A group of men do pull-ups at an outdoor exercise area in the Bronx. REUTERS/Mike Segar

The annual ranking of fittest cities doesn’t address important inequalities.

The new American Fitness Index report ranks the overall fitness of the country’s 50 most populous cities. Topping this year’s list: Washington, D.C. In last place: Indianapolis.

How Do You Measure Fitness?

The project—a collaboration between the American College of Sports Medicine and the Anthem Foundation—doesn’t determine rankings solely based on individuals’ behaviors, such as daily exercise. Yes, cities do score points for residents’ workouts and veggie consumption, but they're also graded on infrastructure that supports healthy lifestyles, including number of recreational facilities, prevalence of farmer’s markets, and acres of park land. For instance, in D.C., 95 percent of residents are less than a 10-minute walk from a local park. Only 31 percent of Indianapolis residents can say the same.

Even cities that earned high marks—such as Sacramento and Portland, Oregon, ranked fifth and seventh, respectively—have a long way to go. In Portland, for instance, nearly 70 percent of residents fail to meet the aerobic exercise guidelines established by the Centers for Disease Control and Prevention.

(AFI Report)

Walter Thompson, chair of the AFI advisory board and a professor of kinesiology at Georgia State University, hopes that the rankings will be a “call to arms,” encouraging lagging municipalities to up their game.

It’s a good idea. But it’s not enough. We need to be talking about the structural  and social forces that contribute to health disparities.

What’s Missing From the Equation

Income inequality. There’s enormous inequality between—as well as within—the cities that are ranked. In D.C., for example, the median household income is $65,830. In Indianapolis, it’s nearly $24,000 less: $41,962. Plenty of research has shown that low-income neighborhoods have limited options for outdoor physical activity—and when there are parks within walking distance, factors such as crime, traffic, and unsafe equipment can limit their accessibility.

Plus, low-income neighborhoods tend to have higher concentrations of fast-food chains and can lack full-service grocery stores that stock fruits, vegetables, whole grains, and low-fat dairy. (However, a handful of programs in D.C., New York, Chicago, and Denver are seeking to encourage corner stores to sell more fresh produce in “food deserts.”) The USDA reports that more than 3,000 farmer’s markets accept SNAP benefits—even so, residents who work multiple jobs or have inconsistent access to transportation may have trouble getting to them.

Food literacy. Exercise is important, sure. But when it comes to reducing obesity, a leading risk factor for stroke, heart disease, and diabetes, tweaking diet may be more effective than exercise—or even the combination of diet and exercise. A number of recent studies have indicated that since exercise stimulates hunger, people tend to consume more post-exercise calories than they burn. This cycle can even result in a net weight gain. Families also can’t cook healthy meals if they don’t know what foods are best to include. Programs that teach and empower families to buy and cook affordable, nutritious food at home could go a long way towards encouraging healthy, lifelong habits. One example: Share Our Strength’s Cooking Matters, which focuses on comparing unit costs to find the best deals on whole grains and produce, then preparing a four-person meal for less than $10.

Unused infrastructure. When it comes to mountains and oceans, cities either have ‘em or they don’t—Indianapolis is not suddenly going to become a mecca for hardcore hikers. But what cities may lack in natural wonders they can make up for in built environments that are conducive to activity. The problem is, even when those are constructed, they’re not necessarily used. In Memphis, for instance, residents can ride more than 60 miles of bike lanes. But they don't: Less than two percent of residents bike or walk to work. The Tennessee city ranks second-to-last on the AFI report. Urban residents tend to report satisfaction with their local parks and rec facilities—but we need to figure out how to get more people to use them.

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