People don’t gain or lose weight because they live near a fast-food restaurant or supermarket, according to a new led by the 91̽��. And, living in a more “walkable,” dense neighborhood likely only has a small impact on weight.

These “built-environment” amenities have been seen in as essential contributors to losing weight or tending toward obesity. The idea appears obvious: If you live next to a fast-food restaurant, you’ll eat there more and thus gain weight. Or, if you have a supermarket nearby, you’ll shop there, eat healthier and thus lose weight. Live in a neighborhood that makes walking and biking easier and you’ll get out, exercise more and burn more calories.

The new study based on anonymized medical records from more than 100,000 Kaiser Permanente Washington patients did not find that living near supermarkets or fast-food restaurant had any impact on weight. However, urban density, such as the number of houses in a given neighborhood, which is closely linked to neighborhood “walkability” appears to be the strongest element of the built environment linked to change in body weight over time.

“There’s a lot of prior work that has suggested that living close to a supermarket might lead to lower weight gain or more weight loss, while living close to lots of fast-food restaurants might lead to weight gain,” said , lead author of the study and a research scientist in the 91̽��School of Public Health. “Our analyses of the food environment and density together suggests that the more people there are in an area — higher density — the more supermarkets and fast-food restaurants are located there. And we found that density matters to weight gain, but not proximity to fast food or supermarkets. So, that seems to suggest that those other studies were likely observing a false signal.”

The UW-led study, published earlier this month in the International Journal of Obesity, found that people living in neighborhoods with higher residential and population density weigh less and have less obesity than people living in less-populated areas. And that didn’t change over a five-year period of study.

“On the whole, when thinking about ways to curb the obesity epidemic, our study suggests there’s likely no simple fix from the built environment, like putting in a playground or supermarket,” said Buszkiewicz, who did his research for the study while a graduate student in the 91̽��Department of Epidemiology.

Rather than “something magical about the built environment itself” influencing the weight of those individuals, Buszkiewicz said, community-level differences in obesity are more likely driven by systematic factors other than the built environment — such as income inequality, which is often the determining factor of where people can afford to live and whether they can afford to move.

“Whether you can afford to eat a healthy diet or to have the time to exercise, those factors probably outweigh the things we’re seeing in terms of the built environment effect,” he said.

The researchers used the Kaiser Permanente Washington records to gather body weight measurements several times over a five-year period. They also used geocodable addresses to establish neighborhood details, including property values to help establish socioeconomic status, residential unit density, population density, road intersection density, and counts of supermarkets and fast-food restaurants accessible within a short walk or drive.

“This study really leverages the power of big data,” said Dr. David Arterburn, co-author and senior investigator at Kaiser Permanente Washington Health Research Institute. “Our use of anonymized health care records allows us to answer important questions about environmental contributions to obesity that would have been impossible in the past.”

This study is part of a 12-year, joint UW�����Ի���Kaiser Permanente Washington research project called Moving to Health. The goal of the study, according to the UW’s , is to provide population-based, comprehensive, rigorous evidence for policymakers, developers and consumers regarding the features of the built environment that are most strongly associated with risk of obesity and diabetes.

“Our next goal is to better understand what happens when people move their primary residence from one neighborhood to another,” Arterburn said. “When our neighborhood characteristics change rapidly — such as moving to a much more walkable residential area — does that have an important effect on our body weight?”

Co-authors include Jennifer Bobb, Andrea Cook, Maricela Cruz, Paula Lozano, Dori Rosenberg, Mary Kay Theis and Jane Anau at Kaiser Permanente Washington Health Research Institute; , 91̽��Urban Form Lab, College of Built Environments; , 91̽��Department of Epidemiology; , 91̽��Urban Form Lab and Center for Studies in Demography and Ecology; and , 91̽��Center for Public Health Nutrition and Department of Epidemiology. This research manuscript was supported by grants from the National Institutes of Health: 1 R01 DK 114196, 5 R01 DK076608, and 4 R00LM012868.

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For more information, contact Buszkiewicz at buszkiew@uw.edu  and Caroline Liou Caroline.X.Liou@kp.org

Understanding Washington residents’ access to food and their economic well-being – or lack of it – during the COVID-19 pandemic is vital for state and community partners to identify those needs and allocate resources effectively.

To help accomplish this goal, the 91̽��, Washington State University and Tacoma Community College, along with input from partners in local, county and state governments — such as the Washington State Department of Health and the Washington State Department of Agriculture — are conducting a series of .

The first wave of this series of surveys was conducted in June and July, and 2,621 Washington residents from 38 of 39 counties responded. Now researchers are recruiting participants in the survey’s second wave.

“The first survey found that food insecurity was high among state residents, and that the majority of food insecure households had children. We also found disparities in the burden of food insecurity by income, race, ethnicity and educational attainment,” said , one of the leaders of the survey team and a 91̽��associate professor of environmental and occupational health sciences at the School of Public Health.

Specifically, the first wave of the found:

• Food insecurity was high, alarmingly so, in the summer following the state shutdown, affecting an estimated 30% of households, exacerbating pre-existing social inequities.
• Highest rates of food insecurity – 58% – were observed among households below the poverty line.
• Households having members with some or no college education were also disproportionately impacted with 44% of respondents experiencing food insecurity.
• 42% of respondents of color experienced food insecurity.
• About 40% of all survey participants reported that their diet got worse.
• Participants reported being concerned about safety in supermarkets and grocery stores, rising food costs, access and transportation.
• Post Covid-19 diets had more eggs, rice, beans, pasta and peanut butter but less meat, seafood and milk and dairy.
• Store bought cakes and cookies decreased but there was a sharp increase in cooking at home.

“Our findings also helped to characterize which and how food assistance programs were working for Washington residents as well as where additional changes might be needed to better support their food needs. Public agencies and anti-hunger networks held the survey up as useful in informing their programs and distribution and outreach needs,” Otten said.

Complete results of the first survey are available .

The second wave of the currently is underway and runs until mid-January.

Survey questions ask about access to food and food assistance, employment conditions and financial needs, as well as diet quality and health. The survey takes about 15 minutes or less to complete and is open to all Washington State residents age 18 years or older.

“Wave 2 will monitor the continuing impact of the pandemic on economic- and food-related wellbeing eight months after the initial lockdown. We hope to continue to add more waves of data collection to monitor the ongoing situation,” Otten said. “The data collected will be used by legislators, public agencies and anti-hunger networks to allocate resources, provide support and promote the recovery of Washington residents.”

The 91̽��team included School of Public Health faculty and staff: , , ;��,��,�������Ի���, all affiliated with the 91̽��Center for Public Health Nutrition. Washington State University was represented by , director of the Food Systems Program, and Tacoma Community College by , professor of health, business and profession services. This project is supported by a charitable donation from the Ballmer Group.

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For more information, contact Otten at jotten@uw.edu.

A 91̽��study,�� in the American Journal of Epidemiology, looked at more than 131,000 adults between 2008 and 2015. The subjects were 25 to 64 years old and were either employed or unemployed but looking for work.

The study found that increases in minimum wages primarily had no effect on health overall. However, they did find a mix of negative and positive effects associated with the health of certain groups of working-age people.

“We found that an increase in minimum wage really didn’t have a huge impact on health overall, which surprised us,” said lead author , a doctoral student in epidemiology in the 91̽��School of Public Health. “We did see, when we looked at subgroups, some mixed health effects there, however.”

For example, the researchers found that a wage increase was associated with an increased likelihood of obesity and elevated body mass index in working-age people of color. They also found that higher minimum wages were associated with a lower likelihood of hypertension among working-age men but higher likelihood of hypertension in working-age women.

Read the complete story here.

Contact:
Kiyomi Taguchi, 91̽��News video producer: ktaguchi@uw.edu / 206-685-2716
Jake Ellison, 91̽��News PIO: jbe3@uw.edu / 206-543-1969

In the decade-long absence of federal action, many states, counties and cities have increased minimum wages to help improve the lives of workers. While political debate over these efforts has long been contentious, scientific research on the health effects of raising the minimum wage is relatively new.

Some have found higher minimum wages associated with positive health outcomes, with little evidence that minimum wages harm health. However, a new study by researchers at the 91̽�� found that increases in minimum wages primarily had no effect on health overall. However, they did find a mix of negative and positive effects associated with the health of certain groups of working-age people.

The 91̽��study, in the American Journal of Epidemiology, looked at more than 131,000 adults who provided information to the federal between 2008 and 2015. The subjects were 25 to 64 years old and were either employed or unemployed but looking for work.

“We found that an increase in minimum wage really didn’t have a huge impact on health overall, which surprised us,” said lead author , a doctoral student in epidemiology in the 91̽��School of Public Health. “We did see, when we looked at subgroups, some mixed health effects there, however.”

For example, the researchers found that a wage increase was associated with an increased likelihood of obesity and elevated body mass index in working-age people of color. They also found that higher minimum wages were associated with a lower likelihood of hypertension among working-age men but higher likelihood of hypertension in working-age women.

“These mixed results shine a spotlight on segments of the population that need to be studied in relation to rising minimum wages in order to learn how best to achieve the goal of reducing inequality with adjustments to the minimum wage,” said co-author , an associate professor in the 91̽��Evans School of Public Policy & Governance.

The researchers looked at several health outcomes: obesity, body mass index, hypertension, diabetes, fair or poor general health and serious psychological distress. And, to make sure they were seeing results tied to minimum wages and not other factors, they compared the health outcomes of working-age people with less formal education — who are most likely to receive the minimum wage — to health outcomes of those with more formal education. If a health outcome appeared in both groups, the researchers could assume that it wasn’t caused by changes to the minimum wage.

According to the researchers, these types of analyses and comparisons set their study apart from previous research on this topic. This gives the team confidence in its main finding — no overall effect on the health of working-age people — even though that result contradicts previously published studies. In addition, the 91̽��study provides detailed data on the effects of minimum wage increases on subgroups of workers based on gender, race and age.

The team points out in the study that an association between higher minimum wage and higher rates of obesity for a specific subgroup of working-age people may reflect differences in how minimum-wage policies affect certain demographics of workers, especially those more likely to have low- or minimum-wage jobs.

The researchers did not explore in this study the obesity or hypertension differences they uncovered, but believe that these results point to potential consequences of minimum-wage policy that should be the focus of future research.

“When we are looking at a minimum-wage policy, or any policy for that matter, we should be looking at the effect overall, but we should also consider how it is affecting different groups. And, if there is evidence that minimum wage or any policy is affecting groups differently, that’s something to hone in on for further investigation,” said Buszkiewicz, who is expanding his research into the minimum wage to include its effects over time and by gender and race.

The authors also point out that this research could help inform policymakers when it comes to establishing wage policy.

“Cities and counties are increasing minimum wages with very good intentions, which is to benefit lower-earning workers and reduce inequality, and yet we still need more research evidence on the effects of the minimum wage on health.” Hill said. “In particular, we need to understand how it affects different types of workers differently.”

Co-author on the study is , an associate professor in the 91̽��Department of Environmental and Occupational Health Sciences and the 91̽��Nutritional Sciences Program. This research was funded by Arnold Ventures and the National Institutes of Health.

Grant: R24 HD042828.

Learn more about the ����’s��Population Health Initiative: a 25-year, interdisciplinary effort to bring understanding and solutions to the biggest challenges facing communities.

The first paper, “,” was published in late December in a special issue of Social Work and Society International Online Journal.

The study found that more than half of Seattle child care businesses were affected by increased labor costs as the policy increased to $13 per hour, and that the majority will be impacted as the policy increases to $15 per hour between 2019 and 2021.

The most common strategic response reported by the businesses has been to raise prices or fees of child tuition and to reduce hours of or number of staff. Center directors reported that employee wages and benefits comprise the majority of business expenses and that child tuition was the primary source of business income. Thus, most businesses reported they would need a mix of strategies to accommodate increased labor costs to ensure that added expenses were not falling entirely onto the families they serve.

In this paper, researchers used quantitative and qualitative data to capture how the policy was affecting wages in the industry and how child care businesses were responding to the policy implementation. Using state payroll data from about 200 child care businesses, the study examined multiple factors including the number of staff per business, staff wages and business payrolls beginning in 2014 and into 2016. Researchers also surveyed 41 business directors at three different times during the rollout of the minimum wage policy. Finally, researchers conducted open-ended, in-depth interviews with 15 child care directors.

“This study illustrates how singular policies can affect more than just payroll and can shape organizational structure and service delivery,” said lead author , an associate professor in the School of Public Health.

The second paper, “,” was published in early January in a special issue of the online International Journal of Environmental and Public Health.

In this paper, researchers examined the effect of Seattle’s minimum wage ordinance on local area supermarket food prices over time and as wages phased in to $15 per hour.

Overall, the authors found no significant evidence of price increases associated with the minimum wage ordinance. The paper also sought to evaluate the potential for differential price changes that might be related to diet quality, including analyses by food group, level of food processing, and nutrient quality. The authors found no evidence of significant price increases in any of the diet quality measures examined that could be attributed to the minimum wage ordinance.

“This is really great news for low-wage earning Seattle shoppers,” said James Buszkiewicz, a doctoral candidate in the Department of Epidemiology and lead author on the study. “Typically null findings do not get that much attention, but in this case, if local food prices remain steady while earnings increase for low and minimum wage workers, then that could mean increased purchasing power for things like fresh fruit and vegetables for the consumers that need it most.”

Buszkiewicz said that the study findings may not be generalizable to all cities and states experiencing minimum wage increases given Seattle’s unique economic circumstances, however, he hopes that this study will serve as a model for other investigators to examine potential price hikes in their state or area.

The investigators collected prices for 106 food items from six large supermarket chain stores affected by the ordinance in Seattle and in six of the same-chain stores in King County and unaffected by the ordinance. The price check occurred at four time points: one month pre- (March 2015), one month post- (May 2015), one year post- (May 2016), and two years post- (May 2017) ordinance implementation.

Funding for the child care study came from , the City of Seattle and a Eunice Kennedy Shriver National Institute of Child Health and Human Development grant to the Center for Studies in Demography & Ecology at the UW.

Other co-authors for the child care study include Katherine Getts of the 91̽��School of Public Health; Heather D. Hill and Scott W. Allard from the Evans School of Public Policy and Governance; Jennifer Romich from the 91̽��School of Social Work; Ekaterina Jardim, who was a postdoctoral researcher at the 91̽��and now works for Amazon; and Anne Althauser, who worked at the 91̽��Evans School of Public Policy and Governance and now works for the 91̽��Office of Planning & Budgeting.

Funding for the food prices study came from Arnold Ventures and the City of Seattle. Other co-authors for the food prices study include Anju Aggarwal and Adam Drewnowski of the 91̽��School of Public Health; Mark Long from the Evans School of Public Policy and Governance; and Catherine House, who was a graduate student in the 91̽��Nutritional Sciences Program.

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For more information about the child care study, contact Otten at jotten@uw.edu.

For more information about the supermarket food prices study, contact Buszkiewicz at buszkiew@uw.edu.