Friday, June 17, 2011

Unzipping Obesity by Zip Code and Race

CDC Map of rate of diabetes per state (WV)

There is an epidemic of Type II diabetes, and it is projected to get worse. The U.S. is ranked third in the world in the rise of diabetes with the numbers doubling in the past 15 years and are projected to double again by 2030. The CDC has a breakdown of estimated population living with diabetes, down to the county. When I checked for my county, Cabell County, West Virginia, we are in the 95% for diabetes. In fact, only 9 counties in the whole state of West Virginia were not in the highest percentile for diabetes, being well-over 10% of the population. This should not come as a complete surprise that the wonderful men and women of the great state of West Virginia are getting decimated by diabetes, considering that the rate of poverty in the state (and the whole Appalachian region) is quite high. According to CDC 2009 data, West Virginia ranked first in obesity with 31.1% self-reported as obese. Alabama came in second with 31.0% self-reported as obese. That puts West Virginia and Alabama at a 6% higher rate of obesity than the lowest self-reported rate of 24.6% in Vermont. And why is that? Why is the Appalachian and Southeastern region of the United States getting killed by obesity and obesity-related illnesses, such as Type II Diabetes?

But, if it is just that easy then why don't more people adhere to that policy? There must be more to it than that! And there is.. 

.The CDC reports that "26.7% of people self-reported as being obese" (Morbidity & Mortality Weekly Report, [MMWR], August 3, 2010). And, the breakdown of obesity rates breaks along racial lines. African-Americans rating highest with 36.8% reported (non-hispanic black women reported at 41.9%), and Hispanics coming in second with 30.7% self-reporting being obese.
CDC Map of Diabetes and Obesity Prevalence Amongst African Americans

  CDC Map of Diabetes and Obesity Prevalence Amongst Non-Hispanic Whites

Also, the obesity rates broke evenly concerning education. The higher your level of education, the lower your rate of obesity. Less than a high school graduate - 32.9%. High School graduate - 29.5%. Some college - 29%. College graduate - 20.8%. (Those figures demonstrate a 12 point difference between people with a college education and those without a high school degree).

One of the most telling figures that I found from the CDC data though, was the breakdown by region. In 2005, it appeared that there was not a great deal of difference in the obesity rate from state to state and coast to coast. From 2005 - 2009, that rate began to show itself, as a regional development, with a significant band forming from West Virginia down into Mississippi.

There is a lot of data from the American Diabetes Association, Health and Human Services (HHS) and the Center for Disease Control (CDS) to show that Type II Diabetes is a preventable disease and treatable with diet and exercise.  But, the data from the CDC shows that people are just not heading that call. The CDC Healthy Youth initiative showed that "nearly two thirds (62.8%) drank any combination of regular soda or pop, sports drinks, and other sugar-sweetened beverages one or more times per day" (CDC). Also, that "male students were more likely than female students and black students were more likely than both white and Hispanic students to drink regular soda or pop, sports drinks, and other sugar-sweetened beverages daily" (CDC). Why would that be? Why would there be a higher rate of obesity and diabetes amongst African-American students than Hispanic or White students? The answer lie between the marketers and the zip code...

A group of researchers from University of California, American University, Johns Hopkins University, University of Texas at Austin and the California Department of Health published a paper in 2009 which looked at "ethnically-targeted" outdoor messaging with "obesity-related advertising, What the researchers were looking for was to see if there was a correlation between billboards in neighborhoods and rates of obesity. Or, as the researchers put it, "This article examines whether African Americans, Latinos, and people living in low-income neighborhoods are disproportionately exposed to advertisements for high-calorie, low nutrient–dense foods and beverages and for sedentary entertainment and transportation and are relatively underexposed to advertising for nutritious foods and beverages and goods and services promoting physical activities."

What they found was that there was a higher rate of obesity-inducing products such as candy, soda and alcoholic beverages were largely represented in African-American neighborhoods and that healthier foods which featured fruits and vegetables are under-represented in those same neighborhoods.
Also, the researchers found that "alcohol products were advertised five times as frequently as in predominantly white areas" with other studies showing the same trend." They show that there was a higher rate of unhealthy point-of-sale products in stores and restaurants in neighborhoods populated by Hispanic and African-American people.

The research does not go so far as to say that this is all a conspiracy to keep poor people and minorities down, any more than the CDC data shows that the population between West Virginia and Mississippi like being obese. The data is real and the facts are staggering. Aside from obesity and Type II Diabetes being disabling and stigmatizing to those populations with highest concentrations, it is also quite costly. The CDC cites that 24% of all medical costs are related to obesity-related disease, such as heart disease, cancer and diabetes. 

The government cannot regulate what we put into our mouths to eat, nor should they. But something can be done and should be done to address the concentrations of this disease in the most susceptible of our population. We are only as strong as a union as our weakest citizens.



  1. The government can't regulate what we put into our mouths to eat, but they can aid in educating people about good food habits and in helping provide resources to make it viable. The citizenry would have to care. Representatives would have to be bold enough to pass the resolutions outlining such aid. In the current national tenor of "take care of your own *&%! self" that's not likely to happen.

    Also, for a study of outdoor placements near impoverished areas, and, therefore, regions of obesity, to be effective, a baseline study would have establish the rate at which ads for high-calorie, low nutrient–dense foods and beverages are placed overall. Then it would be possible to see if low income areas are targeted more than average. I believe there is some evidence that low income neighborhoods have been more heavily targeted for tobacco ads and for the establishment of toxic waste dumps.

    Then too, if these foods are consumed at a higher rate in low income areas, why would a manufacturer advertise anywhere else? Let's work to change the behavior, then the advertising will disappear along with the demand.

  2. We need to remove subsidies from cheap snacks (most have corn or high fructose corn syrup). Snack taxes also work. If the taxes are high enough, marketing and consumer behavior will change accordingly. I'd also recommend the the books Primal Blueprint & Paleo Solution, which point our better paths to health.


Please be kind with your words. I have no intent to offend or ridicule with my blog. I will take into serious consideration, anything which is brought to my attention.