As Americans grew heavier, West Virginians grew heavier faster. Sometime between 1980 and 1992, West Virginia crossed above the national average.
Why? Appalachian researchers and historians say West Virginia faces particular challenges that accelerate the national trend:
As West Virginia's weight rose, more West Virginians developed chronic diseases associated with obesity, until the state led the nation in diabetes, heart attack, hypertension and kidney failure.
In 2011, the federal Centers for Disease Control released a map of counties with the highest diabetes rates. A deadly swath cuts down through the Appalachians to the Gulf Coast, almost exactly overlapping the "obesity belt."
Almost every West Virginia county is firmly inside both belts.
Back to the 1900s
In the early 1900s, historian Lewis said, West Virginians died mostly of contagious diseases such as tuberculosis, pneumonia and influenza. Today's killers -- diabetes, heart disease and hypertension -- were low on the radar screen. Contagious diseases killed people before chronic diseases could.
As West Virginia has gotten a grip on contagious diseases, chronic disease rates have risen.
"The way we think about eating, culturally, makes a difference too," Lewis said. Through the first half of the 1900s, West Virginians associated fat and eating with prosperity and health, he said. "When people thought of a fat person, they thought of a rich person." During the Depression, "eating was even more strongly associated with good health.
"Food also has powerful social meaning in our culture," he said. "West Virginia's rural history is filled with church socials and community dinners. People show love and hospitality with food. It's often a gift of sorts, and it's up to you to show your appreciation by eating a lot of it.
"That worked OK as long as people stayed physically active," he said.
Through the '50s, into the '70s, he said, "we still had an active culture." Children still played outside all day. Most rural people raised gardens.
But the culture itself has changed. In the 1980s, fewer West Virginians raised gardens and more people had desk jobs, "but people still kept that traditional association between eating heartily and health."
By 2008, the average West Virginian was 20 pounds heavier than he or she was in 1998. The diabetes statistics began to climb. "Something went out of balance," Lewis said.
"The way we eat is in some ways a product of our history and culture, mixed with modern advertising," Dr. Walker said. "That does not suit us well as we move into modern life where we drive a four-wheeler instead of walk up the hill and use a chain saw instead of a crosscut saw.
"We've got to find ways to talk about that, as a state."
Reach Kate Long at (304) 348-1798 or katel...@wvgazette.com.
"The Shape We're In" was written with the help of the Dennis A. Hunt Fund for Health Journalism, administered by the California Endowment Health Journalism Fellowships, at the University of Southern California's Annenberg School for Communication and Journalism.
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