A July 20 Health article about Colorado's efforts to keep its residents fit incorrectly described the "complete streets" concept. Governments that follow the policy ensure that all roads built or reconstructed permit safe bicycling and walking -- but not necessarily that they include bike and jogging paths. (Published 7/21/04)

DENVER -- On a sunny summer afternoon, the paths, trails and waterways of Washington Park are approaching human-powered gridlock as Denverites leave work and head outside for their daily fitness fix. Nearly every square foot of asphalt is being used by walkers, joggers and sprinters, bikers and bladers, scooters, skateboards and roller skis (that is, cross-country skis on wheels).

Young parents push strollers as they glide along on roller skates. Canoes and kayaks jostle for paddling room. Soaring soccer balls and flitting Frisbees fill the air.

This kind of frenetic outdoor action is part of daily life for Denver -- and indeed for the whole state of Colorado, where physical activity is a central element of the culture. And this culture of fitness is making Colorado a national model as public health officials gear up for a coast-to-coast war on obesity.

"In some places, people gather around the water cooler and talk about the play they saw the night before, or a new TV show," notes Ned Colange, the state's chief medical officer. "In Colorado, the talk is more likely to be somebody's new personal best for the 5K [run], or the snow conditions at the ski areas."

This statewide zeal for active outdoor living has its rewards -- particularly around the waistline. For years now, federal studies have consistently ranked Colorado as America's thinnest state. The federal Centers for Disease Control and Prevention says that about 16.5 percent of Coloradans meet the clinical standard for obesity -- the lowest percentage of any state.

For most states, the obesity rate is over 20 percent. For 2002, the latest available period, the District had an obesity rate of 21 percent; Virginia rated a portly 24 percent; and Maryland ranked among the more svelte states, with 19 percent of its residents obese. The stoutest state in the union, according to the study, was West Virginia, with an obesity rate of 28 percent.

And as the nation faces up to what is now recognized as an epidemic of overweight and obesity, the experts are studying what Coloradans are doing right in the battle against the bulge.

"We are convinced there are things for all of us to learn here," said Elias Zerhouni, director of the National Institutes of Health, during a Denver visit. "The health consequences of obesity are spreading. We are committed to stopping this epidemic. And we think Colorado has some approaches that we can usefully apply all over the country."

Tall Order

Some of Colorado's advantages, of course, would be difficult to replicate elsewhere. The nation's highest state -- it has 54 mountains taller than 14,000 feet, the nation's highest paved highway (over the peak of Mount Evans) and several world-class ski areas -- is blessed with a moderate climate, with sunshine more than 340 days per year and bright, and warm afternoons even in the depths of February. Rainy days are rare. Winter snow tends to fall for an hour or so and then give way to sunshine.

The result is that Coloradans have a lot of mountains and forests to play in, and year-round good weather for playing. "Every winter, I'm amazed how many snow tires I sell for bicycles," said Denver mountain bike mechanic Don O'Connor. "You know, the snow stops, the sun is out, and people want to ride. And the studded tires work okay, if you're very gradual when you use the brakes."

These gifts of nature make for a sort of virtuous cycle that many states would envy.

"The fact is, we attract healthy, active people just because the opportunities for physical activity are so abundant here," observes Richard Krugman, dean of the medical school at the University of Colorado. "So you have an active population to start with, and a lot of the in-migration is people who are healthy and athletic as well. In terms of a state's public health, that's a pretty good formula.

"The population is a little younger than average, too, and better educated," Krugman goes on. "And those cohorts tend to have lower rates of obesity."

The penchant for exercise, and lots of it, comes as naturally to this state as sipping Coors beer or cheering for the Broncos. Several states now sponsor mass summer bike rides, generally designed to follow a flat route along river valleys. Colorado's annual "Ride the Rockies," in contrast, charts a course up and over the Continental Divide. This year's trek crossed two 12,000-foot mountain passes in the course of a six-day, 600-mile tour of the high country. Some 2,000 riders made the trip this summer, another 5,000 applicants were turned away.

Almost every Colorado city is now crisscrossed with bicycle paths serving most major destinations, with clear signage and free maps to encourage their use. Greater Denver has hundreds of miles of paved paths, leading to office centers, parks and all major sports stadiums. Denver International Airport has bike racks outside its doors, and there are usually a few bicycles parked there, even though the airport is a 20-mile ride from downtown. Almost all public transit systems in the state have bicycle carriers on every bus.

And the official encouragement of an active lifestyle goes right to the top. This spring, Gov. Bill Owens summoned the state capital press corps to his office and announced that he intended to stop using elevators and climb the stairs whenever he could. Announcing a new state program he called "Frequent These Flights," the governor urged all his constituents to switch to stairways as well.

"Colorado continues to have the leanest residents of any state in the nation, and we want to keep it that way," Owens said.

Leading by Example

But in an era of supersizing and Cinnabons, Colorado has found that an outdoorsy tradition and official exhortations may not be enough to keep weights under control. Although it has held on to that cherished ranking as the thinnest state, Colorado has seen its obesity levels increasing each year for the past decade. And so the state has launched a series of official programs and planning efforts to help its citizens keep off the pounds.

These programs are the ones that Zerhouni, the NIH director, has in mind for national application.

The University of Colorado Medical School has developed a campaign to get people to walk more. The "Colorado on the Move" program, designed by the medical school's James Hill, aims to convince people to eat 100 fewer calories and walk at least 2,000 steps more each day. The state hands out free pedometers, or step-counters, by the tens of thousands and then helps communities plan daily walks.

"The idea is that 2,000 more steps will make up for the additional calories in the normal American diet these days," says Colange, the state medical director.

To emphasize the importance, the governor and most members of the state legislature pledged to stick to the program -- although some legislators joke that the main change they made is walking rather than driving to lunch.

This walking program is one of the Colorado initiatives scheduled to go national. The new "America on the Move" program, with a big push from the federal government, got a major boost this spring when McDonald's began handing out free pedometers and information on the walking campaign with its new "adult" Happy Meal.

It has been widely reported that the American suburb is dangerous to public health, because standard street layouts virtually require the use of a car and make it difficult for residents to get anywhere by foot or bicycle. This is another area where Colorado is helping provide the nation new strategies for the fight against fat.

With a grant from the Robert Wood Johnson Foundation, a key player in the anti-obesity campaign, the developers of a major new planned community are building a suburb designed to help control residents' weight . The Stapleton development, on the site of Denver's former airport, will extend across 4,000 acres -- about one-third the size of Manhattan -- and provide housing for about 30,000 people. It will have schools, shopping and offices, with everything connected by a network of walking and biking trails. There is even something called a "walking school bus" -- that is, a safety officer who shepherds groups of children on the walk to school each morning -- to discourage parents from running Johnny over to school in the car.

"Since we had the chance to start from the ground up on this project, we decided to try to cure some of the problems of the standard suburb," says Stapleton's Michael Leccese. "In this community, the basic idea is that you walk to school, walk to shopping. The car is an afterthought. We don't have any of those huge garages on the front of the house like the normal suburban home. We have put all the garages in alleys in the back of the house, so you walk out your front door and just keep walking.

"The lots are smaller than usual, so the place feels compact," Leccese continues. "There are parks just a couple minutes' walk from every door. What we're building here is a model community that makes human-powered transit primary, and the automobile a fallback."

Another Colorado concept that is beginning to go national is the idea of "Complete Streets." This is the principle that any new or repaired street or highway should include bike and jogging paths.

One striking application of this idea is the 35-mile segment of Interstate 70 that winds through the Colorado River gorge called Glenwood Canyon. When this highway segment was widened to four lanes in the 1990s, planners added a separate bicycle path -- in some narrow places, it is literally hanging from the side of the highway -- now recognized as one of the most dramatic mountain bike rides in the state.

Such initiatives make it easier for Coloradans to get where they are going without a car. And that clearly appeals to an active, outdoors-oriented population.

"Yeah, I own a car, but I feel guilty about it," said Keith Malone, a slender, 44-year-old investment adviser who works in downtown Denver and lives in the suburb of Englewood, some eight miles from his office. "I get to work by bike or blade almost every day. If it's snowing, I ride to the bus stop and put my bike on the rack [on the bus]. On the weekend, I like to take my bike up to the mountains, or join the mob riding around Washington Park. You know, that's just the way we live out here."

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In Glenwood Canyon, a 35-mile bicycle path cuts between the Colorado River and I-70 (for aerial view, see inset). Planners added the path to a highway widening project in the 1990s. Colorado's idea that no road is complete without a recreational path is spreading. Two women practice yoga al fresco in Denver's Washington Park. The state's zeal for active outdoor living has brought health rewards.