"He got people united behind a common goal," Pore said.

He announced a Web address -- www.thiscityisgoingonadiet.com. More than 45,000 city residents signed on and started reporting their weight loss. By the end of 2011, they had lost more than 760,000 pounds. They expect to shed a million pounds in 2012. Walkways and bike trails are being built all over the city.

Jorea Marple, state superintendent of schools, says West Virginia's high numbers require a cross-agency attack. "It can't be solved by the education system alone or health care alone," she said. "I would very much like to be part of a discussion across departments. This is a public health issue, and all departments can contribute to its solution."

 She hopes to improve school meals and add physical activity to the children's day, she said. "We need to teach children how to stay healthy," she said. "One in four obese fifth-graders and one in four children with high blood pressure is not acceptable."

Delegate Don Perdue, chairman of the House Health and Human Resources Committee, said he is frustrated to see potentially helpful laws not being implemented.

"We created the GOHELP office partly to inventory our most successful programs so we could try them in other areas," said Perdue, a Wayne County pharmacist, "but GOHELP didn't do that, for whatever reason."

The GOHELP director, Martha Walker, and most of the staff have left. Gov. Earl Ray Tomblin has not filled those positions.

Similarly, "most of the Healthy Lifestyles Act has not been implemented," Perdue said.

Pore praised the state's network of 28 community health centers. "They are strongly oriented toward prevention," she said. Gupta cited Kanawha County's plans to build 100 miles of walking and biking trails.

"West Virginia could definitely lower the numbers, but for us to get there, our top leaders will have to give health care a top statewide priority. That's not happening yet, but we hope for it in the future," Bryant said.

Gallup Healthways surveys 353,000 Americans, 2,400 in West Virginia. Gallup Healthways is releasing its data one condition at a time. They provided the Gazette-Mail with all 12 categories.

West Virginia's 2011 statistics, according to Gallup Healthways, include: obesity, 35.3 percent; high blood pressure, 38.9 percent; high cholesterol, 33.5 percent; diabetes, 15.7 percent; depression, 23.9 percent; heart attack, 7.6 percent; cancer, 8.8 percent; neck or back condition, 38.9 percent; leg or knee condition, 33.9 percent; other recurring pain, 23.9 percent.

At 26.8 percent, West Virginia was second to Kentucky in smoking. At 13.2 percent, the state was sixth in asthma.

Reach Kate Long at 304-348-1798 or katel...@wvgazette.com.

"The Shape We're In" is 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.

Mountain State residents lead the nation in obesity, high blood pressure, high cholesterol, diabetes, depression, heart attack, cancer, neck or back condition, leg or knee condition and "other recurring pain."

More than one in three West Virginians -- 35.3 percent -- are now obese, according to Gallup Healthways.

"If West Virginia lowered its obesity rate, it would most likely lower its ranking in other categories," Healthways official Reggie Ramsey said. Obesity is at the root of most high chronic disease numbers, he said.

"I think someone is sending us a message that our approach to health care hasn't worked," said Dr. Rahul Gupta, director of the Kanawha-Charleston Health Department.

"Almost all these problems are preventable," Gupta said. "We should be trying to prevent diseases as effectively as we try to fix them after they happen." West Virginia is just starting down the prevention road, he said. "If we continue, you will see these numbers come down, but it's going to take time."

"It's time for West Virginians to stand up together and say, 'We've had enough, and we can't stand to have such bad outcomes any longer.'"

"We need a good statewide education campaign," said Pat White, who directs Charleston's West Virginia Health Right. "A lot of people don't even know they can prevent these diseases.

"At Health Right, we spend a lot of time teaching people things like, if you walk a half hour a day, it lowers your risk of heart attack or diabetes. Or if you drink two soda pops a day, you're going to gain 20 pounds a year, which increases your risk of heart disease and diabetes.

 "People aren't born knowing this stuff," she said. "Billboards, radio ads, and so on could have a big impact." What message would she put on a billboard? "Your grandma and sister may have sugar, but you don't have to," she said.

The health reform law will lower West Virginia's numbers, said Perry Bryant, director of West Virginians for Affordable Health Care.

 "If the Supreme Court doesn't strike down the individual mandate and Medicaid expansion, about 190,000 West Virginians will get health insurance. A lot of people will get earlier checkups and catch problems at a preventable stage.

"Even if the mandate is struck down, the law contains many helpful prevention provisions," Bryant said.

 "West Virginia has some effective programs, but they tend to be in urban areas. We need to find ways to spread them to rural areas," said Renate Pore, health policy director for the West Virginia Center on Budget and Policy.

"To do all this, we need strong health leadership," she said. In 2011, Pore surveyed 33 state health and political leaders, asking how the state could improve its numbers. "Every one of them said West Virginia needs effective health leadership from the Governor's Office," she said. "They all said we have lacked leadership from the top."

Oklahoma City Mayor Mike Cornette is a good example of inspirational leadership, she said. Confronted with high heart attack, diabetes and stroke rates in 2008, he challenged his city to lose a million pounds.

"He got people united behind a common goal," Pore said.

He announced a Web address -- www.thiscityisgoingonadiet.com. More than 45,000 city residents signed on and started reporting their weight loss. By the end of 2011, they had lost more than 760,000 pounds. They expect to shed a million pounds in 2012. Walkways and bike trails are being built all over the city.

Jorea Marple, state superintendent of schools, says West Virginia's high numbers require a cross-agency attack. "It can't be solved by the education system alone or health care alone," she said. "I would very much like to be part of a discussion across departments. This is a public health issue, and all departments can contribute to its solution."

 She hopes to improve school meals and add physical activity to the children's day, she said. "We need to teach children how to stay healthy," she said. "One in four obese fifth-graders and one in four children with high blood pressure is not acceptable."

Delegate Don Perdue, chairman of the House Health and Human Resources Committee, said he is frustrated to see potentially helpful laws not being implemented.

"We created the GOHELP office partly to inventory our most successful programs so we could try them in other areas," said Perdue, a Wayne County pharmacist, "but GOHELP didn't do that, for whatever reason."

The GOHELP director, Martha Walker, and most of the staff have left. Gov. Earl Ray Tomblin has not filled those positions.

Similarly, "most of the Healthy Lifestyles Act has not been implemented," Perdue said.

Pore praised the state's network of 28 community health centers. "They are strongly oriented toward prevention," she said. Gupta cited Kanawha County's plans to build 100 miles of walking and biking trails.

"West Virginia could definitely lower the numbers, but for us to get there, our top leaders will have to give health care a top statewide priority. That's not happening yet, but we hope for it in the future," Bryant said.

Gallup Healthways surveys 353,000 Americans, 2,400 in West Virginia. Gallup Healthways is releasing its data one condition at a time. They provided the Gazette-Mail with all 12 categories.

West Virginia's 2011 statistics, according to Gallup Healthways, include: obesity, 35.3 percent; high blood pressure, 38.9 percent; high cholesterol, 33.5 percent; diabetes, 15.7 percent; depression, 23.9 percent; heart attack, 7.6 percent; cancer, 8.8 percent; neck or back condition, 38.9 percent; leg or knee condition, 33.9 percent; other recurring pain, 23.9 percent.

At 26.8 percent, West Virginia was second to Kentucky in smoking. At 13.2 percent, the state was sixth in asthma.

Reach Kate Long at 304-348-1798 or katel...@wvgazette.com.

"The Shape We're In" is 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.