Troubled by a bum knee, Duke thought she might feel better if she lost weight. So when her co-workers at Alexandria High School formed a team for Scale Back Alabama — a statewide weight-loss program — she signed up. She lost 50 pounds.
“I had a lot of help from my daughter-in-law, who’s into fitness,” Duke said. “I was using a stationary bike, eating a lot of protein. I felt good.”
And then it happened. While helping out with the school’s Special Olympics effort — Duke was pushing a wheelchair — she injured her knee, and had to have surgery. Then her 84-year-old mother broke her hip, and needed care. Life, with its chaos, overtook her diet plan.
“I’ve gained it all back,” she said with a chuckle.
Duke is far from alone in her struggle to stay slim. State and federal statistics show that Alabama is among the fattest states in the Union — a problem with deep roots in Southern and American culture, and a problem that may branch out into costly medical epidemics. Despite growing anxiety about our spreading waistlines, statistics suggest that Alabama is a state that can’t seem to keep the weight off, no matter how hard it tries.
When Bonnie Spear started working as a nutritionist 33 years ago, everybody knew that diabetic children had Type 1 diabetes — the kind that happens when the pancreas mysteriously stops producing enough insulin. Only adults got Type 2, the kind often associated with a lifetime of overeating.
These days, kids with Type 2 are common. Spear, who works at UAB Hospital, said kids make up nearly half the Type 2 patients now referred to UAB’s nutrition experts.
“That’s unnerving,” she said.
No one seems to know, for sure, how long the country’s waistline has been expanding, but there’s ample evidence that Alabama has been at the forefront of the phenomenon. When the Centers for Disease Control began collecting information on obesity through a national survey in the mid-1980s, Alabama and its Southeastern neighbors quickly rose to the top of the rankings, with more than 10 percent of Alabamians considered obese. As of 2010, 32 percent of Alabamians were considered obese, putting Alabama among 12 states — most in the Deep South or Appalachians — where more than three in 10 are obese. Only Mississippi and West Virginia have a higher rate.
The CDC numbers are based on a telephone survey that asks people, among other things, to report their height and weight. And those findings are supported by another national study, one that actually weighs and measures the height of randomly selected volunteers.
Throughout their lifetimes, Bonnie Spear’s young diabetes patients can expect to use the public health system much more than they would if they were at a lower weight — and so can thousands of older Alabamians who are considered obese.
According to a study by Emory University, if national obesity trends continue, obesity-related spending could make up 21 percent of all health care spending by 2018. Another study, by the nonprofit Campaign to End Obesity, says that the country’s last 25 years of weight gain may be responsible for 11 percent of current Medicaid costs nationwide. The study didn’t identify costs for Alabama specifically, but Alabama’s total Medicaid budget for 2012 was $643 million.
Still, that’s just money. Bonnie Spear has more troubling statistics in mind.
“If this keeps up, at some point, the life expectancy numbers for these young people are going to have to be revised downward,” she said.
The mystery of Southern fatness
It’s hard to fix a problem when you don’t know what’s causing it.
Everybody knows what causes an individual person to gain weight. If you eat more and exercise less, you get fat. Or, at least, you get fatter than you were.
But that doesn’t explain why millions of people are consuming more calories, and failing to exercise, all at the same time. Or why the South leads the way in this epidemic.
But by most indications, we’re in this boat together — in a way that crosses Alabama’s often harsh lines of race and income. Nationwide, CDC statistics show, black people more likely to be obese than white people — but according to numbers from the State Obesity Task Force, white men and black women in Alabama are almost equally likely to have weight problems.
Poverty, one of Alabama’s endemic problems, goes hand-in-hand with unhealthy weight in almost every study. And there are even studies that show that devoutly religious people, regardless of race or income, are more likely to be overweight.
That’s led many researchers to speculate that our shared food culture — a Southern cuisine that’s high in starch, heavy on meat, with large portions — is to blame.
If traditional Southern fare is the issue, why did the obesity epidemic emerge only in the last 25 years? And why is the rest of the country gaining weight, too?
“It’s a strange problem, given that for a long time, in our thinking about the South, the problem was hunger,” said Ted Ownby, director of the Center for the Study of Southern Culture at the University of Mississippi. “There was a report that New Deal agencies put out that named malnutrition as the biggest health problem in the South.”
Historically, Ownby said, Southerners have always set out big portions of corn, pork and seasonal vegetables — when they could afford to. Then, bellies full, they’d go out to work a long day in the fields.
Then the economy changed, from farm work to indoor work. And it kept changing. Manufacturers moved to more profitable climes, but Southerners maintained a stubborn love of place.
“An awful lot of Southerners drive long distances to their jobs,” he said. “The South’s economy is based not on picking up your belongings and moving, but on driving a longer time to work. That’s not the normal definition of a sedentary lifestyle, but the effect is the same.”
Machines, not humans
But Ownby, like most people who have studied the issue at length, is reluctant to name one single factor.
“It’s a number of things,” said Miriam Gaines, director of the State Obesity Task Force, run by the Alabama Department of Public Health.
Gaines said the lack of “incidental exercise” is one problem. People used to walk to the post office, or to school, she said. But cities aren’t built for that anymore. A Jacksonville native, Gaines cited Anniston Middle School and Jacksonville High — both on the outskirts of their cities — as examples.
“In Anniston you’ve got a beautiful school, but it’s out there between Anniston and Jacksonville,” she said. “Who could walk to school when it’s way out there?”
Jack Plunk agrees. He’s the principal planner for the East Alabama Regional Planning and Development Commission, the agency that plans the area’s future transportation policies. Plunk says that in the past 50 years, Americans have built their cities around cars. The result, he said, is that it’s almost impossible to get around on foot in some places.
“Our cities are made for machines, not for humans,” he said.
And the problem is worst, he said, in the South, where there was a lot of available land and plenty of people willing to live outside the city center.
“If you look at a picture of Noble Street from the 1940s, you’ll see lots of people walking,” he said. “There were residences on Quintard. It was a city where people expected to walk.”
All the old rules of weight control still apply. People who eat while watching TV are fatter, Gaines said, and many families have a TV in every room. Kids don’t play outside anymore, she said, in part because of video games and in part because of parents’ fear of strangers. Portion sizes are getting bigger and bigger, she said, and people no longer bother to learn what a proper portion size is.
It’s the stuff your mama used to lecture about, the stuff your doctor might lecture about today. But lecturing doesn’t always work, Gaines said. Bigger changes may be needed.
“In a lot of communities, you don’t feel safe riding a bicycle. We keep telling people to get out and ride a bike or walk, but we don’t offer a lot of support for that.”
Let them eat cake
For decades, Alabama was the starving state — poster child for New Deal and Great Society programs designed to end hunger. It was no surprise that the people in the country with the least money also had the least food.
Today, the Black Belt counties — the poorest in the state, and among the poorest in the nation — have the highest rates of obesity. It’s a seeming paradox that no longer befuddles most economists.
“People who are poor will buy high-calorie, high-energy food because it’s cheap,” said Tannista Banerjee, a health economist at Auburn University. “With $2 or $3 to spend, you can buy a meal that seems filling, but isn’t very healthy.”
Gaines put another way: If you have $5 to feed your family, and a fast food restaurant offers five roast beef sandwiches for $5, you’ll pick that over fresh fruit every time.
“You want your family to be full,” she said.
Alabama is one of a handful of states that charges a sales tax on food, but Banerjee said she didn’t know whether the higher food prices discourage consumption, or make the obesity problem worse.
“If anyone has studied the effect of this tax, I haven’t heard of it,” she said. Banerjee said most studies showed that modest price hikes had little effect on shoppers’ choices — with one exception.
“Shoppers, and particularly people who are overweight, are sensitive to the price of fresh fruits and vegetables,” she said. Lower prices on veggies, she said, might encourage more consumption.
Big plans, small money
These days, the fight against obesity is everywhere, and it’s nowhere.
Early-morning TV ads sell diets with evangelical zeal. First Lady Michelle Obama makes the rounds of talk shows, pitching fresh food and exercise. Bold warning labels remind us that bottle of lemonade contains no vitamin C.
And every day, we see folks like Joe Jankoski out for a run.
“I know it sounds strange, but running kind of slows you down,” he said. “It’s a great way to focus, and it makes you better able to handle the problems that come up through the day, and makes you a better person in that way.”
A former soldier, Jankoski was already a runner before he moved to Calhoun County. He knew there were prominent local running events, and he knew — in the back of his mind — that his fellow runners were mostly white and affluent.
So he started We All Run, a program to bring the sport of long-distance running to Anniston High School. Jankoski, who is white, is careful to point out that he’s not on a mission to rescue anybody at mostly black Anniston High. He just wants to remove the barriers, whatever they are, that keep most local people out of the sport.
Jankoski has a handful of kids in training now for August’s Woodstock 5K. Local businesses will pick up the entry fees and will pay for the incentives. Kids who train get free running shirts and shorts. Kids who finish the race will get a free pair of running shoes.
Like many runners, Jankoski says he’s a goal-oriented person. But with this project, he’s set his sights on the long term. If a few kids get addicted to running, he said, it’s worth it.
“It’s very easy to complain about things,” he said. “But we can all roll up our sleeves and get to work locally, and eventually we’ll solve the problem.”
But if there are many foot soldiers in Alabama’s war on obesity, there’s no clear general. Gaines’ group, the State Obesity Task Force, is the one state agency tasked with drawing up the battle plan. It has no state funding and is run by volunteers from various state government agencies, nonprofits and hospitals. Indeed, it probably wouldn’t have even been created without a push from Bonnie Spear, the UAB nutrition expert.
“I realized that the CDC was giving grants to states to fight obesity,” Spear said. “But to get the grant, you had to have a statewide strategy to deal with the problem. We didn’t have anything.”
In 2007, the first task force met and hammered out a plan. It’s heavy on encouraging local initiatives like the one Jankoski has started. The task force never got the CDC grants it had hoped for because CDC money ran out before the plan was completed, task force members say.
Despite the late start, Gaines says the task force is actively helping local groups work on small, long-term changes. It helped get a grant for a walking club at Jacksonville State, and another for Auburn architecture students who plan to create walking trails in a south Alabama town. Project by project, Gaines said, they can change Alabama for the better.
And then there’s Scale Back Alabama, another project headed by Gaines. Every year, Alabamians team up for the weight-loss contest, weighing in during January and pledging to lose a pound a week until March.
Some, like Pleasant Valley High School teacher Cerilla Roe, see lasting progress. Roe said she lost 12 pounds last year, and gained back only four.
“I don’t know if I look different,” Roe said. “But I feel better.”
Gaines says she doesn’t know how many contestants, like Cathy Duke, gain it all back after the contest.
“That’s something we’d like to study,” she said. “But we just haven’t had the money for that.”
Assistant Metro Editor Tim Lockette: 256-235-3560. On Twitter: @TLockette_Star.