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Our children are in trouble.

Despite significant advances in medicine, nutrition and technology, they are heavier, less active and more susceptible to heart disease, high-blood pressure and diabetes, among other conditions.

Nationally, obesity rates for U.S. children range from a high of 44.4 percent in Mississippi to 23.1 percent in Minnesota and Utah.

North Carolina ranks a far-from-respectable 14th, with more than 33 percent of its children ages 10 to 17 classified as obese or overweight. In Guilford County, an alarming 44 percent of elementary-aged children are overweight, reports Jason Hardin in today's front-page story.

How we got this way

Some of the contributing factors are obvious: our children are exercising less and eating bigger, less-nutritious meals. They are also reflecting the similarly unhealthy tendencies of their parents. According to the Trust for America's Health and the Robert Wood Johnson Foundation, adult obesity rates increased in 23 states over the past year and did not decrease in any state.

At the same time, the percentage of children who are obese or overweight is 30 percent or higher in 30 states.

It's easy to see why. You can buy a burger these days stacked with as many as four beef patties, plus cheese and bacon. And many of us do.

But this is not only a nutritional issue, it is a planning issue. How we grow our cities can affect how we grow our young. And how healthy the total community is.

Planning our way out

That includes creating a more walkable community that not only provides safe places to stroll and bike for exercise or fresh air, but also to actually go places.

Greensboro has an impressive array of trails and paved paths for walking and cycling. But the current, 80-mile network is scattered and disjointed. And it rarely takes you to a practical destination.

The city's biking and walking paths are centered in parks and along flood plains and typically don't connect. They are destinations in and of themselves -- ironically, we have to drive there for an opportunity to walk there.

The key is not seeing the trails as parks but as transportation networks for human beings.

"A survey says the current greenways aren't being used because they're not convenient to where people live and want to go," Durham-based greenway advocate and designer Chuck Flink told the News & Record.

"If they can get connected up," Flink says of Greensboro's greenways, "and be linear to downtown in a meaningful way, I think more people will use it and in a way other than for just health and fitness."

In other words, walking to the store instead of having to drive would be both healthy and convenient.

Design for people, not cars

Too many times in the past, transportation planning has treated people as afterthoughts, centered on what's best for cars, not necessarily human beings.

If you could actually ride your bike to work on a greenway path, rather than having to fend against cars and SUVs and cranky drivers, Flink says, then maybe you would.

The proponents of Greensboro's downtown greenway make a good point when they cite its health benefits as one advantage, among others, such as boosting real estate values. And the city is making progress toward that vision.

Work began two weeks ago on a $1.2 million pedestrian underpass for the stretch of the "rail trail" planned along Battleground Avenue.

The addition of more sidewalks and bike lanes throughout the city are encouraging as well, as is a downtown design guide that stresses an appeal to pedestrians.

Healthier choices

No one is suggesting sidewalks and greenways as a panacea for obesity, among children or adults.

Other factors are equally, if not more important.

They include providing more nutritious public school menus, a cause the state has been reluctant to invest in, encouraging young people to get out and get active, and avoiding the allure of fat-laden burgers and fries in super-sized portions.

Parents can set better examples by practicing healthier habits themselves.

As the debate over health care reform rages on, one thing is clear: The nation's health care mess is not merely a product of greedy drug companies and cold-hearted insurance bureaucracies. It's also the product of unhealthy choices and lifestyles.

Choices that more and more of our children are paying for as well.