- Email: [email protected]
Obesity in breast cancer survivors: Evaluating its impact on body-related anxiety and physical activity
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Methods: Thirty-four participants were recruited into the study. Of those, 24 completed three months and 18 completed six months on the program. Five psychological measures (The Arthritis Self-Efficacy Scale, Multidimensional Locus of Control Form, Dieting Beliefs Scale, Body Image State Scale, and Beck Depression Inventory II) were completed at baseline, six weeks, three months, and six months. Change in per cent body weight was also calculated, and the relationship between the per cent weight loss at the different time intervals and scores on the measures was examined. results: At six weeks, the mean weight loss was 9.5% of body weight and 16.2% and 26.3% at three and six months, respectively. There was a statistically significant relationship between weight loss and the majority of psychological variables at three and six months, but there was no consistent pattern at six weeks. Locus of Control was least likely to be affected by weight loss. conclusions: It appears from our findings that a minimum 10% loss of body weight is needed before people report improvement on several psychological measures including those measuring body image and depression. This information is helpful for health professionals advising on weight loss, and for women currently attempting weight loss.
Sick Children between October 2007 and April 2010. Data extracted from the charts included maternal demographics, medical data, and the Edinburgh depression scale score (EDPS), which was completed during the clinic session. results: The study population consisted of 413 women. The average weight for all women was 68.9kg ± 18.2kg, ranging from 40.8kg to 145kg. Thirty per cent of women coming to the clinic had diagnosed depression. Pregnant women with diagnosed depression had a higher average weight compared to pregnant women without known depression (71.8kg ± 16.2kg vs. 65.5kg ± 16.3kg respectively, p=0.036). The Edinburgh depression scale score was significantly correlated with weight (Spearman correlation test, p=0.025). conclusions: There is a strong association between maternal weight and maternal depression, whether diagnosed or not. Since these disorders may adversely affect pregnancy and are treatable, screening and addressing both is essential for healthy mothers and babies.
53
K. Boucher1, M. Daoust1, M.-P. Gagnon-Girouard1, A. Lapointe1, S.J. Weisnagel2, V. Provencher3, A-A. Dufour-Bouchard3, C. Trudeau3, S. Lemieux3, and C. Bégin3 1 School of Psychology, Laval University, Québec, Québec, Canada; 2 Diabetes Research Unit, Laval University, Medical Centre, Québec, Canada, and Lipid Research Centre, Laval University Medical Center, Québec, Québec, Canada; 3Institute of Nutraceuticals and Functional Foods, Laval University, Québec, Québec, Canada
restraint, moderation and the stages of weight selfregulation: Implications for cbt for obesity S. Stotland and A. Beauchemin Montreal Comprehensive Weight Management Program, and McGill University, Department of Psychology, Montreal, Quebec, Canada Restraint theory is a prominent approach to understanding the behaviour of individuals trying to restrict their food intake to lose weight or prevent weight gain. Unfortunately for dieters and would-be weight controllers, this theory predicts that intentional efforts to lose weight (or maintain lost weight) through restraint are very cognitively and emotionally taxing and will likely fail eventually. Restraint theory would appear to predict high rates of dietary lapses and collapses, increased weight fluctuation, and gradually increasing weight over time. In our view, the implications of restraint theory for cognitive-behavioural therapy (CBT) for obesity have not been fully integrated. We shall discuss this issue, and then present a new construct we call “mindful moderation,” which we believe offers a realistic alternative to restraint as a means of weight control. We then consider both restraint and moderation within a new “stage model of weight self-regulation.” The stage model provides a framework for CBT to move beyond the usual goal of strengthening restraint, which may ultimately prove unproductive, to the promotion of weight self-regulation through mindful moderation, which we predict is accompanied by growing feelings of autonomy, competence, and pleasure, which develop as one gains greater “expertise” in weight control. Thus, mindful moderation may represent a new, more functional, or expert “stage” of weight self-regulation, and we predict this will translate into improved long-term weight and emotion outcomes. We will present cross-sectional, longitudinal and clinical data in support of this viewpoint and discuss the key implications for CBT practitioners. 54 association between maternal weight and depressive symptoms A. Walfisch, C. Sermer, I. Matok, A. Einarson, and G. Koren The Motherisk Program, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pharmacology, University of Toronto, Toronto, Ontario, Canada Objective: Both maternal depressive symptomatology and maternal overweight have detrimental effects on perinatal health outcomes. We sought to explore the relationship between maternal weight and depression, whether diagnosed or not. Methods: A retrospective chart review was done of the medical records of all women who attended the Motherisk clinic at The Hospital for
55 Obsessive thoughts about food and compulsive eating among weight-preoccupied overweight/obese women
Obsessive thoughts about food and compulsive eating are related to poorer physical and psychological health, as well as inadequate coping styles and problematic eating behaviours leading to difficulties in body-weight regulation (Bryant et al, 2007; Spoor et al, 2007). The Eating Obsessive-Compulsive Scale (EOCS) is an instrument that examines both obsessive and compulsive aspects of eating. This study explores, among a sample of overweight/obese women, whether obsessive thoughts about food and compulsive eating are related to body weight, problematic eating behaviors, and coping strategies, as well as to changes in those variables following an intervention. Sixty-eight overweight/obese women were tested before and after an intervention based either on a non-restrictive approach encouraging a higher intake of fruits and vegetables (HIFV), or a restrictive approach limiting high-fat foods (LOFAT). Baseline scores on the EOCS were positively related to rigid restraint (p<.01), disinhibition (p<.001), susceptibility to hunger (p<.001), binge eating (p<.001) as well as emotion-oriented coping (p<.01). High baseline scores on the EOCS were also significantly associated with a smaller improvement in binge eating after the intervention for both groups (p<.01). In fact, among all the variables correlated with the changes in binge eating scores throughout the intervention, the EOCS score was the only significant predictor as determined by a stepwise linear regression (p=.001). Results emphasize the importance of addressing both obsessive (cognitive) and compulsive (behavioural) aspects of eating when treating overweight/obese women, especially in regard to their impact on the evolution of binge eating. 56 Obesity in breast cancer survivors: Evaluating its impact on body-related anxiety and physical activity J. Brunet and C. M. Sabiston McGill University, Department of Kinesiology & Physical Education, Montreal, Quebec, Canada Introduction: Body image can motivate or deter individuals from participating in physical activity (PA). Social physique anxiety (SPA), which refers to feelings of distress associated with the perceived
abstract
evaluation of one’s physique, is a specific dimension of body image. Given that breast cancer survivors (BCS) frequently gain weight after treatment and experience a number of negative side effects (e.g., hair loss, muscle atrophy, scars), they may be vulnerable to experiencing SPA. The objectives of this study were to examine whether overweight and obese BCS report higher levels of SPA than normal weight BCS, and if weight status and SPA influence BCS’ moderate-to-vigorous PA (MVPA) behaviour. Methods: Recently treated BCS [n = 141 BCS; Mean age = 54.6 years; Mean BMI = 26.5 kilograms / (meters * meters)] completed the Social Physique Anxiety Scale, wore an accelerometer for seven days, and had their height and weight measured. results: Analysis of covariance revealed significant differences in SPA according to weight status [F(2,138) = 16.73, p<.001]. Normal weight BCS reported significantly lower levels of SPA than obese BCS. Hierarchical multivariate regression analyses, controlling for age, showed that body mass index (BMI) and SPA predicted 13% of the variance in MVPA, with BMI making a significant independent contribution ( = -.32, p< .001). conclusions: Findings suggest obesity prevention and management programs should be incorporated into treatment programs for breast cancer patients and survivors to prevent excess weight gain and treat those who are currently overweight, and in turn increase MVPA. Also, such programs targeting BCS should seek to reduce SPA. 57 Do neighbourhood built and social environments have an influence on adult self-reported physical activity and overweight/obesity in the nation’s capital? S.A. Prince1, E.A. Kristjansson2, K. Russell3, J.-M. Billette4, A. Ali3, M. Sawada5, M.S. Tremblay6, and D. Prud’homme7 1 University of Ottawa, Population Health PhD Program and Children’s Hospital of Eastern Ontario, Healthy Active Living and Obesity Research Group, Ottawa, Ontario, Canada; 2University of Ottawa, Faculty of Social Sciences, School of Psychology, Ottawa, Ontario, Canada; 3Ottawa Public Health, Ottawa, Ontario, Canada; 4Health Statistics Division, Statistics Canada, Ottawa, Ontario, Canada; 5University of Ottawa, Laboratory for Applied Geomatics and GIS Science (LAGGISS), Department of Geography, Ottawa, Ontario, Canada; 6Children’s Hospital of Eastern Ontario, Healthy Active Living and Obesity Research Group, Ottawa, Ontario, Canada; 7University of Ottawa, Faculty of Health Sciences, School of Human Kinetics, Ottawa, Ontario, Canada background: There is a paucity of Canadian research examining the combined effects of social and built environments on physical activity (PA) and obesity. Purpose: To determine the relationships between built and social environments, and PA and overweight/obesity across 85 Ottawa neighbourhoods. Methods: Self-reported PA, height and weight were collected from 3,883 adults using the International PA Questionnaire (IPAQ) from the 2003-2007 samples of the Rapid Risk Factor Surveillance System. Data on neighbourhood characteristics were obtained from the Ottawa Neighbourhood Study; a large study of neighbourhoods and health in Ottawa. Binomial multivariate multilevel models were used to examine the relationships of environmental and individual variables with PA and overweight/obesity using survey weights. results: Approximately half the sample was categorized as inactive (low/moderate IPAQ scores) or overweight/obese. Multilevel models suggest that for every additional neighbourhood convenience store, men were two times more likely to be physically active and with every additional specialty food store women were almost two times more likely to be overweight/obese. Higher green space was associated with a reduced likelihood of PA and increased odds of overweight/ obesity in men, and decreased odds of overweight/obesity in women. In men, lower neighbourhood SES, higher voting rates, and lower sense of community belonging were associated with decreased odds of
overweight/obesity. Intraclass coefficients were low, but identified that the majority of neighbourhood variation in outcomes was explained by the models. conclusions: Findings identified that green space, food landscapes and social cohesiveness may play different roles on PA and overweight/ obesity in men and women. However, most of the variation remains associated with individual characteristics. 58 Where do teenagers walk? a study of high school students’ action space in the Quebec city metro area N. Bachiri1, C. Després1, M.-H. Vandersmissen2, G. Vachon1, C. Tremblay2, S. Boucher1, M. Ladd1, M. Vallières3, V. Drapeau4, A. Royer5, and N. Alméras3 Groupe interdisciplinaire de recherche sur les banlieues, Université Laval, Ville de Québec, Québec, Canada 1 École d’architecture, Université Laval, Québec, Québec, Canada; 2 Département de géographie, Université Laval, Québec, Québec, Canada; 3Centre de recherche de l’Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Québec, Canada; 4Département d’éducation physique, Université Laval, Québec, Québec, Canada; 5Agence de Santé publique de la Capitale-Nationale, Québec, Québec, Canada While the role of walking in the prevention of childhood obesity has been clearly demonstrated, much less is known about the role played by the built environment to encourage walking among youth. It is often assumed that children live, study, and play in their neighborhood. This, however, is rarely the case because of urban sprawl, of shared custody, of parents choosing not to send their children to the neighborhood school, etc. As a result, the children’s geographical mobility extends way beyond their residential neighbourhoods. Through an Internet survey, our study identified the large action spaces visited by 173 fourth-year students from five high schools in the Quebec City metro area. The teens pointed out the places they visit regularly around their home(s) and school but also elsewhere in the city. In addition, 53 of them were individually interviewed; among these, 50 filled out a travel diary for up to a week (40 for seven days) to describe why and with whom they went to these places, and which routes they took to reach their destinations. Overall, 1,501 destinations were identified: 33% in the high schools’ neighbourhoods, 27% around the homes, and 40% elsewhere in the metro area. Among them, 37.5 % were reached by foot, 33% by car, and 23% using public transportation. Shopping malls, the cineplex, as well as friends’ houses, were popular destinations frequently reached by bus or car. Places reached by foot were fast food restaurants, friends’ houses and groceries stores found mainly near the high schools. A comparative analysis of the street grids, urban functions, and most frequently used walking paths in the neighbourhoods surrounding the five high schools suggests that groupings of restaurants and stores selling food constitute the main attractor for teens to walk, more so than parks or sport fields. The unaesthetic or insecure qualities of walking paths do not seem to detract teenagers from reaching these destinations. 59 Les règlements d’urbanisme : une voie possible pour améliorer l’offre alimentaire autour des écoles C. David and C. Voyer Association pour la santé publique du Québec, Montréal, Québec, Canada ; Coalition québécoise sur la problématique du poids, Montréal, Québec, Canada contexte : La présence de restaurants rapides et de dépanneurs à proximité des écoles favorise la consommation de malbouffe chez les jeunes et a un effet significatif sur le risque d’obésité. Au Québec, 37 % des écoles publiques sont situées à 15 minutes de marche ou moins d’une chaîne de restaurants rapides. Alors que les écoles se dotent de politiques alimentaires saines, l’accès et la proximité des restaurants
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Methods: Thirty-four participants were recruited into the study. Of those, 24 completed three months and 18 completed six months on the program. Five psychological measures (The Arthritis Self-Efficacy Scale, Multidimensional Locus of Control Form, Dieting Beliefs Scale, Body Image State Scale, and Beck Depression Inventory II) were completed at baseline, six weeks, three months, and six months. Change in per cent body weight was also calculated, and the relationship between the per cent weight loss at the different time intervals and scores on the measures was examined. results: At six weeks, the mean weight loss was 9.5% of body weight and 16.2% and 26.3% at three and six months, respectively. There was a statistically significant relationship between weight loss and the majority of psychological variables at three and six months, but there was no consistent pattern at six weeks. Locus of Control was least likely to be affected by weight loss. conclusions: It appears from our findings that a minimum 10% loss of body weight is needed before people report improvement on several psychological measures including those measuring body image and depression. This information is helpful for health professionals advising on weight loss, and for women currently attempting weight loss.
Sick Children between October 2007 and April 2010. Data extracted from the charts included maternal demographics, medical data, and the Edinburgh depression scale score (EDPS), which was completed during the clinic session. results: The study population consisted of 413 women. The average weight for all women was 68.9kg ± 18.2kg, ranging from 40.8kg to 145kg. Thirty per cent of women coming to the clinic had diagnosed depression. Pregnant women with diagnosed depression had a higher average weight compared to pregnant women without known depression (71.8kg ± 16.2kg vs. 65.5kg ± 16.3kg respectively, p=0.036). The Edinburgh depression scale score was significantly correlated with weight (Spearman correlation test, p=0.025). conclusions: There is a strong association between maternal weight and maternal depression, whether diagnosed or not. Since these disorders may adversely affect pregnancy and are treatable, screening and addressing both is essential for healthy mothers and babies.
53
K. Boucher1, M. Daoust1, M.-P. Gagnon-Girouard1, A. Lapointe1, S.J. Weisnagel2, V. Provencher3, A-A. Dufour-Bouchard3, C. Trudeau3, S. Lemieux3, and C. Bégin3 1 School of Psychology, Laval University, Québec, Québec, Canada; 2 Diabetes Research Unit, Laval University, Medical Centre, Québec, Canada, and Lipid Research Centre, Laval University Medical Center, Québec, Québec, Canada; 3Institute of Nutraceuticals and Functional Foods, Laval University, Québec, Québec, Canada
restraint, moderation and the stages of weight selfregulation: Implications for cbt for obesity S. Stotland and A. Beauchemin Montreal Comprehensive Weight Management Program, and McGill University, Department of Psychology, Montreal, Quebec, Canada Restraint theory is a prominent approach to understanding the behaviour of individuals trying to restrict their food intake to lose weight or prevent weight gain. Unfortunately for dieters and would-be weight controllers, this theory predicts that intentional efforts to lose weight (or maintain lost weight) through restraint are very cognitively and emotionally taxing and will likely fail eventually. Restraint theory would appear to predict high rates of dietary lapses and collapses, increased weight fluctuation, and gradually increasing weight over time. In our view, the implications of restraint theory for cognitive-behavioural therapy (CBT) for obesity have not been fully integrated. We shall discuss this issue, and then present a new construct we call “mindful moderation,” which we believe offers a realistic alternative to restraint as a means of weight control. We then consider both restraint and moderation within a new “stage model of weight self-regulation.” The stage model provides a framework for CBT to move beyond the usual goal of strengthening restraint, which may ultimately prove unproductive, to the promotion of weight self-regulation through mindful moderation, which we predict is accompanied by growing feelings of autonomy, competence, and pleasure, which develop as one gains greater “expertise” in weight control. Thus, mindful moderation may represent a new, more functional, or expert “stage” of weight self-regulation, and we predict this will translate into improved long-term weight and emotion outcomes. We will present cross-sectional, longitudinal and clinical data in support of this viewpoint and discuss the key implications for CBT practitioners. 54 association between maternal weight and depressive symptoms A. Walfisch, C. Sermer, I. Matok, A. Einarson, and G. Koren The Motherisk Program, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pharmacology, University of Toronto, Toronto, Ontario, Canada Objective: Both maternal depressive symptomatology and maternal overweight have detrimental effects on perinatal health outcomes. We sought to explore the relationship between maternal weight and depression, whether diagnosed or not. Methods: A retrospective chart review was done of the medical records of all women who attended the Motherisk clinic at The Hospital for
55 Obsessive thoughts about food and compulsive eating among weight-preoccupied overweight/obese women
Obsessive thoughts about food and compulsive eating are related to poorer physical and psychological health, as well as inadequate coping styles and problematic eating behaviours leading to difficulties in body-weight regulation (Bryant et al, 2007; Spoor et al, 2007). The Eating Obsessive-Compulsive Scale (EOCS) is an instrument that examines both obsessive and compulsive aspects of eating. This study explores, among a sample of overweight/obese women, whether obsessive thoughts about food and compulsive eating are related to body weight, problematic eating behaviors, and coping strategies, as well as to changes in those variables following an intervention. Sixty-eight overweight/obese women were tested before and after an intervention based either on a non-restrictive approach encouraging a higher intake of fruits and vegetables (HIFV), or a restrictive approach limiting high-fat foods (LOFAT). Baseline scores on the EOCS were positively related to rigid restraint (p<.01), disinhibition (p<.001), susceptibility to hunger (p<.001), binge eating (p<.001) as well as emotion-oriented coping (p<.01). High baseline scores on the EOCS were also significantly associated with a smaller improvement in binge eating after the intervention for both groups (p<.01). In fact, among all the variables correlated with the changes in binge eating scores throughout the intervention, the EOCS score was the only significant predictor as determined by a stepwise linear regression (p=.001). Results emphasize the importance of addressing both obsessive (cognitive) and compulsive (behavioural) aspects of eating when treating overweight/obese women, especially in regard to their impact on the evolution of binge eating. 56 Obesity in breast cancer survivors: Evaluating its impact on body-related anxiety and physical activity J. Brunet and C. M. Sabiston McGill University, Department of Kinesiology & Physical Education, Montreal, Quebec, Canada Introduction: Body image can motivate or deter individuals from participating in physical activity (PA). Social physique anxiety (SPA), which refers to feelings of distress associated with the perceived
abstract
evaluation of one’s physique, is a specific dimension of body image. Given that breast cancer survivors (BCS) frequently gain weight after treatment and experience a number of negative side effects (e.g., hair loss, muscle atrophy, scars), they may be vulnerable to experiencing SPA. The objectives of this study were to examine whether overweight and obese BCS report higher levels of SPA than normal weight BCS, and if weight status and SPA influence BCS’ moderate-to-vigorous PA (MVPA) behaviour. Methods: Recently treated BCS [n = 141 BCS; Mean age = 54.6 years; Mean BMI = 26.5 kilograms / (meters * meters)] completed the Social Physique Anxiety Scale, wore an accelerometer for seven days, and had their height and weight measured. results: Analysis of covariance revealed significant differences in SPA according to weight status [F(2,138) = 16.73, p<.001]. Normal weight BCS reported significantly lower levels of SPA than obese BCS. Hierarchical multivariate regression analyses, controlling for age, showed that body mass index (BMI) and SPA predicted 13% of the variance in MVPA, with BMI making a significant independent contribution ( = -.32, p< .001). conclusions: Findings suggest obesity prevention and management programs should be incorporated into treatment programs for breast cancer patients and survivors to prevent excess weight gain and treat those who are currently overweight, and in turn increase MVPA. Also, such programs targeting BCS should seek to reduce SPA. 57 Do neighbourhood built and social environments have an influence on adult self-reported physical activity and overweight/obesity in the nation’s capital? S.A. Prince1, E.A. Kristjansson2, K. Russell3, J.-M. Billette4, A. Ali3, M. Sawada5, M.S. Tremblay6, and D. Prud’homme7 1 University of Ottawa, Population Health PhD Program and Children’s Hospital of Eastern Ontario, Healthy Active Living and Obesity Research Group, Ottawa, Ontario, Canada; 2University of Ottawa, Faculty of Social Sciences, School of Psychology, Ottawa, Ontario, Canada; 3Ottawa Public Health, Ottawa, Ontario, Canada; 4Health Statistics Division, Statistics Canada, Ottawa, Ontario, Canada; 5University of Ottawa, Laboratory for Applied Geomatics and GIS Science (LAGGISS), Department of Geography, Ottawa, Ontario, Canada; 6Children’s Hospital of Eastern Ontario, Healthy Active Living and Obesity Research Group, Ottawa, Ontario, Canada; 7University of Ottawa, Faculty of Health Sciences, School of Human Kinetics, Ottawa, Ontario, Canada background: There is a paucity of Canadian research examining the combined effects of social and built environments on physical activity (PA) and obesity. Purpose: To determine the relationships between built and social environments, and PA and overweight/obesity across 85 Ottawa neighbourhoods. Methods: Self-reported PA, height and weight were collected from 3,883 adults using the International PA Questionnaire (IPAQ) from the 2003-2007 samples of the Rapid Risk Factor Surveillance System. Data on neighbourhood characteristics were obtained from the Ottawa Neighbourhood Study; a large study of neighbourhoods and health in Ottawa. Binomial multivariate multilevel models were used to examine the relationships of environmental and individual variables with PA and overweight/obesity using survey weights. results: Approximately half the sample was categorized as inactive (low/moderate IPAQ scores) or overweight/obese. Multilevel models suggest that for every additional neighbourhood convenience store, men were two times more likely to be physically active and with every additional specialty food store women were almost two times more likely to be overweight/obese. Higher green space was associated with a reduced likelihood of PA and increased odds of overweight/ obesity in men, and decreased odds of overweight/obesity in women. In men, lower neighbourhood SES, higher voting rates, and lower sense of community belonging were associated with decreased odds of
overweight/obesity. Intraclass coefficients were low, but identified that the majority of neighbourhood variation in outcomes was explained by the models. conclusions: Findings identified that green space, food landscapes and social cohesiveness may play different roles on PA and overweight/ obesity in men and women. However, most of the variation remains associated with individual characteristics. 58 Where do teenagers walk? a study of high school students’ action space in the Quebec city metro area N. Bachiri1, C. Després1, M.-H. Vandersmissen2, G. Vachon1, C. Tremblay2, S. Boucher1, M. Ladd1, M. Vallières3, V. Drapeau4, A. Royer5, and N. Alméras3 Groupe interdisciplinaire de recherche sur les banlieues, Université Laval, Ville de Québec, Québec, Canada 1 École d’architecture, Université Laval, Québec, Québec, Canada; 2 Département de géographie, Université Laval, Québec, Québec, Canada; 3Centre de recherche de l’Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Québec, Canada; 4Département d’éducation physique, Université Laval, Québec, Québec, Canada; 5Agence de Santé publique de la Capitale-Nationale, Québec, Québec, Canada While the role of walking in the prevention of childhood obesity has been clearly demonstrated, much less is known about the role played by the built environment to encourage walking among youth. It is often assumed that children live, study, and play in their neighborhood. This, however, is rarely the case because of urban sprawl, of shared custody, of parents choosing not to send their children to the neighborhood school, etc. As a result, the children’s geographical mobility extends way beyond their residential neighbourhoods. Through an Internet survey, our study identified the large action spaces visited by 173 fourth-year students from five high schools in the Quebec City metro area. The teens pointed out the places they visit regularly around their home(s) and school but also elsewhere in the city. In addition, 53 of them were individually interviewed; among these, 50 filled out a travel diary for up to a week (40 for seven days) to describe why and with whom they went to these places, and which routes they took to reach their destinations. Overall, 1,501 destinations were identified: 33% in the high schools’ neighbourhoods, 27% around the homes, and 40% elsewhere in the metro area. Among them, 37.5 % were reached by foot, 33% by car, and 23% using public transportation. Shopping malls, the cineplex, as well as friends’ houses, were popular destinations frequently reached by bus or car. Places reached by foot were fast food restaurants, friends’ houses and groceries stores found mainly near the high schools. A comparative analysis of the street grids, urban functions, and most frequently used walking paths in the neighbourhoods surrounding the five high schools suggests that groupings of restaurants and stores selling food constitute the main attractor for teens to walk, more so than parks or sport fields. The unaesthetic or insecure qualities of walking paths do not seem to detract teenagers from reaching these destinations. 59 Les règlements d’urbanisme : une voie possible pour améliorer l’offre alimentaire autour des écoles C. David and C. Voyer Association pour la santé publique du Québec, Montréal, Québec, Canada ; Coalition québécoise sur la problématique du poids, Montréal, Québec, Canada contexte : La présence de restaurants rapides et de dépanneurs à proximité des écoles favorise la consommation de malbouffe chez les jeunes et a un effet significatif sur le risque d’obésité. Au Québec, 37 % des écoles publiques sont situées à 15 minutes de marche ou moins d’une chaîne de restaurants rapides. Alors que les écoles se dotent de politiques alimentaires saines, l’accès et la proximité des restaurants
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