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MICHELE NORRIS, host:

From NPR News, this is ALL THINGS CONSIDERED. I'm Michele Norris.

Roughly one in three adult Americans is now obese. It's a crisis that in one way or another touches most of us. It affects the way we live and work and eat and travel, and the costs are staggering.

Over the next few months, we're going to report on how life is changing in a country where tens of millions of people are obese and it is changing in the home and at the grocery store, in the doctor's office, on the factory floor, and at the airport. It's a national problem.

But in some places the numbers are especially alarming. In Mississippi, 44 percent of kids are either overweight or obese. First Lady Michele Obama stopped there on her Let's Move campaign.

Ms. MICHELE OBAMA (First Lady): Too many kids in this country don't get enough exercise and they aren't as healthy as they need to be. And if we're honest with ourselves, as all of you know, we know that here in Mississippi, kids struggle with these issues sometimes even more than in other parts of the country.

And so, to begin our reporting on America's battle with obesity, NPR's Debbie Elliott takes us to the frontlines in Holmes County, Mississippi.

DEBBIE ELLIOTT: You can see some of what Mrs. Obama is up against with a stop at the Double-Quick. Part gas station, part convenience store, part lunch counter, Double-Quicks are everywhere in the Mississippi Delta. In many small towns, it's one of the few places to get a hot meal.

Ms. RENE HART (Clerk, Double-Quick Store): We have baked chicken, gravy livers, fried livers, gizzard, potato logs, chicken on a stick, tenders, corn dogs, pizza sticks, okra and we have some fish coming up and shrimp. And some fried pies for your dessert.

ELLIOTT: The clerk, Rene Hart, says today's fried pie is filled with strawberry cream cheese and the fish and shrimp are fried, too.

Peering through the Plexiglas food case, Dan March chooses fried chicken with a side of fried okra.

Mr. DAN MARCH: That's good enough for a poor man isn't it?

Ms. HART: I reckon so.

ELLIOTT: He's a regular customer here...

Mr. MARCH: Well, I need baked chicken but I love fried chicken.

(Soundbite of laughter)

ELLIOTT: And that's where the obesity battle starts that endless struggle between what we need and what we love.

Holmes County is a gateway of sorts, where the rolling hills of east Mississippi give way to the flat, fertile plain that is the Mississippi Delta. It's a region with a history as rich as the soil, but with deeply-rooted social problems.

Holmes is the poorest county in Mississippi with 48 percent of residents living in poverty. Four out of 10 people here are obese, the highest rate in the state. And you see it all around large kids lumbering to get on the school bus, patients spilling over their seats in the doctor's waiting room.

The statistics are heartbreaking says Sandra Shelson, executive director of the Partnership for a Healthy Mississippi.

Ms. SANDRA SHELSON (Executive Director, Partnership for a Healthy Mississippi): I think now for the sixth year in a row, we remain the most obese state in what is the most obese country in the world, I guess making Mississippi the most obese place in the world.

ELLIOTT: Mississippi may top the list, but its Southern neighbors are close behind. The top 10 fattest states are all in the South. We might enjoy our food, Shelson says, but...

Ms. SHELSON: It's much more complex than that than just that we like our fried chicken.

ELLIOTT: She says part of it is psychological. When you look around and see that most other people look like you, it doesn't register that you might have a problem.

(Soundbite of machinery)

ELLIOTT: Gracie Williams is a cook at the Double-Quick.

Ms. GRACIE WILLIAMS (Cook, Double-Quick Shop): To me over, overweight is when you're going past 300-and-something and you're having a hard time walking and breathing. That's when you're overweight.

ELLIOTT: Standing near the noisy deep-fryers, she says she's been holding her own.

Ms. WILLIAMS: Me, for the last five years, I've been a certain weight. I ain't gained a pound, I ain't lost a pound. And, you know, I'm still consider myself being pretty good.

ELLIOTT: Pretty good, for her, is 265 pounds on a 5-foot-5 frame. At 47, Williams has had diabetes for 15 years now. I ask about the size of her three grown daughters.

Ms. WILLIAMS: I got one thin daughter. She's real thin. And my oldest daughter, Violas, no, we healthy. My baby's healthy.

ELLIOTT: Healthy meaning heavy. And that's a common reference in the Delta: Heavy is healthy.

ROCHELLE CULP (Program Director, The Partnership for a Healthy Mississippi): We tend to look at body image different from other states.

ELLIOTT: Rochelle Culp works for a non-profit trying to get a healthy message to her native Holmes County. It's a personal fight for her. Her father was an obese smoker and died when he was just 36 years old. That motivated her to lose more than a hundred pounds - cause for celebration in most parts, but something that can still prompt a different reaction here.

Ms. CULP: Ooh, you need to keep on a couple pounds. You looking frail or thin. As we like to associate this term, it's a country term fine. And fine most times means you have a few extra pounds on.

ELLIOTT: Culp meets me in Tchula, Mississippi, a little town built around the railroad tracks that cut through the cotton and soybean fields of Holmes County. This used to be a thriving agricultural center, but now jobs are scarce. Just about all that's left of the town center is the public library, the drug store, the hardware store and a small supermarket.

(Soundbite of opening door)

ELLIOTT: Culp leads me to what passes as the produce department.

Ms. CULP: We see a few sweet potatoes, a few white potatoes - I guess you could say or Idaho potatoes - bananas and a few onions.

ELLIOTT: Nothing like the rainbow of fruits and vegetables you'd see piled high at a Whole Foods or Kroger in the city.

Ms. CULP: It's funny that they have three selections of onions there but...

(Soundbite of laughter)

Ms. CULP: ...not many other selections of fresh vegetables. And then we see here some beverages and most of these are going to be high in sugar.

ELLIOTT: Right in the produce case brightly colored bottles of sugary fruit drinks. They're called Little Hugs, and they're cheaper than buying an apple or one of the bananas that are starting to turn black.

Culp and other advocates say it's no coincidence that the most obese state is also the poorest.

Dr. DAVID GILDER (Physician): That would be good for me. Let me just listen a bit. Deep breath.

(Soundbite of breathing)

ELLIOTT: In Holmes County, 15 percent of adults have diabetes. And that keeps the doctors busy. At the health clinic in Tchula, Dr. David Gilder is examining Sally Johnson. She's 84 and suffers from diabetes. Her son, Eddie, tells the doctor she's getting up in the night sneaking ice cream and cookies. She grins.

Ms. SALLY JOHNSON: Yeah, my appetite stay good.

(Soundbite of laughter)

Ms. JOHNSON: It sure do.

Dr. GLIDER: To good, huh?

ELLIOTT: Ms. Johnson promises to do better.

Ms. JOHNSON: I'm going to make a start backing up off that food.

Dr. GLIDER: Well, I tell you that eating at night sure make your blood sugar go up in the morning.

ELLIOTT: She's five feet tall, and weighs 255 pounds. She needs a walker to get around. Ms. Johnson wasn't always this big. When she was younger, she worked on the farm.

Ms. JOHNSON: Chopping cotton and picking cotton. That's what we was doing farming on a plantation. But we don't do that no more. Now the machines that they got, cotton picking machines get it. We don't have to get it.

ELLIOTT: Machines do it now, but her fingers still come together as if pulling a boll of cotton from its stem. The appetite that once sustained her and thousands of others through grueling labor is now their enemy.

Dr. Gilder, who grew up in the Delta, sees it every day. Four of the first six patients on his roster today have problems related to obesity: diabetes, heart disease, high blood pressure.

Dr. GLIDER: It's like a war.

ELLIOTT: And half the battle, he says, is just getting people to own up to the fact that their weight is the problem.

Dr. GLIDER: Calling someone obese, they don't like that very much. You know, it's a touchy subject. If you talk about the obese population, well, they're thinking about someone who weighs more than me, no matter what they weigh. But it's a national problem. Holmes County is maybe the worst but it's tough. You know, it's tough to deal with.

ELLIOTT: Even tougher when it's children, he says, like a 75-pound four-year old.

Dr. GLIDER: When I see them, I see the next 20 years. You know, sometimes this is what's going to happen. This is your dad or your grandmother that I'm treating for diabetes, hypertension, heart failure, so many things and this is where it's leading. But it's probably going to be 10 or 15 years earlier in that patient.

ELLIOTT: Obesity is not just a problem for the poor, mostly African-American communities in the Delta. Just look to the Mississippi state capital. Republican Haley Barbour is the governor. He's famously said if you see him drop 40 pounds, you'll know he's running for president. He was about halfway there when he decided not run. And he's not the only lawmaker looking to shed the extra pounds.

PAUL LACOSTE (Personal Trainer): All right. Jumping jacks, ready, go. Let's get moving. Let's get moving.

ELLIOTT: Trainer Paul LaCoste is leading a 6 A.M. boot camp for state lawmakers, lobbyists, and government workers at Jackson State University.

(Soundbite of grunting)

ELLIOTT: That's Steve Holland's grunt, as he makes rapid step-ups onto a riser. He's the long-time chairman of the Mississippi House Public Health Committee and used to weigh a whopping 359 pounds. He's lost 140, after bariatric surgery and coming to these early morning workouts with fellow lawmakers.

Unidentified Man #1: Mother of God.

Unidentified Man #2: Tell me about it.

ELLIOTT: Later, at his capitol office, sitting beneath a sign that says -lobbyists, don't feed the chairman - Representative Steve Holland says Mississippi needs to change.

Representative STEVE HOLLAND (Democrat, Mississippi): We have a culture of easy living, good eating with fatback and lard and things like that. And we like to sit on our porch, and we like our adult beverages, and we like our fellowship and that kind of thing. And when you put all that together over generations, you've got a bad health problem.

ELLIOTT: And nobody seems to have the answer to what to do about it. The state has improved nutrition requirements in public schools and childcare centers, but a push for a tax on sugar-sweetened soft drinks can't get traction, and Governor Barbour vetoed a bill that would have created a statewide obesity council to tackle the problem.

Holland, a Democrat, says the sweating legislators are trying to lead by example, but he concedes that Jackson is a far cry from Holmes County. The tiny towns in the delta don't have gyms or even sidewalks, much less personal trainers paid for by Blue Cross-Blue Shield like their boot camp.

Rep. HOLLAND: And that's the sad commentary on it, and I worry as a public policymaker. I don't know what you can do about it except make it attitudinal across the state.

ELLIOTT: Fitness is sort of like happiness, he says: It's homemade. And people here don't want the government in their kitchen, says Sandra Shelson with the Partnership for a Healthy Mississippi.

Ms. SANDRA SHELSON (Executive Director, Partnership for a Healthy Mississippi): What are you going to do now, you know? You're telling me not to smoke in my office building. What are going to do? Are you going to monitor how many Big Macs I can have?

There is this whole attitude somehow that even if it's good for you that there are things that are hands-off, even if it's going to kill me.

Unidentified Man #3: Fried chicken and (unintelligible).

ELLIOTT: Here at the Double Quick, talk of regulating food, not a good idea.

Mr. RICK BUNING(ph) (Vice President of Food Service, Double Quick): I don't think you can legislate how somebody eats.

ELLIOTT: Rick Buning is vice president of food service for the Double Quick chain.

Mr. BUNING: I always ask myself before we put anything out there: What does our customer want? And, you know, we've seen people talk healthy, but they eat differently. It's still, you know, their choice.

ELLIOTT: In the end, he says, they want traditional Southern foods and a lot for the money, and the Double Quick delivers.

Debbie Elliott, NPR News, Chula, Mississippi.

NORRIS: Our story about Mississippi's struggle with obesity is part of Southward, a new collaboration between NPR and Oxford American Magazine. To see a video from Holmes County, go to npr.org.

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