Living in Unwalkable Neighborhoods Increases the Risk of Developing Diabetes

by Dr Sam Girgis on September 18, 2012

The worldwide diabetes rate has continued to increase alongside the obesity epidemic.  The World Health Organization estimates that there are approximately 350 million individuals worldwide with diabetes, and this will continue to grow due to the ongoing obesity epidemic and the world’s aging population.  There are several risk factors for diabetes and these include being overweight and obese, carrying increased fat distribution in the abdominal region (central obesity), being inactive, having a strong family history of diabetes, and having prediabetes or insulin resistance.  Several other risk factors include increasing age and a history of gestational diabetes, having polycystic ovary syndrome, and having impaired glucose tolerance or impaired fasting glucose.  In a recent study,unwalkable neighborhoods were found to be a risk factor for the development of diabetes.

Researchers, led by Dr. Gillian Booth from the St. Michael’s Hospital and the Institute for Clinical Evaluative Sciences in Toronto, Canada, have found that neighborhood walkability was inversely associated with increased risk of developing diabetes, particularly among new immigrants.  The results of their research were published online in the journal Diabetes Care.  The researchers conducted a population-based retrospective cohort study to evaluate the impact of neighborhood walkability on the risk of developing diabetes.  The study involved 214,882 recent immigrants and over 1 million long-term residents of Toronto, Canada that were followed for a five year period for the development of diabetes.  In addition, neighborhood walkability was evaluated for study participants.  Coexisting poverty was found to worsen the risk of developing diabetes.

The authors wrote, “Our findings demonstratethat residents living in less walkable areas, particularly recent immigrantsin low-income neighborhoods, have anaccelerated risk of developing diabetes compared with those living in more walkable areas. Although diabetes can be prevented through physical activity, healthy eating, and weight loss, the environment in which one lives may pose barriers to achieving these measures that are difficult to overcome”.

The authors additionally wrote, “Our findings support the concept that neighborhood design potentially could influence the health of urban populations through the opportunities it provides for residents to undertake healthy behaviors. This may have practical implications for community-level interventions aimed at diabetes prevention…Our findings are supported by other studies demonstrating an association between neighborhood features that discourage physical activity and risk factors for diabetes such as physical inactivity, insulin resistance, and obesity”.

The authors speculated, “We hypothesize that living in a less walkable neighborhood increases one’s risk of diabetes through its effects on physical activity and obesity”.

This study depicts the interplay of our environment with our health and shows the dramatic impact that environment can have on our risk of developing diabetes and likely other physical activity/ obesity related diseases.  Since physical activity and obesity is also related to other diseases such as heart disease and stroke, future studies should investigate the role environment and neighborhood walkability influences these diseases.  In addition, future studies should focus on determining whether physical fitness campaigns can decrease the risk of developing diabetes in unwalkable neighborhoods.



Gillian L. Booth et al. “Unwalkable Neighborhoods, Poverty, and the Risk of Diabetes Among Recent Immigrants to Canada Compared With Long-Term ResidentsDiabetes Care Published online before print September 17, 2012, doi: 10.2337/dc12-0777

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