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More obesity clustering

May 26, 2010

Working on the last post, I was interested to run across some information from the West Virginia DHHR: Obesity: Facts, Figures, Guidelines–particularly the appendices and graphs. (Not so much “The Burden” and “The Economic Costs” of Obesity preaching, which are just about as bad as one would expect.)

As in the last post, I am not pretending to do any kind of reasonable analysis, but thought I would point out some patterns which stood out to me.

Looking at one pair of graphs, Figure 2 Prevalence of Obesity by County, West Virginia BRFSS, 1990-1994 and 1995-1999, some interesting patterns also became obvious:

The cluster is more evident in the first, before it turns darker in the second time period. (The BMI standards changed in 1998, creating a sudden epidemic of redefined fatness, on the spot.) Most of the higher-prevalence counties are clustered in the coalfields in the vaguely southeastern part of the state. The darkest counties in the first, staying dark in the second? Mingo and Logan–named after a Mingo chief whose people settled there among the existing Mingo/Wendat/Shawnee–smack in the middle of the coalfields (well, the middle as they extend into neighboring Kentucky*).

Map with counties labelled, for reference:

Map Courtesy of

Here are the figures the graphs are based on, with ranking: Appendix A: Obesity Prevalence by County, WV BRFSS, 1990-1994 and 1995-1999.

Something I cobbled together, out of curiosity, using USDA County-Level Unemployment and Median Household Income for West Virginia figures:

Obesity Ranking by county, WV BRFSS 1995-1999, and % of State Median
HH Income 2008
1. Logan (also #1 in 1990-1994); 90.2%
2. Wyoming; 84.4%
3. Boone-Lincoln; 87.4%/79.5%
4. McDowell; 54.6%
5. Raleigh; 92.2%
6. Berkeley; 139.8%
7. Mingo; 73.1%

Berkeley is the only county in the top 7 not located in the coalfields cluster, and the only one with a household income over the state median. Bear in mind that West Virginia as a state was ranked** #49 in the U.S. for median household income, also #49 for per capita income, both from 2000 Census data. So, even 139.8% of the state’s median is not a huge income.

Are there other things which make this cluster of counties special? I already mentioned the reliance on mineral extraction, frequently by mountaintop removal mining, after many decades of union busting. Could that be dangerous (including all the flooding and home damage from blasting) and lead to some chronic stress all by itself? You might want to check out’s America’s Most Endangered Mountains video series, along with the rest of that site.

I was actually surprised to see that Logan Co. in particular was no lower in median household income than it was in 2008; I hope things really have improved other than through statistical fiddling since I last spent much time in that area in the mid-’90s. I believe it was in neighboring Mingo Co. where I saw a decent, one-story house right along US 52 for sale by owner for $8,000–and it looked like it had been on the market for a while. That’s how bad economic conditions seemed to be at that point, and things didn’t look much/any better in neighboring counties. (Or a bit further away, as evidenced by Poverty Digs Deep In Southwest Virginia Mining Towns.)

Very relevant, bearing in mind the last post’s patterns? These are areas in which the American Bureau of Ethnology and US Census identified multiple Native “pocket communities”–from the AAIWV‘s excellent timeline (PDF). Unusually for a state in which (from its 1863 founding) ‘“Indians” by law did not exist and it was not legal to register a child as “Indian” at birth’, there is some documentation, and these folks have not mysteriously disappeared in the intervening century or so. All the Mingo did not leave Mingo and Logan counties, though they were not specifically recorded in the late 19th-early 20th centuries. They (and the Tutelo) did intermarry extensively with the Cherokee and Shawnee who were recorded.

That’s where my biodad’s paternal family comes from, mostly along the Big Sandy (formerly “Totteroy”, Tutelo) and Guyandotte (Wendat/Wyandot***) drainages. When John Lawson met some Tutelo ca. 1700, he described them as “tall, likely men, having great plenty of buffaloes, elks, and bears, with every sort of deer amongst them, which strong food makes large, robust bodies.” I may as well just refer back to an earlier post, Obese West Virginia. The brief version: there are still a lot of tall, robustly built people in that particular area. I have seen them; I am related to a lot of them.

See Theo Pavlidis’ The (Lack of) Science behind the Body Mass Index (BMI) for why this measure is particularly inapplicable to people who are toward either end of height distribution and/or muscular and/or with much in the way of a skeletal structure. Not to mention Top 10 Reasons Why The BMI Is Bogus. Also BMI: Braindead, Meaningless, Insidious: ‘Frankly, BMI is roughly as useful a medical concept as “the vapors,” or “hysteria.” It would be funny if it wasn’t so frequently used as a weapon against all of us.’ I could go on linking.

So, what do we have here? An area full of a specific population group, who may or may not really be obese (other than by unadjusted BMI), and may or may not really be getting progressively fatter. (It’s hard to figure out what is really going on, through all the moralistic screeching.) Lots of inequality reflected in low incomes and environmental destruction, leading to plenty of chronic stress, which really can make people gain weight through a number of known mechanisms. It will sure give people a lot of other health problems.

Oh yeah, and they’re pretty consistently getting blamed for the Dread Obesity. Which wouldn’t raise stress levels, at all.

Ha, I ran across another amazing one from Medscape: More Obesity, Diabetes in South, Appalachia.

Besides the South, high prevalence for obesity and diabetes was found in the Appalachian region and some tribal lands in the West and Northern Plains.

Eighty-one percent of counties in the Appalachian region that includes Kentucky, Tennessee, and West Virginia have the highest rates of diabetes and obesity. So do 77% of the counties in Alabama, Georgia, Louisiana, Mississippi, and South Carolina…

The agency says obesity costs the nation some $147 billion in medical costs and estimates the price tag for diabetes at $116 billion…

William H. Dietz, MD, director of CDC’s Division of Nutrition, Physical Activity and Obesity, says in the news release that the small-area estimates should help communities prevent and reduce obesity of their citizens.

I think we can do with less of the kind of fearmongering and fatty-blaming “prevention efforts” they usually mean, and more work on underlying problems.

From another report:

There are a range of possible explanations for counties in the South and Appalachia have the highest rates of obesity and diabetes, experts said. A culture that embraces fatty, unhealthy foods and shuns exercise may be one. Genetics may be another. Income and education probably have a lot to do with it, too — people living in poor communities may not have the money to eat healthier, more expensive foods or may not have access to gyms or safe jogging trails, they said.

Or a lot of the poor ones could be coming home from physically demanding jobs and then working their asses off in the garden, trying to make sure their families have food. (Is it healthy if you haven’t bought it at all?!) That would be closer to my guess; hell, I’ve seen it in action close up. There is a real lack of designated jogging trails and gyms****back in the woods, the same woods that anybody can run through to their heart’s delight if they’re not too busy or tired from, erm, working their asses off… *grumbles*

Oh yes, another tidbit ripe for similarly unbiased interpretation, gleaned from the CDC’s Behavioral Risk Factor Surveillance System (BRFSS), which produced the obesity data by county: “The estimated prevalence of teeth extraction among adults aged >/=65 years was lowest in Hawaii (10%) and highest in Kentucky (39%) and West Virginia (41%).”

* Not too surprisingly, there is a similar pattern showing in neighboring areas of Kentucky, in The Kentucky Obesity Epidemic — 2004 (PDF): “In general, many counties in eastern Kentucky have higher rates of overweight and obesity than the rest of the state.” It looks like Pike County, neighboring Mingo Co. WV, is at the tip of the arrowhead shape on p. 6. They are also not counting any racial/ethnic categories but “Black” and “White”, not that it would likely be an accurate population reflection anyway. And, from the best I could find offhand from Virginia, “Within Virginia, the Southwest region had the highest obesity rate at 38.5 percent in 2008.” Yep, that’s where I grew up.

** Some names in the bottom fifth for median household income ought to ring some bells from the last post: #40, South Carolina: #41, Louisiana; #43, Tennessee; #45, Oklahoma, #46, Alabama; #47, Kentucky; #48, Arkansas; #50, Mississippi. Montana and New Mexico are the exceptions in the Bottom 10. Per capita income is not too different a picture.

BTW, if you want a picture of inequality in action, look at Virginia’s (#8 MHH, #6 per capita) county breakdown, and 2006 Census estimates. Unfortunately, I couldn’t find any kind of map plotting, so the clustering won’t be obvious unless you already know the geography. The main prosperous areas are around DC and Richmond (though the City of Richmond itself has 29.3% of “Under age 18 in poverty”, in a too-familiar urban pattern). Hardly all of the income differences have to do with cost of living.

“Montgomery County [for these purposes, includes Radford] had Appalachian Virginia’s highest poverty rating, with 24.5% of its residents living below the poverty line.”# I grew up in Radford. Mongomery Co. was also one of the few places which refused to join the Appalachian Regional Commission for years, on the basis that nobody would be drawn to Virginia Tech if they realized it was in Appalachia. (One would think all the mountains would be a giveaway there, but hey.) Yes, this region has two decent-sized universities, and both the economic inequality and the regional bias/racism are less than subtle.

*** Who also got referred to as “Mingo”, as a generic slur (section: ‘The “Mingo”) against those sneaky Northern Iroquoian-speaking SOBs. 😉 Just to complicate matters further, the two groups frequently lived together when they were in the same area. “Tutelo” was similarly used by Iroquoian speakers to refer to Eastern Siouan people. English speakers just didn’t know who they were dealing with half the time.

**** Unless someone decides one is needed, and messes up land and water usage patterns. That is not all on railroad right-of-way. It is along a particularly gorgeous section of the river, though I didn’t use it when I was back after hearing some of the (justified, AFAICT) bitching from people affected through, say, losing part of their “unsightly” gardens (in limited rich bottomland) and having new trouble irrigating what was left. I understand that some sections screwed up remaining canebreaks*****, as well.

***** “[R]udimentary furniture”?!

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