Memphis' "BIG" Problem 

One third of adults in Shelby County are obese. How did we get this way and what can we do about it?

At the Church Health Center Wellness facility, instructor Pamela Joyner Robinson leads a fitness class.

Justin Fox Burks

At the Church Health Center Wellness facility, instructor Pamela Joyner Robinson leads a fitness class.

Saying no to a juicy hamburger, a barbecue sandwich, or a large milkshake can be difficult. Unfortunately, a steady diet of these Mid-South staples can contribute to excess weight gain and, eventually, obesity.

According to the Centers for Disease Control and Prevention's 2010 Behavioral Risk Factor Surveillance System survey, nationally, about one in four adults — 27.5 percent — is considered obese. In Tennessee, the average is a little higher: 31.7 percent.

Unfortunately, the bad news doesn't stop there. The study showed that more than 35 percent of adults in Shelby County qualify as obese — about one in three adults.

Obesity is technically defined as a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems.

A person is determined to be obese by a measure known as the body mass index (BMI), which compares a person's weight and height. If a person's BMI is 30 kg/m2 or greater, he or she is considered obese.

The South has the highest rate of obesity in the nation at 29.4 percent.

Addressing the Problem

Memphian Clintonia Simmons weighed 185 pounds at the peak of her battle with obesity, which may not sound like too much, but it is when you're just over five feet tall. The healthy weight for a woman her height is 99 to 126 pounds. At 185 pounds, Simmons had a BMI of 35 kg/m2.

"When I got on the scale and it read [185 pounds], I just stopped weighing myself. I couldn't believe that I weighed that much," Simmons says. "When I first started feeling heavier, I made excuses. 'Oh, I'm getting older.' But being an adult is not an excuse to be out of shape. I didn't have as much energy. I'm short, so I like to wear high heels a lot, but when I gained all that weight, I couldn't wear them. I was too heavy to wear the kind of clothes that I like. I started having little aches and pains in places that I hadn't before."

Simmons attributes her weight gain to pregnancy, a low amount of physical activity, and irresponsible eating. Unhappy with her new look and the physical pain that came along with it, she decided to change her eating and living habits. She's managed to lose around 50 pounds.

"It's not just a matter of people eating less. I wish it were that simple," says Dr. Scott Morris, executive director of the Church Health Center. "Obesity is a complicated factor that is partly genetic and partly about our environment. In Memphis, it has a lot to do with the fact that we've created a culture that absolutely promotes obesity — from the proliferation of fast food restaurants to the difficult walkability that our city offers. It's hard to walk from one place to the other, so people are always in their cars. The amount of food that we consume is so much more than it was even 30 years ago.

"Addressing obesity has to occur in families and in communities. Almost nobody can address obesity alone. Being on a stair-stepper with headphones doesn't solve anybody's problem."

Healthy Memphis Common Table is among the local organizations that have become concerned by the area's obesity problem and are implementing community projects to help change our habits. Common Table recently collaborated with the Shelby County Health Department to launch the Let's Commit to Healthy Activity and Nutrition Goals Everyday initiative. "Let's CHANGE" is providing strategies to more than 30 participating organizations to help limit the rise of obesity in the Mid-South. These include helping ensure adequate access to healthy food and physical activity, providing means for people to make better health choices, and advocating for policies that provide access to a healthy lifestyle.

"Today, in our community, we don't have policies that make the healthy choice the easy choice, so people are [physically] drowning," says Renee Frazier, executive director of Common Table.

"They're constantly being confronted with opportunities to eat unhealthy foods, and they don't have environments for a lot of activity. We want to get out and focus on vending machines, soda machines, sugary drinks, desserts at meetings, [and] helping caterers better provide healthier meals. We [also] want to make sure that people have environments where they can walk safely and frequently and be active. It is not easy to eat healthy in our community, and often it's not easy to be active in our community. That's something that we have to focus on, so individuals have better choices."

Common Table's momentum doesn't end with the Let's CHANGE initiative. In December, the organization was awarded a grant of nearly $200,000 from the Robert Wood Johnson Foundation to launch the "Million Calorie Reduction Campaign Match." The initiative will allow the organization to work with more than 125 local businesses, churches, and community groups, encouraging them to adopt policies that call for healthier food options and promote exercise.

Representatives from Common Table will do assessments on organizations' vending machines, informing them of the calorie amount in the machines. They will then provide information on how to reduce the calorie amount by as much as 50 percent. The group will also focus on increasing healthy choices in soda and vending machines, in cafeterias, and at meetings and functions.

"For us to become leaner, we need to have a way to reduce the amount of calories that everybody injects at the end of the day," says Connie Binkowitz, project manager for Common Table. "Caloric reduction is the objective. People can do this by changing their drinks from sugar-sweetened to non-sugar-sweetened drinks. For some, it means eating smaller portions instead of bigger portions. Baked chicken instead of fried chicken. Baked fries instead of fried fries."

Obese Children and Teens

Excessive weight gain isn't just prevalent among Mid-South adults. According to the CDC, obesity now affects 17 percent of all children and adolescents in the United States — triple the rate from just one generation ago. The 2011 High School Youth Risk Behavior Survey — an anonymous questionnaire administered to high school students in grades 9-12 — revealed that national child obesity averages 13 percent. However, the Tennessee average is 15 percent, and in Memphis, 18 percent of high school students are considered obese.

As with adult obesity, excessive weight gain among kids is attributed to the consumption of too many calories and a low level of physical activity. Television, the Internet, limited access to healthy affordable foods, and low numbers of safe or appealing places to play are additional reasons.

"Most kids go home after school and sit and play video games or watch television," says Joan Randall, administrative director of the Vanderbilt Institute for Obesity and Metabolism. "Those are all things that contribute to the lack of activity, so they're gaining weight. Back in the day, moms would cook their kids dinner. That doesn't happen so much anymore. Nowadays, over 50 percent of the meals are bought outside of the home. People are stopping for fast food, which is more calories and bigger portion sizes. Kids are consuming way more calories than they used to. Plus, they're drinking a lot of soda, [which] is probably the number-one contributor to childhood obesity."

Stefan, a 16-year-old high school senior, has struggled with his weight since adolescence. At 5' 9", he weighs 426 pounds and has a BMI measurement of 62.9 kg/m2. The ideal weight for a teen his height is 136 to 169 pounds. His heavy build has led to teasing from peers, a lack of friends, and even suicide attempts.

"I've tried to choke myself with a seat belt. I've tried to drown myself," Stefan says. "I was mad that [the attempts] didn't work. I thought that I would be better off dead. I wouldn't get picked on or talked about. I figured that if I were gone, my mom would save money, because she wouldn't have to pay for so much food. I was just eating every day but for no reason. When I got bored, I'd eat. When I got depressed, I'd eat. When I got happy, I'd eat."

The problem of youth obesity has led the Memphis City Schools system to take a more hands-on approach to curbing the issue. Jean Massey, MCS health coordinator, said Coordinated School Health is working with district staff and community partners to provide health-related initiatives for students.

"The Nutrition Services Division is concentrating on preparing healthy meals within state and federal guidelines and has discontinued frying food for several years," Massey says. "Access to unhealthy sweetened and salty snacks is controlled within schools. Physical activity is encouraged through multiple initiatives, including Walking School Bus Day, where parents of elementary students are encouraged to walk their children to school and secondary students are encouraged to walk in groups."

In addition, Coordinated School Health contributes stability balls and Nintendo Wiis in some MCS classrooms to help encourage physical activity in a way that's more amenable to young students. 

Students are also being encouraged to participate in Common Table's version of the national 5-2-1-0 Campaign, an initiative that calls for a daily consumption of five fruits and vegetables, no more than two hours of screen time, one hour of physical activity, and zero sweetened beverages.

Simmons, a mother of three, is making her own efforts to help lower childhood obesity. She founded Healthy Kids and Teens, a nonprofit organization that focuses on ending childhood obesity by educating and motivating kids into a healthier lifestyle.

The organization sponsors the CampGetFit Foundation, which is geared toward kids from 6 to 15 and promotes nutrition and fitness education, along with physical training. The camp is held at Grahamwood Elementary. There are more than 60 participants, who have collectively lost more than 160 pounds thus far.

"The kids lost that weight just changing what they do every day. No one went on a diet," Simmons says. "Weight loss is a by-product of living healthy. If you start making changes to your lifestyle — you become more active, you change portion sizes — the weight's going to come off without you having to say that you're going on a diet."

Unhealthy Costs

Obesity can also have detrimental financial effects on taxpayers. Heart disease, diabetes, certain cancers and asthma, and other chronic diseases are linked to obesity. In Tennessee, the annual medical cost of obesity-related diseases is an estimated $2.8 billion.

"An obese person has $1,429 more in medical costs per year than the average person," Randall says. "People who have diabetes have huge medical costs. They have to go to the hospital or doctor constantly, and a lot of these people don't have insurance, so the public pays for it through Medicare, Medicaid, or TennCare. There are a lot of medical conditions that people have that would not be the case if they weren't so overweight or obese."

"Increased weight creates stress on your joints, which leads to more arthritis," Dr. Morris says. "Diabetes and hypertension increase your risk of stroke, heart attack, [and] the increased risk for kidney and eye disease. It's just a terrible stair-stepped approach that impacts quality of life and life expectancy. How many people have you met who are 70 years old and weigh 300 pounds? Not many."

Food Deserts

In Memphis, there are a large number of "food deserts," places where there are few or no options for fresh food and produce. They're normally found in impoverished communities, where, due to the scarcity of grocery stores and farmers markets, residents commonly rely on corner stores or convenience stores for food. Because the food available in such stores is usually processed, laden with sugar and salt, and high in calories, eating healthy is difficult for many low-income residents.

"It doesn't take a lot to realize that much of Memphis is in these areas where there isn't [enough] access to fresh fruits and vegetables," says Chris Peterson, executive director for GrowMemphis. "Our primary goal is to help people take lack of food access into their own hands. Our organization provides them with the opportunity to grow a free source of fresh fruits and vegetables for themselves and their neighbors."

How to End the Epidemic

The area's obesity dilemma is an issue that can't be tackled on a person-by-person basis but rather through community efforts — including increasing awareness of obesity's causes, school initiatives to lower caloric intake, making healthy foods more available in underserved neighborhoods, and increased exercise opportunities, to name a few.

"If we do not address this issue, it will be the greatest public health disaster in the history of America and certainly in the history of Memphis," Dr. Morris says. "I'm not sure what a parallel will be, because the impact will rain down on our children and our grandchildren for generations to come. It's not an option to not deal with it. We have to or else the consequences will be beyond our ability to anticipate." ·

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