- Marion T. Stevens
Obesity has emerged as one of the leading causes of death in the United States of America. In the Bible belt (Southern States) obesity is very common which complicates health and the economy as well as treatment to individuals. Furthermore, obesity in the southern states is a result of culture, economic status and ethnicity. According to Akil (2011), obesity is basically a manifestation of energy imbalance mainly defined as the balance between the consumed energy, by drink as well as food, and the energy expended through physical activity and metabolism. Obesity, which correlates to lifestyle behaviors, can be characterized by reducing levels of physical activity or increased consumption of diets that are energy-dense, or even both. Over the past three decades, the US has witnessed a dramatic increase in the prevalence of obesity as well as reports on disparities among the population. With regard to the disparities in the prevalence of diabetes among the US population, the Southern States of the US record the highest obesity rates in the country based on the new report by the Institute for America’s Health. According to the report obesity rates increased in twenty eight states by 2010 with a decline only reported in Washington, DC. Out of the 11 states recording the highest rates, 10 of them are situated in the South, with Mississippi recording the highest rate for six consecutive years (World Health Organization, 2013).
Statement of the problem
There has been an increasing debate and the controversy over the appropriate intervention measures to be taken in order to curb the prevalence of diabetes in the southern states. The issue is whether the government should intervene and take a stand on the daily recommended dietary consumption. For instance, as a response to this and for the very first time, the Southern Obesity Summit, the largest regional obesity prevention unit, held its 7th Annual Southern Obesity Summit in November, 2013, drawing a majority of the participants from the sixteen southern states. Looking at it from a broader cultural perspective, the increased rate of diabetes can be attributed to the lifestyle of the Southerners and their nutrition.
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The high prevalence of obesity in the southern states of the US (the Bible Belt) poses challenges to both the government as well as health institutions. This phenomenon complicates the health and the economic situation of the region as well as the high cost of treatment. As pointed out in Wang and Beydoun (2007), the cost of treatment stood at $ 117 billion annually. Today, the cost has almost tripled (Centers for Disease Control and Prevention, 2009). The CDC survey report goes further to indicate that over 30 percent of the population in the Southern States is obese. Studies have shown that obesity in these Southern States is mainly as a result of socio-economic factors, ethnicity, as well as the culture of the Southerners.
Review of Literature
According to the Institute for America’s Health Report (2010), obesity in America in 2008 cost the nation approximately $147 billion in weight-related medical bills that is double the amount in the previous decade. Parham and Scarinci (2007), point out that people with obesity have an annual medical bill of $ 1,429 higher than the normal-weight people. The leading states in the south for obesity rate include: Mississippi (33.8%), Alabama and Tennessee (31 % tie), West Virginia (31.3 %), Louisiana (31.2%), Kentucky (30.5%), Arkansas (30.1%), South Carolina (29.9%), and Michigan (29.4%) tied with North Carolina (29.4%) (United States Census Bureau, 2009).
According to Akil (2011), the higher rate of obesity can be linked to socioeconomic factors such as income, poverty, and unemployment, among others. The study indicates that the higher rates of obesity were recorded among the Southerners as compared to the Northerners. The prevalence was highest in Mississippi, which also recorded the highest level of poverty with 21 percent of its residents living below the poverty line. Alabama and West Virginia, which rank second and third in obesity prevalence rates respectively, are both ranked the fifth poorest (Ezzati, Martin, Skjold, Vander Hoorn, & Murray, 2006). Generally, the south has a poverty rate of 14 percent being the most impoverished part of the country (U. S. Census Bureau, 2009). The income disparities among the population is considered as a contributing factor to this trend in the US and more so in the Southern States. The southerners have limited access to healthy food with little purchasing power.
The cultural lifestyle of the southerners predisposes them to obesity. Southerners enjoy feeding on fried food ranging from chicken, onions, green tomatoes, and pickles, to corn bread. Nutritional educators attribute the increased rate of obesity to the regional feeding habits. This situation is aggravated by poor physical exercise among the Southerners, since it is difficult for them to exercise outdoors when an opportunity arises, it is often hot, at times over 100 degrees, and humid. Furthermore, states such as Mississippi and Tennessee lack abundant sidewalks and have narrow roads, hence jogging and biking becomes hard for them (Wang & Beydoun, 2007).
Nutritional education is a significant contributor to the increased rate of obesity among the residents of the southern states of America. Nutrition educators have put concerted efforts in educating the people on the proper eating and exercise habits (Balluz, Okoro & Mokdad, 2008). The majority of the population feed on junk food, fried food, and do not engage in regular physical exercise, thus predisposing themselves to obesity. For instance, Arkansas passed a body mass index-screening program, in elementary schools to assess weight and then send the results to the parents. Tennessee, on the other hand, encourages schools to purchase fresh ingredients from the local growers. In 2007, the state of Mississippi adopted certain nutritional standards for its school lunches. All these nutritional interventions are taken in a bid to combat this affliction (Powell, Stater, Mirtcheva, Bao & Chaloupka, 2007).
The study used descriptive survey design where data was collected and analyzed (CDC, 2013). Since it is hard to study the whole population in the southern United States, the research sample was selected using random sampling technique. The following southern states were selected for the study: Mississippi, Oklahoma, Tennessee, and Arkansas. Colorado was also selected in the sample for comparison. The study was mainly qualitative, and qualitative data was collected and analyzed. Data was presented using texts, to describe the prevalence of obesity among the Southern Unites States. This research paper derives from secondary sources, mainly the obesity and obesity-related health studies conducted in the Southern States and the United States at large, and the above stated southern states in particular. Factual data has been retrieved from articles published in Peer Reviewed Health Journals as well as from world fact sheets. The study collected demographic data such as ethnicity, sex and geographic location. Data analysis was done using regression analysis and analysis of variance (ANOVA).
Results and Discussion
The research study found that obesity in the Southern States is exacerbated by inadequate significant policies to address issues of community design, such as suburban sprawl and sidewalks, as well as wider accessibility and affordability of healthy food options including the ‘urban grocery store gap’ (World Health Organization, 2013). The results indicated that there is a correlation between ethnicity and obesity in the southern United States. This high prevalence is mainly attributed to the lifestyle of southerners who mainly feed on fried foods. For instance, in 2004, a study by the University of North Carolina found out that majority of the food-shopping options in most part of the southern region fall under the category of ‘convenient stores’ since traditional grocery stores are situated too far away, hence the aforementioned gap. The lifestyle of Southerners is a predisposing factor to obesity due to their dietary habits. In addition, the high rate of obesity in the southern states is as a result of economic constraints. The majority of the states in the southern region are ranked among the poorest in the country (Ezzati et al, 2006). Colorado recorded the lowest rate of obesity, according to the study results (Akil, 2011). The researcher included Colorado in the study sample so as to check for any disparity and/or offer a comparison. The findings of this study provided a justification for hypothesis that there is a significant relationship between obesity and the Southerner’s nutrition education.
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Deriving from the finding of this study it is evident that the rate of diabetes is highest among residents of the southern states of the United States. The causes are mainly attributed to socioeconomic factors, culture and lifestyle, as well as ethnicity. However, the US government has put in place policy measures to combat the affliction. The intervention measures are mainly skewed toward provisional of nutritional education and implementation of poverty reduction strategies. The health status was found to improve with the rise in incomes. The poorer people have a limited access to groceries and health care.
Limitations of the Study
Since it was hard to study all the states in the south, only a few states were selected for the study. Moreover, there could be other predisposing factors for obesity rather than those focused on by the researcher. The demographics of the study also need to be more detailed, the study did not address race and income levels nor did it cover the environment of green space available for exercise within the studies.
Recommendation for further Research
There is need for further research to check for any relationship between obesity and other factors such as education, gender, heredity, climate and age. Similar studies should be extended to other states in the north to establish other causal factors that could be leading to the increased obesity rates in the south as compared to the northern states. Routine (BMI) Body Mass Index calculation, weight, height and blood pressure should be conducted at all routine patient visits. If the BMI is above 85 percentile, initiate farther screening. Obesity warrants immediate attention; consider using the HEAT clinical practice guidelines (McAdams, 2010). The key to battling obesity is prevention in the early stages; this will be led by promoting health eating and exercise to the new generation of youth.
Akil, L. (2011). Effects of Socio-economic Factors on obesity rates in four southern states and Colorado. National institute of Health Journal. 21 (1): 58-62.
Balluz, L. S., Okoro, C. A, & Mokdad, A. (2008). Association between selected unhealthy lifestyle factors, body mass index, and chronic health condition among individuals 50 years of age or older, by race /ethnicity. Ethnicity Dis. 18(4):450–457.
CDC, (2013) Health Disparities and Inequalities Report United States. Retrieved on February 20, 2014 from: www.cdc.gov
Ezzati, M., Martin, H., Skjold, S., Vander Hoorn, S. & Murray, C. J. (2006). Trends in national and state-level obesity in the USA after correction for self-report bias: analysis of health surveys. J R Soc Med. 99:250–257.
McAdams, Cynthia (2010). The environment and pediatric overweight: a review for nurse practioners. American Academy of Nurse Practitioners, 22 (9), 460-467. Dio 10,1111/j.1745-7599.2010.00537.x
Parham, G. P. & Scarinci, I. C. (2007). Strategies for achieving healthy energy balance among African Americans in the Mississippi Delta. Prev Chronic Dis. 4(4): A97.
Powell, L. M., Stater, S., Mirtcheva, D., Bao, Y. & Chaloupka, F.J. (2007). Food store availability and neighborhood characteristics in the United States. Prev Med. 44(3): 189–195.
The Institute for America’s Health. Retrieved on January 23, 2014 from: www.healthy-america.org
United States Census of Bureau (2009). Cen-Stats Database. Retrieved on January 23, 2014 from: www.censtats.census.gov
Wang. Y., Beydoun, M. A. (2007). The obesity epidemic in the United States—gender, age, socioeconomic, racial/ethnic, and geographic characteristics: a systematic review and meta-regression analysis. Epidemiol Rev. 29:6–28.
Word Health Organization. (2013). Obesity and overweight. Available at: http://www.who.int/mediacentre/factsheets/fs311/en/index.html
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