Heavyweight states

In Bledsoe County, Tenn., the 32.3 percent obesity rate isn't just a shocking number on paper -- it's impossible to ignore just walking down the street.

"Pretty much everybody's fat. We just all eat too much," said Paul Putnam, chairman of the Bledsoe County Health Council and local emergency medical services paramedic.

County-level obesity figures from the U.S. Centers for Disease Control and Prevention paint a picture of widespread obesity in Tennessee and Georgia while providing few glimmers of hope.

In Hardeman County near Memphis, nearly two in every five people -- 37.5 percent -- are obese, which means a body-mass index of 30 or more.

Even in the state's healthiest county in terms of weight -- Williamson County near Nashville -- more than one in five people are obese, with a 24.4 percent obesity rate.

In Georgia, obesity rates range from a high of 35.8 percent in Jefferson County near Savannah to a low of 22.8 percent in Atlanta's Fulton County.

In McMinn County, Tenn., a full one-third of the population is obese, making it one of 10 counties in the state in which at least 33 percent of the population is obese, said Elsie Owens, board member of the McMinn County Health Council.

"Obese -- it's not even overweight," she said. "Those were astounding numbers."

The county-level data compiled by the CDC and released this winter gives health officials a visual map of where obesity rates are concentrated. Researchers hope the data will give them more direction in efforts to tackle the out-of-control rise in chronic illnesses, deaths and health care spending fueled by the obesity epidemic, CDC officials said.

The rise in obesity is a problem that spans the nation, but eight of the 10 states with the highest percentage of obese adults are in the South, according to the Trust for America's Health.

The CDC has devoted funding to obesity-fighting efforts and is encouraging states to enact highly targeted programs that will address environmental barriers to leading a healthy life. Last year, Tennessee and Georgia were two of 25 states where the CDC spent money to help address the obesity

epidemic with more coordination and precision.

In 2009, Tennessee received a $450,000 CDC grant to be doled out over five years and since 2003, Georgia has received $1.3 million from the CDC for planning and implementing anti-obesity programs.

The CDC is focusing so many resources on the problem of obesity because of the condition's link to a web of deadly -- and costly -- health problems, said Dr. Liping Pan, an epidemiologist in the Nutrition, Physical Activity and Obesity branch of the CDC. Addressing obesity should have a ripple effect on the incidence of heart disease, stroke and cancer, she said.

"It's a primary prevention for the other diseases," she said.

FAT IN THE SOUTH

Obesity not only has dire health consequences for individuals, but the disease is eating up huge amounts of public and private health care dollars.

Obesity-related health expenditures topped $147 billion in 2008 -- almost 10 percent of all U.S. health care spending and nearly twice the amount 10 years prior, according to an article published in the journal Health Affairs.

The factors underlining the battle against obesity are complex, including rural and urban spaces that aren't conducive to exercise, cheap foods that are chock full of fat, salt and highly concentrated sugar products, and -- particularly in the South -- a tradition of deep-fried cooking and lower education and income levels.

For many, getting healthy just doesn't rank high on the priority list, said Mr. Putnam of the Bledsoe County Health Council.

"Everybody could adopt a little bit better eating style, get up and exercise more," he said. "The plain simple fact is people just don't want to do it. As long as you feel good most of the time and get up and go, that's about all pretty much anybody is interested in."

CHOICES LIMITED

For those on fixed incomes, food choices are limited by their pocketbooks as well as by the food vendors in their neighborhoods, studies show.

Fewer and fewer jobs incorporate physical activity, making exercise purely for health's sake a luxury that many can't afford, experts say.

Unsafe neighborhoods or a lack of infrastructure that encourages walking or biking as opposed to driving also can be major barriers to an active lifestyle, said Ms. Owens of the McMinn County Health Council.

"I live in Calhoun (Tenn.), and there are no sidewalks," she said. "I see mothers who try to take their kids to school in the morning and they're basically walking in the streets."

Health officials recognize that, from a policy perspective, fighting obesity will require addressing more than just educating people about how to be healthy.

States and counties have focused funding and initiatives on creating safe places for people to play and exercise. In Hamilton County, advocates are hoping to improve access to affordable fresh produce in low-income communities

In Chattanooga, city officials and health advocates are expanding greenways and walking trails and opening up school playgrounds for public use outside school hours.

Dr. Veronica Gunn, chief medical officer with the Tennessee Department of Health, said policies in the state aim to change the environment and add opportunities for adults and children to lead healthier lives.

Obesity is "a reflection of not just personal choices, but also what the available resources are -- food resources, social supports, transportation and the like," she said.

Mr. Putnam said the solution to such a tangled problem will be multifaceted but also will require a shift in the public's thinking.

"It's going to have to be just an overall, national wake-up," Mr. Putnam. "There's not real one way to sit down and say, 'This will cure it.'"

"Obesity is becoming more and more of a problem ... We are seeing some men and women in their 20s and 30s now coming ... with significant blockages in their arteries." -- Dr. Andrew Fowler, cardiologist, Chattanooga Heart Institute

Obesity is "a reflection of not just personal choices, but also what the available resources are -- food resources, social supports, transportation and the like." -- Dr. Veronica Gunn, chief medical officer, Tennessee Department of Health

"Healthy foods are more expensive. If I have to pick between a 99 cent burger and trying to buy a $2 to $3 salad then I'll go for the burger, more than likely." -- Elsie Owens, board member, McMinn County Health Council (hopefully getting mug)

"I hate to lay all the blame on fast food, but I think a lot of it has to be left there." -- Dr. Leonard Reeves, family medicine doctor, Floyd Medical Center