An Epidemic of Fat
The counties in Florida with the highest percentages of obese people tend to be rural and poor — but more than half of all Floridians are either overweight or obese.
"Originally, when I looked at the data, I thought we'd find people in rural counties weighed less. I thought they might be working out on the farms and in the fields. (But) it was more the rural counties that have an obesity problem," says Goss, who today serves as the nursing program director at Tallahassee Community College. Data collected by the state show that the seven counties in Florida with the highest average body mass index -- a measurement of body fat based on one's height and weight -- all were rural (see "Weighing In," below).
"Traditionally, people in rural counties eat food that is probably higher in fat and has a higher calorie content," says David Janicke, an assistant professor of clinical and health psychology at the University of Florida. Traditional Southern fare like fried chicken was less a problem when the ingestion of higher calorie foods was offset by labor-intensive activities. People today "are more sedentary," says Janicke.
Other data show relationships between obesity and income and education. Along with being rural, the counties with higher portions of obese people tend to be poor. In Hardee County, a small rural county in south-central Florida, 36.8% of the population is obese. The county ranks 61st out of 67 counties for per capita income, with a median household income of $28,004. More than 23% of its people are considered "poor," and 18.7% of households are on food stamps.
Obesity-related medical expenses in Florida reached an estimated $4 billion in 2003, according to a study by RTI International.21%
of non-Hispanic white adults, 26% of Hispanic adults and 33% of non-Hispanic black adults in Florida are obese.60%
of Florida adults are overweight or obese, putting the state in a slightly better condition than the rest of the country as a whole. Approximately 119 million adult Americans, or 64.5%, are either overweight or obese, according to the Trust for America's HealthThe same holds true in Washington County, where more than 32% of residents are fat. The county ranks 57th in the state in per capita income, with a median household income of $27,671. Nearly one in five of its people lives in poverty.
Florida's trimmest counties, by comparison, tend to be wealthier. Residents of Collier County, which includes Naples, have an average BMI of only 25.5 -- normal is between 18.5 and 24.9 -- and rank fourth in the state in per capita income, with a median household income of $47,591. Only 4% of Collier County households are on food stamps, and less than one in five residents is obese. Martin County, one of the state's wealthiest counties, has a 15.2% obesity rate, and residents there have an average BMI of 25.74. Martin County residents rank second in the state in per capita income, and the median household income was $43,692 in 2002.
The thinner, wealthier counties also are better educated. In the seven counties with the highest BMIs, only 10% of residents, on average, held bachelor's degrees.
Educated people don't get off unscathed: As education increases, so does the likelihood of being a little overweight. But increasing education diminishes the likelihood of becoming obese, experts say.
And while rural counties may have higher percentages of obese people, that doesn't necessarily mean most of Florida's obese people live in rural counties. The entire population of the seven counties with the highest average BMI totals about 150,000, meaning that approximately 51,000 individuals in those seven counties are obese. Seminole County, north of Orlando and among the five counties with the lowest BMI, is home to nearly double that number, or about 93,000, obese people. Collier County, meanwhile, is home to about 55,000 obese Floridians, and Sarasota County has 60,000 fat residents.
And it remains a fact that the entire population in Florida is growing heavier. In 2004, 60% of all adults in Florida were considered overweight or obese -- an increase of more than 50% since 1986. The biggest fallout is the myriad health problems that obesity brings, including higher rates of diabetes, hypertension, cancer and heart disease. Six of the seven fattest counties on Goss' list exhibited some of the highest rates of diabetes in the entire state, according to Health Department data. In Liberty County, which has the third-highest average BMI in the state, almost one-fifth of the adult population has diabetes. And six of the seven heaviest counties were given the "least favorable" rating by the Florida Department of Health for the incidence of death by stroke, which has been linked also to diet.
Goss is hoping that her thesis, which was published in the Journal of Community Health Nursing, will provide some sage advice: "We looked at 10% of the counties with the lowest mean BMI," she says. "The one thing that stands out is that they eat five to nine servings of fruits and vegetables every day."
Chewing the Fat
Being overweight is to some degree linked to income
and educational levels.
obeseHardee28.248.4%6118.7%36.8%Jefferson28.2116.9%3613.0%33.9%Liberty28.167.4%5611.3%38.9%Gadsden27.9212.9%4517.1%33.0%Madison27.8810.2%5917.2%34.1%STATE AVERAGE26.9022.3%N/A9.0%22.3%Lightweight Counties
obeseCollier25.5027.9%44.0%18.3%Alachua25.6838.7%259.9%16.8%St. Johns25.6933.1%74.4%16.4%Martin25.7426.3%23.2%15.2%Seminole25.8531.0%84.7%22.7%Sources: Journal of Community Health Nursing; Woods & Poole Economics; Enterprise Florida; Florida Department of Children & Families