Journal of Urban Health

, Volume 89, Issue 1, pp 196–213 | Cite as

Prioritizing Obesity in the City

  • Jennifer Asanin DeanEmail author
  • Susan J. Elliott


A decade ago, the World Health Organization declared obesity to be a global epidemic. Accordingly, there is a growing body of research examining how “obesogenic environments” contribute to the increasing prevalence of obesity. Using the ANGELO Framework, this research explores the role of municipal policies and practices in constructing obesogenic environments in two Southern Ontario cities in order to examine how socio-cultural and political environments shape excess body weight. Data was collected from municipal policy documents, public health websites, and key informants in Hamilton and Mississauga, Ontario, Canada. Results indicate that while the cities took different approaches to dealing with obesity, they both reflected the cities' overall prioritizing of health. Additionally, the findings reveal the pervasiveness of values and attitudes held in the socio-cultural environment in further shaping (and being shaped by) political as well as economic and physical environments in the cities. The importance of explicitly acknowledging the official discourse of the city, which this study demonstrates to be a significant factor in constructing obesogenic environments, is highlighted. Theoretical contributions and policy implications are also discussed.


Obesity Environmental determinants ANGELO Framework Municipal priorities Socio-cultural factors Political factors 



We would like to extend our appreciation to the key informants who took part in this study. This research was financially supported through ancillary funding from the Canadian Heart Health Surveys Follow Up Study (Canadian Institutes for Health Research and Heart and Stroke Foundation of Canada), and Jennifer was additionally supported through a Doctoral Fellowship from the Social Science and Humanities Research Council of Canada (No. 752-2009-1170 03).


  1. 1.
    World Health Organization. Obesity: Preventing and Managing the Global Epidemic. Geneva, Switzerland: WHO Technical Report Series; 2000: 894.Google Scholar
  2. 2.
    Katzmarzyk PT, Ardern CI. Overweight and obesity mortality trends in Canada, 1985–2000. Can J Public Health. 2004; 95(1): 16–20.PubMedGoogle Scholar
  3. 3.
    Vanasse A, Demers M, Hemiari A, Courteau J. Obesity in Canada: where and how many? Int J Obes. 2006; 30: 677–683.CrossRefGoogle Scholar
  4. 4.
    Katzmarzyk PT, Janssen I. The economic costs associated with physical inactivity and obesity in Canada: an update. Can J Appl Physiol. 2004; 29(1): 90–115.PubMedCrossRefGoogle Scholar
  5. 5.
    Yach D, Stuckler D, Brownell KD. Epidemiologic and economic consequences of the global epidemics of obesity and diabetes. Nat Med. 2006; 12(1): 62–67.PubMedCrossRefGoogle Scholar
  6. 6.
    Dyck R, Klomp H, Tan L. From ‘thrifty genotype’ to ‘hefty fetal phenotype’: the relationship between high birth weight and diabetes in Saskatchewan Registered Indians. Can J Public Health. 2001; 92(5): 340–344.PubMedGoogle Scholar
  7. 7.
    Procter K. The aetiology of childhood obesity: a review. Nutr Res Rev. 2007; 120: 29–45.CrossRefGoogle Scholar
  8. 8.
    Taylor J, Evers S, McKenna M. Determinants of healthy eating in children and youth. Can J Public Health. 2005; 96(3): S20–S26.PubMedGoogle Scholar
  9. 9.
    Willms JD, Tremblay MS, Katzmarzyk PT. Geographic and demographic variation in the prevalence of overweight Canadian children. Obes Res. 2003; 11(5): 668–673.PubMedCrossRefGoogle Scholar
  10. 10.
    Crandall C, Schiffhauer K. Anti-fat prejudice: beliefs, values, and American culture. Obes Res. 1998; 6(6): 458–460.PubMedGoogle Scholar
  11. 11.
    Evans B. ‘Gluttony or sloth’: critical geographies of bodies and morality in (anti)obesity policy. Area. 2006; 38(3): 259–267.CrossRefGoogle Scholar
  12. 12.
    Campos P, Saguy A, Ernsberger P, Oliver E, Gaesser G. The epidemiology of overweight and obesity: public health crisis or moral panic? Int J Epidemiol. 2006; 35(1): 55–60.PubMedCrossRefGoogle Scholar
  13. 13.
    Gard M, Wright J. The Obesity Epidemic: Science Morality and Ideology. London, England: Routledge; 2005.Google Scholar
  14. 14.
    LeBesco K. Revolting Bodies: the Struggle to Redefine the Fat Identity. Boston, MA: University of Massachusetts Press; 2004.Google Scholar
  15. 15.
    Davison K, Birch L. Childhood overweight: a contextual model and recommendations for future research. Obes Rev. 2001; 2(3): 159–171.PubMedCrossRefGoogle Scholar
  16. 16.
    Egger G, Swinburn B. An ‘ecological’ approach to the obesity pandemic. Brit Med J. 1997; 315: 477–481.PubMedCrossRefGoogle Scholar
  17. 17.
    Swinburn B, Egger G, Raza F. Dissecting obesogenic environments: the development and application of a framework for identifying and prioritizing environmental interventions for obesity. Prev Med. 1999; 29: 563–570.PubMedCrossRefGoogle Scholar
  18. 18.
    King T, Kavanagh A, Jolley D, Turrel G, Crawford D. Weight and place: a multilevel cross-sectional survey of area-level social disadvantage and overweight/obesity in Australia. Int J Obes. 2006; 30: 281–287.CrossRefGoogle Scholar
  19. 19.
    Harrington D, Elliott SJ. Weighing the importance of neighbourhood: a multilevel exploration of the determinants of overweight and obesity. Soc Sci Med. 2009; 68: 593–600.PubMedCrossRefGoogle Scholar
  20. 20.
    Janssen I, Boyce W, Simpson K, Pickett W. Influence of individual-and area-level measures of socioeconomic status on obesity, unhealthy eating, and physical inactivity in Canadian adolescents. Am J Clin Nutr. 2006; 83: 139–145.PubMedGoogle Scholar
  21. 21.
    Pearce J, Witten K, Hiscock R, Blakely T. Are socially disadvantaged neighbourhoods deprived of health-related community resources? Int J Epidemiol. 2007; 36(2): 348–355.PubMedCrossRefGoogle Scholar
  22. 22.
    Ellaway A, Anderson A, Macintyre S. Does area of residence affect body size and shape? J Obes Relat Metab Disord. 1997; 21: 304–308.CrossRefGoogle Scholar
  23. 23.
    Mobley L, Root E, Finkelstein E, Khavjou O, Farris R, Will J. Environment, obesity, and cardiovascular disease risk in low-income women. Am J Prev Med. 2006; 31: 109–117.CrossRefGoogle Scholar
  24. 24.
    Robert S, Reither E. A multilevel analysis of race, community disadvantage, and BMI among adults in the US. Soc Sci Med. 2004; 59: 2421–2434.PubMedCrossRefGoogle Scholar
  25. 25.
    Latham J, Moffat T. Determinants of variation in food cost and availability in two socioeconomically contrasting neighbourhoods of Hamilton, Ontario, Canada. Health Place. 2007; 13: 273–287.PubMedCrossRefGoogle Scholar
  26. 26.
    Zenk S, Schulz A, Israel B, James S, Boas S, Wilson M. Neighbourhood racial composition, poverty and the spatial accessibility of supermarkets in metropolitan Detroit. Am J Public Health. 2005; 95: 660–667.PubMedCrossRefGoogle Scholar
  27. 27.
    Carver A, Timperio A, Crawford D. Playing it safe: the influence of neighbourhood safety on children’s physical activity—a review. Health Place. 2008; 14(2): 217–227.PubMedCrossRefGoogle Scholar
  28. 28.
    Stafford M, Cummins S, Ellaway A, Sacker A, Wiggins R, Macintyre S. Pathways to obesity: identifying local, modifiable determinants of physical activity and diet. Soc Sci Med. 2008; 65: 1882–1897.CrossRefGoogle Scholar
  29. 29.
    Timperio A, Salmon J, Telford A, Crawford D. Perceptions of local neighborhood environments and their relationship to childhood overweight and obesity. Int J Obes. 2005; 29: 170–175.CrossRefGoogle Scholar
  30. 30.
    Booth K, Pinkston M, Poston W. Obesity and the built environment. J Am Diet Assoc. 2005; 105: S110–S117.PubMedCrossRefGoogle Scholar
  31. 31.
    Papas M, Alberg A, Ewing R, Helzlsouer KJ, Gary T, Klassen AC. The built environment and obesity. Epidemiol Rev. 2007; 29(1): 129–143.PubMedCrossRefGoogle Scholar
  32. 32.
    Tucker P, Irwin J, Gilliland J, He M, Larsen K, Hess P. Environmental influences on physical activity levels in youth. Health Place. 2009; 15(1): 357–363.PubMedCrossRefGoogle Scholar
  33. 33.
    Raine K, Spence J, Church J, et al. State of the Evidence Review on Urban Health and Healthy Weights. Ottawa, Canada: Canadian Institute for Health Information; 2008.Google Scholar
  34. 34.
    Kirk S, Penney T, McHugh F. Characterizing the obesogenic environment: the state of the evidence with directions for future research. Obes Rev. 2010; 11: 109–117.PubMedCrossRefGoogle Scholar
  35. 35.
    Berkman L, Kawachi I. Social epidemiology. New York, NY: Oxford University Press; 2000.Google Scholar
  36. 36.
    Curtis S, Taket A. Health and Societies: Changing Perspectives. London, England: Arnold; 1995.Google Scholar
  37. 37.
    Evans RG, Barer ML, Marmor TRE. Why are Some People Healthy and Others Not? The Determinants of Health of Populations. New York, NY: Aldine Transaction; 1994.Google Scholar
  38. 38.
    Lupton D. The Imperative of Health: Public Health and the Regulated Body. London, England: Sage Publications; 1995.Google Scholar
  39. 39.
    Badland H, Schofield G, Witten K, et al. Understanding the relationship between activity and neighbourhoods (URBAN) study: research design and methodology. BMC Public Health. 2009; 9: 224–235.PubMedCrossRefGoogle Scholar
  40. 40.
    Farmer T, Robinson K, Elliott SJ, Eyles J. Developing and implementing a triangulation protocol for qualitative health research. Qual Heal Res. 2006; 16(3): 377–394.CrossRefGoogle Scholar
  41. 41.
    Wakefield S, McMullan C. Healing in places of decline: (re)imagining everyday landscapes in Hamilton, Ontario. Health Place. 2005; 11(4): 299–312.PubMedCrossRefGoogle Scholar
  42. 42.
    City of Mississauga. Awards for 2007. Website. Updated 2008. Accessed July 12, 2010.
  43. 43.
    World Health Organization. Urban Health: Healthy Cities. Website. Updated 2010. Accessed August 13, 2010.
  44. 44.
    Statistics Canada. 2006 Canadian Census. Ottawa, Canada: Statistics Canada; 2007.Google Scholar
  45. 45.
    Statistics Canada. Canadian Community Health Survey: Cycle 3.1. Ottawa, Canada; Statistics Canada; 2005.Google Scholar
  46. 46.
    Shields M, Tjepkema M. Regional differences in obesity. Health Rep. 2006; 17(3): 61–67. Statistics Canada Catalogue No. 82–003.PubMedGoogle Scholar
  47. 47.
  48. 48.
    City of Mississauga. Strategic Plan: Our Future Mississauga. Website. Updated 2009. Accessed June 25, 2010.
  49. 49.
    City of Hamilton. Public Health Services Strategic Plan. Website. Updated 2007. Accessed June 21, 2010.
  50. 50.
    Region of Peel. 2009–19-Staying Ahead of the Curve: Peel Public Health’s 10-year Strategic Plan. Website. Updated 2009. Accessed June 21, 2010.
  51. 51.
    Hamilton Public Health Services. Website. Updated 2010. Accessed June 20, 2010.
  52. 52.
    Peel Public Health Unit. Website. Updated 2010. Accessed June 20, 2010.
  53. 53.
    Fairclough N. Language and Power. London, England: Longman; 1989.Google Scholar
  54. 54.
    Wodak R. What is critical discourse analysis about? In: Wodak R, Meyers M, eds. Methods of Critical Discourse Analysis. London, England: Sage Publications; 2009.Google Scholar
  55. 55.
    Hamilton Partners for Healthy Weights. Website. Updated 2007. Accessed June 29, 2010.
  56. 56.
    Peel Public Health. Child Obesity Website. Updated 2010. Accessed June 29, 2010.
  57. 57.
    Patton M. Qualitative Research & Evaluation methods. London, England: Sage Publications; 2002.Google Scholar
  58. 58.
    Buist S. Code Red: where you live affects your health. The Hamilton Spectator. Website. Updated April 10–16, 2010. Accessed June 29, 2010.
  59. 59.
    Monaghan L. Discussion pieces: a critical take on the obesity debate. Soc Theory Health. 2005; 3: 302–314.CrossRefGoogle Scholar
  60. 60.
    Townshend T, Lake AA. Obesogenic urban form: theory, policy and practice. Health Place. 2009; 15(4): 909–916.PubMedCrossRefGoogle Scholar
  61. 61.
    Ferreira I. Environmental correlates of physical activity in youth–a review and update. Obes Rev. 2007; 8: 129–154.PubMedCrossRefGoogle Scholar
  62. 62.
    Van der Horst K, Oenema A, Ferreira I, et al. A systematic review of environmental correlates of obesity-related dietary behaviours in youth. Heal Educ Res. 2007; 22(2): 203–226.CrossRefGoogle Scholar
  63. 63.
    Wendel-Vos W, Droomers M, Kremers S, Brug J, Van Lenthe F. Potential environmental determinants of physical activity in adults: a systematic review. Obes Rev. 2007; 8: 425–440.PubMedCrossRefGoogle Scholar
  64. 64.
    Frohlich K, Ross N, Richmond C. Health disparities in Canada today: some evidence and a theoretical framework. Health Policy. 2006; 79: 132–143.PubMedCrossRefGoogle Scholar

Copyright information

© The New York Academy of Medicine 2011

Authors and Affiliations

  1. 1.School of Geography & Earth SciencesMcMaster UniversityHamiltonCanada
  2. 2.School of Public Health & Health SystemsUniversity of WaterlooWaterlooCanada

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