The barriers to living and eating healthily are multiplied for people in poorer communities and households where time and money are scarce, local researchers and health advocates say.
"We're only really beginning to understand the social determinants of obesity," said Dr. Robin Cleeland, a professor at Dalton State College whose research focuses, in part, on the economic factors that contribute to unhealthy weights.
"We focus a lot on behavior and the choices people make, but what we've coming to understand is that some people have a great many more choices than others do," she said.
A number of studies have linked obesity with low-income status in some populations, Dr. Cleeland said.
In 2008 she studied blue-collar workers at three large manufacturers in North Georgia. Even among this working population, she found what she said was a shocking level of "food insecurity," or the inability to afford foods that provide balanced nutrition, paired with higher-than-average rates of diabetes and obesity.
More than three-quarters of the 98 employees surveyed were overweight or obese, she said, and almost 40 percent said they could not afford balanced meals.
"These were employed workers who are doing relatively well financially and still had the food security issues," Dr. Cleeland said. "And we did this prior to the recession, so it makes me really wonder what the situation is now and to what extent the problem has worsened."
Many health advocates believe that efforts to fight obesity not only must address individual choices but also tackle bigger issues - such as the accessibility and affordability of healthy foods.
and the creation of safe places to exercise - that will make it easier for people of all income levels to be fit.
"There are places in town where it really isn't safe for a kid to play outside," said John Bilderback, program manager for Step One, the anti-obesity program of the Chattanooga-Hamilton County Health Department.
Some local advocates are working to create joint-use agreements that would allow local families to use school playgrounds, he said.
It also costs more to eat healthy food, experts say.
Prices for processed foods made with high-fructose corn syrup, such as soft drinks and fast food, have declined sharply since 1985, while the cost of fresh fruits and vegetables has risen nearly 40 percent in two decades, according to the Institute for Agriculture and Trade Policy. The Minneapolis-based institute advocates for sustainable food, farm and trade systems.
"We've got an overweight population that does not have money to buy the right kinds of food," said Nancy Kennedy, executive director of the North Georgia Healthcare Partnership, a nonprofit organization focused on healthy lifestyles. "They're buying the fast foods where for $4.99 you get the double burger and curly fries and 32-ounce Coke."
Poor neighborhoods also may have fewer grocery stores that carry fresh fruits and vegetables. Residents must shop at convenience stores and gas stations, which focus on more processed and unhealthy options, Mr. Bilderback said.
Lori Quillen, policy analyst with the Ochs Center for Metropolitan Studies in Chattanooga, cited a recent study of federal food stamp use in Hamilton County. She said that in the five areas with the highest use, almost 90 percent of the stores that accepted food stamps are considered "fringe food" outlets, such as gas stations and convenience stores.
"What that begins to get at is that, in some of these lower-income neighborhoods, there actually is less access to healthy food," she said.
Mr. Bilderback said some school and neighborhood leaders are using grant money to build community gardens for residents to grow their own produce.
Federal food assistance programs also are a way to help poor people afford healthy foods, local advocates say.
This year, Tennessee's federal Women, Infants and Children food assistance program began offering fresh produce from farmers' markets for enrollees. The Georgia WIC program has partnered with local farmers markets for a few years.
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