Living Large: 5 Reasons Knoxville is (Still) Fat

Tennessee has the fourth-highest rate of adult obesity in the country. So why can't we lose weight?

Sherry Johnston knew she was overweight—sort of. But she had already been selected as a contestant on NBC's The Biggest Loser Season 9—vying for a $250,000 prize if she was the last one of 20 standing, a "couple" with her daughter Ashley—and was at the doctor's for a physical before she had what she calls her "come to Jesus" moment.

At 51, she was 5' 1" and around 218 pounds, "about double my healthy weight," she says. "I didn't see myself that way, that severe. My concern had always been for Ashley [who by this time was age 27 and 374 pounds]. But we had to have a doctor sign off before we could participate in The Biggest Loser. It was a blessing, really. He told me I was borderline diabetic. That my cholesterol was out of control and I needed to be on cholesterol meds. That I was at risk for a heart attack."

Johnston reeled. "I'm diabetic? I'm at risk? I never dreamed I was putting my health in jeopardy. That moment of my life turned me around, physically, emotionally. Suddenly I knew, ‘I have to change, I have to do something.'"

The timing couldn't have been better: Johnston was next whisked out of Knoxville and off to a ranch for controlled meals, trainer coaching, and constant attention to the best and healthiest way for her to lose a lot of weight and fast. At about 55 pounds lost, she was voted off the show in the episode that aired March 23, with nine contestants left to go. She returned to Knoxville in a veil of secrecy to continue competing for the "at home" prize of $100,000, and when her "Where Are They Now" segment aired, she had lost 80 pounds, weighing 138. (Daughter Ashley is still in the on-air competition, which makes her ineligible for interviews of any sort. As of the episode that aired April 6, she had lost 110 pounds, or 29 percent of her original weight.)

Now, awaiting the show finale May 25, which will be filmed live, Johnston hopes to serve as an inspiration to others in Knoxville. "I'm hoping people will look at me and think, ‘If she can do it.' I was 51 years old before I was ready to stand up and do something. I had never been to the gym one time. I knew every Dollar Menu in town.

"And I hope it doesn't take everyone around here like it did me—having to think they're going to die before they change."

How Fat Are We?

The fact is, even the knowledge of impending doom might not be enough to sway much of Knoxville's population to start losing weight. We're fat—part of the state with the No. 4 highest rate of adult obesity, with Centers for Disease Control statistics from a study last run in 2005 saying Knox County is 36 percent overweight and 24 percent obese, with 54 percent of females at an unhealthy weight.

Admittedly, Knox County obesity figures are slightly below the rest of the state, and pretty close to the national average of 25 percent. Still, the sheer numbers are alarming—about one in four adults in these parts is obese, which is based on Body Mass Index of over 30, and with that comes increased risk of heart disease and stroke, high blood pressure, diabetes, cancer, gallbladder disease, osteoarthritis, sleep apnea, and asthma.

But somehow, these numbers and health threats fail to make an impression. We were one of the states leading the trend toward obesity that began in the '90s, says Siri Khalsa-Zemel, a registered dietician/nutritionist (LDN) in Knoxville who holds a Certificate of Training in Adult Weight Management from the American Dietetic Association. We reached high levels of obesity and being overweight early on, but as other states catch up, we are holding steady—we show no signs of becoming a culture that supports or encourages weight loss.

Of course, that hardly makes Knoxville unique in a nation of fat Americans. But some of the reasons Knoxvillians resist losing weight are specific to the area, from cooking ingredients to religious beliefs to our own brand of denial—about the weight, and about the potential consequences.

Just ask Johnston, a Knoxvillian through and through, born at Fort Sanders hospital, graduated from West High School, and now living in West Knoxville. She may be a healthy weight now, but she's lived every one of these reasons why Knoxville's (still) fat:

Why We're (Still) Fat: Reason 1

We eat like our Southern ancestors, while sitting at a desk.

Johnston is quick to point out that The Biggest Loser contestants on Season 9 came from many states, and "they were just as fat as us. But while it's true everywhere, it may be even more true for Southerners that when we're celebrating—having a life event—we're always around food."

She laughs a little when describing a typical family menu for, say, Christmas dinner, one that would cause no remark, that was "normal for all of us. This would consist of a huge turkey, dressing, homemade gravy, stuffing, macaroni and cheese. All kinds of desserts—a coconut cake, a chocolate cake, brownies, cookies. You'd bake or you'd buy them at the store; sometimes both."

Of course there were vegetables. "Green beans, but in green bean casserole. Fried okra—it's a great vegetable, but that's what we do with it, fry it. Before I went on the show, I never realized how to cook without butter. Nutrition labels? I never looked at them. If I was cooking greens, I'd have to put butter in there, and ham or bacon, some kind of meat to flavor."

Did anyone say a word about the nutritive value of these celebration staples? "No, not at all," says Johnston. "In fact, at any of our extended family get-togethers, if anyone brought anything kind of healthy—that wasn't chicken and dumplings—it would be more like, ‘What's that?'"

This proud-to-be-Southern-style eating is a major factor both in weight gain and continued obesity, but only because it's paired with activity levels from a society chock full of conveniences, says Khalsa-Zemel. "Our grandparents and great-grandparents farmed the land and used their bodies and they ate classic Southern food," she says. "Our culture is built on dishes like biscuits and gravy and country-fried chicken."

Alas, to eat like our forebears without bloating would mean toiling like them, too. "Our ancestors who prepared and ate these foods burned so many calories throughout the day, farming, washing clothes, picking from the garden, using their two legs to walk, they could get away with it," says Khalsa-Zemel. "The foods are still here, the family recipes that in part define the South. Our activity patterns have changed but our foods have not."

Johnston says turning her back on salt and butter was tough, but so much easier in the confines of the ranch, since there wasn't a salt shaker in sight. When the group had to learn to cook for themselves, she focused on sauces in particular. "I was constantly trying to find a way to make a sauce healthy, because here if it doesn't have a sauce, why eat it, right?" she says.

Why We're (Still) Fat: Reason 2

It's lonely to make healthy changes around here.

Adjusting recipes can be done, but adjusting attitudes so you can establish healthier eating habits in this Southern-fried culture, that can be a lonely battle, which is one of the reasons we give up on trying to change.

In fact, any turn toward a healthier lifestyle might bring ostracization with it, says Paula Pavelka, a Knoxville-based registered nurse and integrative nutritionist and health counselor who leads international wellness retreats through her business, Body Mind Soul Living. "Deciding to step out and have something that's not white bread, or to participate in a sport, there's still a general stigma to that," she says. "You may be chastised, and just at a time when you're feeling most vulnerable and sensitive anyway, so it's even tougher to stick with the lifestyle change."

Pavelka has experienced this "loner" mentality since she was a child. She grew up in the area, but the glitch is that her parents were from Vermont and a steel-mill town respectively. "We had a garden, and weren't allowed to eat processed food. I remember begging my mother for Hamburger Helper, she was like, ‘No way.' A big treat for us was Life cereal, plain Life."

Nowadays a typical meal for her might involve red lentils cooked at home with cumin, carrot sticks, and a raw chocolate dessert with dates. In another area of the country, say Colorado (with an 18.4 percent obesity rate) or her mother's native Vermont (obesity rate 21.1 percent), Pavelka might be greeted with interest. "What you generally experience in Knoxville, as opposed to say, San Diego, or Denver, where everybody's doing power yoga or eating sprouts, is ‘What are you doing? What's that?' We're starting to have more healthy food and lifestyle options here, but it's still on the fringes. If you're going to try it, you have to have some backbone and perseverance."

Why We're (Still) Fat: Reason 3

Bible Belt believers are worried about drink and drugs—not lemon meringue pie and love handles.

Johnston's younger daughter Ashley (older daughter Cyndie Goss also lives in Knoxville) could not fasten her seatbelt to drive and needed a machine to breathe in her sleep—she was 27 and weighed more than 370 pounds. And yet, she and her mother had never broached the issue of her weight. Not once.

If either woman had been abusing alcohol or drugs, that probably would have drawn more overt negative attention from their close-knit extended family, or the church group they're involved with, or from other friends, which would perhaps have led to an intervention. But no one breaks the silence about life-threatening obesity. "We didn't want to hurt anyone's feelings. We never talked about weight with family—it's taboo," says Johnston.

Part of the reason excessive weight goes unchallenged when other harmful behaviors are addressed is connected to our Bible Belt culture, says Khalsa-Zemel, who coaches women who come to her Women's Way weight management center to lose around 1/2-2 1/2 pounds per week healthily. While substance abuse, or, in some denominations, any alcohol at all, are clearly forbidden in church culture, eating too much food is an acceptable coping mechanism, she says. "Difficult life situations affect us all, and when folks have limited ways of coping, many go to food as a means of escape," she says.

And there's the celebratory angle, too—who's counting calories at church pot-luck tables laden with sausage balls, cheesy casseroles, apple brown Betty, and real mayo macaroni salads?

Eating to cope can be replaced with mindful ways of coping with stress—meditation, breathwork, and communication skills, says Khalsa-Zemel—even in Knoxville. "As compared to the rest of the state, or the rest of the country, there's nothing genetically or environmentally that puts us at a disadvantage when we try to replace mindless weight gain with mindful stress reduction. But it's just plain hard work."

Why We're (Still) Fat: Reason 4

We live in a poor state.

While no one has yet done the definitive study on why Tennessee's obesity rate, and that of much of the South, is a bit higher than most of the Northeast and Pacific Northwest, Khalsa-Zemel says studies have ascertained that economy plays "a very big role. The lower the socioeconomic level, the higher the rate or risk of overweight and obesity," she says.

As of the most recent U.S. Census estimate (2008), some 14 percent of the Knox County population lives below the poverty line, which is a percentage point above the national average and a point below the state rate. That leaves a fair number of folks to buy cheap junk food, which recent studies have shown inevitably equates to high amounts of high fructose corn syrup, high saturated fat, and high carbs. "It's interesting that in the food economy the most readily available foods to those who are lower income are foods of the poorest nutrition," says Khalsa-Zemel. "Why does a head of broccoli cost more than a box of Twinkies?"

As an administrative assistant at Freedom In Christ Ministries, Johnston is solidly middle class, but says ever-present fast food and convenience-store bargains helped keep the scales at a high number for her and Ashley both.

"I never worried about it. At McDonald's I loved those Big Macs. If I really wanted to feel good, I'd get that burger with lettuce and tomato. I could tell you every dollar deal in town. There is this Pilot with a McDonald's near our house; I pass it every day on the way to work. As a kid, there was this little Icee machine at this little grocery store. It made me remember my childhood to go to the Pilot every day before work. I'd duck in and get the biggest Icee they had, and then scoot over to the McDonald's and get the biggest breakfast sandwich that was on sale. Every morning.

"You think you're eating cheap, but you're robbing yourself."

These days, Johnston forgoes the Icees and the full-sugar sodas, and sweetens her tea with Truvia, a natural no-calorie sweetener introduced at the ranch. She gets her protein from 4-ounce portions of chicken (found on sale at Food City) that she cooks in a Crock-Pot with garlic and onions and carries to work and sometimes on lunch dates with her friends. "I can now eat anywhere with anyone," she says.

A few days ago, she went to the Chik-Fil-A and ended up getting just a salad—lettuce and other raw veggies, no cheese or croutons, and she brought her own Galeos miso dressing, which is 19 calories per tablespoon. Says Johnston: "I look back on all that fast food now and think, ‘Who was that?'"

Why We're (Still) Fat: Reason 5

We play the diet game.

At 51, Johnston could still remember what it was like to be thin. And she'd certainly lost some of the 200-plus pounds she weighed in 2009 before—at least once. "We've all tried the diets," she said. "But I couldn't really settle myself in. Once, I did Weight Watchers, and while there is nothing wrong with Weight Watchers, I lost 40 pounds with them strictly with diet control. I never once entered a gym, I never walked around the block even once. And pretty soon I began to cheat, a little here, a little there. And the weight began to come back."

Johnston's short-sighted, sort-of game-playing approach isn't beneficial for most anyone, says Khalsa-Zemel. "We do have literature on this. Women tend to go on a diet when they want to lose weight. Men tend to exercise when they want to lose weight. Both of those are short-term strategies unless real lifestyle change has occurred and can be sustained."

For Johnston, the boot to start the genuine lifestyle change came at a very real time—with the physical exam that revealed her potential diabetes—but the process that followed was fairly unnatural, at the BL ranch with nothing to do, no responsibilities but to train and lose weight.

The real test came, she says, when she got off the plane after being eliminated from the show and went back to work the very next day, past the Pilot/McDonald's and toting a lunch. "I'm doing the workouts three or four mornings a week with a trainer, before I go to work," she says. "I try to do something I enjoy in the afternoon, when my motivation is lower, like walk outside on the greenway. And I'm losing weight with real foods. Like my snack for today was strawberries, fresh, and I dipped them in Oikos yogurt sweetened with Truvia. And the one other thing is, I don't go hungry. Everybody thinks when you're losing weight that you're probably hungry a lot, but I'm eating filling foods, with lots of nutrition. Like scallops. Ashley and I love scallops, and we prepare them the night before a weigh-in."

Most importantly, says Johnston, she is using the fact that she was able to be selected for the show and succeed with weight loss to open a conversation with others about the possibilities. "I've told some of my relatives we should have a gathering and sit and talk about it, and a lot of them are already getting with their own doctors to see what might be a safe way to start," she says. "I'm not trying to make anyone feel guilty; they'll do it if and when they're ready. But I feel great, and I get more confident by the day, with each little success.

"I'm 52, but I feel more like I did in my 20s."