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For the first time in history, more than half of the global population lives in cities, and almost four in ten adults are overweight or obese. With obesity and urbanisation on the rise, the built environments in which we work and live are increasingly recognised as having a profound influence on our well-being and waistlines.

Our cities are not designed for health and ‘obesogenic environments’ which encourage people to eat unhealthily and do little exercise, have been recognised by the National Institute for Health and Care Excellence (NICE) as playing a role in obesity. Examples of obesogenic environments include urban spaces that promote driving over walking, offices and shops with prominent lifts and escalators but staircases hidden away, and high streets, stations and cinemas which are dominated by shops selling fried chicken, burgers, sugary drinks and sweets.

The health threat is most pronounced among poorer communities in wealthier countries and in low- and middle-income countries (LMICs). In Sri Lanka, a country experiencing rapid urbanisation, adult obesity prevalence is already almost threefold higher in urban than rural populations.

Jessica Renzella and Alessandro Demaio’s editorial in the British Journal of Sports Medicine recommends the use of health-promoting urban design to ensure the easiest and preferred options for transport, housing and diet are also the healthiest. They stress the need for city planners and health professionals to work together and cite the Amsterdam Healthy Weight Programme which is based on a framework that supports shared responsibility for overweight and obesity across all policy areas at the city level, and collaboration between the Public Health Service and the Department of Physical Planning.