Earlier this month, survey company WalletHub marked Asheville as one of the “Fattest Cities” in the country. Asheville ranked No. 43 among the 100 most populated U.S. metro areas for obesity levels, weight-related health problems and environmental factors.
The Centers for Disease Control and Prevention, meanwhile, reports that the South has the second-highest regional rate of obesity in the United States after the Midwest. Twenty-five years ago, North Carolina’s obesity rate was 12 percent; 15 years ago, it had risen to 20 percent; and two years ago, it was 30 percent, according to the CDC. The WalletHub survey arrived at its rankings by analyzing such factors as the number of people who are inactive, amounts of fruits and vegetables consumed and the weight of individuals. What do local health psychologists, dietitians and therapists see as sources and solutions to the hefty issue?
“I think the work of big organizations and programs like Eat Smart, Move More is the way to go,” says Dr. Robert Swoap, health psychologist and professor of psychology at Warren Wilson College. Research should be conducted on community-based interventions, partnering with schools and other organizations to identify places where intervention is possible, he says.
“Most people have a mistaken belief that the obesity epidemic is largely caused by personal choices around eating, and my opinion is that the obesity epidemic is largely a structural environmental and cultural issue.” Swoap, a speaker at the April 25-26 Art and Science of Health Promotion in Orlando, Fla., explains that making interventions structural in nature means creating an environment in which healthy choices are also the easiest choices.
The CDC reports that two out of three adults in the U.S. are considered overweight or obese, but Swoap says that we have the “fundamental attribution error,” which over-attributes obesity to a person and under-attributes it to the environment.
The issue, Swoap says, is that people are finding themselves in toxic food environments where the easiest choices to make are also the least healthy. “Financial situations are a big piece of this,” he says. “The food that promotes obesity tends to be the least expensive and most heavily promoted by the food industry.”
We are also living in an era in which jobs encourage inactivity, and our lifestyle is highly sedentary, he adds.
Swoap recommends that people trying to lose weight set very small goals and get support in making small changes, despite the environment of highly processed foods. People can make a choice to make one meal a week different from their normal meal, then gradually change to include more fresh veggies. He also encourages adults to teach children from an early age to try all sorts of different foods, colorful veggies and fruits.
Sheree Vodicka, registered dietitian, chair of Eat Smart, Move More NC and executive director of the North Carolina Alliance of YMCAs, agrees with Swoap that the focus needs to be on prevention. “Our current emphasis on paying to take care of people after they are already sick is unsustainable. We have an estimated 2.5 million people, just in North Carolina, with pre-diabetes,” Vodicka says.
“Making our communities more walkable, which requires investments of public dollars into building and maintaining sidewalks and bike lanes and better, more connected transit … that would go a long way to reducing the burden of obesity,” she says.
Another change that needs to happen, Vodicka says, is that employers need to take prevention seriously and design health insurance packages and worksite wellness efforts that support employees in getting and staying healthy. For example, she notes, the Cleveland County government screened all of its employees for health risks. Those at risk for diabetes were referred to the YMCA’s Diabetes Prevention Program. The program was so successful — with significant numbers of employees increasing their physical activity to 150 minutes per week and dropping at least 5-7 percent of their body weight — that the county was able to lop $500,000 off its health insurance premiums.
Buncombe County states its health priorities in the Community Health Assessment Report for 2015-2018: “With 50 percent of adults and 33 percent of children either overweight or obese, it is essential to continue to make the healthy choice the easy choice. Diabetes mortality rates have worsened for the past eight years. There is a huge health disparity seen in diabetes deaths in North Carolina. There is a great deal of momentum around active transportation, access to affordable healthy foods, and new partnerships with clinical partners to build links between clinical care and community supports. In addition, there is a great deal of work happening to improve diabetes care and linkages with community partners.”
A popular slogan among health psychologists, Swoap reports, is “Our jeans don’t fit our waist because our genes don’t fit our environment.” The brief comfort in greasy, calorie-dense foods gives a quick boost in energy, he explains, but fast-food consumption is associated with overall body inflammation, which negatively affects mood in the long run. Noting the “brain/gut connection,” Swoap says, “When you feed [the gut] with highly processed, sugared foods, you create a feedback system … that is associated with worse brain health. There needs to be education around eating healthy food choices, not just regarding longevity and diabetes, but more immediate benefits for energy levels and to regulate emotions and to make effective decisions.”
We need to build in opportunities for movement throughout the day at school and work rather than add on 30-45 minutes a day of exercise, Swoap says. He completed a research project with Instant Recess, a nationwide program created by Dr. Tony Yancey, to test the effectiveness of movement throughout the school day to improve mood, attention and focus in the classroom setting.
“There is a relationship between poverty and health, so people in lower socioeconomic status situations are at higher risk for obesity and its related problems, including diabetes and heart disease,” Swoap says. “In Asheville, we have a problem with affordable housing and living, so we may have the perfect storm of people having less of an ability to buy and cook healthier choices.”
Hillary Goldrich, registered dietitian for the Reuter YMCA and instructor for FEAST Asheville, also believes modeling good behavior is important for younger generations. Goldrich works with children in schools to help them try new foods, become more comfortable with food preparation and recognize there are multiple ways to prepare the same items. The kids practice hands-on food preparation in the classroom and are required to take a “no-thank-you bite” to try what they made, she adds.
“I try to get students to use all five senses, since eating is an all-encompassing experience.” Goldrich says. “Oftentimes, there is produce students have never had or seen before.”
The older population has a responsibility as well to combat the obesity epidemic sweeping our nation, Goldrich says; if they do not take care of themselves or are rescued by modern medicine, younger generations won’t learn how to take care of themselves and the negative implications of obesity will continue to grow.
“Asheville is nature’s playground,” Goldrich says. “Find something you like to do that moves your body and do it. Rome wasn’t built in a day, so a 10-minute walk each night will make a difference and incrementally increase over time.”
“There is usually a connection with a person’s family culture, what they were raised in, how they were taught and undiagnosed medical conditions that can affect all obesity,” says Corey Brown, licensed professional counselor in the state, expressive art therapist and yoga teacher. She utilizes all of her skills when working in individual, group and educational settings to promote stress reduction and healthy eating habits. We need a total paradigm shift, not just in diet and quality of food but also in education about eating as an emotional issue, which requires support medically and nutritionally, she argues.
“One of the things that I notice when people come to me is that there is more of a lack of understanding and incongruent information than anything.” It’s a societal issue, Brown adds, in which the culture is constantly reinforcing the public to consume and do more.
“So we fill ourselves up, and during the day our cortisol levels become so high, it affects appetite, metabolism and mood; so people want to collapse at the end of the day,” Brown says.
She helps clients create a program that covers them from the moment they wake up to recharge and keep their cup full instead of emptying it out and not having energy to do anything at the end of the day. Brown also encourages breathing exercises, planning dinner times with family and other stress-reduction techniques, such as art and yoga therapy.
Sometimes eating is symbolic for something a person feels hungry for — spiritual, creative or expressive. Over time, poor eating habits could develop if those needs are not pursued, she explains. Eating instead becomes a coping mechanism to reward, relieve stress or deliver fulfillment. “Everyone wants to be able to say there is a magic thing that is going to change the obesity issue, to focus on one key factor, but we can’t,” says Brown. “We have to look at the whole picture, including quality of food, stressors, and education.”
Dr. Robert Swoap
Eat Smart, Move More
NC Center for Health and Wellness
Art and Science of Health Promotion
Art and Science of Health Promotion