Physical Inactivity and Obesity in the Appalachian Region

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The list of things that affects our health is longer than the list of things that don’t. The genes we inherit from our parents, the environments we live and work in, the medical care we’re able to receive, the food we put into our bodies. While we have some control over these areas of our lives—excluding, of course, the genes we inherit—external factors also play a large and influential role.

We’re all born somewhere, grow up somewhere, get jobs somewhere—and these somewheres are, for the most part, beyond our ability to control. While occupations with labor mobility permit some residents to choose locations based on desirability of environment, for many others this is not possible, particularly low-wage workers in low-skill positions. But regardless of labor mobility, oftentimes there’s another, more important factor that determines where we choose to work and live: where we consider to be home, and for many people, home isn’t so much something we choose as something that chooses us.

And so an important component of our homes, of these living and working environments, is access to medical care—in terms of both insurance coverage and supply of healthcare providers. According to the Health Disparities in Appalachia report, there are fewer healthcare providers per capita in Appalachia than in country as a whole. For instance, there are 12 percent fewer primary care physicians per 100,000 population in the Region than in the United States as a whole, as well as 35 percent fewer mental health providers, 28 percent fewer specialty physicians, and 26 percent fewer dentists.

Another influencer of health: the food we eat. In terms of grocery store availability, Appalachia has 14 percent fewer grocery stores per capita than the United States a whole. It should be noted, however, that this indicator doesn’t provide a perfect measure of the availability of healthy food, as it fails to account for distance to stores and access to transportation, two particularly important considerations for rural communities.

Another factor, one that’s not noted above, is one that we arguably have the most control over: our physical inactivity levels. Though there are certainly extenuating circumstances such as injuries, environmental factors, and a lack of leisure time, for most people there exist some opportunities—before and after work, going for a walk during a lunch break, playing with children, etc.—throughout the course of a week to engage in some sort of physical activity.

Across Appalachia, however, physical inactivity levels are higher than those found in the United States as a whole. Among adults age 20 and over in the Region, 28.4 percent report being physically inactive, whereas the figure is 23.1 percent for the country overall. These values are based on a national survey in which respondents were asked whether they engaged in any sort of leisure-time physical activity in a typical week.

The disparity between Appalachia and the United States overall is most notable when considering the central subregions, where the levels of physical inactivity are higher than both the regional and national averages:

  • 33.8 percent of residents in Central Appalachia engage in no leisure time physical activity in a typical week, as well as:
    • 31.1 percent of residents in North Central Appalachia
    • 30.1 percent of residents in South Central Appalachia

Why should we be concerned about physical inactivity levels?

Because exercise and physical activity can help prevent weight gain, while at the same time reducing the likelihood of a wide range of diseases, including diabetes, hypertension, heart disease, stroke, and even cancer. In fact, recent research has shown that engagement in physical activity leads to a decrease in overall mortality risk. And physical activity doesn’t just lead to improvements in physical fitness; it can also improve mental health and cognitive function.

Realizing the vital role physical activity plays in overall health, an issue brief focused exclusively on obesity was recently released as part of the final stage of the Creating a Culture of Health in Appalachia research initiative. Obesity, of course, is a health issue for which physical inactivity is a significant risk factor. In the issue brief, strategies and recommendations are provided for three distinct groups of stakeholders: community leaders, policymakers, and funders. A selection of these recommendations are featured below.

For community leaders, actively promoting physical activity across all age groups—children, adults, seniors—is a simple yet highly impactful strategy for reducing obesity in a community. After-school programs (e.g., supervised time at a playground) and community events (e.g., a walking club) are two examples of possible initiatives. Community leaders also play a significant role in educating residents regarding the importance of physical activity.

For policymakers, it’s about making healthy initiatives easier to adopt and implement, which includes not only making funding available for initiatives, but also creating the environments necessary for the activities to take place, such as parks and recreation centers. An additional area of focus may be the workplace, where policymakers can encourage employers to adopt healthy work environments while also promoting healthy initiatives for its employees. Making healthy foods available in schools—as well as in the community as a whole—is another vital role policymakers can play in the fight against obesity.

Funders are critical to filling the holes that may otherwise go unfilled due to a community’s lack of resources. Writing grants and initiating cross-sector initiatives are two simple yet vitally important examples. Also, by helping build an evidence base—for example, by supporting and funding research efforts and sponsoring initiatives—funders play a critical role in not only in our understanding of the issues, but also how to best tackle them.

Like any health issue facing a community, physical inactivity and obesity are challenges, yes, but they’re also opportunities. They show us where we need to improve, and how we can get better. The initial stage of this research initiative identified the health disparities between Appalachia and the United States as a whole, with subsequent phases then providing actionable strategies and recommendations for communities throughout the Region. Take a look at the obesity issue brief to find out how you can help your community increase physical activity, decrease obesity, and improve overall health.