Big cities win out over smaller communities when it comes to healthy, happy residents, and it's largely because of sidewalks, parks and good public transport, according to a new survey.
The top five cities in the report might not immediately shriek "healthy living" to the average Americans, but they score high on important health measures, the report from Gallup and Healthways found.
The cities include: Boston, San Francisco, Chicago, New York and Washington, D.C.
"Residents in these top five communities have, on average, significantly lower rates of smoking, obesity, diabetes, high blood pressure, high cholesterol and depression compared with those in the five lowest-ranked active living communities," Gallup, the polling group, and consultant firm Healthways said in a statement.
The bottom five cities were Tulsa; Durham, North Carolina; Indianapolis; Oklahoma City and Fort Wayne.
The four key components the group identified are walkability, easy biking, parks and public transit.
The two organizations have been working together for years to identify and quantify the elements that help people incorporate healthy behaviors into day-to-day living. They build on a large body of research that finds exercise, access to green spaces, healthier eating and lowered stress really do translate into lower rates of disease and longer, healthier lives.
Many public health groups, along with the federal government, are trying to help and encourage communities to do what they can to get Americans out of their cars and off their sofas; and to help them ditch the junk food in favor of fresh fruit and vegetables.
The big cities identified by Gallup and Healthways often have had these attributes by virtue of how they grew over the decades. But smaller cities without the natural infrastructure can make changes, the survey of 149,938 people in 48 cities found.
For instance, Albert Lea, Minnesota, boosted its well-being score, Gallup said.
"Albert Lea established more than 10 miles of bike lanes and new sidewalks, and enhanced streets to support walking and biking," the report reads.
"The city adopted policies to reduce tobacco use, and started workplace programs to promote health and social interaction. Grocery stores, restaurants, schools, and workplaces made changes to make healthy choices easier; and several restaurants added outdoor dining areas."
Smoking rates fell between 2014 and 2016 -- along with a drop in rates across the nation. More people ate fresh produce and even community pride rose, the report said.
The findings fit in almost directly with polls by other groups. The American College of Sports Medicine consistently ranks Washington as the fittest or one of the fittest cities in the U.S., alongside Minneapolis. Last place often goes to Indianapolis or Memphis.
More than two-thirds of Americans are overweight or obese. Americans have high levels of heart disease, diabetes and other obesity-related diseases, including certain cancers.
Federal dietary guidelines aim to get people to eat more vegetables, less fat and salt and to exercise more. The U.S. Institute of Medicine recommends that Americans get at least 60 minutes a day of moderate exercise, such as brisk walking.
But that can be difficult in areas with no sidewalks, parks or other recreational areas.