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By MIKE STOBBE, AP Medical Writer Mike Stobbe, Ap Medical Writer Sun Nov 16,
10:46 pm ET
HUNTINGTON, W.Va. As a portly woman plodded ahead of him on the sidewalk, the
obese mayor of America's fattest and unhealthiest city explained why health is
not a big local issue.
"It doesn't come up," said David Felinton, 5-foot-9 and 233 pounds, as he
walked toward City Hall one recent morning. "We've got a lot of economic
challenges here in Huntington. That's usually the focus."
Huntington's economy has withered, its poverty rate is worse than the national
average, and vagrants haunt a downtown riverfront park. But this city's
financial woes are not nearly as bad as its health.
Nearly half the adults in Huntington's five-county metropolitan area are obese
an astounding percentage, far bigger than the national average in a country
with a well-known weight problem.
Huntington leads in a half-dozen other illness measures, too, including heart
disease and diabetes. It's even tops in the percentage of elderly people who
have lost all their teeth (half of them have).
It's a sad situation, and a potential harbinger of what will happen to other
U.S. communities, said Ken Thorpe, an Emory University health policy professor
who is working with West Virginia officials on health reform legislation.
"They may be at the very top, but obesity and diabetes trends are very similar"
in many other communities, particularly in the South, Thorpe said.
The Huntington area's health problems, cited in a U.S. health report, are a
terrible distinction for the city, but the locals barely talk about it. Many
don't even know how poorly the city ranks.
Culture and history are at least part of the problem, health officials say.
This city on the Ohio River is surrounded by Appalachia's thinly populated
hills. It has long been a blue-collar, white-skinned community overwhelmingly
people of English, Irish and German ancestry.
For decades, Huntington thrived with the coal mines to its south, as barges,
trucks and trains loaded with the black fuel continually chugged into and past
the city. There were plenty of manufacturing jobs in the chemical industry and
in glassworks, steel and locomotive parts. Nearly 90,000 people lived in the
city in 1950.
The traditional diet was heavy with fried foods, salt, gravy, sauces, and
fattier meats dense with calories burnt off through manual labor. Obesity was
not a worry then. Workplace injuries were.
But as the coal industry modernized and the economy changed, manufacturing jobs
left. The city's population is now fewer than 50,000, and chronic diseases
many of them connected to obesity seem much more common.
Shari Wiley is a nurse at St. Mary's Regional Heart Institute in Huntington.
She runs a program that identifies heavy school children and tries to teach
them better eating and exercise habits. The effort began because of an alarming
trend.
"A lot of the patients we were seeing were getting heart attacks in their 30s.
They were requiring open heart surgery in their 30s. And we were concerned
because it used to be you wouldn't see heart patients come in until they were
in their 50s," Wiley said.
The Huntington area is essentially tied with a few other metro areas for
proportion of people who don't exercise (31 percent), have heart disease (22
percent) and diabetes (13 percent). The smoking rate is pretty high, too,
although not the worst.
However, the region is a clear-cut leader in dental problems, with nearly half
the people age 65 and older saying they have lost all their natural teeth. And
no other metro area comes close to Huntington's adult obesity rate, according
to the report by the U.S. Centers for Disease Control and Prevention, based on
data from 2006.
Perhaps fittingly, hospitals are now Huntington's largest employers. Another is
Marshall University, home of the "Thundering Herd" football team depicted in
the 2006 film "We Are Marshall" which dominates local sports conversations.
The river runs along the edge of town, but it's not a focal point. Marshall and
one of the city's remaining factories sit to the east with several blocks of
hotels and office buildings farther west. A new complex called Pullman Square
which includes a movie theater and a Starbucks is trying to become a retail
and dining center and illustrates a transition to a service economy.
The area's unemployment rate was about 5 percent in September, actually a bit
better than the 6.1 percent national average that month. But often the jobs are
not high-paying. Many workers lack health insurance, and corporate wellness
programs common at large national companies are rare.
Poverty hovers, with the area rate at 19 percent, much higher than the national
average. In the hilly coal fields to the South, people still live in houses or
trailers with drooping, battered roofs. They stare hard at any stranger in a
new car. In Huntington and its outskirts, many people think of exercise and
healthy eating as luxuries.
The economy needs to pick up "so people can afford to get healthy," said Ronnie
Adkins, 67, a retired policeman, as he sat one recent morning on the smoking
porch of the Jolly Pirate Donuts shop on U.S. 60.
Doughnut shops don't help either, of course. But breakfast pastry shops aren't
the most common outlets for fatty food. Pizza joints are. They are seemingly on
every block in some parts of the city. The online Yellow Pages lists more pizza
places (nearly 200) for the Huntington area than the entire state of West
Virginia has gyms and health clubs (149).
Hot dog places also abound, with the city hosting an annual hot dog festival
every summer. "I've never seen so many places that are hot dog oriented. I
guess it's a cultural thing. Appalachian," said Mayor Felinton, who grew up in
Maryland and moved to Huntington to attend Marshall University and stayed put.
Fast food has become a staple, with many residents convinced they can't afford
to buy healthier foods, said Keri Kennedy, manager of the state health
department's Office of Healthy Lifestyles.
Kennedy said she had just seen a commercial that presented "The KFC $10
Challenge." The fried-chicken chain placed a family in a grocery store and
challenged them to put together a dinner for $10 or less that was comparable to
KFC's seven-piece, $9.99 value meal.
"This is what we're up against," said Kennedy, noting it's an extremely
persuasive ad for a low-income family that is accustomed to fried foods. "I
don't know what you do to counter that."
Lack of exercise is another concern. During a warm and sunny autumn week in
Huntington the kind of weather that would bring out small armies of joggers
in some cities it was unusual to see a runner or bicyclist. The exercise that
does occur is mostly confined to a local YMCA, at campus recreation facilities
at Marshall, or at Ritter Park in a tony neighborhood south of downtown.
Some attribute the problem to crumbling sidewalks in the city and a lack of
walkways along busy rural roads. Others blame it on lack of motivation, as well
as a cultural attitude that never included exercise for health.
There's a connection between education and lack of exercise, too, said Dr.
Thomas Dannals, a Huntington family physician.
"The undereducated don't know the value of it. They don't have the drive for
it. There's a reason you're successful, you've got drive. The same is true for
exercise," said Dannals.
Dannals has been trying to change cultural attitudes. The local newspaper has
called him "an exercise evangelist" for founding the city's triathlon, marathon
and other projects designed to make exercise popular and fun. He's also
spearheading a riverfront exercise trail project, called the Paul Ambrose Trail
for Health (PATH).
Ambrose was a Huntington physician who died in the Sept. 11, 2001, jet that
crashed into the Pentagon. Just before he died, he had been working on a U.S.
Surgeon General report on obesity, and was on the plane that morning to attend
an adolescent obesity conference in Los Angeles.
But the PATH project, first proposed more than a year ago, has yet to win the
necessary funding. The lack of support is not surprising: Dannals can't even
get a company to sponsor the Huntington marathon.
Local politicians tend to be equally tepid about improving health, said Dr.
Harry Tweel, director of the Cabell-Huntington Health Department.
Smoking a common sin in West Virginia has been hard to control, Tweel said.
When the health department tried to restrict smoking in local bars and
restaurants, a group of local businesses fought it all the way to the state
Supreme Court. (The restrictions were upheld in 2003.) Even hospitals have
fought smoking restrictions in the past, Tweel said.
Other communities have taken more ambitious steps to control the amount of fat
in local restaurant food. In July, the Los Angeles City Council placed a
moratorium on new fast food restaurants in an impoverished area of the city
with above-average rates of obesity. In 2006, New York City became the first
U.S. city to ban artificial trans fats in restaurant foods. Other cities are
considering similar measures.
Forget it, Tweel said. Not in Huntington.
"You're mentioning areas (of the country) that are well beyond this local
region in accepting that kind of change," said Tweel.
"People here have an attitude of 'You're not going to tell me what I can eat.'
The cultural attitude is 'My parents ate that and my grandparents ate that,'"
he said.
Mayor Felinton echoed Tweel. Felinton had stomach surgery last year to help him
lose weight and has been walking to work about three days a week. He has shed
nearly 80 pounds and became sort of a local poster boy for weight loss. But in
the midst of a re-election campaign last month, he said he had no plans to
plunge into a fight over fat in restaurants.
"We want as much business as we can have here," said Felinton, who lost his
recent re-election bid and leaves office in January. "As many restaurants as
you have, it kind of enhances the livability. Maybe not the health."
To be fair, most people in Huntington don't seem to be aware of how poorly
their city looks in national health statistics.
The latest numbers came from the CDC report, released in August, but
little-publicized. It was based on survey data from 2006, comparing about 150
metropolitan areas. The Huntington area includes five counties two in West
Virginia, two in Kentucky and one in Ohio.
Of the 40 Huntington-area residents interviewed for this story, many had heard
something about West Virginia being one of the unhealthiest states. But only
one Tweel knew about the latest report showing how bad Huntington compared
with other metro areas.
Some doctors, on hearing the statistics, noted the Huntington area is not in
such bad shape by West Virginia standards. A recent state study found that
health problems are significantly worse in the more rural coal counties to the
south. But those places didn't show up in the CDC report, because they were too
small.
Still, Huntington is an unusually obese place, said Dr. John Walden, chairman
of the family and community health department at Marshall University's medical
school.
Walden is a third generation physician in the area, but he's also traveled
extensively around the world. He says it's always a little jolting coming home
and realizing how obese his hometown is compared to the rest of the world.
"I don't know that I've ever been in a place where I've seen so many overweight
people," he said.