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By Taylor Knopf

After a healthy cooking class in Lee County, some of the participants said they loved the new nutritious recipes, but that they didn’t have some of the cooking utensils at home to make them.

So one local group came up with the idea to put kitchen utensil lending libraries in food banks and local churches throughout the county.

Woodland community members work together to install new playground equipment at Woodland Park in September 2017. Photo courtesy of NC State University Cooperative Extension.

This is just one of many efforts to reduce obesity by promoting healthy eating and physical activity using a two-year grant from the Centers for Disease Control and Prevention.

The CDC’s High Obesity Program gave $8.2 million to counties in 11 states where the obesity rate in the adult population is 40 percent or higher. Four North Carolina counties received grant money: Lee, Edgecombe, Halifax and Northampton.

Obesity is a growing problem. One in three Americans are obese, which can contribute to Type 2 diabetes, stroke, heart disease and other health problems.

“By anyone’s measure, we are not only experiencing an epidemic of diabetes, it’s also considered a pandemic around the world,” said Leandris Liburd, associate director of the CDC’s Office of Minority Health and Health Equity. Liburd spoke at the 14th annual Jean Mills Health Symposium at East Carolina University earlier this month,

More than 30 million U.S. adults have diabetes and about a quarter of them don’t know they have it. The disease is the leading cause of cause of kidney failure, lower-limb amputations and adult-onset blindness, according to the CDC. And diabetes is the seventh leading cause of death for Americans.

Then there is prediabetes, a condition where a person’s blood sugar is creeping up, but not quite high enough to be diagnosed as diabetes. About 84 million American adults could be diagnosed with prediabetes, one in three people. And 90 percent of those people don’t know they have it.

How did we get here?

Leandris Liburd, associate director of the CDC’s Office of Minority Health and Health Equity spoke at the 14th annual Jean Mills Health Symposium at Eastern Carolina University earlier this month. Photo by Taylor Knopf.

According to Liburd, there are a number of factors that contribute to a person’s risk for being overweight or obese, including genetics, physical activity and diet, but also policies, worksite programs, and the social and economic environment.

There are also certain populations more at risk for obesity. Hispanic and black populations have higher rates of obesity, as well as women in general, she said. People living in rural areas with less access to grocery stores or places to be physically active, such as gyms or parks, have higher rates of obesity also.

Diabetes is more likely to occur if someone is:

-Overweight
-Age 45 or older
-Has a relative with diabetes
-Is physically active fewer than three times a week
-Had gestational diabetes while pregnant
-Gave birth to a baby weighing more than 9 pounds.

Ultimately a lot of obesity and diabetes prevention efforts come down to helping people eat a healthy diet and stay active. But it’s not that simple for everyone. Liburd spoke about the social determinants of a person’s health that can impact health more than one’s own genetics sometimes.

“Social determinants of health are conditions in the environment where people are born or live, work, play, worship or age,” she said. “In the simplest form, who we are around and what we do has a profound impact on our health status and behaviors.”

Liburd said many people think it’s expensive to eat healthy and takes a lot of time to prepare nutritious meals.

“Some people call the Whole Foods market the ‘Whole Paycheck’ market,” she said.

“Food that is highly processed is cheap, and people are going to try to fill bellies and do the best they can with the resources they have,” Liburd added.

Gaston Market Manager, Tim Green, displays the market’s recently awarded Healthy Food Retail designation certificate in Northampton County. Photo courtesy of NC State University Cooperative Extension.

There are new initiatives to promote the use of Supplemental Nutrition Assistance Program benefits (often called food stamps) at many of North Carolina’s farmers’ markets and get fresh vegetables and fruits into mom-and-pop corner stores.

Working out also takes time. Additionally, people need access places to do those activities, such as sidewalks, parks and gyms.

Liburd noted that fighting obesity and diabetes is also a cultural battle.

She said people often say, “I have a touch of sugar” or “I’m borderline diabetic.” But these are serious conditions.

“The other thing is my personal favorite, people where I come from say, ‘you’re thick, big boned, plus size, stout,’ but you are never obese,” Liburd said. “You have to be really, really large where I come from to be seen as obese.”

She said people look to those around them to establish what is normal or OK.

“I’ve asked women, what did the women look like when you were growing up? What did they do?” Liburd said. “If you grew up in a place where women were very conscientious about weight control or where they were physically active, in your own subconscious, you are thinking this is the thing you do.”

When she was growing up, Liburd said she remembers girls being thin in high school because they were into sports. Then after their education, they went to work, were more sedentary and gained weight.

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“Then you started having children and there was this expectation that women would be larger,” she said. “But we have an opportunity to shift those role models, be more active, model that for our community and our children.

“It’s going to take a cultural shift, but it’s absolutely possible,” she said.

Doing something about it

Part of the CDC’s High Obesity Program grant paid for recruiting and hiring a person from each of the four counties to coordinate on the ground obesity prevention efforts. N.C. State University facilitates the money which runs through its cooperative extension branch which has a presence in each of North Carolina’s 100 counties.

Youth participants in 4-H Physical Activity Fun STEMP Camp have fun learning about bike safety during a Bike Rodeo in Lee County. Photo courtesy of NC State University Cooperative Extension.

“It made sense for the grant to come through a local organization that already has community ties and relationships,” said Bill Stone, county extension director in Lee County. “The extension provides good footing to come in and make impacts in a short time span.”

He said in Lee County, they were able to hire a woman who speaks both Spanish and English to reach the large Latino population in their community.

After connecting with churches and other community groups, they’ve started a food and nutrition class, including healthy cooking classes. The class sessions cover cooking on a budget, stretching your food dollar, and creating good-tasting nutritious foods.

“Healthy eating can taste good and be affordable,” Stone said.

Kids from the 4H club came to a community outreach meeting and said they enjoy riding bikes around Sanford but there are not enough bike racks, Stone said. So the Lee County program used part of the CDC grant to purchase 14 bike racks for the community.

Since it’s a two-year grant that’s ending this fall, Stone said they’ve tried to create sustainable projects.

They were also able to hold a STEM (science, technology, engineering, and mathematics) camp for the 4H kids last summer using the grant. Stone said the camp focused on the biology and chemistry behind movement.

They purchased bikes and used them to talk about safe riding practices. The camp featured obstacle courses and a BMX show with ramps. And the bikes are kept at the cooperative extension facility to be used for other programs.

Over in Northampton …

Each county is using the grant to meet its own unique needs. The Northampton County grant coordinator Lauren Morris helped her community open a playground for the town of Woodland.

Jackson Grocery Co-owner, Jeff Best, displays the grocery’s recently awarded Health Food Retail designation certificate in Northampton County. Courtesy of NC State University Cooperative Extension.

The small town received some hand-me-down playground equipment, and they were able to bring in a certified playground installer and purchase signage and ground surface material with the grant.

About 300 people came out in October 2017 for the grand opening and dedication, Morris said.

“The town of Woodland has a lot of energy and passion,” she said. “They really want opportunities for children, and living in these rural communities there are not a lot of activities available. Now that they have a playground equipment, they are really excited.”

Morris is also working to foster shared-use agreements between schools and churches and the surrounding community. The agreement would allow the community to use a school’s playground or a church gym after operation hours. Signs are put up with the rules and Morris can help make the public aware of the newly available space.

Bringing fresh food to Northampton is also a priority. There are only three grocery stores in the entire county of more than 20,000 people. Morris said some people have to drive half an hour to access fresh food. So the state’s corner store initiative is a big deal for Northampton.

Morris said she’s also helping enhance the county’s very small farmers’ market.

Taylor Knopf

Taylor Knopf covers rural and mental health news. She previously wrote for The News & Observer as a politics and general assignment reporter. Before that, she worked at a small daily newspaper in southern...