Dr. Greg Heath

In American society, the unhealthiest food choices are the most affordable.

Strenuous activity is almost always optional. And citizens pride themselves on freedom of choice.

That makes it nearly impossible to find a cut-and-dried way to combat obesity.

"This is not just a public health issue. It's an issue of how we live, how we work and how we learn," said Dr. Greg Heath, head of the department of Health and Human Performance at the University of Tennessee at Chattanooga.

To find an answer will require efforts from public health to urban planning to transportation and education.

"It's really environmental, it's political, it's social. So many things come into play that make living a healthy lifestyle really hard," said Kristin Harvey, who runs Scenic City Boot Camp in Chattanooga. Dr. Harvey lost 40 pounds herself through a 15-week exercise and nutrition program before she launched her fitness boot camp here last year.

Local public health advocates are promoting healthier portions and menu items at area restaurants, and school systems in Chattanooga and North Georgia are revamping their menus.

Work-based programs emphasizing wellness aim to make healthy habits more convenient to employees and cut down on future health care costs, said Dr. Adam Long, vice president of research and informatics with Gordian Health Solutions, a personal health coaching company in Nashville. The company is a subsidiary of BlueCross BlueShield of Tennessee.

In October, Tiffany Shaw, 33, of Smyrna, Tenn., was at her highest weight -- 265 pounds, at 5-feet-6-inches.

She decided to make a change soon after she began working as an assistant at Gordian. She'd been diagnosed with hypertension, Type 2 diabetes, fatty-liver disease and elevated cholesterol.

After beginning an on-site workout and nutrition program at Gordian, she lost 50 pounds in five months and diagnosis after diagnosis went away, leaving her doctor "floored," she said.

Ms. Shaw said she's now medication-free for the first time in years.

"I would never go back," she said. "My energy level is out the roof. I'm able to go hiking and actually enjoy the hike."

Still, she said the overwhelming prevalence of fast food means individuals face an uphill battle to eat right.

"It's absolutely the environment. If you go to a grocery store, to purchase a meal, yeah, it's going to feed you but ... it's cheaper just to go to Taco Bell and get two 89-cent burritos," she said.

Willpower vs. Addiction

How to fix the nation's health problems is linked to the question of individual responsibility.

Dr. Billy Arant, a pediatrician and hypertension specialist in Chattanooga, emphasized that the problem of obesity is "self-induced" and said he advocates a straightforward, unapologetic discussion with patients who aren't balancing the calories they consume with the calories they expend.

"If I hurt their feelings or save their life, that's my choice," he said. "They're not bad people. What they don't understand is their choices cause the problem. God didn't do this. The environment didn't do this. ... The food they eat results in a condition (obesity) that poisons their body."

Others contend that for most people, simply deciding to become fit isn't a practical option in a society bloated with cheap, unhealthy food choices with little need for physical activity.

Solutions must address the environmental and socioeconomic barriers to healthy living, said John Bilderback, program manager for Step ONE, the anti-obesity program of the Chattanooga-Hamilton County Health Department.

"Health should be the automatic default," he said. "It should be the easy thing to do. It should not be the hard thing to do."

Legislating Healthy Living

Increasingly health officials are advising that local governments implement policies to help people live healthy lives.

An Institute of Medicine report released this summer recommended zoning restrictions on fast-food restaurants near schools and playgrounds and taxes on unhealthy foods and drinks.

But organizations such as the Center for Consumer Freedom as well as restaurant industry groups emphasize personal responsibility and bristle at proposals to limit consumer choice or saddle businesses with health-related requirements.

Some experts agree that the solution will lie within individuals and shifting their attitude toward food.

"I don't think you can legislate personal habits and personal choice," said Donna Day, dietitian at Hutcheson Medical center in Fort Oglethorpe. "People are going to resent it. Nobody wants me to come to their house every night and say, 'This is what you're going to eat.'"

Health advocates here point out that laws restricting the choices of smokers, and discouraging smoking through tax hikes, have compelled many to quit and improved the population's health as a result. Those kinds of regulatory interventions also could help fight obesity, Dr. Heath said.

"It takes a while for society to catch up with what we see is an issue because we believe so much in an individual's right to make choices," he said.

Efforts to force large chain restaurants to post calorie counts on menu boards have stalled in Tennessee and aren't likely to gain traction in Georgia, either, lawmakers have said.

A Tennessee House subcommittee plans to reintroduce a bill this session that would force chain restaurants with 20 or more locations to display calorie counts and other nutritional information on their menu boards. A bill passed last year in the Georgia state Legislature that prevents local entities from mandating nutritional displays in restaurants.

The socioeconomic barriers to eating right cannot be ignored either, local health officials said.

A recent report from the Ochs Center for Metropolitan Studies emphasized the challenge facing residents from low-income communities in accessing healthy foods, when transportation is limited and the only nearby food options are convenience stores and gas stations.

Step One, the anti-obesity program of the Chattanooga and Hamilton County health departments, is working with a number of groups to bring local community gardens into these so-called "urban food deserts," as well as citing research that could encourage large grocery stores to bring their healthier options to neighborhoods now considered food deserts.

BRINGING BACK ACTIVITY

The differences between youthful play today and 30 years ago are striking, said Stephanie Bostick of Brainerd.

"I look at my daughter now and think, she doesn't even know what it's like to climb a tree," Ms. Bostick said. "Now kids come home and put on their iPods and get on the computer. In the summertime, you don't even see kids outside."

The 38-year-old single mother for the first time began an exercise program in 2006 through the local Urban League's Sisters Together program, established three years ago to improve the health of black women in the area.

Local programs such as Sisters Together and the University of Georgia Cooperate Extension office's Walk Georgia program provide incentives and camaraderie for those looking to get active, organizers say.

Making outdoor activity safe, accessible and a regular part of everyday life is a goal of Trust for Public Land in Chattanooga, said director Rick Wood.

Staff Photo by Dan Henry
Taffe Bishop, right, runs an obstacle course as other participants follow during a Scenic City Adventure Boot Camp led by Dr. Kristen Harvey behind the Kenco River Mill.

In partnership with Chattanooga, the group is working to link miles of trails and greenways, from the downtown Riverwalk to the Brainerd Levee to Camp Jordan, Mr. Wood said. One hundred miles of trails are planned that would extend the opportunity for safe walking and biking trails throughout the city centers, he said.

The idea is a throw-back to a pre-suburban America, a time when walking and riding a bike were not just exercise, but practical modes of transportation, he said.

"The way communities used to be set up is that you could walk to the store or you could walk to the drugstore or even walk to work," Mr. Wood said. "That was built into your everyday routine. ... When these trails are built close to people, population centers ... people will use them."