Sometimes when Regina Stout is walking to work through Ashland, a town of 25,000 in the northeastern corner of Kentucky, a friendly driver will pull over and ask her if she needs a ride somewhere. The neighborhood she walks through is nice, and the distance is short — eight blocks from her front door to her office.
People in Ashland just aren’t used to seeing pedestrians.
“They’re surprised to hear that I’m walking by choice,” she said.
Every time this happens, she realizes again just how much work she has ahead of her. Stout, the executive director of the Kentucky Heart Foundation, is in charge of a new project to reduce obesity in Ashland, as well as in surrounding Boyd County and neighboring Greenup County.
The area has one of the highest obesity rates in Kentucky, which is itself one of the heaviest states in the country. More than three quarters of the area’s 86,000 residents are overweight or obese and a third get no exercise at all. Not surprisingly, diabetes, heart disease and stroke are common.
A 2009 study of children in after-school programs in the two counties found that half were overweight or obese and three percent had high blood pressure— a very high number for that age group.
The area’s health crisis has many causes, but Stout and other experts say that a good part of the problem stems from the physical environment: the plethora of fast-food restaurants, the lack of adequate grocery stores, and the dearth of places to walk and bicycle.
In both counties, fast food is almost the only option for people who want to buy a cooked meal.
“We have one restaurant that’s not fast food in Greenup County,” said Scarlet Shoemaker, who oversees the program in that county. That exception is a family-owned place that serves homecooked meals, most of which are high in calories.
Neither county has many supermarkets or grocery stores that sell fresh fruits, vegetables, and other healthy fare. Except for the city of Ashland, which has some buses, the area has no public transportation, so anyone without a car has an especially hard time buying nutritious food. Greenup County has just three supermarkets; these stores are on one side of the county, which means that some people must drive an 80 miles round trip to get fresh lettuce or oranges. Otherwise they must rely on smaller stores that stock only small quantities of fresh food, and tend to charge more for what they do offer. In Wurtland, a town of 1,000 in Greenup County, residents have only a Dollar General store, which carries a limited selection of packaged food, snacks, and soft drinks. The closest supermarket is five miles away.
“Availability is a big issue, and price is a big issue,” said Shoemaker. “It’s a double whammy.”
Poverty plays a major role in the area’s high obesity rate. The two counties’ per capita income is just over $26,000, and many families must get by on much less. In recent years, many of the region’s industries, such as coke processing and steel manufacturing, have shut down or downsized, and unemployment is high. Increasingly, residents survive by taking low-paying service jobs.
Stout said many people tell her they just don’t have enough money to buy fruits and vegetables.
“Health is not a priority,” said Shoemaker. “For a lot of families, a bigger priority is just getting a paycheck and getting food on the table, regardless of quality. You can buy a lot more chips than you can fresh vegetables. People’s weight is not usually on the radar.”
Another problem: the region does not make it easy for those who want to be physically active. Few areas have streets with sidewalks, and there are not many walking trails; most of those can only be reached by car. “Mostly there are two-lane curvy roads with a ditch on either side,” said Shoemaker, who works as the director of school safety and public relations for the Greenup school district. The terrain itself discourages many from exercising. The area is in the Appalachian foothills, and walking the steep hills and valleys can be difficult, especially for those who are already overweight and out of shape.
The region’s culture also plays a role. Stout said people in Greenup, Boyd, and throughout Appalachia tend to fry their food, eat a lot of lard and other fats, and not pay too much attention to health or weight.
In an era when nearly everyone did physical labor, and many meals included home-grown vegetables, these practices weren’t such a problem. But now, with significantly fewer opportunities to burn calories, and the disappearance of backyard gardens and home canning, these habits are contributing to the region’s high obesity and chronic disease rates
Last year, a coalition of 26 local groups, led by the Kentucky Heart Foundation, started an effort to reduce obesity in Boyd and Greenup. The goals: to increase kids’ level of physical activity, teach them about good nutrition, and encourage healthier eating. Called Healthy Kids, Healthy Communities, the group (not to be confused with the Robert Wood Johnson Foundation program of the same name) includes county and city governments, school districts, the public health and medical community, and nonprofit groups. The initiative received a three-year, $75,000 grant from a consortium of national groups and government agencies, including CDC, the YMCA, and the National Association of Chronic Disease Directors.
So far, the program has worked with schools to institute an “active recess” policy for the two counties’ 12 elementary schools. In the past, recess in Boyd and Greenup often involved very little actual activity. Especially in late fall and winter, students typically spent recess in classrooms, talking or watching movies. Even when recess was outside, many kids didn’t exercise much. In addition, many teachers punished students for bad behavior by restricting recess time or using the time for schoolwork.
To help kids move more, the coalition bought exercise equipment, including jump ropes, hula hoops, and balls, for the two school districts. Elementary school PE teachers received information on how to make recess more active.
Shoemaker summed up the new policy succinctly: “Everybody moves.”
In addition, the group is working with the school districts to improve the quality of school meals. Shoemaker said that in Greenup, school cafeterias are already doing a lot more baking than frying. Still, she said, the food could include more fresh fruits and vegetables.
The coalition is now talking with local governments about the possibility of introducing Complete Streets laws, which would require more bike lanes and sidewalks. And it is talking with some employers about starting wellness programs, which encourage workers to exercise more and eat better.
In the future, the coalition wants to build more trails and bike paths. Each county now has one walking trail. Ashland has a bike route, but Stout says it’s not as safe or as continuous as she’d like: riders have to get off their bikes and walk to get across several busy intersections.
She hopes to eventually expand the project to surrounding counties, which will present an even larger challenge. These areas are deeper in Appalachia than Boyd and Greenup, and have higher obesity and poverty rates, and even fewer supermarkets and sidewalks. But before moving on to that challenge, she’ll have to convince the drivers in Ashland that being a pedestrian isn’t something out of the ordinary.
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