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Land of the fat
Obesity kills 300,000 people a year in America and is the nation's number-one health
hazard. Nowhere is this more true than in Mississippi, where food is cheap and
exercise unheard of. Matthew Engel visits the heaviest state of a country that is in
danger of busting the scales.
Matthew Engel
Thursday May 2, 2002
The Guardian
It is one of those silent, brooding mornings in a small Dixie town: already hot and
humid just after breakfast- time. There is hardly anything here: just a shop, a filling
station and a building with a sign saying Total Fitness, though judging by the rusty
chain holding the padlock, that has been closed for a long time. There is hardly
anyone about either, and they all move slowly: partly because of the heat, partly
because they cannot do otherwise. The average weight of the population appears to
be around 20 stone. The name of the place, without a word of a lie, is Chunky,
Mississippi.
The US has what has widely been described as an obesity epidemic. And Mississippi
is the sickest state in the country. More than 62% of its population meet the accepted
definition of being overweight, and 24% are officially obese. These figures are certain
to be understated because the information comes mainly from phone surveys, and
people tend to lie about their weight. But they always did lie; and still the rates
have
almost doubled in a decade.
Obesity is now said to be responsible for 300,000 American deaths every year -
that's 100 times the number killed on September 11 - and it eats up 12% of all the
US's healthcare costs: $100bn a year. Mortality increases by up to a quarter for the
overweight, and can double for the obese, never mind those described as
"supermorbidly obese". Last month, the US tax authority formally recognised obesity
as a disease, allowing patients to claim for the cost of prescribed weight-loss
treatments. This disease causes heart attacks, strokes and diabetes. As a health
problem, it now far outstrips drinking and smoking.
Manhattan and San Francisco may be full of joggers and rich young things rushing to
see their personal trainers before dawn. But any European who penetrates the very
different Bible-bullets-and-Big Mac America that exists outside these sophisticated
cities will spot the symptoms at once. Many of the people there no longer walk; they
waddle. Most of the time they prefer to sit. In Mississippi, 33% of adults take no
exercise at all.
The other half of the equation can be seen in any restaurant. The word "sandwich"
conveys something more like a large loaf: Americans believe they are being swindled
if they are not served portions that would disgust most Europeans. A middle-aged
Englishman, mildly concerned about his paunch, can look around the room and feel
like Gulliver in Brobdingnag: a midget amid a race of giants.
It would be fitting if Chunky were the true Fat City: Ground Zero of this catastrophe.
But there are plenty of other contenders in Mississippi alone. The problem is known
to be acute in the river delta, where mechanisation took away the harsh old jobs in
the cotton fields. The Overeaters Anonymous class in Tupelo has a valid claim for
the title of America's corpulence capital, as does the office handing out food stamps
to welfare claimants in Meridian (next to Sam's Fashion, which sells 58-inch waist
trousers).
The clientele on the slot machines in the Starlight Lounge of the casino on the
Choctaw reservation in Neshoba County are fairly substantial, though they are
outweighed by the customers of the Piggly Wiggly supermarket next door, where the
Choctaw shop. There may be nowhere at all to match aisle 10 in Piggly Wiggly's,
between the Brown Cow ice-cream ("swirled with thick, rich chocolate syrup") and the
giant-sized packs of bacon-and- cheddar fries.
The worst of this will not be in the rich white suburbs. Mississippi is used to coming
first - or last - in national league tables. Usually, it is ranked number one among the
states for poverty, and 50th for education. Both are relevant. But Mississippi is not
unique. Its obesity figures are only slightly worse than several other states: not
only in
the south (Colorado, with its mountain air and bike paths, is at the other extreme, at
about 13%). The worst-affected community of all is said to be the Pima Indian tribe of
Arizona. The US is not even the most obese nation on earth: in parts of the South
Pacific, such as Western Samoa and Nauru, the slender have been driven almost to
extinction.
Dr Alan Penman, an epidemiologist with the Mississippi department of health, prefers
not to use the word epidemic. "That implies something that comes and goes," he
says. "What we have here are normal adaptations to the kind of environment we now
live in. It's Darwinian. Everyone is at risk, if not actually affected, because we have
created what some people have called an obesogenic environment. The Americans
have done it very well, better than anyone. And it's not going to go away for
generations."
Chief among the probable causes of the crisis is prosperity. The old correlation
between poverty and starvation is no longer relevant in the US, a country where it is
exceptionally cheap and easy to eat large quantities of bad food. Indeed, it can be
difficult to do anything else: supermarkets have a far less sophisticated selection
than in the UK, especially in poor areas, and a huge proportion of space devoted
solely to snacks. American consumers are bombarded with far less of even
thespurious health information found on British packets ("85% fat-free" - ie 15% fat).
The price of a double whopper with cheese is coming down, though its calorific value
(1,060) is not.
Black women aged 45-54 (56% of whom are obese in Mississippi) are the worst
affected of all. But the epidemic, or Darwinian adaptation, affects all sections of
society: black and white, male and female, rich and poor, old and - most worryingly -
young. Obesity rates among American children are rocketing, and both the US and
the UK have recently observed the first childhood cases of type two diabetes, a
disease formerly confined to the rotund middle-aged.
Penman comes from Ayr, and recognises in Mississippians some of the
characteristics that have given the Scots similar, if milder problems: a taste for
fried
food, and a distaste for exercise. Many of the causes are endemic to all western
societies: sedentary jobs, irregular mealtimes, couch-potato children. But he is
confident that things will never get as bad in Britain as they are in the US.
For a start, in some parts of the country, Americans have eliminated not merely the
need to walk, but even the possibility of it. "I'd love to be able to walk to the
store,
pick up some milk and come home again, but our towns don't really allow that,"
laments Mary Gilmore, a dietician in Meridian. The distances are too great, the
pavements non-existent. In the sprawling suburbs and small towns, public transport
is often as rare as in an English village. In any case, it is almost impossible to
carry
the milk: it usually comes in gallon containers (a US gallon is four-fifths of a UK
gallon). In a country where the cost of packaging exceeds the cost of the food,
buying any other way is far more expensive.
This does not apply only to milk. Gilmore runs classes to encourage people not to
diet - which rarely works in the long term - but to change their lifestyles. Her
students,
many of them now disarmingly svelte, were reminiscing for me about how they
became fat. "One of those bars is a dollar and six cents, but a six-pack is only two-
fifty," one of them, Judy, was saying. "I like a lot for my money." Unfortunately, I
had
missed the start of the sentence. "Frozen Snickers," she repeated. "Go try."
Frozen Snickers are not particularly Mississippian, but other items are: fried catfish,
crawfish, shrimp and oysters; even fried green tomatoes and fried dill pickles (rather
tasty, actually). Plus lashings of sweet iced tea ("the house wine of the south"). Even
the local attachment to religion is unhelpful. "Church puts a lot of weight on folks,"
according to Candace, another class member. "There are regular social occasions,
and food is always there, and you don't want to offend people by refusing what
they've brought. We have a lot of family reunions, too. We even overeat at funerals.
There are casseroles, and people put in cream of chicken soup, tons of Velveeta
cheese, bacon and ..."
"Hush, Candace," said Bill, across the room. "You're making me hungry."
The attraction of Gilmore's class is that she does not rule out casseroles or even
Frozen Snickers. She advises regular sit-down meals - which happen less and less
in societies where mothers have full-time jobs - and regular exercise, however light.
She calls her programme "10,000 Steps", the number she thinks people should take
a day, and hands out pedometers to help them keep count. Some of her clients have
dropped as low as 1,200: sub-sedentary, she calls them. Most people must use 300
just going to the toilet and back.
In Mississippi, there is also the climate, which for half the year is too enervating to
make any activity attractive. Before air conditioning, it was as easy for kids to play
outside as in; now it is easier to justify their inactivity.
The state is only just starting to wake up to the problem: a bill to reintroduce
compulsory PE in schools failed in the legislature this year, when schools
complained that they did not have the time or resources to implement it. The
popularity of American football means many parents are happy to see their boys gain
weight, even if it is fat, not muscle. And the grandmothers are pushing in the same
direction: many of them remember when poverty in Mississippi really did mean
starvation.
Dr Ed Thompson, the state health officer, feels a sense of frustration at dealing with
a disease that cannot be cured by normal medical means. "We've protected society
from many communicable diseases. But we're now dealing with lifestyle decisions,"
he said. "We can immunise you, we can keep malarial mosquitoes away from you,
we can give you clean water. But we can't exercise for you. In the end, the individual
has to make the choices. We want to make it the norm to have a healthy body
weight. How do we achieve that? As soon as I figure out how to achieve world peace,
I'll tell you."
"You can't just put out messages saying, 'Eat Less. Exercise More,' " says Penman.
"That only works for the worried well. You have to create an environment where
people make those choices without thinking."
But as things stand, everything in American society is heading in the opposite
direction. Britain is to some extent protected by its lack of space and stern planning
laws. American developers, meanwhile, can put up houses however and wherever
they want, and communities are becoming ever more car-oriented. What's more, the
fast-food industry is going through what USA Today calls "drive-thru mania", with
80% of the growth going in sales to customers who have cut out, of their alleged
10,000 a day, the 50-odd steps to get from the car park to the counter and back. This
applies even to such unlikely companies as Starbucks and 7-Eleven. "I don't like
getting out of my car," a Californian single mother told the newspaper. "Who does?"
The health professionals are doing little to buck the trend. Gilmore's class takes
place in a hospital building with a drive-through pharmacy. The Mississippi health
department, where Thompson and Penman work, has just moved into a new four-
storey office block. Except in emergencies, it is effectively impossible to use the
stairs.
Guardian Unlimited � Guardian Newspapers Limited 2002
End<{{{
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