Who Is The Fattest Of Them All?

Patricia Salber

First posted 7/20/11 on The Doctor Weighs In

What state has the highest rate of obesity in the land?  If you guessed Mississippi, you would be correct.  For the seventh straight year, Mississippi tops the list of the “Fattest States in the Nation.”  When they first took possession of this top ranking of one of the nation’s most infamous lists of unhealthiness, the rate of obesity was just 19.4%.  Now, they are almost unbeatable with a (whopping) rate of 34.4%.  Congratulations, Mississippi.  You are the fattest of them all.

Most people knowledgeable about obesity in the US know that is it going to take a multi-pronged effort to reduce obesity – one of the leading causes of death in this country because it is the fuel for Type 2 diabetes and associated conditions, such as hypertension, heart disease and stroke.

Folks who don’t really understand the complexities of obesity like to blame the fatties – you have heard it:  “they have no will power, they don’t exercise, they don’t this and they don’t that.”  These “personal responsibility advocates” are not willing to put on the table societal contributing factors, such as the following:

• Ubiquitous presence of fast food restaurants and their seductive advertising ploys
• Lack of full service grocery stores in some low income neighborhoods – you  can buy alcohol in its various forms, but not fresh fruits and vegetables
• Lack of health literacy – because this is not a priority in our schools
• Poverty – a Big Mac may be cheaper than a couple of tomatoes from the farmer’s market
• Exercise-unfriendly neighborhoods – unsafe streets, no exercise facilities, no support

I could go on and on, but I think the socioeconomic and political atmosphere of our Fattest State helps to explain Mississippi’s long-standing hold on the “Fattest State” title:

“Mississippi is the most obese state in the nation, but Republican Gov. Haley Barbour says it doesn’t need another layer of bureaucracy to study the issue.   Barbour has vetoed a bill that proposed creating a 34-member council on combating obesity. He said it duplicates programs that have been in place for years.  “This bill simply adds to the fat of state government,” Barbour wrote in his veto message, which was signed Tuesday and released Wednesday [Associated Press, April 27, 2011].”

Nah, we don’t need any government intervention.  Let “the people” do what they want even if it means Mississippi adults and children have diabetes, hypertension, stroke and heart attacks at higher rates than almost any other state in the nation.  What the heck, it is their choice, right?  If “they” only wanted to stop eating too much, they would. If they wanted to stop smoking bad enough they would.  They must be really, really, bad irresponsible (etc. etc.) people.

We used to honor the concept of Public Health in this country.  Public health’s foundation is based on looking at epidemiologic data to determine root causes of preventable disease: study a problem, determine the contributing causes, ameliorate them, and restudy to see if the intervention made a difference. We made great strides when our nation invested in and responded to Public Health initiatives.  (Think eradication of polio, food borne illnesses, reductions in the rates of high cholesterol and some forms of heart disease.)

But now it seems our repudiation of all things governmental trumps knowledge and science.  The talk show hosts seem to have convinced people that it is preferable to die of preventable illnesses rather than give up any god-given right to eat, drink, and smoke whenever, wherever and whatever they want.

I am not sure how this happened.  Is it because we are no longer rigorously educating our young people?  Is it because journalism/journalists have become so politicized that no story, even one about an important public health issue, can be presented without a left/right wing spin?  Is it because we simply don’t care anymore (geez louise, I hope this isn’t the case).  But I do know that we have to come together somehow and seriously address the obesity crisis – hopefully in a more productive way than we have been addressing the debt crisis.

We need some brave leaders, with thick skin (and some independent funding) to lead the way….and  we have to have the collective “guts” (pun intended) to support them.