NYC MDs: Tackling Obesity Takes Systemic Change and Safer Streets

So it looks like the lasting media image from last week’s City Council hearing on bike policy will be Marty Markowitz’s string of non-sequiturs sung to the tune of “My Favorite Things.” The routine was allowed to proceed even though committee chair Jimmy Vacca began the hearings with a call for decorum at all times. (Maybe that’s what prompted NYC Greenmarket founder and car-free Central Park pioneer Barry Benepe to observe, “The entire process appeared to be staged for the benefits of the loudmouths.”)

Linda Prine
Linda Prine

After Markowitz had his moment, dozens of other people came to testify with less camera-ready but more substantive comments. One of them was Linda Prine, a primary care physician who works for a network of New York City-based health centers called the Institute for Family Health. She also heads up the Manhattan chapter of the New York State Academy of Family Physicians. Streetsblog had a short chat with Prine this week about what led her to testify.

Prine and a group of colleagues who cycle regularly (they call themselves “biker docs”) began meeting and strategizing early this fall about how to promote active transportation. “Those of us who are in primary care are struggling with what to do with obesity and the health problems that come with it,” she said. “One of the good pieces of data about exercise, is that people who incorporate exercise into their commute have a better likelihood of actually exercising regularly.”

The biker docs came to the conclusion that promoting physical activity was “a systems problem,” Prine said. One doctor at a time telling patients to exercise won’t change habits on a large scale, but “making systemic changes like putting in bike lanes gets more people to bike.”

The day of the City Council hearing, Prine presented a letter from her and more than 150 medical professionals to Mayor Bloomberg supporting the continued expansion of the city’s bike network.

The biker docs are also taking their message out to peers in the medical community. Prine will be giving a presentation this Friday to the Beth Israel family medicine department, making the case for policies that promote biking and walking. Other biker docs will make similar presentations at Mount Sinai, Bellevue, and Montefiore medical centers.

You can read the letter to Bloomberg as a PDF and follow the jump for Prine’s testimony to the Council.

Testimony Dec 9th Linda Prine MD

I am a family physician practicing in lower Manhattan in a Federally Qualified Health Center, one of the types of practices that are expected to double in capacity under health care reform.  In health care, we are dealing with an obesity epidemic. Obesity contributes to diabetes, heart disease, high blood pressure, joint problems and depression.

The medical community has seen the amazing public health benefits that the stop smoking initiatives of the Mayor and City Council have had on the smoking rates in NYC.  We have learned from this that systemic change does much more than one doctor at a time telling one patient at a time to stop smoking.

Studies show that commuting to work by walking or biking is one of the most effective ways to lose weight and stay fit.  Exercise is good for joints, hearts, muscles, memory, and even effective against depression.  But most people can’t find time to exercise, and don’t manage to do it just because doctors tell them to.  Exercise by commuting, however, is much more plausible for most busy New Yorkers.  Cities with a high percentage of the population getting to work by bike correlate with cities with a low rate of obesity.

Biking to work is a good thing in so many ways:  less dependence on oil, cleaner air, more exercise for the individual, less need for parking spaces, less crowding on subways…  It is really hard for me to conceive of how there could be opposition to making this a priority for New York City.  Our gridlock of cars and trucks is unhealthy.  It clogs up our air, it causes many of the 250 plus traffic deaths every year, it promotes a sedentary lifestyle, and it uses up our public space with heavily trafficked streets and parking spaces.  This public space could be put to much better use, the way the Broadway mall has beautified the Times Square area.

Biking lanes provide a safe passage for those of us who bike to work.  I bike to work every day and now get to happily use the new Columbus Avenue bike lane.  I take it from 93rd street to 77th street.  Then, I take my life in my hands from 77th street to 33rd street until the 9th Avenue bike lane begins.  At that point, I feel safe again and can travel the rest of the way to East 16th street on bike lanes.  On the way home, I take Sixth Avenue in a skinny and unprotected bike lane until it disappears north of 44th street.  That upper section of Sixth Avenue is really scary, with cars easily going 50 miles an hour. I breathe a big sigh of relief when I hit Central Park and the rest of my commute home is lovely.

Biking to work for me is essential to my health.  I have two sisters who are several years younger than I am, and they both need medication for high blood pressure and high cholesterol and they both weigh about 100 pounds more than I do.  These are the genes that I have, too, but I don’t have the same medical consequences because I bike 5 miles or 40 minutes twice a day, every day, to and from work.  It would take me 40 minutes to get to work anyway, and this way I get my exercise done for the day.

Over half of New Yorkers who drive cars to work are going 5 miles or less!  Most of these are going 3 miles or less.  These people could be walking or biking to work.  Imagine how much that would cut down on traffic, add to the health of these individuals, and make our air cleaner.  But when I ask my patients why they don’t bike or walk to work, they answer that the streets in their neighborhood are not safe for biking and sometimes not even for walking.

Anyone who cares about the health of New Yorkers must understand the importance of promoting bike travel.  European cities have made it happen and collected the data on health benefits.  New York should lead the rest of the US, as they have in providing mass transit and as they have in stopping smoking, by making biking a safe commuting option for our residents.  And, as we know from the stop smoking campaign, this requires systems changes like congestion pricing, more bike lanes, lower speed limits, increased parking fees, speed cams, bike parking lots, bike racks on busses, car-free parks and so on.

I hope to see some brave leadership from the City Council’s committee on Transportation in order to make New York a safer and healthier city.  More and better bike lanes is a good way to start.

In talking to you today, I want you to know that I represent the New York County Chapter of the NY State Academy of Family Physicians.  We have more than 100 family physician, resident, and medical student members in Manhattan.  We hope that you will help us make New Yorkers healthier; physicians can’t really do it alone.

Linda Prine MD
President, NY County Chapter of the NY State Academy of Family Physicians
Institute for Family Health
16 E. 16th Street NY, NY 10003

  • Doug

    Markowitz is a political genius, it seems. He takes defeat (from every perspective) on the PPW lane and parlays it into a total media victory with the bike hearings. The advocates need to step up to get the meetings back on their turf.

    I love this testimony. I got flak from my step mother, who is also a doctor, about the “dangers” of biking.

  • J. Mork

    Wonderful post, Dr. Prine. Thanks for your testimony.

    My only suggestion is to try 8th Ave.

  • When is the Montefiore talk?

    Also, on the suggestions tip, I suggest the Hudson River Greenway via 91st St entrance through Riverside Park, then get out at W 18th St, at the Gehry building.

  • CW11 did a segment on Markowitz last night. He got to sing his little song. Literally no airtime was given to the opposing point of view — not even the usual short soundbite to serve as a figleaf of propriety.

  • Emily S.

    Excellent testimony by Dr. Prine. Thank you for posting.

  • Joe R.

    Dr. Prine makes great point-namely that the best way to get exercise is to make it incidental to your daily routine. Whether you walk to stores, bike to work, and even just take public transit ( which doesn’t go door-to-door ), you’re getting exercise you simply wouldn’t get using an automobile.

    One point not being emphasized strongly enough in my opinion is the severe impact motor vehicles have on air quality. Not only is this air pollution the cause of asthma and various cancers, but its presence detracts from the quality of life. It may very well prevent people from engaging in outdoor activity who otherwise might. This is why in conjunction with reducing motor vehicle use, the city should pass a law mandating that only zero-emission vehicles may be operated within the five boroughs by a certain date. The date will depend upon the state of development of electric vehicles, but offhand I would say 2020 sounds good. This is more than enough time for people who wish to drive to either purchase a new electric vehicle, or retrofit their existing one. Besides cleaner air, such a mandate would create a huge market for electric vehicles. One of the excuses frequently heard from auto manufacturers regarding their failure to produce electric vehicles is supposed lack of demand. Assuming this is true ( even though the popularity of the defunct EV1 says otherwise ), a mandate in a place like NYC would mean huge captive demand. That in turn would give efficiencies of mass production which would allow EVs to be sold at prices on par with gasoline cars. Given that some segment of the population will need to use motor vehicles, it makes sense to make sure they don’t impact air quality when they do.

  • BicyclesOnly

    Good point on the “lifetime fitness” aspect of cycling, Linda and Joe. I’ve been trying to get my son’s school to soften their emphasis on team sports and gymnasium activities in the PE curriculum and include a unit on cycling as some schools (notably, Spence) do. For kids living in the city, activities like softball and soccer, no matter how intrinsically fun and character-building they may be, are extremely unlikely to become sources of daily exercise in later life. In the city, getting together ten to twenty friends with free time at once and finding a place to play is not that easy. Competition even for basketball courts is fierce, and often my daughter and I have visited three courts before finding a place to play.

    My son’s and daughter’s schools both have stationary “exercycles” in their gyms, but again, most city dwellers don’t have space to keep one of those in their home. Unless you buy a gym membership, most gym equipment is inaccessible.

    In contrast, cycling is a low-impact areobic exercise that is accessible to the most out-of-shape person from the very first–once you learn how, it’s easier than running. And by incorporating it into your commute, you can keep it part of your daily regimen your entire life.

  • JamesR

    Joe R, what would you do about the thousands of vehicles that pour into the city daily from Long Island, Jersey, Westchester, and CT? I don’t see how you’d be able to implement such a mandate without an any regional governance structure in place, as those who really want to own cars more than they want to live in NYC will just move to the suburbs and commute in.

  • Joe R.


    That’s not as hard as you would think given that there are relatively few major highways/bridges to get into the city. Just turn anything with a tailpipe around at city limits. For the few who might somehow sneak in on local streets, vigorous enforcement would solve the issue.

    Ideally you’re right-a regional or even national mandate makes more sense. Of course, try that and the automakers will give every excuse why they can’t convert their fleets to 100% zero emissions within a decade. The real reason isn’t that they can’t, but rather that they want to continue to use the machines they have to make ICE vehicles until the machines wear out. Also, there’s an enormous spare parts business with ICE vehicles which would mostly disappear if we went to EVs. Bottom line is Detroit makes far more on gas guzzlers. Until we can change the economics of that model, perhaps with a carbon tax, the automakers will fight any ZEV mandates tooth and nail. But make no mistake. The emissions from motor vehicles cause a greater annual death toll than collisions do. I read a figure of 600,000 annually once but I can’t find the link to the report.

  • matt bikes

    When are the other presentations? Also today (Friday)? I can’t pass this along to my doctor friends who work at Bellevue if I don’t know when the talk will be.

  • The other presentations are not yet scheduled, they will be in the spring. I will see if there is some way to post them here.
    As for my route to work, I do take the greenway in the warm weather, but I broke my ankle sliding out on a patch of ice on the greenway a few winters ago, so I don’t take it when the temperature is below 35.
    And as for the air quality issue, it is a public health problem, too. Children who live along the Cross Bronx Expressway and the BQE have more asthma than other kids. I’d say it’s a social justice issue, too, since it’s the poorer neighborhoods that these polluting thruways traverse.


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