Neighborhood social determinants of health and postoperative weight loss

New publication – Pratt, K.J., Hanks, A.S., Miller, H.J., Outrich, M., Breslin, L., Blalock, J., Noria, S., Brethauer, S., Needleman, B. and Focht, B. (2022) “The BARI-hoods Project: Neighborhood social determinants of health and postoperative weight loss using integrated EHR, Census, and county data,” Surgery for Obesity and Related Diseases, online first.

(I may be the first geographer to co-author a paper in Surgery for Obesity and Related Diseases, but I am willing to be corrected.)

HIGHLIGHTS

  • While living in close proximity to foods stores does not ensure utilization, in this study, patients who lived within a 10-minute walk to food stores had better weight loss two years after bariatric surgery.
  • Black patients with access to more food stores within a 10-minute walk and White patients with more access within a 5-minute walk had greater %TWL (percent total weight loss)  over 24 months.
  • Living in areas with lower poverty levels did not negatively affect weight loss for Black patients.
  • There were no significant associations for weight loss based on unemployment rate or proximity to fitness/recreational facilities and percent open area.

ABSTRACT
Background.  While social determinants of health (SDoH) have gained attention for their role in weight loss following bariatric surgery; electronic health record (EHR) data provides limited information beyond demographics associated with disparities in weight loss.

Objective. To integrate EHR, Census, and county data to explore disparities in SDoH and weight loss among patients in the largest populous county of Ohio.

Setting. 772 patients (82.1% female; 37.0% Black) who had primary bariatric surgery (48.7% gastric bypass) from 2015-2019 at The Ohio State University.

Methods. EHR variables included race, insurance, procedure, and %TWL at 2/3, 6, 12, and 24 months. Census variables included poverty and unemployment rates. County variables included food stores, fitness/recreational facilities, and open area within a 5- and 10-minute walk from home. Two mixed multilevel models were conducted with %TWL over 24 months, with visits as the between subjects factor; race, Census, county, insurance, and procedure variables were covariates. Two additional sets of models determined within group differences for Black and White patients.

Results. Access to more food stores within a 10-minute walk was associated with greater %TWL over 24 months (p=0.029). Black patients with access to more food stores within a 10-minute (p=0.017) and White patients with more access within a 5-minute walk (p=0.015) had greater %TWL over 24 months. Black patients who lived in areas with higher poverty rates (p=0.036) experienced greater %TWL over 24 months. No significant differences were found for unemployment rate or proximity to fitness/recreational facilities and open area.

Conclusion. Close proximity to food stores is associated with better weight loss two years after bariatric surgery. Lower poverty levels did not negatively affect Black patient weight loss.

Remarks at 2022 World Day of Remembrance for Road Traffic Victims, Columbus

I had the privilege to speak briefly at the 2022 World Day of Remembrance for Road Traffic Victims event in Columbus, Ohio, on Sunday, November 20 1-2pm at Washington Gladden Social Justice Park. Below are the notes from my remarks. I hope you find it useful for thinking about road design, traffic violence, and what we can do about it.

Here’s the problem. For decades, we have designed roads for speed not safety.

Under today’s traffic engineering standards, someone crossing a street is less important than the fast-flowing movement of cars. Even multiple people dying at an intersection may not be enough to install a stop sign or walk signal, because the fast movement of cars is most important thing.

Also, consider the concept of Level of Service. Did you know that traffic engineers grade our streets and roads based on one thing: how freely vehicles are flowing. Nothing else. And they make decisions to try to raise those grades.

We must recognize that these protocols are not fundamental principles or laws of nature. They are value judgements: they are opinions about what we should prioritize in our street designs. And they say that drivers are more important that pedestrians, cyclists and public transit users

They also say that speed as the primary objective of our street, road and highway networks, not human lives, air quality, the climate and making our communities social and livable places for all people.

The other problem is that traffic engineers fail to take into account the complexity of human behavior. Humans react to the design of streets and roads, and behave accordingly. If our street designs suggest that you can drive fast, people will drive fast.

So what we have in practice are streets that are designed like highways: they assume that with the proper design, people will behave rationally and error-free, and therefore can drive powerful heavy vehicles at fast speeds in crowded urban spaces with no consequences.

But people are not rational or error-free, especially when they drive! The result is the mayhem we see on our streets. It must stop.

What can we do as a community?

  • We need to change our design standards for streets and roads: we need to throw out 50 year old standards and protocols that assume we can design error-free driving at fast speeds in favor of standards that take a safe systems approach: assume that people will make errors, and reduce the consequences of these errors. This is where the USDOT under Pete Buttigieg is taking us, but the state DOTs is where the rubber hits the road. They have to join and support this transition.
  • There are standards for designing Complete Streets: streets that accommodate all users: drivers, pedestrians, cyclists and public transit users.  This requires reallocating some of our street space for pedestrians, cyclists and public transit users.  This can include better and wider sidewalks, protected bike lanes and dedicated bus lanes.  This will make our streets safer for all users – including drivers

 

What can you do as a citizen?

  • Show up and voice your opinion – you need to show up at public meetings, city council meetings, neighborhood associations meetings and make your voice heard.
  • Ask questions –  when a traffic engineer tells you that we can’t do something, ask why. When they tell you what their traffic studies say – ask them how they reached those conclusions.  I’ll let you in on a secret – the math is scary but the concepts are very simple. Anyone can understand them if they are explained well.
  • Do some homework
    • I want to recommend a book by Charles Marohn – Confessions of a Recovering Engineer: Transportation for a Strong Town. A very clear and well-written book that explains why the conventional approach to traffic engineering is making people less safe, bankrupting towns and cities, destroying the fabric of communities, and actually worsening the problems (like congestion) engineers set out to solve. He also talks about how transportation can be fixed.
    • I also encourage you to explore and read websites such as the National Association of City Transportation Officials (nacto.org) who have very readable policy briefs and recommendations concerning street design.

 

Fixing the mayhem on our streets will involve not just engineers, but local residents and officials who have become effective and empowered advocates, connected with others to make real change. Everyone here is part of the solution.