America's 12 Most Obese States (And What the Numbers Don't Tell Us)
US regulators on Wednesday approved the first drug to treat obesity in 13 years, a drug called lorcaserin, marketed as Belviq and made by Arena Pharmaceuticals.
America! Where we love to watch toned, determined athletes strive for new heights at the Olympics while we sit on the couch (guilty as charged); where Coke and McDonald's, sponsors of noble athletic events, try to woo us with seductive spots highlighting their fat-laden products; where food is marketed like porn and diet companies feed our guilt; where the numbers say that we're more obese than ever while eating disorders continue to plague us.
No, our country does not have a healthy relationship with nutrition and health. But where is that relationship the worst? Well, figures released Tuesday by the CDC broke down self-reported obesity by category and it turns out that many of our reddest states--and states that suffer from poverty-- also score highest on the percentage of obese residents.
But here comes a major caveat. Overall health and "obesity"--as determined by Body Mass Index--are not necessarily as directly correlated as we think. Kate Harding, a blogger who writes about "fat acceptance," puts it this way:
Poor nutrition and a sedentary lifestyle do cause health problems, in people of all sizes. This is why it’s so fucking crucial to separate the concept of “obesity” from “eating crap and not exercising.” The two are simply not synonymous — not even close — and it’s not only incredibly offensive but dangerous for thin people to keep pretending that they are. There are thin people who eat crap and don’t exercise — and are thus putting their health at risk — and there are fat people who treat their bodies very well but remain fat. Really truly.
In other words--the obesity numbers are not equivalent to the general health survey. Even the CDC acknowledges this:
BMI is just one indicator of potential health risks associated with being overweight or obese. For assessing someone's likelihood of developing overweight- or obesity-related diseases, the National Heart, Lung, and Blood Institute guidelines recommend looking at two other predictors:
- The individual's waist circumference (because abdominal fat is a predictor of risk for obesity-related diseases).
- Other risk factors the individual has for diseases and conditions associated with obesity (for example, high blood pressure or physical inactivity).
And though much of the "obesity epidemic" may indeed have to do with a lack of access to nutrition, sedentary lifestyles, Americans being too busy to cook and so on, these factors are not inexorably wedded to one another. There's also the influence of genetics, there are different body types and there are, as Harding notes, thin people who smoke and eat chips all day.
Furthermore, the diet industry and food industries--many of which are run by the same parent companies-- tend to make things worse by attaching both positive and moral value to food and keeping Americans from intuitive eating. I recommend clicking on links at Harding's site if you're unfamiliar with these basic concepts of fat acceptance and Health at Every Size (HAES).
HAES encourages people to declare a truce with their body angst, detach themselves from socially imposed ideas about food, and start exercising and moving their bodies for fun. These are admirable goals. But whether you term it combating obesity or HAES, there are important policy changes that could help improve health: improving access to nutritious food in poor neighborhoods; better school lunches for kids; safer places to play, like walking paths and public parks; urban gardens and farms; and mandatory physical education classes and better facilities in public schools.
So there are many things the obesity prevalence numbers absolutely cannot tell us. But, since you still want to see those numbers, here's what they do say. The CDC zeroed in on 12 states that had a more than 30% obesity prevalence ranking: Alabama, Arkansas, Indiana, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Oklahoma, South Carolina, Texas, and West Virginia.
Many of these states essentially coincided with the overall unhealthiest state rankings that arrived earlier this year, partly because those rankings include obesity as a de facto, but also because of things like tobacco use and child welfare: "Mississippi was again the unhealthiest state in the nation -- a spot it has held for the past decade, thanks in part to high rates of obesity, childhood poverty, and preventable hospitalizations. Alabama, Arkansas, Oklahoma, and Louisiana rounded out the five least-healthy states."
If you look at child well-being numbers, you also have many of the same states plus Nevada, New Mexico and California, places where foreclosures and the recession have hit hardest.
- By state, obesity prevalence ranged from 20.7% in Colorado to 34.9% in Mississippi in 2011. No state had a prevalence of obesity less than 20%. 39 states had a prevalence of 25% or more; 12 of these states had a prevalence of 30% or more: Alabama, Arkansas, Indiana, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Oklahoma, South Carolina, Texas, and West Virginia.
- The South had the highest prevalence of obesity (29.5%), followed by the Midwest (29.0%), the Northeast (25.3%) and the West (24.3%).
Here's a visualization:
(image via CDC)
So it's true that an ultra-red, ultraconservative state with a high-poverty index like Mississippi and many of its neighbors frequently end up on the bottom of these health index lists. But it's also true, based on the CDC numbers, that correlation between obesity and income and education levels are both insignificant, particularly for men. So there has to be more going on.
My instincts tell me that what Americans need most of all to get healthy is time and basic quality of life issues taken care of, rather than shaming. When it comes to states, just like individuals, shaming and laughing at the most obese ones may not help. Access to better nutrition, safer places to play outdoors, and good health facilities-- whether it's a pool, a clinic, a farmer's market or a doctor's office--are more needed than diets. And things like paid sick leave, more vacation time, better wages and shorter work days are probably much more effective in getting Americans out of the fast food lines and home to cook than any shaming or public awareness campaign can be.