Face it. We're fat.
While the nation's borders haven't grown at all over the last 10 years, its residents have. In only 6 states (Massachusetts, Colorado, Montana, Arizona, Connecticut, and New Hampshire) can less than 15 percent of the population be called obese—defined as a Body Mass Index over 30, which generally translates to more than 30 pounds over a person's ideal weight. Just for comparison's sake, a decade ago, only four states had more than 15 percent obese. Since '91 in the U.S., obesity among adults has increased by nearly 60 percent. In just a decade, fat has gone from a public health issue only in Michigan, West Virginia, Mississippi, and Louisiana to an epidemic that is spreading like butter on a hot biscuit.
"Obesity," says Jeffrey P. Koplan, M.D., director of the Centers for Disease Control, "should be taken as seriously as any infectious disease epidemic. Being overweight is linked to more than 300,000 premature deaths each year in the United States, second only to tobacco-related deaths."
Tennessee, while not in the fat four in '91, jumped on the trend just two years later, when more than 15 percent of the population grew into obesity. By 1999, 20.1 percent of Tennesseans—one person in five—were in that category. The good news is that we're the thinnest state in our region, which includes heavyweights like Kentucky (21.1 percent), Alabama (21.8 percent), and Mississippi (22.8 percent). The bad news? This region is the fattest in the country.
In just one year, between 1998 and 1999, obesity rose by 6 percent nationally. If you need more numerical proof, in that same period of time, those aged 30-39 had a 10 percent rise, as did the number of people with some college education. Break it down along racial lines and you'll discover that the number of fat white people grew by 7 percent that year and that 27.3 percent of all black people are obese, according to the CDC statistics.
"As obesity rates continue to grow at epidemic proportions in this country, the net effect will be dramatic increases in related chronic health conditions such as diabetes and cardiovascular disease in the future," continues Dr. Koplan. Coronary heart disease from physical inactivity costs the U.S. around $5.7 billion (yes, that's billion) per year. Diabetes increased by 33 percent among adults in the 1990s, rising with obesity rates and proving that fat is more than a cosmetic problem. Obesity can not only lead to low self-esteem, discrimination, and clothing issues, it can also severely effect your physical health.
In the face of all of this information, it's hard not to just reach for another Little Debbie and let the fat pack on where it may. But one solution is as close as the front door.
Take a walk. Walking may be the simplest and most effective way to fight the spread of this disease—plus it's pretty cheap, doesn't require a gym membership, and is a skill most of us already posses. While there are some challenges to putting one foot in front of the other in Knoxville, there are also some distinct advantages, like our extensive greenway system. And there are more people doing it than you might imagine.
The benefits of physical activity aren't news, really, but bear repeating because most of us still aren't receiving the message. Most sources agree that some sort of moving around will decrease risks of cardiovascular disease, colon cancer and diabetes mellitus, will maintain muscle strength and joint function and is necessary for normal skeletal development in childhood, and may relieve depression, anxiety and other mental illnesses. Oh, and you just might lose a pound or two.
On top of that, regular activity will save you money—approximately $330. In October of last year, the CDC analyzed data from a 1987 survey of National Medical Expenditures and discovered that Americans who took up at least 30 minutes of moderate activity three or more times a week had annual direct medical costs of $1,019. Those who didn't had their costs average $1,349. The level of exercise used in this report is actually below what the surgeon general recommends, which is the same level—30 minutes—five times per week.
If you could get every last U.S. citizen over the age of 15 to become more active, the savings would hover around $29.2 billion—and that's in 1987 dollars. In 2000 dollars, the savings estimate would be closer to $76.6 billion. The cost savings hold true for most demographic groups you look at: men would save as much as women, smokers as much as non-smokers. The biggest difference was among women over 55, however, which "supports the widely held belief that the potential gain associated with physical activity is especially high for older women," according to the study's authors.
At least one older woman in Knoxville is getting her daily dose of moderate activity. Pam Small recently moved here from Montana, one of the skinniest states. Nearly every day, this 60-year-old microbiologist walks from her home just north of Fourth and Gill to her UT lab, a little less than three miles, proving that you can indeed walk in this city. Small's tried a variety of routes, sometimes walking down Broadway, other times through the Old City and up through Market Square.
"Where ever I've gone, I've done whatever type of activity was easiest to do there," she says. "We lived near a swimming pool, so I swam a mile five days a week. But here, I really like to cycle and was very disappointed—I'd never been at a university where there were so few bicyclists on the campus. So I just started walking and I found it wasn't that far.
"I enjoy it. I didn't start doing it as part of a concerted plan—one day it was just too cold to ride my bike so I started walking. And it was just enjoyable. I think there's just a simplicity to it. You don't have to worry about whether your car works, you just walk out the door and there you go."
Walking to work—especially if you live a short distance away—isn't as challenging as we may perceive. And simply judging by appearances, you'd never peg Small as a walker. She's not tall, not rugged looking, doesn't call to mind the image of an urban trailblazer. In fact, if pressed, this grandmother could best be described as, well, matronly. Does this unimposing woman ever feel unsafe?
"No. But maybe I'm just naive. I don't see anything threatening at all," she says. "When I come across the bridge on Gay Street, there are often people around there—there must be some kind of mission or something. They sometimes say hi. I've never had anybody make any kind of a strange comment to me. When I rode my bike I had somebody shout at me once—but not walking.
"I think it's really pleasant. It's not cold here so that's not an issue at all. There doesn't seem to be any bad weather. It hardly ever seems to rain. It's kind of strange to me. It's such a non-weather event sort of an area."
So if it's nice to walk, why don't more people do it in Knoxville?
"I really don't know—and you do see other people walking but I have to say a lot of people I see walking might not have cars. In Montana, a lot of people walked to the lab. But I have a feeling that people who live even a mile from where they work don't walk, even though there's a parking problem. Maybe they dress up more or something.
"But if you walk to work, you really get exercise automatically—as a part of your life without having it have to be an extra thing to do. I really do like that. It's nice to have it be part of my schedule."
While the supersizing of portions and the rise of the fast food franchise might seem like the most obvious cause of the supersizing of the U.S. population, that simple argument doesn't work if you look at more data. Compared to 20 years ago, most adults consume around 100 more calories per day. The percentage of fat in the average diet has dropped from 42 percent to 34 percent. Yes, those extra calories translate out into a weight gain of 10 pounds per year but the statistics are more complicated when you look at how little we move around to compensate for them.
"Our world has gotten a lot easier to live in," says Dr. Tom Schmid, also with the CDC. "We sit in cars, we don't walk to the store on the corner and we don't walk to the park."
It may be that our own affluence—most people have the luxury of owning at least one car—and the subsequent flight to the suburbs will be largely responsible for Americans drowning themselves in their own fat. A study of Seattle residents by the Georgia Institute of Technology found a direct correlation between the year a house was built and the amount of physical activity its residents received. Folks who lived in neighborhoods built before 1947 walked or cycled at least three times every two days. People on post-'47 streets used cars almost exclusively. A follow-up study is set to begin in Atlanta in March.
Several groups devoted to bringing walking back to our daily lives have sprung up across the country. AmericaWALKs, founded in 1996 and based in Portland, Ore., is a national coalition of local groups and perhaps the forerunner (or walker) in this movement. AmericaWALKs promotes two principles—1) walking is a practical transportation choice for both individuals and their communities and 2) local grassroots advocacy is the most effective way to transform our country's transportation systems.
While Knoxville doesn't have a local chapter, Nashville does. "We are a pedestrian and cycling advocacy group," says Kibby Clayton, chair of Walk-Bike Nashville. "In Nashville, we definitely have made big strides. We looked at what other cities had done and made recommendations to the city council about what we thought were improvements that could be made in Nashville—to make it safer.
"But I don't want to say it's not safe, because then everybody will be like, 'Oh no, I can't walk outside,' but it could be safer. It's hard to walk in neighborhoods where there's no sidewalks and there's a lot of traffic and there's no shoulders on the roads—there are all kinds of impediments to actively getting out. And that's what Walk-Bike Nashville is all about, to bring these things to the public mind.
"I think Nashville is probably pretty average," Clayton continues. "It's kind of a nationwide movement. People are starting to go, 'Wait a minute. My community sucks. I can't even get out and walk around the block.'"
Clayton, though, doesn't think this move toward more walkable communities is a recent development.
"It's something I've been thinking about for a long time. I got interested in the issue when I was a stay-at-home mom 20 years ago. I lived about a quarter of a mile from a grocery store and we only had one car, which my husband took to work, and I could not safely walk to the grocery store.
"We don't build neighborhoods anymore. We build subdivisions. We don't put sidewalks in because developers don't want to spend the money. Then once the neighborhood is built, the developers come back in and say 'Well, now we have to put a sidewalk in.' And people go, 'But I planted my rosebush and now you want to uproot it for a sidewalk?' But it's something people are starting to notice. We're not going to be able to drive cars forever and that's something people are also starting to realize. Gas prices are going up.
"Plus children can't go anywhere—they can't visit their friends because mom and dad have to drive them. So they are essentially isolated. Also, if kids can't get out to see their friends, they're not burning any calories. And I think more people are starting to become aware that there is a solution. We can make our cities better. We don't have to keep moving farther and farther out."
Despite Knoxville's lack of a visible, organized group devoted to changing the city's transportation systems, Knoxvillians are still using the city's streets to walk to work. Small, who largely walks in areas in the center city where there are sidewalks, has it easy compared to those who live and work in areas where pedestrian access is challenging.
Like Peter Van Eenam, the organist and choir master at Westminster Presbyterian Church, who walks to work down Northshore Drive almost everyday.
"The main thing for me is that I just like to walk, to just get away from the phone or the car," he says. "Sometimes I just get tired of getting into my car to drive everywhere.
"I grew up in a St. Louis neighborhood where you could walk everywhere—walk to school, walk to the store, walk to church. There were sidewalks everywhere. You didn't need a car. You didn't want a car.
"When we came to Knoxville [20 years ago], it was kind of a shock that the city wasn't laid out in a way that was conducive to walking everywhere. Out in West Knoxville, it doesn't make a lot of sense. The neighborhoods really aren't integrated with business. You have to travel some distance to get to the store. Luckily, the whole time we've been here, I've been around the corner from the church. Now I've come to rely on the walk. It's time to air out, to think."
But this route is not without its challenges.
"The only thing is that there are some blocks on Northshore where the shoulder is kind of narrow and there is not enough grassy area to walk in. You just have to be watching, ready to jump off into the bushes if somebody gets too close," he says, with a laugh. "I really haven't had many close calls. Probably more than anything I get people honking at me, to try to scare me or yell out the window to startle me or whatever. But outside of that, everybody is pretty cool about it. A lot of times you'll see drivers move over a little bit, to try to give me more room. I've never found it too dangerous."
Van Eenam's kids, however, aren't able to be as avid walkers as he is. They aren't able to integrate walking into their daily activities like getting to school, swim lessons, or visiting with their friends.
"It's not real practical for them," he says. "But they love to ride bikes and walk with me, just down to the store or whatever. I think they would walk if what they did were more convenient."
Children seem to be the most affected by the expanding of America, and the number of overweight kids has doubled in the last 20 years. Fourteen percent of children ages 6 to 11 are overweight; 11 percent of 12- to 17-year-olds are, too, according to the National Center for Health Statistics.
In October of 2000, Stephanie Lavoie, the Health Council Coordinator for the State of Tennessee Department of Health tried out a program designed to take at least one small step towards getting kids up and moving. Walk Our Kids to School Day was essentially just that. Two schools participated in the event—Christenberry Elementary and Powell Middle School—and 300 parents and kids spread between the two schools.
"Both schools, I think, were a little surprised at the parents' interest in this event. And they were both interested in participating again this year," Lavoie says. Walk Our Kids to School Day will be Oct. 2.
"When we surveyed the participants, the concerns that seemed to come out the most strongly were safety issues such as crime, speed of traffic, congestion around the school, lack of sidewalks, lack of walking areas. Those were parents' top concerns about walking to school and their kids walking to school. Convenience issues such as time in the morning, other activities their kids were involved with and the distance to school—those didn't seem to be strong issues.
"We thought that if the parents get out on the street and start walking around they might see problems in their community and actually do some advocating themselves, and we'd be able to address some of the issues that way. It's sort of a grassroots effort," she continues.
"It addresses a lot of other issues too—like physical activity and pedestrian safety—the best way to teach kids about it is to actually show them, rather than to just talk to them about it. So this was a good way for parents to show their kids a safe way to walk."
Lavoie is a walker herself and received a pedometer, which measures the number of steps taken in any given period of time, as a Valentine's Day present. She lives in Old North Knoxville and walks her neighborhood with her dog on a daily basis.
"I also walk a lot during lunch," she adds. "Anytime I can, I would prefer to walk. One interesting fact—most of the car trips that are made are under a mile. That's something that I take to heart.
"I feel perfectly safe. My husband worries about me sometimes. I think that I would feel safer if I saw more people out walking."
UT's department of Exercise Science and Sports Management has been spearheading studies about exactly what walking can do to improve health. Recently, they found a link between walking and hypertension when they outfitted hypertensive women with pedometers and a walking program.
"There were no other changes in their life—just walking. On average, it was probably about an increase of two to three miles a day—and they could be accumulated during the day as long as they accumulated them at some point. That's what appears to make the difference," explains Dr. Dixie Thompson. "We reduced their blood pressure by about 10 millimeters of mercury. It had a really big impact. Some of these women after were able to go off of medications. That's the kind of result we like to see."
Now the team is performing a similar study with women who have the precursors for Type II diabetes. "We're trying to see if we can use walking as a roadblock to that condition, too," Thompson says. "We're really quite excited about it."
Some of her excitement may stem from how accessible this method of improving health is. "I think that most people probably can begin a walking program. Not everybody—there are people who have orthopedic concerns and other underlying states where it might not be the best choice. If they have been sedentary for a large period of time, they should start slowly and probably get some input from a physician if they haven't had a check-up within the last year," she says.
"The majority of Americans can start a low-to-moderate intensity walking program—go out and walk 10 minutes during your lunch hour and build up to accumulating about 30 minutes a day of walking is a good place to start."
Will Skelton, one of the leaders of Knoxville's Greenways Coalition, agrees. "It's easy. That's one thing—unless you are physically handicapped—anyone can walk."
Knoxville's greenways system is something to be proud of. In the city, it consists of 20-plus miles, most of which were built after 1991, and the city leads the state of Tennessee in greenway mileage. In the surrounding area, Maryville, Alcoa, and Oak Ridge all sport systems.
"They're popular, really, throughout the country," Skelton explains, and adds that some of the best are in Colorado, which, interestingly, is one of the skinniest six states. "It's one of those things whose time has come. Everybody likes them. And, really, the reason that greenways are so popular is that they appeal to everybody 100 percent of the time. So many dollars that we spend for parks and recreation are so limited, if you think about it. Baseball fields—they don't play baseball all the year round. Or all day long. But greenways appeal to every segment of the population, all the day long, all year long."
The miles already constructed are just the beginnings of what the greenway system will be. Right now the Coalition is working to build a significant greenway—over 2 miles—in every geographic section of town. The land for the northwest and northeastern sections has been acquired. Now the challenge is to get them designed and built.
"Once we get them in all parts of the town, then we'll try to connect them [to each other]. Then we'll connect Knoxville to other places, like to Gatlinburg, to Maryville, and to Oak Ridge. If we can make those connections—that's the ultimate goal."
Other than having a greenway in South Knoxville named after him, Skelton's reward for keeping this project moving is the same as Knoxvillians as a whole receive.
"The only self-interest I have and the only benefit I get out of all of this is that I get to use them," he says. "And I do use them."
On any given Saturday, especially when the weather is pleasant, Skelton's statements become fact. Knoxville comes out to stroll, to walk, run, and bike on these paved trails, proving that we can get up and move if we want to. In the process, we might just be able to thin out this part of the country and no longer lead the nation in fat.