Mississippi consistently ranks low in health measures.
THE NEED FOR PREVENTION and wellness efforts is starkly evident across the nation but much more so in Mississippi, a state that consistently ranks low in health measures. Realistic but tenacious efforts are driving the state's anticipated improvements, one patient at a time.
QuaShunda Edwards has twin 6-year-old daughters. One is obese; the other is normal weight. And yet, this Mississippi single mother has worried more for the health of her comparatively slender daughter than the obese twin because she weighs so much less than her friends and neighbors.
In a state in which up to 75% of residents are overweight or obese, Jones' perspective of what is "normal" weight has become skewed, says Richard S. deShazo, MD, the Billy S. Guyton Distinguished Professor of medicine and pediatrics, University of Mississippi Medical Center.
After years of enduring top obesity rankings, leaders and health officials are taking steps they hope will at least halt the increasing rate of obesity. With 67% of Mississippi's residents obese, according to the Kaiser Family Foundation, state leaders are beginning to see the grim economic and societal impact.
ACCOMMODATING LARGER PATIENTS
Dr. deShazo, an Alabama native, says he first saw the economic impact of obesity when he became chairman of the department of internal medicine at the University of Mississippi medical school about 12 years ago, and he was surprised by the number of patients with obesity-related metabolic syndrome, diabetes, hypertension and stroke.
Over the course of five to 10 years, patients became so large they couldn't fit into MRI and CT imaging systems, and they were breaking beds and wheelchairs because of their weight. Special ambulances were constructed to transport patients who weighed up to 700 pounds.
"It became an economic issue because we had to and buy a whole set of imaging equipment just to take care of them," he says. "It was an obvious epidemic."
Convinced that at least part of the problem was a lack of health education, Dr. deShazo began hosting a radio program on Mississippi Public Broadcasting that helps to inform listeners about the need to limit their fat, sugar and salt intake. The show's popularity led to a four-part public television documentary in which Dr. deShazo examines the cultural, economic and societal impact of obesity.
The media outreach coincides with an innovative 2007 state law, the Healthy Schools Act, which mandates that schools improve nutrition, exercise and health education. Efforts have included removing soda machines from schools, and replacing fried foods with baked versions prepared in "convo-therm" ovens. The law also requires 150 minutes each week of physical education, and at least 45 minutes each week of health education.
Children who are fit have higher test scores, says Therese Hanna, MHS, executive director of the Center for Mississippi Health Policy. The reverse also is true, she adds.
"We need to reach the children before their lifestyle is so ingrained that it makes difficult to change," Hanna says. "They're in public school and there's an understanding that the state has a responsibility in terms of the environment in the school. Policy changes can occur for that population a lot more quickly [than for adults]."
It's harder to reach adults, beyond the arm of public policy. And that's where complex social determinants, such as literacy, poverty and government subsidies, come into play.
"It's not as simple as 'we like our fried chicken,'" Hanna says.
The epidemic is driven by a combination of poverty and a food policy that is counterproductive to good health, Dr. deShazo says.
Agriculture policy, including the federal Farm Bill, subsidizes crops such as sugar, corn, rice, cotton and soybeans at the expense of fresh fruits and vegetables. The Mississippi Delta contains some of the richest farmland in the United States, yet most farmers do not find it as profitable to grow fruit and vegetables here. As a result, fresh food is expensive and hard to find in this region.
"If you're working two or three jobs, and have three or four kids, it's easier, quicker and less expensive to feed your kids fast food than to pay $3 for a head of lettuce in a food mart," Dr. deShazo says. "The reason you can't get it is because we don't grow it."
In one segment of Dr. deShazo's program, a doctor at a free clinic recommended patients should stop eating red meat. Later, clinic patients said that they had stopped eating red meat: They cooked it, so it wasn't red.
"When you start with people who are barely literate and try to explain calories to them, you can forget it," Dr. deShazo says.