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What happened?

Fellowship Story Showcase

What happened?

Picture of Kate Long

West Virginia is among the top five on just about every national chronic disease list. The state leads the nation in diabetes and obesity, according to the Gallup Healthways poll.

Surveys show that many West Virginians do not realize obesity is a leading cause of many chronic diseases. Many also feel those diseases are hereditary, and there is nothing a person can do to prevent them.

The state's children raise major red flags for the future. West Virginia University screens thousands of schoolchildren every year. In 2010-11, they found that 24 percent of fifth-graders have high blood pressure, 26 percent have high cholesterol, and 29 percent are obese. Eighteen percent of kindergartners and 23 percent of second-graders are obese.

There has been little public discussion of this problem. "The Shape We're In" project aims to stir up that discussion. Written and photographed by Annenberg fellow Kate Long, it will be divided into three parts in The Charleston Gazette, the state's largest newspaper:

• Children at risk
• Programs that work
• Communities making a difference

Some segments will be accompanied by West Virginia Public Radio pieces.

Part 1: "This is a public health emergency"

Part 2: A growing problem

Part 3: Putting the pieces together

Part 4: Health officials say W.Va. can reverse its chronic disease numbers

Part 5: W.Va. man: diabetes programs work

Part 6: "Get kids moving"

Part 7: Daily activity affordable, Department of Education says

Part 8: Wood researchers: Active kids do better academically

Part 9: Rocking the gym at 7:30 a.m.

Part 10: Nebraska school district lowers obesity rate

Part 11: What happened?

Part 12: 'Everyday heroes' saving own lives

Part 13: W.Va. ranks first in heart attack, diabetes, eight other categories

Part 14: Success from scratch

Part 15: Great Kanawha food fight

Part 16: Better focus

Part 17: W. Va. slammed with sugar

Part 18: Glenda and Jill vs. diabetes

Part 19: This is how bad diabetes can be

Part 20: Recognize diabetes before it's too late

Part 21: Logan hardest hit by diabetes

Part 22: Even if your relatives had diabetes, you don't have to

Part 23: Body and spirit

Part 24: American Diabetes Association is MIA in W.Va.

Part 25: Young people contending with diabetes

How, why, when did W.Va. pack on the pounds?
The Charleston Gazette
Saturday, February 25, 2012

CHARLESTON, W.Va. -- More than 30 years ago, Ric McDowell helped start a Lincoln County summer camp for low-income kids. "When we first started," he said, "we had skinny campers. We were always trying to find ways to get food into them."

Then in the early '90s, "we started getting heavier campers," he said. "We weren't sure what to make of that." By the mid-'90s, almost all their campers were heavy.

McDowell was watching the national obesity epidemic happen. It began in the mid-1980s, about the time those heavier campers were born.

"I'm sure it's more complicated than this, but convenience food and fast food appeared in Lincoln County in the early '90s," he said.

"Pizza came first," he said. "Now, when people have the choice of McDonald's or cooking at home, it's McDonald's."

Then along came No Child Left Behind, the federal education law. Teachers were pressured to get kids ready for achievement tests, and "schools cut back on phys ed," McDowell said. They also stopped offering home-ec classes. "Kids don't learn to cook anymore."

Many parents also quit cooking, he said. "When we were trying to raise money for the camp, I suggested a potluck dinner, and people said, 'That won't work. People don't cook anymore. They pick up stuff.'

"Sometimes when I stop for gas at a convenience store, I watch people picking up what I assume is their breakfast. Cookies and chips and wrapped doughnut sticks, and I think of the chemical ingredients in that food. Who knows what we're taking into our bodies? Who really knows why this is happening?"

Have we always been this way?

Have West Virginians always been heavy? Is it our culture?

"That's just not historically accurate," said Ron Lewis, a longtime West Virginia University professor who specializes in early West Virginia history. "It's been the opposite."

In the early 1900s, magazine writers traveling through the Appalachian Mountains used words like "lean," "slab-sided" and "stomachless" to describe people they met there, Lewis said.

"They all said, 'Here is your prototypical mountaineer: long, lean, lanky, high endurance.'"

"A fat mountaineer is a curiosity," Horace Kephart wrote in 1913. "The hill folk even seem to affect a slender type of comeliness."

"A hundred years ago, life was hard and punishing for most people," Lewis said. Men worked the fields and ranged the hillsides, hunting and trapping. "Food was a full-time job."

"Today, doctors urge us to get our bodies moving," he said. "A hundred years ago, nobody needed to urge people to be active. If they weren't active, they didn't eat.

"Now they tell us not to eat processed food so we won't have a heart attack. Processed food didn't exist back then. They burnt up every calorie they ate."

Until the 1980s, few West Virginians are overweight in archival photos. In the 1960s and 1970s, during the poverty war, Americans got used to seeing pictures of bone-thin West Virginians on the evening news.

Only 13.4 percent of Americans were obese then. Nobody was measuring obesity in West Virginia. There seemed no need to do so.

Now, one in three West Virginians is obese, at higher risk of diabetes, heart attack, stroke, and other conditions their ancestors didn't worry about.

The price is huge. In 2009, in "The Future Costs of Obesity," health care economist Ken Thorpe reported that obesity-related diseases cost West Virginia $668 million in 2008. That number will rise to $2.4 billion by 2018, conservatively, he said, if nothing changes.

How did this happen?

In the late 1970s, Dr. Bob Walker -- now state Health Sciences chancellor --worked as a primary care doctor in rural, mountainous Lincoln County. "Families tend to pass a diet down through generations, he said, "and historically, our diet was geared to hard work. Work caused people to burn a lot of calories, timbering, farm work, coal mining, labor of different kinds.

"Rural people often got up early and ate an enormous meal, generally biscuits, gravy, eggs, bacon. They'd pack a high-carbohydrate, high-fat lunch in a pail to take with them, to sustain them through the day.

"So our diet has definite historical roots. The problem is, those kinds of jobs have disappeared, and we haven't changed the way we eat. So now we take in a lot of calories and fat that don't get burned off."

In the mid-1980s, Americans -- including West Virginians -- started gaining weight. On the national obesity chart, the rate stays steady until the late '80s, then the line zooms upward. Between 1980 and 2000, national obesity doubled.

Why? Nationwide, scientists and researchers say that, starting in the 1980s, Americans were overtaken by a perfect storm of:

  • Processed food: Manufacturers developed cheap calorie-dense, microwavable foods.
  • Food marketing: Food advertising saturated the airwaves.
  • Soda pop: In 1997, the average American consumed 53 gallons of soda pop, a 51 percent increase over 1980.
  • Extra calories: From 1971 to 1974, the average American man took in 2,450 calories a day. By 1999-2000, it was 2,618.
  • Eating out: In 1977-78, people ate 18 percent of their food away from home. By 1994, that was 32 percent.
  • Fast food: Portion sizes kept growing
  • Microwaves: Families and schools quit cooking.

At the same time, Americans became less active:

  • Twenty six percent of Americans -- and 32 percent of West Virginians -- now get no exercise at all off the job.
  • Most West Virginians now work lower-activity jobs.
  • In many families, both parents work.
  • In 2009, more than 60 percent of West Virginia high school students got no physical education. Many schools have cancelled recess.
  • In 1969, 48 percent of American children 5 to 14 walked or biked to school.  By 2009, it was 13 percent.
  • Computers, TV and other screen activities keep kids inactive.

As Americans grew heavier, West Virginians grew heavier faster. Sometime between 1980 and 1992, West Virginia crossed above the national average.

Why? Appalachian researchers and historians say West Virginia faces particular challenges that accelerate the national trend:

  • Chronic poverty. In counties where more than 35 percent of people are obese, the poverty rate ranges from 20 to 40 percent, compared with 18 percent statewide.
  • Education level. In the heaviest counties, six to 12 percent of people attended college, compared with 17 percent statewide.
  • Environmental risks in water and air. West Virginia University researchers have documented an association between lung cancer, heart disease, and birth defects and proximity to coal mining operations.
  • Isolation. The heaviest counties tend not to be near Interstate highways.

As West Virginia's weight rose, more West Virginians developed chronic diseases associated with obesity, until the state led the nation in diabetes, heart attack, hypertension and kidney failure.

In 2011, the federal Centers for Disease Control released a map of counties with the highest diabetes rates. A deadly swath cuts down through the Appalachians to the Gulf Coast, almost exactly overlapping the "obesity belt." 

Almost every West Virginia county is firmly inside both belts.

Back to the 1900s

In the early 1900s, historian Lewis said, West Virginians died mostly of contagious diseases such as tuberculosis, pneumonia and influenza. Today's killers -- diabetes, heart disease and hypertension -- were low on the radar screen. Contagious diseases killed people before chronic diseases could.

As West Virginia has gotten a grip on contagious diseases, chronic disease rates have risen.

"The way we think about eating, culturally, makes a difference too," Lewis said. Through the first half of the 1900s, West Virginians associated fat and eating with prosperity and health, he said. "When people thought of a fat person, they thought of a rich person." During the Depression, "eating was even more strongly associated with good health.

"Food also has powerful social meaning in our culture," he said. "West Virginia's rural history is filled with church socials and community dinners. People show love and hospitality with food. It's often a gift of sorts, and it's up to you to show your appreciation by eating a lot of it.

"That worked OK as long as people stayed physically active," he said.

Through the '50s, into the '70s, he said, "we still had an active culture." Children still played outside all day. Most rural people raised gardens.

But the culture itself has changed. In the 1980s, fewer West Virginians raised gardens and more people had desk jobs, "but people still kept that traditional association between eating heartily and health."

By 2008, the average West Virginian was 20 pounds heavier than he or she was in 1998. The diabetes statistics began to climb. "Something went out of balance," Lewis said.

"The way we eat is in some ways a product of our history and culture, mixed with modern advertising," Dr. Walker said. "That does not suit us well as we move into modern life where we drive a four-wheeler instead of walk up the hill and use a chain saw instead of a crosscut saw.

"We've got to find ways to talk about that, as a state."