the “Divergent relationship with PA”, I found that some studies showed there was a significant relationship between this factor and physical activity. And lastly, if in the “Significant relationship” box, I found that a vast majority of studies show there is a significant relationship with physical activity. Out of all the determinants that has been studied on, the vast majority of studies end up in the “no relationship box (Duncan et al., 2005), however there are a number of factors that are in the other two boxes as well. The factors that are included in this study will only be related to the physical or built environment, or perceived physical or built environment. This of course rules out all social environment factors such as social support, having someone to talk to and self-efficacy. In addition, it rules out population-factors that might be considered as environmental, for example factors such as gymnastics at school and commercial in media.

Over the last years, there have been some systematic reviews and general overviews over the field of physical environmental factors to physical activity (Bauman, & Bull, 2007; Humpel et al., 2002; McCormack et al., 2004 Trost, Owen, Bauman, Sallis, & Brown, 2002; Wendel‐Vos, Droomers, Kremers, Brug, & Van Lenthe, 2007). Some of them have defined the environmental factors more narrowly than others. For example Wendel‐Vos et al., (2007) names the factors “traffic”, “trip distance” and “hills” whereas Bauman & Bull (2007) defined those as one factor, defined as “Route related factors: Hilliness, traffic”, naturally this makes it harder to compare and leads to some ambiguous results within studies., they did both however find a positive relationship with 5 factors. Table 2 gives an overview of the environmental factors I have looked at in this article, as well as their relationship with physical activity.

Table 2 Summary of environmental factors with their relationship level to physical activity

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