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A Site Selection Web Exclusive, December 2016
WEB Exclusive story

Time to Shape Up:

New reports show where healthy lifestyles reign.

Boulder tops healthy lifestyle lists year after year.
Photo courtesy of Boulder CVB

by Adam Bruns

Looking for motivation for that New Year's fitness commitment? Looking for a healthy populace from which to hire? New reports on obesity and heart attack incidence could be your guides for both.

As part of their State of American Well-Being series, Gallup and Healthways in November released their 2015 State and Community Rankings for Incidence of Diabetes report, ranking 190 metro areas as well as the 50 states.

"Since Gallup and Healthways began tracking this metric in 2008, an estimated 2.2 million more adults report that they have been diagnosed with the disease," said the organizations, noting the nation's 11.5-percent diabetes incidence rate, "while the obesity rate, a significant risk factor for the development of diabetes, has climbed by almost three points since 2008, to reach 28.3 percent nationally in 2016."

Incidence of Diabetes in States Across the U.S.

Lowest Incidence

1 Utah 7.40%
2 Rhode Island 7.60%
3 Colorado 7.90%
4 Minnesota 8.40%
5 Montana 8.70%
6 Alaska 8.80%
7 Massachusetts 8.90%
8 Vermont 8.90%
9 Nebraska 9.10%
10 Wyoming 9.30%

Highest Incidence

41 North Carolina 13.50%
42 Missouri 13.50%
43 Ohio 13.50%
44 Kentucky 13.70%
45 Arkansas 14.10%
46 South Carolina 14.40%
47 Tennessee 14.40%
48 Mississippi 15.60%
49 West Virginia 16.10%
50 Alabama 16.10%

The analysis measures prevalence of the disease by asking individuals if they have ever in their lifetime been diagnosed with diabetes. The state ranking is based on a subset of 176,885 telephone interviews with US adults across all 50 states, while the community ranking is based on 246,620 interviews. Utah, Rhode Island and Colorado have the lowest incidence of diabetes in the nation, with less than 8 percent of their adult populations having been diagnosed with the disease. Alabama and West Virginia have the highest diabetes prevalence, both with more than 16 percent of their residents diagnosed with diabetes.

Boulder, Colorado; Bellingham, Washington; Fort Collins, Colorado; and Provo-Orem, Utah, are the communities with the lowest prevalence of diabetes. No wonder it seems like Mountain Time means healthy time.

"Boulder distinguishes itself as the only community in the Gallup-Healthways rankings with less than five percent of its population reporting having been diagnosed," said a release. "Residents of Mobile, Alabama and Charleston, West Virginia, report the highest rates in the nation, with more than 17 percent of their respective adult populations having the disease.

Incidence of Diabetes in Communities Across the U.S.

Lowest Incidence

1 Boulder, CO 4.90%
2 Bellingham, WA 6.10%
3 Fort Collins, CO 6.50%
4 Provo-Orem, UT 6.50%
5 Cedar Rapids, IA 7.30%
6 Salinas, CA 7.40%
7 Ann Arbor, MI 7.40%
8 Anchorage, AK 7.70%
9 Amarillo, TX 7.80%
10 Bridgeport-Stamford, CT 8.00%

Highest Incidence

181 McAllen-Edinburg-Mission, TX 15.70%
182 Beaumont-Port Arthur, TX 15.80%
183 Rockford, IL 16%
184 Flint, MI 16.30%
185 Columbus, GA-AL 16.40%
186 Little Rock-Conway, AR 16.50%
187 Hickory-Lenoir-Morganton, NC 16.80%
188 Corpus Christi, TX 16.90%
189 Charleston, WV 17.60%
190 Mobile, AL 17.70%

Obesity, commonly defined as having a Body Mass Index (BMI) of 30 kg/m2 or greater, is a significant risk factor for the development of type 2 diabetes. Other risk factors include age, physical inactivity, race and ethnicity, and genetic predisposition. How do you calculate obesity? By looking at the international standard followed by the World Health Organization: the body mass index, or BMI. It's a person's weight divided by the square of his or her height. As the Milken report and the NIH's own BMI calculator define things, here are the cutoffs:

  • Underweight: below 18.5
  • Normal: 18.5 to 24.9
  • Overweight: 25 to 29.9
  • Obesity: 30 or higher

The U.S. standards follow the WHO’s and, tellingly, include a classification of extreme obesity, indicated by a BMI of 40 or higher.

Toxic Mix Calls for Blended Solutions

The coincidental Milken Institute report seeks to document the price of obesity, and declares that the "total cost to treat health conditions related to obesity — ranging from diabetes to Alzheimer’s — plus obesity’s drag on attendance and productivity at work exceeds $1.4 trillion annually. That’s more than twice what the US spends on national defense. The total, from 2014 data, was equivalent to 8.2 percent of US GDP, and it exceeds the economies of all but three US states and all but 10 countries."

In 2014, 98.7 million US residents had obesity, and another 89.9 million were overweight, Milken says. If the obesity epidemic is not stopped and reversed, says the report, "the first generation of Americans born after the baby boomers (Generation X) could be the first to see its life expectancy decline, undoing many of the benefits that improving health status bestowed on our economy in the 20th century."

Diabetes By State Gallup

Why has it occurred? Affordable bad food in big portions, and less physical activity as the services economy and leisure time filled with electronics means a work day and play time alike that overload the brain but ignore the rest of the body. Milken turns to its technology expertise for the metaphor: "According to the first law of thermodynamics, energy cannot be created or destroyed. In the context of obesity, the human body expresses that principle by converting energy to fat for use at another time."

Where do other nations stand? As recently as 2013, Mexico was just behind the US with obesity at 32.4 percent. "New Zealand, Hungary, Australia, Canada, Chile, the UK, and Ireland were not far behind. East Asian nations such as Japan and South Korea had the lowest obesity rates at 3.6 percent and 4.6 percent, respectively," says the report. "However, pre-obesity rates in these nations are growing at substantially faster paces, suggesting that the obesity epidemic and its associated conditions may be coming to their shores."

In 2014, the direct costs of medical treatment for health conditions causally related to obesity and overweight totaled $427.8 billion in the US. Among those conditions, type 2 diabetes had the highest treatment costs, at $111.9 billion. Alzheimer’s disease and vascular dementia were next, with $56 billion in direct treatment costs. Gallbladder disease was next with $43.9 billion, followed by osteoarthritis at $42.1 billion.

CO School of Mines Climb
Bicycling is as big in Bellingham, Washington, as in other metro areas leading in low diabetes incidence.
Photo courtesy of Bellingham Whatcom County Tourism

However, said Milken, a review of interventions designed to reduce obesity concluded that for individuals with a body mass index (BMI) of 40 or greater, "a 5-percent weight reduction would yield $2,137 in medical cost savings annually. For individuals with a BMI of 35, the same percentage reduction would result in $528 savings."

"We see a great need for a multifaceted, long-term commitment to advocating for healthy body weight," the report concluded, including a call for an anti-obesity campaign similar to the anti-smoking ads of the 1970s. "Employers, medical providers, insurers, biopharmaceutical firms, the food and beverage industry, governments, and communities must work together — and the individuals affected by obesity and being overweight need to accept some personal responsibility to modify their behavior."

A separate report in the Well-Being Index series from Gallup-Healthways ranks communities by incidence of heart attack. Again, being in the mountains or in a college town seems to help.

Boulder and Ann Arbor have the lowest incidence of adults who have experienced a heart attack during their lifetime, each with 1.3 percent.

"Both communities have consistently demonstrated high well-being as measured by the Gallup-Healthways Well-Being Index since 2008, as well as low incidence of other chronic conditions such as high blood pressure, high cholesterol, and diabetes," said the report. "Tallahassee, Provo, Austin, and San Jose are the other top metros, each with less than a 2.0-percent incidence of heart attack," closely followed by two more California communities, the hometown of the University of Florida (Gainesville) and, amazingly enough for you stereotypers out there, the cheesehead capital of the world — Green Bay, Wisconsin — with an incidence of just 2.2 percent.

Milken Costs Of Med Conditions

"At the other end of our rankings, eight communities have more than 7 percent of residents who have experienced a heart attack," said the report. That means you, Charleston, West Virginia; Deltona-Daytona Beach-Ormond Beach, Florida; Duluth, Minnesota-Wisconsin; Huntington-Ashland, West Virginia-Kentucky-Ohio; Youngstown-Warren-Boardman, Ohio-Pennsylvania; Lake Havasu City-Kingman, Arizona; Chico, California; and Fort Smith, Arkansas-Oklahoma.

The report points to the growing field of lifestyle medicine — exemplified by the Ornish program — as one possible solution to improved heart and overall health.

Ways Forward?

What might this have to do with corporate location decision-making? Well, just as companies look for other kinds of infrastructure to undergird their sites — water, transit and highways, electrical power, broadband — they might look more closely at the infrastructure of an active lifestyle. A Gallup-Healthways report authored by Dan Witters and nader Nekvasil issued earlier this fall offers some guidance.

Gallup and Healthways created an Active Living Score for 48 medium to large MSAs by analyzing metropolitan infrastructure data — including walkability, bike-ability, transit infrastructure and park infrastructure — based on each community's Walkscore® and ParkScore®.

Top and Bottom 10 Communities for Incidents of Heart Attack

Have you ever been told by a physician or nurse that you have had a heart attack?

Top 10 Communities

1 Boulder, CO 1.30%
2 Ann Arbor, MI 1.30%
3 Tallahassee, FL 1.50%
4 Provo-Orem, UT 1.60%
5 Austin-Round Rock, TX 1.80%
6 San Jose-Sunnyvale-Santa Clara, CA 1.90%
7 Visalia-Porterville, CA 2.00%
8 San Luis Obispo-Paso Robles-Arroyo Grande, CA 2.10%
9 Gainesville, FL 2.10%
10 Green Bay, WI 2.20%

Bottom 10 Communities

181 Kingsport-Bristol-Bristol, TN-VA 6.80%
182 North Port-Sarasota-Bradenton, FL 7.00%
183 Fort Smith, AR-OK 7.10%
184 Chico, CA 7.10%
185 Lake Havasu City-Kingman, AZ 7.20%
186 Youngstown-Warren-Boardman, OH-PA 7.40%
187 Huntington-Ashland, WV-KY-OH 7.70%
188 Duluth, MN-WI 7.70%
189 Deltona-Daytona Beach-Ormond Beach, FL 7.90%
190 Charleston, WV 8.80%

"Among the 48 communities examined nationwide, Boston and San Francisco metropolitan areas score the highest in their overall infrastructure to support active living, followed by Chicago, New York and Washington, D.C.," said the report. "Indiana and Oklahoma each produce two of the bottom five active living communities: Fort Wayne, Indianapolis, Oklahoma City and Tulsa. Durham-Chapel Hill, North Carolina, has the fourth-lowest active living community ranking."

The New York City and Boston metropolitan areas are the top two communities for both walkability and transit. Madison, Wisconsin, and Portland, Oregon, have the highest bike scores, while Minneapolis and Washington, D.C., have the highest park scores.

How can your community do the right thing? The report offers some examples ... even in leading light Denver. And bicycling seems to be a thing:

  • "Albert Lea, Minnesota, established more than 10 miles of bike lanes and new sidewalks and enhanced streets to support walking and biking. The city adopted policies to reduce tobacco use and started workplace programs to promote health and social interaction. Grocery stores, restaurants, schools and workplaces made changes to make healthy choices easier, and several restaurants added outdoor dining areas. These active living improvements helped Albert Lea increase its overall well-being score by 2.8 points from 2014 to 2016, significantly outpacing both the state and the nation."
  • "Marion, Iowa, requires consideration of pedestrian and cyclist needs in all street projects, and new developments must have sidewalks installed within five years. Guidelines integrate trees, green space and other natural features to make streets more walkable. The city's "Complete Streets" policy has revitalized its historic Uptown district, redirecting cars from the area and creating a pedestrian-friendly atmosphere."
  • "Denver's Department of Public Works coordinates a coalition to fund the Safe Routes to School (SRTS) program, constructing new trails to encourage children to walk or bike to school in safe environments. Residents of Denver's Park Hill neighborhood trade community service for free refurbished bicycles. And Fort Collins, Colorado, has invested in at least 48 neighborhood parks and 35 miles of trail systems while boasting one of the best bicycle commuter rates in the nation."
  • "Eugene, Oregon, which has reduced its obesity rate since 2008, is home to well-planned and well-used cycling networks that include 28 miles of off-street paths, 78 miles of on-street bicycle lanes and four bicycle/pedestrian bridges spanning the Willamette River. Similar to Fort Collins, Eugene's share of workers who commute by bicycle is one of the best rates in the nation among midsize cities; at 9 percent, it is well ahead of the national average, which is lower than 1 percent."
  • "In Chattanooga, Tennessee, the 2014-2015 obesity rate dropped by about four percentage points (from 28.5 percent to 24.6 percent) since 2008 — likely benefiting from the Grow Healthy Together Chattanooga (GHTC) partnership, which leverages Healthy Kids, Healthy Communities grant money to increase access to healthy fruits and vegetables, expand options for physical activity, and enhance infrastructure for safe movement of pedestrians and bicyclists."

"There are tangible policies that communities can adopt to actively cultivate and improve residents' well-being," says Dan Buettner, National Geographic Fellow and founder of Healthways' Blue Zones Project, in the report. His comments could just as easily apply to company wellness programs as to communities:

"Policies that nudge people into healthy activities — where it is easy to walk to the store, bike to a friend's house, get access to fresh produce and be surrounded by healthy-minded, supportive friends — are ones that make the healthy choice the easy choice," he said. "Sustained transformation depends on building an environment and establishing social policies that support and reinforce these programs."

CO School of Mines Climb
In Colorado, the techies are as healthy as everyone else, thanks to traditions such as the M Climb: At the Colorado School of Mines in Golden each fall, incoming freshmen carry a 10-pound rock from campus to the M on Mt. Zion and coat the symbol with fresh whitewash. Graduating seniors are invited to return to the M and retrieve their rocks.
Photos courtesy of Colorado School of Mines

Adam Bruns
Editor in Chief of Site Selection magazine

Adam Bruns

Adam Bruns is editor in chief and head of publications for Site Selection, and before that has served as managing editor beginning in February 2002. In the course of reporting hundreds of stories for Site Selection, Adam has visited companies and communities around the globe. A St. Louis native who grew up in the Kansas City suburbs, Adam is a 1986 alumnus of Knox College, and resided in Chicago; Midcoast Maine; Savannah, Georgia; and Lexington, Kentucky, before settling in the Greater Atlanta community of Peachtree Corners, where he lives with his wife and daughter.


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