“Jenni” is one of thousands of West Virginia children and teenagers whose high blood pressure and weight puts them at risk of future heart disease, diabetes and other chronic diseases.  Photo by Lingbing Hang

By KATE LONG | Feb. 11, 2012 | Charleston Gazette

MORGANTOWN, W.Va. — Jenni, a young teenager, sat on a West Virginia University examining table, twisting her fingers, waiting for the heart doctor. Sitting nearby, her dad patted her arm and closed his eyes.

Her Braxton County doctor had asked for a consultation. Jenni’s blood pressure was spiking.

In a room down the hall, pediatric cardiologist Dr. Bill Neal and his team looked at Jenni’s test results. “Her heart defect’s not a problem now, but her weight is,” Neal said.

Jenni — not her real name — weighed 209 pounds, at about 5 feet tall.

Neal turned to dietitian Leah Woodburn. “We need to bring her weight and blood pressure down,” he said. “You’ve talked with her?”

“She’s a sweetheart,” Woodburn said, “giggles and smiles and a puppy at home. She eats oodles of ramen noodles, and she’s taking in at least 1,000 calories a day in soda pop.

“She thinks she can cut down on soda and the ramen noodles,” Woodburn said. “If she does, she’ll lose weight. Even 500 extra calories a day adds up to a pound of weight gain a week.”

“Physical activity?” Neal asked. Lots of video games and texting, Woodburn said. Otherwise, not much.

Neal sighed. “She’s above the 99th percentile in weight, with high blood pressure and the neck rash that says that she probably already has high insulin resistance. This child is at very high risk of developing Type 2 diabetes.”

He turned to the medical student attached to their team. It would be fairly straightforward to help Jenni, he said, if her county had a public health dietitian or an after-school physical activity program. The problem is, there was nothing affordable to refer her to, near her home.

“This is a huge problem in most rural counties. We have thousands of pre-diabetic, obese children with high blood pressure who need to get physically active,” Neal said. “They need support and follow-up at home.”

“We could prevent a lot of type 2 diabetes if there was a way to get them active,” he said.

Ninety to 95 percent of diabetics have type 2 diabetes, which is preventable through exercise and diet. It used to be called adult-onset diabetes. “Nobody calls it that anymore,” Neal said.

Small steps

Jenni’s eyes widened as Dr. Neal entered the exam room. He pulled up a chair between her and her father. “The tests show your heart defect isn’t causing you any problem,” Neal said. Jenni’s shoulders sagged in relief. A shy smile spread across her face. Her cheeks turned pink.

“But your weight is a serious concern,” Neal said. “Your high blood pressure is, I think, related to the extra weight you’re carrying.” Jenni drew a deep breath, blushing.

“You’ve talked about this with the dietitian, haven’t you?” Neal said. She nodded. “What do you think you could do to take off some of those pounds? “

Jenni said she could cut down on soda pop. “And I could walk my puppy,” she said. Her dad reminded her he bought her a video exercise program. “I could play with that more,” she said.

Cutting down on soda pop was the number one priority, she and Neal agreed. “Let’s see if you can lose 10 pounds,” Neal said. “Small steps.”

After the team left the room, dietitian Woodburn shook her head “If we could reduce soda consumption, obesity rates in this state would drop,” she said. “Just that one thing.”

“A 20-ounce Orange Crush has 20 teaspoons of sugar and 250 calories,” she said, “and 500 extra calories every day, for seven days, translates into one pound weight gain and that’s more stress on her heart.”

Ramen noodles are double-fried. They’re second on her hit list.

Your address matters

Jenni and her dad went back to Braxton County, where last year, 26 percent of fifth-graders — 11 and 12-year-olds — had high blood pressure.

Also, 29 percent were obese, according to West Virginia University’s CARDIAC screening data. For children, “obese” means they weigh more than 95 percent of children their age and height in the national norm group.

Braxton County runs slightly above the state average in obesity, and well above the national average of 20 percent for children ages 12 to 19.

“I know we need to do something,” said Sissy Price, Braxton County’s public health nurse. “These kids are on their way to diabetes, but it’s gotten so common for a child to be that heavy, I think people forget it’s dangerous.”

Price, a part-time sanitarian and a part-time administrator hold down the fort at the county’s tiny health department.

“I wish I could tell you we have something for these kids, but we don’t,” she said. There are no after-school physical fitness programs for kids who aren’t on a sports team, she said.

“One of the coaches is trying to raise money to build a community building where families could exercise,” she said. “All we’ve got is Curves and an adult gym that costs $40 a month. Nothing for kids or people who can’t pay $40 a month.”

“This is a real problem in small rural counties especially,” said House of Delegates Majority Leader Brent Boggs, D-Braxton. “In Braxton County, we’ve got a track team with no track. There’s one football field for the entire county youth and one swimming pool that opens only in summer, so we can’t have swim teams. The list goes on and on.”

The county per capita income is $18,263. The county’s 14,890 residents are mostly scattered about deep rural hollers and steep hillsides. A lot of residents drive to other counties for work. Only about 960 people live in Sutton, the county seat.

Sissy Price grew up in Braxton County. “I love this place, its beauty, the friendly people. That’s why I’m here,” she said. “I want to be useful here. At the health department, we do our best with what we have, but it’s a drop in a bucket that doesn’t have many drops.”

Diabetes and heart disease used to top the public health priorities list, she said, but “drugs and meth have pushed everything down the list. Diabetes is about number ten now. Even teenage pregnancy, drugs have pushed that down the list.”

She’d like to help that coach raise money for the community building, but she can’t do that on the job, she said.

Earlier this year, the health department had a dinner so the community could set public health priorities, she said. “They want us to spend most of our time on drug abuse,” she said. “If I do, I don’t have time to organize a program for diabetes prevention or fitness.

“I am one nurse serving 14,900 people, and more people are coming to the health department, but our funds for are being cut. We got a big cut in immunization money. Small counties are struggling.

“I have to keep my eye on our primary mission. I am not letting vaccine-preventable diseases creep into our county. I won’t let our teenage pregnancy rate rise.

“But we shouldn’t have to choose,” she said. “This is public health. To me, helping children be healthy and fit is just as important as keeping people off drugs.”

Kids on drugs could die today, she said, but kids like Jenni could die 20 years from now and undergo expensive treatment before they do. “Why would we help one and not the other?”

‘Lots of kids’

Braxton County isn’t unique. There is very little to help kids like Jenni in most counties, said Emily Murphy, obesity specialist for West Virginia University Extension Service. This is the elephant in the living room, the reality that isn’t often discussed when people talk about solutions for the state’s chronic disease or obesity problems.

“In many counties, there are no programs where you can refer at-risk kids, no after-school physical activity programs, no Y,” Murphy said. “It’s heartbreaking, because with a little exercise, these kids could turn their health around.”

Jenni won’t get much exercise at school. Students at the high school get only one semester of physical education in four years. Middle school kids get 18 weeks per year, 44 minutes every day for 18 weeks, then no PE for the rest of the year.

The school lunch? “I eat with my child at least once a month,” Price said, “and I can’t say the food isn’t fattening.” She pauses. “They’re trying, making progress.” The menu features brown rice, salad and whole wheat rolls, sometimes bean burritos.

Price dreams of a dietitian — “even somebody who comes once a month” — to run groups for families and kids who want to tackle their weight and learn to cook. “None of the kids know how to cook anymore. Lots of parents don’t cook. All they do is reheat stuff.”

She dreams of after-school physical fitness classes for kids — all kids, not just overweight kids — in “a community building with a swimming pool,” she said. “We could share it with two or three other counties, maybe put it at Flatwoods, close to Gilmer County.”

“There’s a lot of folks like myself who have been meeting and talking about how we can remedy this,” Boggs said. “The bottom line is, the public will have to say, ‘This is what we want.’ Because there’s no federal money for it now, and the state can’t fully fund it. So we’d have to come up with our share.”

If Jenni lived in Beckley, she could go to the YMCA cardio workout program for kids. If she lived in Kanawha County, she could find after-school programs. If she went to East Bank Middle School, the school-based health center would help her work on her weight, as part of a West Virginia University research study.

But there are only 8 YMCAs statewide, and Braxton has no school-based health center yet.

Kanawha also has the state’s only multi-week medical program for overweight kids, Charleston Area Medical Center’s eight-week Healthy Kids program. In that program, Jenni would see a dietitian and doctor every week and meet with other kids. She’d try different ways of exercising. The staff would help her fit physical activity into her life.

Healthy Kids has a long waiting list. It takes a year to get in. Fewer than a hundred kids attend.

Jenni also would have been eligible for Camp New You, a free two-week summer camp for pre-diabetic, overweight kids developed at WVU through the CARDIAC project. Camp New You was cancelled last summer for lack of funds.

“I wish we had something for her,” Sissy Price said. “There’s lots of kids that need it.”

“You can do all that screening, and you can send a letter, and then it can still not work because nobody talked with the parents,” says Lincoln County school nurse Pam Dice. | Kate Long photo for Charleston Gazette

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By Kate Long | February 11, 2012 | The Charleston Gazette

CHARLESTON, W.Va. — Every year, for 12 years, Lincoln County school nurse Pam Dice sat down and telephoned parents of kids who had what she calls “dangerous numbers.”

Each year, after West Virginia University’s CARDIAC project screens schoolchildren, they send school nurses a list of results. Dice always went through her list, looking for kids with high numbers.

Each year since 1998, CARDIAC has found that one in four West Virginia fifth-graders has very high blood pressure, risky cholesterol and obesity. Those are early warning signs of future diabetes, heart disease, and stroke, Dice knew.

In Lincoln County, last year, 34 percent of children screened had high blood pressure and 28 percent were obese. “They showed us which kids need attention,” she said, “so I picked up the ball.

“Nobody told me I had to do it,” said Dice, who retired this year. No state agency has ever asked its employees to follow up on the children at risk. “But I knew some kids wouldn’t make it to a doctor if I didn’t.”

Dice called a few parents at a time. She knew CARDIAC had sent them a letter, telling them their child’s results, advising them to take their child and the letter to their doctor for advice.

“But people get all kinds of things in the mail, and they don’t know the people who sent that letter, and I felt like somebody local needed to call, too.

Pam Dice

“I know for a fact that a lot of kids made it to the doctor because of those calls, so it was time well spent,” she said.

What did she say? “Nothing complicated,” she said. “I just asked if they had questions, then mostly listened. Lots of people just needed to hear that I thought they should pay attention to the letter.”

The letter lists a toll-free number parents could call with questions. “But some people hesitate to call someone they don’t know.”

Sometimes parents hadn’t read the letter, she said. “Some couldn’t read it. And there’s some who’ve got other troubles, things on their mind, drugs or mortgages or something else, and maybe they threw it in the trash or laid it down without reading it.

“I’d just tell them what the letter said, and we’d go from there.

“Most wanted to do something, once they understood they could save their child a lot of trouble down the road. People want the best for their kids.

“Nothing takes the place of a conversation,” she said. “You can do all that screening, and you can send a letter, and then it can still not work because nobody talked with the parents.”

Today’s young adults

The first children screened by the CARDIAC program turned 23 years old in 2011.

How are they doing? If they had dangerous numbers, did their parents take them to the doctor?

Nobody knows.

Individual nurses like Pam Dice followed up. Nobody knows how many others did the same. They were not asked to contact parents to see if they had questions.

Every year, lawmakers wrestle with the state’s mushrooming high chronic disease bills. They have been warned that those costs will double between 2008 and 2018 if the state does not find a way to reduce the number of people developing diabetes

But in 13 years of CARDIAC, no state or regional agency has systematically followed up on thousands of children identified as at risk, as a way of lowering the state’s diabetes numbers.

“We should be following up in some way on the CARDIAC results,” said Delegate Don Perdue, chairman of the House Health and Human Services Committee. It’s a chance to save children and their families a lot of expense, he said, and “probably would have saved the state millions of dollars in the future.

“We’ve been warned that our health care expenses could at least double if we don’t lower the percent of people who have chronic disease,” said Perdue, a Democrat and a Wayne County pharmacist. “Once the alarm bell has rung, the house is on fire, and you need to be putting it out. But we are not good at prevention.”

Whose responsibility?

The state-funded CARDIAC program is finishing its 13th year in the schools. This spring, CARDIAC will send the schools new lists of children who have early warning signs of chronic disease. No systematic response is planned.

“It’s a lot harder to organize a follow-up than it might sound,” said Joe Barker, director of state Office of Community Health Systems. “Whose responsibility would it be? Therein lies the problem.”

“School nurses would like to follow up on those children, but they are already overwhelmed with kids who are already diagnosed with asthma, seizure disorders and insulin-dependent diabetes and behavior disorders,” said Becky King, coordinator in the state Office of Healthy Schools.

Nurses are also responsible for dealing with STDs, pregnant teenagers, kids on drugs, and kids with HIV, she said. To do more, she said, nurses need more troops.

Can local health departments help? Only three have full-time directors, Barker said. The rest are tiny, independent entities, so no central body can order them to “do this, across the state.”

Melanie Purkey, director of the state Office of Healthy Schools, said that, with limited personnel, the school system is trying to improve the health of all children instead of following up on specific at-risk children.

The schools have managed to get soda pop and junk food out of vending machines, she said. The Department has launched statewide efforts to improve school lunches and increase physical activity. “Those things will help all children,” she said.

“We feel specific children should be treated in their medical homes,” she said. All kindergartners now must have physical exams before they enter kindergarten, as a means of requiring parents to establish a “medical home” for the children.

The Bureau of Public Health also does not have resources to organize a statewide contact-the-parents effort, Barker said. The state Diabetes Prevention Program has only three staffers to cover the whole state.

“No one agency is equipped to follow up on these kids,” Barker said. “Obviously, somebody should, but everyone’s pretty overwhelmed, understaffed, and under-resourced.”

“We can beat this. If we decide from top to bottom that we’re going to do this, we can do it.” — Dr. Alan Ducataman, interim dean of the WVU School of Public Health  [Kate Long photo]

By KATE LONG | Feb. 13, 2012 | Charleston Gazette

CHARLESTON, W.Va. — “We can beat this,” said Dr. Alan Ducatman, interim dean of the West Virginia University School of Public Health. “If we decide from top to bottom that we’re going to do this, we can do it.”

West Virginia occupies a top slot on almost every awful health ranking: diabetes, heart disease, stroke, kidney disease and others.

“There’s a new feeling that it doesn’t have to be that way,” said Christina Mullins, director of the state Office of Maternal Child and Family Health. “There is new energy to lower these numbers. There’s a sense of urgency.”

One in four West Virginia fifth-graders have high blood pressure, cholesterol and obesity, well above the national average.

As millions in health reform dollars roll into West Virginia, “we have the chance of a lifetime to make it different,” said Dr. Rahul Gupta, director of the Kanawha-Charleston Health Department.

Two years from now — if the Supreme Court doesn’t strike the federal health care law down — more than 100,000 West Virginians will get health insurance. That alone should lower the numbers, Gupta said. “People will be able to get checkups, and we’ll catch a lot more diabetes and heart disease early.”

“It’s an exciting time to be working in health care,” Mullins said. “A lot of things are possible that weren’t possible before.”

Federal health care reform forces agencies to cooperate, she said. “A lot of good is coming from that. People who never talked before are seeing how their pieces fit together, comparing notes, saying, ‘Oh! We could work together here.’”

The state Bureau of Public Health and the state Department of Education are meeting regularly to plan for children, she said. DHHR gave the schools a half million for playgrounds. They designed a joint teen pregnancy campaign. They want to let residents of communities with no gyms use school gyms after school.

That kind of cooperation adds up to healthier communities, said Dick Wittberg, director of the Mid Ohio Valley Health Department.  “Doctors or health departments can’t do it alone. The schools can’t do it alone. County government can’t do it alone. Everyone has a part.”

In 2009, Wittberg’s health department got a $4.5 million federal grant to demonstrate what communities can do. They tried to choose things that would be possible without a big grant, he said.

They helped start school mountain bike and running clubs. They organized farmers markets in six counties and installed bike racks all over Parkersburg. Volunteers from the West Virginia Mountain Bike Association cut a web of biking and walking trails through six counties.

They convinced two Walmarts, three Foodlands, and now several Kroger stores to start healthy checkout aisles “so customers can have the choice of a banana instead of candy or chips.”

Parkersburg is also home to the River City Runners and Walkers, a volunteer-run club with more than 1,000 members that sponsors weekly events for grownups and children. “We’re making this a running town,” said Sharon Marks, volunteer board president.

“Each of these things may seem small, but they add up to a community where it’s easier to live a healthy life,” Wittberg said.

Puzzle pieces in the air

“If you lower diabetes, you lower the rest.” — Ken Thorpe, Professor, Rollins School of Public Health

By 2025, at the current rate, 61 percent of Americans will be diabetic or pre-diabetic, Johns Hopkins University and others estimate. An estimated 315,000 West Virginians would be diabetic, if that were to happen, and another half million would be pre-diabetic, meaning they have blood sugar close to diabetic.

Diabetes already costs West Virginia more than a billion dollars, according to the American Diabetic Association. The cost will triple in the next 10 years, the CDC estimates.

If that happens, the budget will be swamped and major new taxes or cutbacks will be needed, health care economist Ken Thorpe told the Legislature in November 2011.

His recommendation:  Target diabetes. Let people know it is preventable. Diabetes leads to heart disease, stroke and other diseases and is strongly linked with obesity, he noted. “If you lower diabetes, you lower the rest.”

His challenge: Help people help themselves. Set up a network of free prevention courses so any resident can get support and solid advice. Train local people to run the courses.

If West Virginians learn to prevent and control diabetes, he said, the state’s longterm picture will improve.

A lot of pieces are in the air, but nobody is really keeping track, said Perry Bryant, director of West Virginians for Affordable Health Care. “They’re good pieces, but nobody knows where they all are, how they’re going to land or if they’ll fit together when they do.”

Here are a few:

“To me, food was just food, like fuel for your car,” he said, ” except I have to say,  I was a whole lot more careful about what I put in my car.” | Kate Long photo for the Gazette

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By KATE LONG |  Feb. 12, 2012 | Charleston Gazette |

BELLEVILLE, W.Va. — Dannie Cunningham, 61, climbed the steep hill behind his house, crunching briskly through oak leaves, whacking weeds with his walking stick. “Maybe I’ll get lucky and flush out a rabbit,” he said.

He was headed for his hunting camp at the top of the second hill, hustling up the path, laughing and teasing a reporter trailing along behind him. “I hear you puffing a bit there, don’t I?” he called over his shoulder.

This is a man who beat back diabetes and chopped his blood pressure and cholesterol in half.

Experts have advised West Virginia to establish statewide diabetes management programs. Dannie Cunningham can testify that they work.

“Last year, I couldn’t have climbed like this,” he called. “I owe it to Devena.”

Devena Moore is one of the state’s too-few diabetes reduction counselors. “I lucked into her program,” Cunningham said.

He stopped to philosophize. “Now I’ll ask you a question,” he said, jabbing the air with his finger. “Why aren’t we as careful with our bodies as we are our cars? I’m a stickler when it comes to my cars and four-wheelers, stuff like that. I change the oil when I’m supposed to. I change the air filters. But before Devena, I was nowhere near as careful to maintain my own body. Why is that?”

Not missing a beat, he shrugged and started back up the path. “Now I’ll tell you how I got in trouble,” he said. “After my first wife died, I spent eight years as a bachelor. That’s when I packed on the pounds.”

He was working at a glass plant as he had for 20 years, he said, mostly running machines. “I had a long drive to work, so I got used to shoveling the fast food in. I’d eat a hamburger while I drove to work, then throw down a hamburger on the way home.

“I never thought a thing of it, kept it up till I got married again. To me, food was just food, like fuel for your car, except I have to say, I was a whole lot more careful about what I put in my car.”

He stops to point out deer tracks. “These are fresh,” he said.

He pointed up a second steep hill. “My wife and I, we’ll stay up at hunting camp two or three days at a time,” he said. “It’s a real getaway.” Turkey and deer stroll by their window in the morning, he said. Nobody can reach them by phone. The stars shine clear and bright at night.

“My grandkids love it up there,” he said. They set a bathtub against the hillside by the stream. The pond’s full of bass and bluegill. “My wife shot our first deer this year up there, with her crossbow.

“The grandkids like to wrassle their old poppy,” he said. “I can keep them going now. Last year, I couldn’t.”

Last year, he weighed almost 250 pounds at 5′ 7.” “I couldn’t go anywhere without huffing and puffing,” he said. “In church, it had got so I had to prop my Bible on my belly, because I couldn’t get it down between my legs.”

Cunningham stopped walking and laid his hand over his heart. “I’ll tell you what happened to me,” he said. “One day, I was walking to the mailbox, and all the sudden, I felt like somebody had grabbed me from behind and was crushing my chest.”

His blood pressure shot up to 220 over 180. His wife rushed him to the hospital. The doctors put a stent in his heart and sent him home. “Three months later, it happened again. That time, they put in a longer stent.”

He patted his chest. “My doctor said if I didn’t lose the extra weight, I’d be gone from this world,” he said. “I made up my mind to shed some pounds.”

He stretched out an arm over the broad farming valley rolling out below the hill. “You can see why I’d like to stick around,’ he said.

“And I’ll tell you something else,” he said, cocking his head, “It’s kind of embarrassing to see a doctor write out that word ‘obese.’ That was a real wakeup call all on its own.”

Worth it

One in three adult West Virginians is now obese. Dannie Cunningham — at 237 pounds in this 2009 photo — is no longer among the one in three. “I lowered that statistic a little bit,” he said. [Courtesy photo]

“I want you to tell people it’s possible,” he said. “I want people to know they can do it. That’s why I’m talking to you. People need somebody like Devena to get them started right, but they can turn it around.”

His doctor referred him to Devena Moore, who runs DREAM, the diabetes self-management program for the Mid-Ohio Valley Health Department in Parkersburg.

Nobody keeps an accurate list of such programs in West Virginia. At the professional diabetes educator site, fewer than 80 are listed for West Virginia, mostly located in Charleston, Huntington, Morgantown, Parkersburg, and the Eastern Panhandle.

Very few are listed in rural southern and central West Virginia, where the need is greatest.

Lucky for Dannie Cunningham, he lives near Parkersburg. When he first walked through Moore’s door, he was diabetic, with high blood pressure and cholesterol and serious heart issues.

“It had never really hit me that my weight could be causing all those things,” he said. “I didn’t know you could get your blood sugar back down to normal level.

“Devena teaches you how to manage your own health,” Cunningham said. “You learn what food does in your body and how exercise helps and what’s in the food you buy. She teaches you how to measure a serving and little tricks that make medicine work better for you.

The first week in the program, he said, he wore a pedometer that counted his steps. “First thing, you find out what you’re already doing, so you know where you’re starting from. Then the second week, she starts you keeping a food log. You don’t change anything you do. Just write down everything you eat.

“That’s what I did, and I’m telling you, there were surprises! I found out I was eating more than I thought at night!

“Devena and me, we’d go over my list, and she’d make suggestions.”

“It’s not something you can do in 15 minutes, visiting a doctor,” he said. “It takes more time than that.”

After six months, his triglycerides had dropped from 597 to “a little less than 200,” he said. He cut his cholesterol in half, to 130.

Moore taught him how to read food labels and count carbohydrates and keep track of the fuel he was putting into his body, compared with what his body burned with exercise.

As he marched up the hill toward the camp, he pulled back his flannel shirttail to show he had his pedometer on. “I’ve got a little book called Calorie King that breaks down fast food menus,” he said. “I was getting Burger King spicy chicken sandwiches, thinking they were low-fat till I looked in there and found it has more fat than a hamburger.” He switched to a low-fat sandwich.

His weight is staying off, but he still keeps his food log. “It’s part of my life now. It keeps me on track. I check in with Devena once a month so I can show off.”

At the top of the hill, he threw his arms wide, gesturing at a wide, round field. “Take a look at heaven,” he said. A camper sits at the edge of the field under a shelter. He showed off the pathways he mows through the brush to attract deer.

“I climb up here several times a week,” he said. “Right now, there’s not much more I want out of life, except maybe a 10-point buck.

“My neighbor got a nine-point yesterday. That means I need to get a 10-point,” he said. “I’ll be back up here tonight, waiting for it.

“If I have to keep track of what I eat, to have this, it’s worth it,” he said. “I just wish everyone knew how to do it.”

West Virginians have known diabetes for a long time. Few families have not experienced the diagnosis. But what was until recently a grandparents disease is increasingly showing up in teens and young adults. Children are showing warning signs even earlier.

On the front page of this newspaper begins a careful look at the problem. “The Shape We’re In” is a special project by staff writer Kate Long, a Dennis A. Hunt Health Journalism Fellow. The news is alarming:

* By fifth grade, 24 percent of the state’s children have high blood pressure, 26 percent have high cholesterol and 29 percent are obese. They are heading straight for life-altering and life-ending diseases.

* At the current rate, West Virginia’s total health care spending — by all public and private payers — will double by 2018, to $22.5 billion.

But for children and adults, the damage can be slowed, or even stopped.

In the coming months, “The Shape We’re In” will examine many aspects of the state’s chronic health problems, particularly as they relate to obesity. Americans have recognized for decades that people are gaining too much weight. Some contributing factors are well-known — the sedentary nature of most work, lack of exercise, too many refined foods that the body easily converts to fat, limiting children’s activity and outdoor time.

But this project plans to go further. Unlike any other health threat, this problem can be influenced and even reversed by individuals.

Certainly better health care is important. Access to doctors and related professionals make a difference. But the power to slow, stop and then reverse this epidemic is held by everyone.

West Virginians choose every day, sometimes by default, to go down this deadly road and to take their children with them. The choice is made dozens of times a day with decisions large and small. Breakfast. Soft drinks. Driving. Sitting. Neglecting safe play spaces. Procrastination. Denial. A lack of belief that one’s actions make a difference.

There are obstacles, without a doubt. It can be tough, even dangerous, to walk regularly around blind curves with little shoulder, let alone sidewalks. Schedules are tight. Work and family responsibilities are demanding. But obstacles can be overcome. Problems have solutions. Small steps lead to significant changes.

We hope West Virginians find themselves on these pages, along with ideas, motivation and inspiration to make a difference in their homes and communities.

Health statistics suggest that there are children alive today who will live shorter lives than their parents because of the habits they are learning now — the foods they are conditioned to prefer, the lack of opportunities to form lifelong exercise habits.

This growing problem threatens to void all the state’s other efforts in pursuit of prosperity and happiness. Who will pay these doubling health bills? Who will be left to work even when more diverse jobs and industries are developed?

Study this issue with us. Conscientious people who understand the problem and what is at stake can turn this situation around.

Using historic and contemporary photographs, the video outlines two starkly different paths today’s West Virginians can choose.

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By KATE LONG |  Feb. 25, 2012 | Charleston Gazette

CHARLESTON, W.Va. — More than 30 years ago, Ric McDowell helped start a Lincoln County summer camp for low-income kids. “When we first started,” he said, “we had skinny campers. We were always trying to find ways to get food into them.”

Then in the early ’90s, “we started getting heavier campers,” he said. “We weren’t sure what to make of that.” By the mid-’90s, almost all their campers were heavy.

McDowell was watching the national obesity epidemic happen. It began in the mid-1980s, about the time those heavier campers were born.

“I’m sure it’s more complicated than this, but convenience food and fast food appeared in Lincoln County in the early ’90s,” he said.

“Pizza came first,” he said. “Now, when people have the choice of McDonald’s or cooking at home, it’s McDonald’s.”

Then along came No Child Left Behind, the federal education law. Teachers were pressured to get kids ready for achievement tests, and “schools cut back on phys ed,” McDowell said. They also stopped offering home-ec classes. “Kids don’t learn to cook anymore.”

Many parents also quit cooking, he said. “When we were trying to raise money for the camp, I suggested a potluck dinner, and people said, ‘That won’t work. People don’t cook anymore. They pick up stuff.’

“Sometimes when I stop for gas at a convenience store, I watch people picking up what I assume is their breakfast. Cookies and chips and wrapped doughnut sticks, and I think of the chemical ingredients in that food. Who knows what we’re taking into our bodies? Who really knows why this is happening?”

Have we always been this way?

Have West Virginians always been heavy? Is it our culture?

“That’s just not historically accurate,” said Ron Lewis, a longtime West Virginia University professor who specializes in early West Virginia history. “It’s been the opposite.”

In the early 1900s, magazine writers traveling through the Appalachian Mountains used words like “lean,” “slab-sided” and “stomachless” to describe people they met there, Lewis said.

“They all said, ‘Here is your prototypical mountaineer: long, lean, lanky, high endurance.’”

“A fat mountaineer is a curiosity,” Horace Kephart wrote in 1913. “The hill folk even seem to affect a slender type of comeliness.”

“A hundred years ago, life was hard and punishing for most people,” Lewis said. Men worked the fields and ranged the hillsides, hunting and trapping. “Food was a full-time job.”

“Today, doctors urge us to get our bodies moving,” he said. “A hundred years ago, nobody needed to urge people to be active. If they weren’t active, they didn’t eat.

“Now they tell us not to eat processed food so we won’t have a heart attack. Processed food didn’t exist back then. They burnt up every calorie they ate.”

Until the 1980s, few West Virginians are overweight in archival photos. In the 1960s and 1970s, during the poverty war, Americans got used to seeing pictures of bone-thin West Virginians on the evening news.

Only 13.4 percent of Americans were obese then. Nobody was measuring obesity in West Virginia. There seemed no need to do so.

Now, one in three West Virginians is obese, at higher risk of diabetes, heart attack, stroke, and other conditions their ancestors didn’t worry about.

The price is huge. In 2009, in “The Future Costs of Obesity,” health care economist Ken Thorpe reported that obesity-related diseases cost West Virginia $668 million in 2008. That number will rise to $2.4 billion by 2018, conservatively, he said, if nothing changes.

How did this happen?

Beginning in the 1980s, things changed. West Virginia and the rest of the country were overtaken by a perfect storm of less physical jobs, processed food, soda pop, fast food, reduced physical education and hours of video games and texting. | Kate Long photo for the Gazette

In the late 1970s, Dr. Bob Walker — now state Health Sciences chancellor –worked as a primary care doctor in rural, mountainous Lincoln County. “Families tend to pass a diet down through generations, he said, “and historically, our diet was geared to hard work. Work caused people to burn a lot of calories, timbering, farm work, coal mining, labor of different kinds.

“Rural people often got up early and ate an enormous meal, generally biscuits, gravy, eggs, bacon. They’d pack a high-carbohydrate, high-fat lunch in a pail to take with them, to sustain them through the day.

“So our diet has definite historical roots. The problem is, those kinds of jobs have disappeared, and we haven’t changed the way we eat. So now we take in a lot of calories and fat that don’t get burned off.”

In the mid-1980s, Americans — including West Virginians — started gaining weight. On the national obesity chart, the rate stays steady until the late ’80s, then the line zooms upward. Between 1980 and 2000, national obesity doubled.

Why? Nationwide, scientists and researchers say that, starting in the 1980s, Americans were overtaken by a perfect storm of:

A Charleston Gazette video depicts the roving activity cart, which rolls a host of activities into schools rooms during the day at Wood County, West Virginia school.

………
KATE LONG | Feb. 18, 2012 | Charleston Gazette

DIANA, W.Va. — Four Webster County High School seniors danced on the kindergarten rug.

“Fly like an eagle!” they called, flapping their arms. Kindergartners flapped their wings.

“Jump like you’re popcorn popping! Run from a growling bear! Slither like worms! Sway like a tree in a windstorm!” The Diana Elementary kindergartners jumped, learning vocabulary as they slithered and swayed.

The older students slithered and swayed too. They’d come to promote a new campaign to get kids up and moving through the school day.

To battle obesity, West Virginia Schools Superintendent Jorea Marple is asking schools and teachers to weave 15 extra minutes of physical activity into each day. “Plenty of research tells us physical activity improves a child’s ability to listen and focus and learn.”

Since September, Marple’s staff has crisscrossed the state, putting on more than 125 “Let’s Move! West Virginia” demonstrations. They haven’t reached all schools yet. “It sounds good, but I never heard of it,” a Kenna Elementary teacher said last week.

In Webster County, one of Marple’s staff members trained the high school students to demonstrate for younger kids. “I plan to be a pediatrician, so this has been a great experience,” said senior Levi Stout. “It helped me understand why it’s important for kids to be active.”

“It’s taught me how important exercise is, how it helps kids pay attention, stay healthy, and avoid things like diabetes,” said Ashley Short, who plans to be a nurse.

At Diana Elementary, they played a quick, aerobic round of rock, scissors, paper with the fifth-graders, then the kids sat back down smiling, faces flushed.

“Our kids come from the hollers around Diana,” said Rondlynn Cool, Diana Elementary principal. “A lot don’t get much exercise outside of school. We’re in favor of this.”

A few miles away, the lunchtime crew at the Hometown Diner was in favor, too. “These kids ought to be out climbing trees and playing,” owner Sharon Hall said, “but they’re stuck to those little game machines. Their thumbs get plenty of exercise, but not the rest of them.”

What can 15 minutes do?

As part of the state push to increase physical activity, Webster County high school seniors taught active games to kindergartners at Diana Elementary. Senior Levi Stout (left), who wants to be a pediatrician, said, “I understand a lot more now about why its important for kids to be active.” | Kate Long photo for the Gazette

Above all, Superintendent Marple wants to limit chair time — children sitting for hours.

“We have an obesity and wellness problem, and the schools can do their part by getting kids moving,” she said. “We know, from research, that when children sit for too long, they lose the ability to concentrate.”

They are also more likely to gain weight and have high blood pressure or cholesterol. “We’d like to see younger kids up and moving every 20 minutes,” Marple said.

Soon after she took office, Marple cancelled rigid requirements that dictated the exact number of minutes teachers must spend on each subject. “If students are excited, I don’t want them to have to cut a lesson off because the time’s up,” she said.

She also wants teachers to be free to weave bursts of physical activity through the day. “We’re giving teachers the flexibility to say, ‘I know that I need to get my kids up and moving. They’ll come back more ready to concentrate.”

“Kids are happier when they get to move,” she said. It can positively change a school’s culture, she said.

Marple hopes eventually to lower the obesity rate. In 2010-11, 18 percent of kindergartners and 23 percent of second-graders came to school obese. One in four fifth-graders had high blood pressure and red-flag cholesterol levels, and one in four was obese, according to measurements by West Virginia University.

Obese children are at higher risk of future heart disease, diabetes, stroke and other problems.

“We also have a huge percent of children who live in poverty,” Marple said. “Children who live in poverty often suffer from chronic stress. When you suffer from chronic stress, you may have difficulty focusing on instruction, and you’re more likely to be obese. Research tells us you can lower stress by getting the heart rate up. All these things are interconnected.”

How do we do this?

By the end of January, about 109 elementary and middle schools had signed on to Marple’s “Let’s Move! West Virginia” campaign.

There are already at least 130 West Virginia schools in the national Healthy Schools Network, aimed at increasing physical activity and good nutrition in schools.

Mary Weikle is in charge of the “Let’s Move! West Virginia” campaign. Fifteen minutes is not enough, but it’s important to start with something that’s easily possible for a classroom teacher, she says.

She knows some teachers will resist. “With No Child Left Behind, teachers are under a lot of pressure for their kids to score well. They feel like there’s no time to lose. We hope to convince them short physical activity breaks will help, by keeping kids alert and reducing discipline problems.”

“Physical activity is very inexpensive and do-able… If they had asked for the cost of daily physical activity, instead of physical education,  the numbers would have been much lower.” –  Melanie Purkey, director, state Office of Healthy Schools. | Kate Long photo for the Gazette

By KATE LONG | Feb. 18, 2012 | Charleston Gazette |

In 2007, legislators asked the state Department of Education how much it would cost for every student to have physical education five days a week.

“It seemed like the obvious step to take,” said Sen. Erik Wells, D-Kanawha. One in four fifth-graders has high blood pressure and cholesterol. One in four eleven-year-olds is obese, a clear red flag for the future.

They sent the department a resolution that began with “Whereas, seven of 10 West Virginians will die of heart disease, cancer or stroke; and whereas, 28 percent of West Virginia fifth-graders … have one or more cardiovascular risk factors …”

“We knew that, if we could get our kids active, we could prevent a lot of type 2 diabetes, obesity and heart disease,” said Sen. Dan Foster, D-Kanawha.

But to their dismay, state Department of Education officials told them daily P.E would cost between $13 million and $1.5 billion.

“The legislators got upset at us for that,” said Melanie Purkey, director of the state Office of Healthy Schools, “but they asked for the cost of physical education, not the cost of physical activity.”

Wells is still upset. “The department knowingly and effectively killed any effort to have physical education five days a week,” he said. “At interims, when Melanie said $1.5 billion, you could just see legislators shifting to ‘Well, we can forget that.’

“I have learned that when the department doesn’t want something, they put a high estimate on it,” he said.

“We had to give them a range, so we had to include the worst case scenario,” Purkey said. The $1.5 billion included a gym for every school that didn’t have one, she said. The low end, $13 million, added classroom space only.

“We don’t need all those new gyms and classrooms, just to get kids moving five days a week,” Wells said.

Purkey agrees. There are other ways kids can be active every day for a fraction of that cost, she told the Gazette-Mail in January. In the past five years, given the obesity epidemic, there has been a national movement to get kids moving through physical activity, she said.

“If the Legislature had asked us for the cost of daily physical activity, instead of physical education, the numbers would have been much lower,” she said.

“As soon as you use the words ‘physical education,’ you run into code and policy requirements:” teacher certification, facility specifications, scheduling and teacher/pupil ratio,” she said. “We had to take all that into account.”

“Physical activity” has no such requirements under West Virginia law. It means get kids moving: running, jumping rope, zumba, walking, whatever. Anyone approved by a school can supervise physical activity. It can happen anywhere, anytime it fits.

Physical education involves classroom time, learning about the body and its functions. Physical activity is simply moving the body. “Physical activity costs very little and is very do-able,” Purkey said. “You can require all kids to participate.”

“Well, why didn’t they say that five years ago?” Wells asked. “Why didn’t they say then that daily physical education may not be doable, but there’s something else we can do?

“We tried to tell them,” Purkey said.

She added, “We don’t want more bad P.E.,” of the type that causes kids to hate exercising or is a classroom, non-movement situation. “We’re concentrating on improving the quality of what we have.”

What’s the difference between education and activity?

“I can hire somebody to run good physical activity sessions for half of what I pay a good P.E. teacher.” — Don Chapman, assistant director, state Office of Healthy Schools. | Kate Long photo for the Gazette

State Schools Superintendent Jorea Marple is a strong advocate of daily exercise, any way it can happen. “We’ve got to look at what’s possible,” she said.

Cash-strapped West Virginia could get kids moving every day through a combination of physical education and physical activity, she said earlier this month.

In the past five years, many school systems nationwide have adopted the P.E./physical activity combination, Purkey said. At least 12 states require daily physical activity outside of the required amount of physical education, according the National Association of State Boards of Education.

The cost? “I can hire somebody to run good physical activity sessions for half of what I pay a good P.E. teacher,” said Don Chapman, assistant director of the Office of Healthy Schools.

“Parent volunteers run those sessions in some school systems,” Purkey said.

Teachers’ groups don’t like that idea. “They’re trying to piecemeal it instead of realizing it’ll take money to fix the problem,” said Dale Lee, president of the West Virginia Education Association. “We lead the nation in obesity. We need to get kids more active, and qualified physical education teachers should be the ones to do it.”

“We’re not trying to replace P.E. teachers,” Chapman said. On days when the children don’t have P.E., he said, a trained person can still lead children in physical activity like zumba and races.

Elementary children must have a half hour of P.E. three times a week, by state law. “A child could have physical education three days a week, then do physical activity two days,” Purkey said.

And then there’s recess

“We need to get kids more active, and qualified physical education teachers should be the ones to do it.” — Dale Lee, president, West Virginia Education Association. | Kate Long photo for the Gazette

Crowded school schedules can be a roadblock, Purkey said, so, nationwide, many school systems are organizing games and structured activities at recess and after lunch. They have recess coaches. “We’d like to do that, too,” she said. The Department of Education has been looking at an elementary-level program called PlayWorks.

A problem: West Virginia law does not require recess, and many schools are skipping it, to give themselves more time to prep kids for standardized tests, she said.

State school board policy strongly recommends recess before lunch for elementary schools, but schools are free to ignore recommendations.

“The crunch of No Child Left Behind has made teachers nervous about instructional time and time to reteach kids who aren’t getting it, so we’re seeing recess get taken away,” Purkey said.

“And even when a school has recess, some schools use it for discipline and take it away if a child didn’t do well academically,” she said. “That’s backwards from what the research tells us is good for kids.

“The Department of Education has never required recess because we never thought anyone would want to drop it,” she said, “but it looks like we need to require it, and we probably need to help schools understand why children need it.”

“We obviously need to pick up this conversation and continue it,” said Brent Boggs, the House of Delegates majority leader from Braxton County. “Daily exercise seems like the most basic way we could help with childhood obesity and lower type 2 diabetes. We can pay for it now or pay much more later in medical costs and lack of workplace productivity.”

The state School Building Authority gives counties money to build new gyms and other school facilities, but it usually wants counties to come up with part of the money first, “and people aren’t in the mood to vote for that,” Chapman said. That’s another reason for looking at physical activity, he said. Levies that included gymnasiums failed recently in Jackson and Marion counties, he noted.

Ginny Ehrlich, CEO of Alliance for a Healthier Generation, sponsored by the American Heart Association, oversees a network of 14,000 schools. “When it’s done well, it’s not an either/or,” she said. “Both physical education and less formal physical activity are part of the overall equation for childhood obesity prevention.”

Senator Wells is leery that physical activity might have no structure. “If they just let kids out for recess and call it physical activity, you could end up with half the kids standing around texting,” he said.

Trained people should led the sessions, and they should involve all students, Purkey said.

“It may not be something we can fix all at once,” Boggs said. “But we could at least start to fix the problem and maybe look at some pilot projects.”

Wells is submitting a new resolution, this time requesting that the Joint Committee on Government and Finance conduct “a study of multiple topics, all related to health, nutrition and wellness programs in public schools; including fitness requirements, nutrition in school meals and the inclusion of West Virginia food products in school meals.”

“We need to look at the whole problem and make sure we do something effective,” he said.

“We’d be glad to have that conversation,” Purkey said.

……….
By KATE LONG | Feb. 19, 2012 | Charleston Gazette

DAVISVILLE, W.Va. — It’s 7:15 a.m., still dark outside Wood County’s Kanawha Elementary School. In 15 minutes, school buses will roll up to the door. Sleepy-eyed kids will spill into the school.

In the gym, Principal Mike DeRose and gym teacher Vicki Lacey are hauling stuff out of a closet: crates of jump ropes, huge rubber balls, tummy scooters. They spread giant plastic bowling pins, hopscotch sheets and hula hoops across the gym floor, creating colorful, instant activity stations.

“Every morning, we get these kids moving for a half hour before school,” Lacey said.

“They used to come in off the buses and just sit on the bleachers, waiting for school to start. Now we work their bodies and get their heart rate up. They have fun, then they’re alert and ready to sit down and work.”

State Schools Superintendent Jorea Marple is encouraging each school to add at least 15 minutes of physical activity a day to their schedule. Kanawha Elementary needs no encouragement. “This school is doing what she hopes to see all over the state,” Lacey said.

A former physical education teacher, DeRose is a fan. “They need this,” he says, pulling jump ropes out of a crate. “Actually, they need a whole lot more than 15 minutes. Over my 29 years in the schools, I’ve seen a change in the kids. They’ve gotten much less active. They’re sitting around a lot more, and they’re getting heavier. That’s not good.”

Physical education time has dropped as the demands of the federal No Child Left Behind Act escalated, he says. “P.E. is getting crowded out of the schedule. We’re trying to fill that gap.”

Maybe because Wood County has emphasized physical activity in recent years, the county’s obesity rate is significantly lower than the state average: 22 percent, compared with 29 percent.

At 7:30, the buses pull up outside the school. Kids pour through the doors, strip off coats and pile them on cafeteria tables. Some head for breakfast. Others head for the gym.

They know what to do. Within minutes, the gym is rocking with bouncing, jumping, rolling, scooting kids. Nobody’s telling them what to choose. “The rule is, pick anything you want to do, but no fighting and no sitting,” DeRose says.

Research shows that when kids are allowed to choose activities, they get more actual exercise, he says. The kids have choices, within a structure. At a different time of day, this would be called a “structured recess.”

Within minutes, in one corner, kids are doing push-ups on a plastic sheet. At one end of the gym, they propel up and down on tummy scooters. On the other side, they’re rolling down a long plastic sheet as human bowling balls, knocking down plastic pins.

Laughter and excited talking echoes off the walls, mixed with the thwack-thwack of jump ropes.

DeRose is circulating, chatting and patting kids on the shoulder. “These are country kids,” he says. Sixty-six percent of the school’s 315 kids are eligible for reduced price meals.

In the center court, a dozen kids are bouncing on huge, colorful rubber balls. To one side, big jump ropes circle. Boys are out-jumping the girls. In another corner, three kids are making up a game with hula hoops and a jump rope.

“I love it,” DeRose enthuses. “Gets the blood going. Gets brain cells stimulated! Reduces classroom problems too, you know?”

Every morning, first thing, Wood County’s Kanawha Elementary students hit the gym for 30 minutes. Sometimes they dance, sometimes they choose activities like these. | Kate Long photo for the Gazette

Some mornings, he says, the kids line dance. Other days, they do aerobic exercise. “We try to mix it up. Last year, all we did was walk in the mornings. It got old, but at least they were moving.

“So we brainstormed over the summer and came up with this program. Everyone’s loving it.

“Childhood obesity is a major problem, and we want to at least establish the mindset in these kids that physical activity is fun,” he says. “Then hopefully, they’ll carry on when they get older.”

The kids swirl and drift from one activity to another, laughing and talking. The half hour speeds by. At the signal, kids gather up the equipment and carry it to the closet. Within minutes, the gym floor is clear, and the kids are in the bleachers, waiting for the signal to line up, class by class.

Then they’re off, to class or breakfast. Nobody looks sleepy anymore.

Taking a break

A couple of hours later, it’s raining outside, so Vicki Lacey is at the cafeteria tables, playing cup-stacking games that causes the kids to cross right hand over left. The clatter of cups fills the cafeteria. “Eye-hand coordination helps when you’re learning to read left to right,” Lacey says.

A teacher pulls a cart filled with colorful items out of a storage closet and wheels it down the hall. “That’s our activity cart,” DeRose says. “They’re getting ready to take a physical activity break.”

The activity cart goes into the classroom, and within minutes, fourth-graders are standing by their desks, throwing colorful scarves in the air, trying to turn around before they catch them. A few are pitching foam horseshoes. Others throw fuzzy balls at a sticky target. They’re laughing, having fun.

In about 10 minutes, the teacher gives a one-minute warning. Students put the items back on the cart. “I love it that you can roll the cart in and roll it out,” the teacher says. “Then we’re back to work.”

Out in the hall, DeRose is walking a child to class. “Kids became less active about the time technology started to boom,” he says. “Instead of going out to play after school, they went home to watch MTV. And from MTV, they got on their computers and PlayStations, etc. etc. etc. and pretty soon, they were sitting most the time.

“At least at this school, they’re active.

“This should help us pull our school’s test scores up too,” he says. “There’s research that says kids do better academically when they’re physically active. It all goes together, doesn’t it?”