Drivers to Obesity-A Study of the Association between Time Spent Commuting Daily and Obesity in the Nepean Blue Mountains Area.

Obesity has become a public health challenge in every country on this planet, with a substantial contribution to global mortality and morbidity. Studies of the built environment have shown some promise in understanding the drivers of this obesity pandemic. This paper contributes to this knowledge, by focusing on one aspect of the urban environment and asking whether there is an association between commuting and obesity in residents of the Nepean Blue Mountains area on the fringes of Sydney. This is a cross-sectional study with obesity being the dependent variable, and commuting the independent variable, where 45 min or less was defined as local and distant commute was more than 45 min. In the sample of 158 respondents, the risk of obesity was twice as likely in the distant commuters than in the local commuters (OR 2.04, 95% CI 1.051 to 3.962, p = 0.034). Investigation of possible mediators of this association was limited by sample size; however, mode of transport was found to be a significant mediator. The results support the design of cities to provide health supporting environments for all residents, including equitable access to employment at a reasonable distance and effective public transport.

The built environment and obesity: You are where you live.

BACKGROUND: Obesity has continued to rise in prevalence globally. Its association with many chronic diseases is posing a large threat to public health. OBJECTIVE: The aim of this article is to examine briefly the nature and complexity of the problem of obesity and to present evidence about the elements of the built environment that are associated with obesity. DISCUSSION: Management of obesity is far more complex than just requiring people to 'eat less and exercise more'. Social and environmental drivers are known to influence an individual's decisions about healthy behaviour. Some elements of the built environment shown to be associated with obesity are urban sprawl, urban design, land-use mix, transport systems, access to and type of food outlets, and building design. This evidence augments the current individual clinical management of obesity by providing guidance to advocates of health and regulators so they are able to design and create environments that foster healthy eating and personal activity.

A brief review of global climate change and the public health consequences.

BACKGROUND: Global climate change (GCC) will have an enormous impact on public health in the 21st century. Evidence clearly implicates the use of fossil fuels and the resultant anthropogenic greenhouse gases as the major source of GCC. OBJECTIVE: This paper seeks to examine briefly the association between fossil fuels and GCC, the consequent environmental changes and the predicted public health effects. DISCUSSION: Complex and interrelated climate changes are forecast to present immense challenges, including increased morbidity and mortality, arising from heatwaves, extreme weather events, infectious and non-communicable diseases. The subsequent health effects, modulated by socioeconomic determinants, will be distributed inequitably primarily to vulnerable populations, largely in the tropics. A response to GCC is urgently required, involving strategies to mitigate and adapt to GCC. Not only will general practitioners be managing health conditions caused by GCC, but they are also well placed in the community to advocate for GCC mitigation.

Travelling safely to places at high altitude - Understanding and preventing altitude illness.

BACKGROUND: Greater numbers of people are travelling to places at high altitude each year. Altitude illness is common in places at high altitude and may be life-threatening. General practitioners (GPs) are best placed to provide evidence-based advice to keep travellers well informed of the possible risks they may encounter in places at high altitude. OBJECTIVE: The aim of this article is to review knowledge on altitude illness in order to help GPs assist patients to travel safely to places at high altitude. DISCUSSION: Acclimatisation to high altitude is a complex process and when inadequate leads to the pathological changes of altitude illness, including high-altitude headache, cerebral oedema, pulmonary oedema and acute mountain sickness. Higher ascent, faster rate of ascent and a previous history of altitude illness increase the risk of altitude illness. Acetazolamide and other medications used to prevent altitude illness are discussed in detail, including the finding that inhaled budesonide may prevent altitude illness.