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Social Determinants of Health

The Case of the Potential New Tenant

Bui, Simonetti, Benson, Malek and Anderson

Published 11/30/2014


A 47-year-old man with obesity and type 2 diabetes presents to your clinic for a follow-up visit.  His hemoglobin A1C’s have ranged 8-9% while taking glipizide and metformin with good adherence.  He has had several failed attempts at losing weight. He eats fast food several times a week and cites broken sidewalks as excuse for not walking.  He also works long evening and night shifts as a security guard for an office building downtown.  He and his wife are searching for a new apartment because of noisy neighbors.  His physical examination reveals a BP 118/72, BMI 45.  Your main concern is his elevated A1C and obesity. Though he agrees with your concern, he does not wish to begin insulin therapy.

You should spend this visit discussing:

a) The importance of seeing a dietitian

b) Carb counting and exercise options

c) The need to start insulin

d) Access to healthy food sources, distance from fast food restaurants and proximity to recreational facilities when looking for his next apartment


Fast fact:

Greater availability of chain fast food restaurants may promote greater fast food consumption in low-income groups.  Providing or increasing awareness of the availability of parks, playgrounds, or open space may decrease the odds of obesity, especially in ethnically diverse neighborhoods.  Access to recreational or playground facilities and more walkable neighborhoods lead to increased physical activity, decreased sedentary behavior, or lower BMI. Proximity to supermarkets might not influence diet quality or promote more fruit and vegetable intake.


  • Boone-Heinonen J, Gordon-Larsen P, Kiefe CI, Shikany JM, et al. Fast food restaurants and food stores: longitudinal associations with diet in young to middle-aged adults: the CARDIA study. Arch Intern Med 2011; 171(13): 1162-70.
  • Sulllivan SM, Brashear MM, Broyles ST, Rung AL. Neighborhood environments and obesity among Afro-Caribbean, African American, and non-Hispanic white adults in the United States: results from the National Survey of American Life. Prev Med 2014; 61:1-5