Bring on the Fat People!

This week the state of Tennessee was recognized as having the 5th highest rate of obesity in the US, behind (in order) Mississippi, Alabama, West Virginia, and Louisiana. See the report here- http://healthyamericans.org/reports/obesity2005/Obesity2005Report.pdf, or the abbreviated report for Tennessee here- http://healthyamericans.org/reports/obesity2005/release.php?StateID=TN. Findings state that 27.6% of Tennessee's population is clinically defined as obese, an increase of 1.6% from the previous year. It also demonstrates that obesity rates are highest in the South and Southeast.

How does this come about? Having moved to Nashville after growing up and living in Arizona for the majority of my life, and practiced in rural communities as a physical therapist for the past 4 years, my observations bring me to 3 conclusions:
1. Those with lower educational levels choose poorer diets and exercise less (or not at all) both from a lack of knowledge and time in their lives. It is easy to run to the nearest Krystal or Hardees and get a fatburger or sausage biscuit with their obscene number of calories after your 8-10-12 hour day than spend the time making or learning how to cook a much healthier meal, and sitting down in front of the TV and resting after what essentially has been a very physical workday.
2. Those with lower socioeconomic status also choose poorer diets and exercise less (or not at all) due to a lack of resources available to them. Again, it is easier to buy high calorie, lower nutrition value food instead of purchasing better food for you that costs more on a limited budget. Plus, getting regular exercise is somewhat limited by financial difficulties encumbered with joining a health club, even with sliding fee scales available to those who qualify. Yes, running/walking on roads or playing basketball in the park is always an option, but it is becoming less safe to do these activities in neighborhoods where the poor typically live, and for many people these are not activities their bodies or their interest level correspond with. In addition, who wants to run when the heat index is 106 degrees with high humidity? Remember, these people are already unhealthy, and the stress of exercise in this climate invites more serious medical conditions to develop.
3. Tradition and personal values implore that the current intake of high fat, high calorie food is what has always been the norm and thus perfectly acceptable. In a culture that values the sausage biscuit each and every morning, fried chicken once a week for dinner, and a Coke every time you get thirsty, it is difficult to change people's perceptions that what they are doing is bad for them. I saw a woman who was obviously on a limited budget take healthier items such as fruit out of her shopping cart instead of hash browns and ice cream as she tried to be able to purchase her groceries in a store.

These factors, while sometimes blindingly obvious to an outside observer in the culture, are completely misunderstood to the above people in their own lives. Or, in those already affected by the diseases of diabetes, heart disease, or low back pain, discarded as something that they are not willing to change or somehow is not related to their current state of health. And because behavior is the hardest thing to change in one's life, this population, already displaying a lack of discipline in controlling their health, will continue to increase here in Tennessee. The silver lining for me, however, is that being a health care practitioner, there will be no shortage of patients! As long as these trends continue, and surely they are again being passed down to the next generation, I have great job security.