From Our 2009 Archives
Fattest State Weighs Its Options
Once Again the Nation's Heaviest State, Mississippi Grapples With Its Growing Girth
Reviewed By Louise Chang, MD
July 1, 2009 -- It's official, again. For the fifth year in a row, Mississippi is still the nation's heaviest state -- ground zero for obesity in the U.S.
That's according to a new report, F as in Fat 2009, issued today by the nonprofit Trust for America's Health in partnership with the Robert Wood Johnson Foundation.
Topping the obesity charts is getting to be a habit for Mississippi. And that's prompting some navel-gazing in the state.
Here are eight steps two Mississippi mayors and a Mississippi endocrinologist say it will take for Mississippi to put the brakes on obesity.
1. Address the environment.
Yes, personal choices about diet and activity are important. But if there's no healthy food available at affordable prices, and no place to exercise or even take a walk, that's a problem.
"I am not here to tell you to be healthy or force you to be healthy. I'm just here to give you an opportunity for it," Chip Johnson, mayor of Hernando, Miss.," I have to put that opportunity out there, and if the people don't take advantage of it, that's their choice."
Johnson says Hernando, which is located about 12 miles south of Memphis, Tenn., has a population of 15,000 people and is in Mississippi's Delta region.
"Mississippi is the fattest state in the fattest nation in the world at the fattest time in all of history, and the Delta is the fattest area of our state. So we're right here, smack-dab in the middle of the fattest thing going on," Johnson says.
2. Spring for sidewalks.
Gene McGee, mayor of Ridgeland, Miss., says his town (population: 23,000) mandates sidewalks for new subdivisions. "That, hopefully, encourages families or individuals to walk in the subdivisions," McGee tells WebMD.
In Hernando, Mayor Johnson says grants will pay for sidewalks to be installed in the city's poorest neighborhood, and crumbling sidewalks elsewhere have also been upgraded.
Johnson says he's seen more people walking on the new sidewalks. "It's like that movie -- if you build it, they will come," he says.
3. Spruce up parks.
"I think it's very important to encourage communities to have facilities such as multi-use trails or parks that encourage physical activity," says McGee, noting Ridgeland's system of multi-use trails for biking, jogging, or walking.
Johnson says in Hernando, volunteers rehabbed an overgrown football field and track at a burned-down high school, turning it into a site for youth football and soccer and a place for neighborhood residents to walk and jog.
4. Reframe obesity.
Obesity shouldn't be thought of as a personal failure or sheer gluttony, but as a "chronic medical condition," says Gabrial Uwaifo, MD, FACP, FACE, an endocrinologist at the University of Mississippi in Jackson, Miss. Uwaifo wants obesity to be covered by insurance, not paid for out of pocket.
5. Step away from the fryer.
Uwaifo, who moved to Mississippi two years ago from the Washington, D.C., area, says he was surprised by how Mississippians eat.
"I was amazed at how virtually everything was fried," Uwaifo says. "I've seen oranges dunked in oil" as well as fried bananas and apples.
Uwaifo isn't ruling those foods out totally, but he says if they're dietary staples, "it could be dangerous for your heart, it could add up over time."
6. Launch a public health blitz.
That's something Uwaifo wants to see happen. He likens it to the antismoking public campaign.
"Just the same way we finally got people to understand that the Marlboro Man looked good but all that smoking wasn't good for him and will kill him eventually. That's the sort of public health onslaught I think needs to be put out regarding food. People need to understand that we do end up being what we eat," Uwaifo says, cautioning that messages should be tailored to different ethnic populations and age groups.
"It has to be handled sensitively and carefully. It cannot be one-size-fits-all," Uwaifo says.
If Mississippi really steps up to the plate by making a major commitment to tackle obesity, the state could end up being an obesity underdog. Given the high rate of obesity, even small changes could make a "measurable impact," Uwaifo notes.
7. Make healthy food available and affordable.
This hasn't been as simple as putting in sidewalks. Mississippi is one of the nation's poorest states, and as Uwaifo points out, "as long as it's far cheaper to get high-fat, high-carbohydrate, simple starchy things, whatever public education you put out there is not going to work. People finally have to work with what is in their pocket."
Johnson points to a new farmer's market -- all with local food -- on the Hernando town square on Saturday mornings that is proving popular. It's within walking distance of poor neighborhoods and also draws people from up to 60 miles away, says Johnson, adding that the city's poorest neighborhood also has a new community garden.
But he's not happy with the choices at local stores in certain neighborhoods.
"We still don't have healthy foods accessible in our lower-income neighborhoods," Johnson says.
"People who don't have a car and who walk to the corner market for their meals, well, their only options are the fried chicken and the fried pizza sticks and all that stuff sitting there in the counter. When you go in these corner stores, there's no fresh vegetables. There may be a brown banana laying there, that's the best you can hope for. So we're trying to encourage that, and that part has not happened here yet," Johnson says.
8. Walk the walk.
"Setting an example for people is very important," says McGee, who is an avid cyclist, covering 100-150 miles per week on his bike. But he wasn't always like that.
"When I started cycling, I was probably 35 pounds over what I am right now," he says. Taking up cycling "helped me to lose weight, and it also taught me that to exercise, I've also got to eat right, and so I've learned to turn down those foods that aren't good for you."
National Obesity Findings
Mississippi is in the least desirable spot on the obesity list. But other states don't have much room to crow.
The report shows rising adult obesity rates in 23 states, and no states with declining adult obesity rates.
That's better than last year's report, which showed rising adult obesity rates in 37 states. "We're still getting fatter but maybe a little more slowly than before," James Marks, MD, MPH, senior vice president of the health group at the Robert Wood Johnson Foundation, said today in a news conference.
For perspective, only one state -- Colorado -- has an adult obesity rate of less than 20%. But in 1991, no state had an adult obesity rate over 20%, and in 1980, the national average of obese adults was 15%.
State Adult Obesity Rankings
Here is the average percentage of adults who were obese from 2006 to 2008, according to CDC data cited in the report. States with the same percentage of obese adults are listed together.
State Childhood Overweight and Obesity Rankings
Here is the report's list of the percentage of children 10-17 in each state and Washington, D.C., who are overweight or obese. States with the same percentage of overweight or obese children age 10-17 are listed together.
Those rankings are based on data from the 2007 National Survey of Children's Health.
SOURCES: Trust for America's Health and Robert Wood Johnson Foundation: F as in Fat 2009: How Obesity Policies are Failing in America. Chip Johnson, Mayor, Hernando, Miss. Gene McGee, Mayor, Ridgeland, Miss. Gabriel Uwaifo, MD, FACP, FACE, associate professor, division of endocrinology, University of Mississippi Medical Center, Jackson, Miss. James Marks, MD, MPH, senior vice president, health group, Robert Wood Johnson Foundation. News release, Trust for America's Health.
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