Alabama has an obesity rate of 21.8% among children ages 10 to 17, which is the fifth highest in the country behind Kentucky, Mississippi, Louisiana, and West Virginia.
That’s according to a report titled “State of Childhood Obesity” from the Robert Wood Johnson Foundation, the nation’s largest philanthropic organization devoted to public health.
Experts in the field say factors leading to Alabama’s high rate of childhood obesity include poverty, bad eating habits and the Southern culture and climate.
Another factor is the number of rural food deserts, or geographical areas lacking access to affordable and nutritious food.
“A large portion of Alabama is rural,” said Lauren Thigpen, a registered dietician nutritionist with East Alabama Heath Diabetes and Nutrition Center in Opelika, “and with those rural areas comes a lot of food deserts, which means they don’t have easy access to grocery stores with fresh produce.”
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In these areas, she said, sometimes the only option is to pick up fast food or go to a convenience store.
Dr. Richard Glaze, of Pediatric Clinic LLC, with an office in Auburn and Opelika, said poverty also prevents access to healthy food and can lead to obesity.
“When you’re struggling to get by, everything’s expensive,” said Glaze, a pediatrician for 18 years who screens patients for obesity and related conditions such as diabetes and joint problems. “Right now fresh fruits and vegetables are certainly expensive.”
In Alabama, 17% of adults and 23% of children struggle with food insecurity, according to the Alabama Department of Public Health.
Another factor contributing to childhood obesity is the importance of fried food, sweet tea, and other dinnertime staples in Alabama.
“What you’ll also find here in the South is we love to eat,” Glaze said. “We eat stuff that oftentimes isn’t good for us, and that’s often generations of those kind of choices.
“Food is an important part of our lives. It’s a part of our celebrations, it’s a part of our family time together, and we don’t want to demonize food in general, but we want to make sure we give it its proper place.”
Thigpen said the average child in Alabama drinks a lot of sugary, sweetened beverages including sweet tea, Capri Sun, Kool-Aid, juices, and sodas throughout the day.
She also said the portions in fast food menu items and packaged convenience snacks like chips and cakes are bigger than they were 20 years ago.
Glaze also points to the heat and humidity in Alabama, where he says people want to spend their time inside air-conditioned homes and buildings to avoid the heat. Instead of playing outside, children spend more time indoors playing video games, watching television, and snacking.
Research
Geetha Thangiah, an associate professor in the Department of Nutritional Sciences at Auburn University, conducts research on childhood obesity. She said childhood obesity is a complex disease with multiple factors behind it including daily habits, eating patterns, physical activity levels, parental perception, environment and genetics.
Genetic factors can include race, the way someone’s body retains fat and the type of bacteria and fungi in the stomach.
There are trillions of healthy and unhealthy bacteria and fungi in the digestive system, she said, and one way to improve the amount of healthy bacteria and decrease the chances of obesity is by eating a healthy diet of fruits, vegetables, and whole grains.
Thangiah wanted to know why there’s a higher rate of obesity among Black children than white children, and this led to research in collaboration with Mayo Clinic in Rochester, Minnesota.
Looking at the fecal samples of the children who participated in the study, Thangiah found that white children, or American children of European descent, had similar gut microbe profiles whether they were obese or not. On the other hand, Black children, or American children of African descent, who were obese had a greater abundance of gut Klebsiella and Magasphaera bacteria than Black children who were not obese.
The study suggests that a specific approach to confronting childhood obesity is required for each population.
Federal and state programs
In tackling childhood obesity, Alabama must focus on all age groups of children, from the youngest to the oldest.
Alabama participates in several government initiatives including the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), which provides federal grants to states for supplemental foods, health care referrals and nutrition education for low-income pregnant, breastfeeding and non-breastfeeding postpartum women, and to infants and children up to age 5 who are found to be at nutritional risk.
In Alabama as of 2020, 15.6% of its WIC recipients ages 2 to 4 were obese, higher than the surrounding states of Mississippi (14.4%), Tennessee (14.6%), Georgia (12.9%) and Florida (13.4%).
Other federal programs used in Alabama include the Supplemental Nutrition Assistance Program (SNAP), a food stamp program and Head Start, which provides public assistance for children from birth to age 5 from low-income families.
Public schools throughout Alabama have nutrition and physical education guidelines to follow, and health and physical education courses are aligned with the Alabama Course of Study, which addresses obesity, nutrition plans and healthy active lifestyles.
The Alabama Physical Fitness Assessment is a requirement for all students in grades 2-12, and data is reported to the State Department of Education.
In 2019, 17.2% of students in grades 9–12 in Alabama were obese, above the national average of 15.5%. Mississippi had the highest high-school obesity rate at 23.4%.
Fruits and vegetables
Molly Killman, a registered dietician and director of the Alabama Department of Public Health Nutrition and Physical Activity Division, said the State of Alabama has set up numerous programs to address obesity.
These include the Farm to School program, Farm to Early Childcare program, and Healthy Wellness Initiative.
Killman said Farm to School is a program that connects local farmers with schools to provide students with fruits and vegetables.
“It’s a win-win situation,” she said. “The farmers are getting their products out to the schools, and the children are getting to eat produce that is locally grown, right here in Alabama.”
Farm to Early Childcare, which began in 2017, is a similar program that reaches children under the age of 5. Besides providing local produce, the program also helps daycare centers start their own gardens.
“The earlier you can expose children to fruits and vegetables and let them try fruits and vegetables, the more likely they are to continue eating those types of foods as they grow older,” Killman said.
The Healthy Wellness Initiative, which began in 2005, works with afterschool programs by providing training and resources for teaching children about good nutrition and physical activity.
“Education is very important, and a lot of these programs are about education and making sure that information on nutrition and physical activity is shared,” Killman said. “We’re also doing a lot of work that increases access to healthy food and nutrition.”
The state is also working on nutrition labeling and how to market food to children, she said.
Thangiah said that dollar stores are starting to add fresh fruits and vegetables and that there has been a push to educate people about health food and physical activity, especially in low-income counties.
For those who think children don’t like fresh fruits and vegetables, consider which items from the Farm to School initiative and Alabama farmer partnerships are most popular among students.
According to Ashley Powell, director of child nutrition for Auburn City Schools, these were the favorites last year among the students she serves: Fresh strawberries from Clanton and romaine lettuce from Birmingham.
Tips for families
For parents, grandparents and guardians who are raising children, Thigpen, Glaze, and Thangiah offer some advice.
Thigpen, the nutritionist, suggests following the plate method: Half of the plate should be fresh vegetables, a quarter of the plate should be protein and the remaining quarter should be a starch such as rice or bread. The meal should be accompanied by fruit and water or milk, and she recommends that every meal have fruit, vegetables and dairy.
Glaze, the pediatrician, urges everyone to cut down on sugary drinks including tea, soda, juice, and sports drinks.
He also suggests that families eat most of their meals inside their home and cut drive-thru or restaurant visits down to once a week.
In her research, Thangiah, the Auburn professor, found that children who go to bed later than 8:45 p.m., those who eat dinner after 7 p.m. and those who watch more than one hour of television tend to be more obese.
Glaze also strongly suggests that parents place restrictions on screen time and believes that this will encourage children to go outside and play.
He adds this simple advice: When you’re full, stop eating.
Thangiah has research to back that up. She said she found that children with parents who pressure them to finish eating everything on their plate even though they’re full tend to be more obese.
“Cleaning your plate is not always the best thing,” she said.