Obesity in the South
Updated: Apr 18
Finally. After debating about whether or not to even post this and then pining over every word and sentence with a fine-tooth comb: I bit the bullet.
First, I want to point out that I live in the south. I grew up near Chicago (I’m a “yankee” so I’ve been told), moved to South Carolina for college, and have lived there ever since. I love the south. My husband Grant and his family, who are now my family, are from the south.
Since 2017, 7-8 months out of the year are spent traveling with Grant for baseball. I've gotten to visit parts of the country I otherwise probably wouldn’t have seen. Between the traveling, being immersed in different cultures and atmospheres, comparing my north vs. south experience, and studying obesity in my NASM certifications, the idea for this blog started churning in the fall of 2018.
It's taken so long for me to post because I don’t want to come off as offensive, harsh, or pointed. I'm detailed; I like to fully explain myself and acknowledge all sides. It's not a bad thing, but it can lead to long and sometimes off-topic rambles. With this blog, I felt like it was a constant battle between my intentions and hyper-consideration of whoever reads this, my explanations vs. how this may be perceived.
Keep in mind that the last thing I ever want to do is insult someone’s health status or body image. I want to help - and at times, help comes in different forms. I believe that understanding the WHY or causation can result in mental shifts and lasting changes.
Imagine hanging out with a big group of your friends or at a family get together
Chances are, more than half of the people you care about in that room are overweight or obese. According to the CDC, more than 7 in 10 adults 20+ years old are overweight or obese. It's undeniable that weight shapes our health status - being overweight or obese is the 5th leading risk for all deaths globally.
What’s intriguing (to me at least) is looking at it from a geographic standpoint. Compared to the rest of the country, obesity is predominant in the southern states.
10 of the top 15 most obese states are in the south. Of the top 10, 7 are southern.
It also depends what you define as "the south" - some consider Maryland, Delaware, and Missouri as a part of the south. They were slave states and part of the Missouri Compromise which could be why they're part of the south to some. So if you were to take those states into account, then 11 of the top 15 states in 2018 (73%) and 8 of the top 10 (80%) are southern.
There are obvious differences between the north and the south. But what differences in particular could be causing such drastic disparities in obesity rates?
Why is the south being singled out?
The first thing that comes to my mind is food. Fried chicken, biscuits & gravy, fried okra, chicken fried steak, beignets, chicken & waffles, hushpuppies (a personal fave) - fried food and comfort food go hand in hand. So could the food be causing the higher obesity rates??
Well, southerns definitely aren't the only ones who can get down with some not good for you, but good for the soul kind of comfort food. Chicago and deep dish pizza & hot dogs. New England and clam chowder. Ohio and buckeyes. Philly and cheesesteaks. Arizona and chimichangas. Wisconsin and fried cheese curds.
It goes deeper than food.
What about food deserts?
Not dessert, desert. A food desert is an area that has limited access to grocery stores and other sources of nutritious, affordable food; more than 1 mile away for urban and suburban areas and more than 10 miles away for rural areas.
Less grocery stores = more convenient stores. I know when we’re traveling, seeing a fresh piece of fruit in a gas station is a rarity. With limited options, it's easier to make impulsive food choices (which is why we pack a majority of our food when we travel).
But Montana and New Mexico are high in food deserts yet their obesity rates aren’t as high as the southern states...
$ Moooolah $
Money, the root of all evil, right?
My junior year of college, I was visiting my parents in Illinois for Christmas. I was on a Greek yogurt and pineapple kick, so when the craving came a-callin’, I braved the frigid cold and went to Target for the goods. This was a semi-regular purchase for me so I knew about how much it'd cost, but when the cashier said my total, my jaw nearly dropped. $4 more than it was in South Carolina??! $4 more for 2 ITEMS?
Overall, the cost of living is much cheaper in the south, but so is the income.
Compared to the rest of the country, the south generally brings in a lower income which makes people more likely to opt for cheap, quick, calorically dense foods like take out and fast food. (BTW "healthier" options aren't always the answer, some "healthy" choices are equally, if not more unhealthy than a regular burger!)
Little sidebar: eating out is typically thought of as cheap and convenient. Convenient? Sure. But cheap? Not so much. The average American spends $1,200 a year on take out. The average meal is $13. Grant and I's meals usually range from $2-3 per meal, so let’s say $2.50 per meal. If 2 meals per day are eaten out, that’s $26 per day and $182 per week. Compared to prepping 2 meals at home, that’s $5 per day and $35 per week. That extra effort to cook a bit more at home can save your money AND health.
Studies have shown that economic disparity and insecurity may cause physiological, behavioral, and cognitive changes (which makes sense) that can result in an increased energy intake (AKA food intake). So if more food is being consumed and physical activity isn’t increased to counter that extra food, the consistent, excess calories will result in weight gain. Steady weight gain over time can easily lead to obesity.
Certain economic hardships like unemployment for instance are associated with an increased prevalence of obesity so yes, money IS a factor. But trends show that the prevalence has increased in adults at ALL income and education levels.
And if money is an issue, there are countless resources on how to save money and eat well on a budget - Google, bloggers, my Simply Understand Nutrition eBook (~shameless plug~), YouTube
There’s nothing quite like the south. The cozy, quaint, comforting, small-town feel sprinkled with genuine, southern hospitality - it's an appeal that other parts of the country simply don’t have.
But do those charming factors that set the south apart also contribute to obesity rates?
The dark, winding, backroads in South Carolina are my favorite. They're so calming to drive; especially at night with the bright, pollution-free stars and sing-song sounds of the crickets and frogs. But with those roads, there aren’t many sidewalks, bike lanes, or even shoulders making jogging, dog walking, bike riding, and after dinner walking difficult and dangerous.
Growing up, the train station was a 3 minute walk away. Then a 35-40 minute train ride later, we'd be in downtown Chicago. When I moved to South Carolina, I was SO CONFUSED about the train situation. I saw train tracks, but they were different than the ones in Illinois and I never saw any trains?? Turns out, that’s normal when you’re not close to a big city. And with less public transportation, there's less walking to and from train stations, bus stops, and destinations AKA less daily activity.
Arguably one of the best parts of the south? No more bone-chilling, wind ripping through your clothes, chipping ice off of windshields, snow shoveling winters. And hellooo sunny and 75 fall days and getting a “snow day” when there’s a mere chance of snow (I had more snow days in my 4 years of college than I did in my 12 years of school in Illinois)
T or F: warm weather = easier to be active
Well it's not that cut and dry. The thick, nearly suffocating humidity in the spring and summer months makes it tough to exercise outside. And not everyone can afford to workout at a gym during those humid months - most gyms have sign up fees, cancellation fees, and more expensive month-to-month memberships.
It’s more than just the humidity, too. Environmental factors have a surprising role in obesity rates.
A lot of research is being done about the relationship between the environment and body composition: thermal comfort zones and thermoneutrality minimizing the frequency of energy expenditure exertion needed to maintain a core body temperature thus decreasing metabolic rate, global warming and CO2 potentially shifting the pH balance and behavior in organisms similarly to that of ocean acidification. It'll be interesting to see just how complex the environment's role really is.
It’s easy to be inactive
Another revelation I had after moving down south - gym class is optional!
If you asked me in middle school if I wanted to gym class to be optional, I wouldn’t think twice. Even as an athlete, I didn't like gym. Maybe it was because my elementary school gym teacher was former military and would have us march around the playground chanting old army songs (not kidding). Or maybe it was the whole getting sweaty in the middle of the day to go sit in class afterwards. Either way it didn’t matter, it wasn’t optional.
We all had to take the basics; math, history, science, English. Over time, we got a feel for what we liked and didn’t like. So without gym class, how are kids supposed to know if they even like a certain sport or activity? Especially since they may not have the opportunity to try it outside of school.
Physical inactivity is the leading cause of obesity.
And it makes sense. There are so many justifications that really do feel like (and sometimes are) valid reasons to skip out on exercise: long day at work, too tired, have to be up early, don’t want to drive to the gym, lost on to what to do. I’ve experienced all of those too. Everyone has, and if they say they haven’t - they’re lying!
But we can’t justify being inactive.
You can lose weight without working out. But it’s only temporary. Physical activity is vital. Just like you can’t out train a bad diet - you can't lose weight and keep it off without activity (research supports this).
Aside from weight loss, the physiological benefits you can reap are endless; reduces stress (which we all have), increases energy, improves mood, confidence, & body image, prevents or helps manage certain medical conditions, promotes more restful sleep, decreases symptoms associated with depression.
I love sweets, warm weather, and James Patterson books. Whereas the person next to me might love savory foods, snowy winters, and documentaries. And you might like a bit of both or something totally different.
We all have different preferences. And that goes for physical activity too! The gym isn’t everyone’s cup of tea and that's okay! Running is NOT my cup of tea, it's like torture to me - but to a lot of people, running is their solace.
Don't limit yourself to just the gym, physical activity goes beyond that. Expand your definition - home workouts, kayaking, spin classes, outdoor body weight workouts, yoga on YouTube, running with your dog, pilates, hiking. I could go on and on. Explore. Try something new. Find what brings you joy.
The Payoff: I Want It NOW
If exercise is so valuable and can be done without spending money - why aren't more people thriving and taking advantage of that?
For one, it takes consistent commitment and dedication. That means prioritizing activity even when you have all the reasons not to.
Changing your eating habits for example, is HARD. Eating behaviors are complex and innate - they often go unnoticed. Try to observe patterns, recognize cues that influence your actions, and understand your behaviors:
Do you tend to eat more when you’re stressed? Or less?
Do you snack more when you’re tired? (Hint: lack of sleep is associated with increased appetite and decreased energy expenditure AKA activity - I graze like a cow when I'm consistently sleep-deprived)
What internal (emotional eating) and external (watching TV, eating with friends) cues are associated with overconsumption and your eating habits in general?
We like instant gratification, that's no secret. Who doesn't like an immediate reward? Wedding planning was hard. We'd spend weeks, sometimes months discussing and emailing back & forth with vendors. At the end of it, we'd either make a decision and get to check ONE item off of our to do list or worse, we'd be back to square one and start the task all over again. During the process, the value of the reward can decrease over time. It can be really easy to forget what it means to you. We felt like we were spinning our wheels at times. But we couldn't let the grunt work blind us to the bigger picture, our WHY behind all the stress.
If I asked you to make achieving and maintaining a healthy body weight (not goal body weight) your goal for this year - what comes to mind? Do you see the steps to get there as dreadful, restrictive sacrifices? Or are you wondering why should you care, why should you change your way of life just to "achieve a hEaLtHy boDy wEigHt?"??
All valid questions. That goal probably wouldn't mean much unless you had a deeper why. Discovering your why, so WHY you want to create healthier habits (for your kids, to get off of blood pressure meds for example) will adjust everything. With a deeper why, your perspective, attitude, motivation, and adherence will fall in line. Uncover what motivates you most - hold onto that and lean on it when you're discouraged or unmotivated.
It’s on you, but it’s not your fault
Humans typically choose their partners through assortative mating for phenotypes, one being adiposity (or body fat) for example. Opposites do attract. But when you think about it, a lot of couples have similar behaviors, body compositions, eating habits, and tendencies. Which can be a good thing, unless they feed into each other in a negative way.
Obesity is genetic. Read that sentence again. It's NOT about a lack of willpower. It's ignorant when people assume those who are overweight are just lazy because it's much more than that. It's partially out of their control.
When at risk, overweight, or obese couples have children, the genetic component comes into play increasing the risk of obesity in their offspring. We cannot help our genetics, some people are literally born into obesity - all the more reason to avoid passing judgements or even worse, remarks about a person's weight!
The number of fat cells that we have today, in our adult lives, were largely determined in childhood. Fat cells shrink with weight loss and expand with gain, but the number of fat cells remains the same. One study that examined trends in obesity from adolescence to individuals in their 30's found that 36.1% of the sample were obese in 2008 with ~90% of obese adolescents remaining obese into adulthood.
So the example being set for younger generations and our future kids is more crucial now than ever before. The foundation of healthy, practical habits are laid in childhood.
How do the parents eat?
Are family dinners taking place regularly? Do they encourage quality time together and also show the importance of wholesome, balanced, home-cooked meals?
Are kids involved in the kitchen?
How interactive is their daily life - are they outside running around or is technology being used to quietly entertain them? (Because there is a correlation between an increase in screen time + a decrease in activity with an increase in appetite, overeating, and risk of obesity)
Are the family members active?
The environment in which children grow up in is key - kids are highly impressionable and learn largely by example. It's easier for a child to develop healthy eating habits and achieve a healthy weight than it is to try to reverse trends later in life in adulthood. The solution is in our hands. It's on us to educate, lay a foundation, create an optimal environment, and lead by example.
Are you wondering what's the point? What's in it for you? What is this supposed to do for you??
I want people to see that this impacts us all. Obesity isn't an issue limited to south. For the first time in 2010, the prevalence of obesity among US adults was greater than 20% in ALL 50 states. It's a global issue. Even if you personally aren't overweight or obese, chances are you know someone that is. I do. And that person is really, really important to me. It hurts to see their health and quality of life compromised.
So what can we do?
If weight is something you struggle with and if you feel at fault in anyway - I hope that you now realize the role that factors other than yourself have on your body. And with that, I hope that you can take the blame off of your shoulders and forgive yourself - because you're not solely at fault here.
We are responsible for our own decisions, but there are elements around us that impact where we are today. I want people to be more aware of their surroundings. And see the role that outside factors such as the environment, the company we keep, and our perspective have on our health. It's important to have an awareness of those parts so we're better able to identify them, acknowledge their role (in this case, in obesity), but move forward knowing that those factors aren't determinants. They don't have an iron grip on us or our health; they are not deciding factors.
Knowledge is power. By becoming more informed about obesity, I believe that puts us all in a better position to pinpoint triggers and unhealthy behaviors, seize control of our health, build a healthy & fulfilling lifestyle, feel confident in our decisions, and set an example for others through the sustainable habits that we created.
Let your actions speak for themselves. You never know who's watching or what someone's going through. A seemingly small task that we do could actually be incredibly influential through someone else's eyes. If I can inspire just one person by taking care of myself and being myself, then that's a massive win in my book. That's how we can create change. And that's how we can impact the global obesity statistic for the better.
This is by no means a conclusive list of the causes or probable causes of obesity nor is it meant to single out the south as obesity is a global epidemic. I wanted to highlight possible reasons as to why we see higher numbers largely in the south. Obesity is dynamic, highly dependent on the individual, and something that we are continuing to learn more and more about every day.
NASM WLS Certification Course: https://www.nasm.org/products/CEU161K