Shaping the conversation: obesity and chronic disease

West Virginia's obesity rate
July 6, 2012

The late Ned Chilton, crusading publisher/owner of The Charleston Gazette, was a fiercely independent soul whose motto was "sustained outrage." He always felt it isn't enough to present the public with a large chunk of outrage on a subject one, two, or even three times. He wanted the outrage sustained for months. Keep after it, he urged reporters. Hit it month after month from many different angles. Change the public conversation.

Chilton applied sustained outrage to corrupt politicians, scams, environmental wreckage and various forms of injustice. In my Dennis Hunt Fellowship project, The Shape We’re In, I have applied his philosophy to West Virginia’s staggering rates of obesity and chronic disease.

West Virginia, my home state, has the nation’s worst statistics in 10 out of 12 categories measured for the 2011 Gallup Healthways ranking: obesity, diabetes, heart attacks, high blood pressure, high “bad” cholesterol, depression, cancers, neck or back condition, leg or knee condition and “other recurring pain.”

This has been, in some ways, a labor of love for me. One in four West Virginia fifth-graders has high blood pressure and abnormal cholesterol, according to 2010 measurements by West Virginia University’s CARDIAC program. Thirty percent were obese. Eighteen percent of kindergartners arrived at school obese.

One in three adult West Virginians – 35.3 percent – were obese in 2011, according to Gallup Healthways.

“This is a public health emergency,” the wellness director of West Virginia Public Employees Insurance Agency said, in the series’ first story. But until recently, there has been little public conversation about it and little public awareness of the fact that obesity leads to diabetes, heart attacks, strokes, kidney disease, and many other sources of suffering.

We have kept the subject before the public. Between Feb. 12 and June 10, 2012, the Gazette published 36 stories and nine multimedia pieces in The Shape We’re In project. They can be found at www.theshapewerein.wordpress.com and www.wvgazette.com/theshapewerein. The multimedia pieces alone are at http://www.youtube.com/playlist?list=PL98E8D3919A5969FD&feature=plcp.

West Virginia is a small state. The Gazette is the state’s largest newspaper, read by most policymakers. We aimed to create and shape a statewide conversation about our epidemic. To that end, the newspaper gave almost every story prominent, front-page or section-front treatment and high-profile promotion. They gave me a wonderful editor, Dawn Miller. They supported the series editorially.

Obesity is not an easy subject to discuss. Five months after we began, we are frequently told that, as one person put it, “this series has given us all a way to talk about this.” A local pediatrician said, “I never go to a meeting anymore where people are not talking about something they read in this series.” It brought the subject out in the open, people say. Individual readers say the series sent them to their doctors. Some found they had diabetes. Others started exercising. Counselors and doctors tell us their patients come in talking about the series.

We have wanted the series to be a tool that can used to shape policy, so we have tried to set up ways for that to happen. For instance:

  • We partnered with the West Virginia University Extension Service to set up a new Web site called www.livewell.com that features The Shape We’re In.
  • We partnered with the West Virginia Association of Counties is co-sponsor a Healthy Counties conference in July that will feature “The Shape We’re In” series.
  • We alerted political bodies that copies are available. The state legislature is using the series as study materials, aimed toward 2013 legislation. The 2012 legislature set up a yearlong study group on obesity and chronic disease, “in part in response to your articles,” the chair of the state legislature’s joint Health and Human Resources Committee wrote.
  • More than a dozen organizations, such as the state chapter of the National Association of Social Workers, have routinely sent out the URLs of the Shape stories to their members.
  • The school system has put Shape stories and videos on their list of resources for teachers.
  • Academics have already used Shape stories in public health and nursing classes. We will send blanket e-mails to encourage others to do the same.
  • We recently created the state’s only listing of diabetes self-management services and are now sending it around to the medical community.
  • We plan a series of fall public meetings around goals illustrated by The Shape We’re In (e.g. daily physical activity in schools).

We have profiled “health heroes.” Each Shape package combined a range of information with profiles of down-to-earth West Virginia people without much money who found ways to beat obesity and diabetes without gyms, trainers, tracks or good grocery stories. 

By allowing their stories to be told, these people showed others how they did it and told them, in effect, “It’s possible. You can do it too.” Readers responded strongly and positively to stories about people such as:

We linked these West Virginia stories to solid national research with the help of the West Virginia Prevention Research Center. We provided readers with extensive links to research and resources. And we repeated certain basic facts over and over: Obesity leads to serious, deadly diseases. Diabetes alone costs West Virginians more than $1 billion a year, according to the American Diabetes Association. If your relatives had diabetes or heart disease, you can still prevent them. Physical activity and diet are key to prevention and control.

This project has been the biggest reporting challenge I have faced in 28 years. I reported and interviewed for six months before the first story appeared. I had to gather extensive information on several subjects at once, from breastfeeding to physical education to diabetes self-management classes. My brain felt like an overloaded buffet plate, with seven or eight meals piled on top of each other.

By the time we began publishing, I interviewed more than 50 state health leaders and national figures and read dozens of research studies. They provided the wider context for people’s stories.

Our first stories focused on children. Adults care what happens to kids, and West Virginia’s child statistics are shocking and little-known. We covered the push for more physical activity in the schools; the schools’ cook-from-scratch campaign; the history of obesity in West Virginia; the fact that the American Diabetes Association closed its West Virginia office; different aspects of diabetes; and diabetes self-management, among other subjects.

Before the end of the year, we plan to cover “programs that work,” “communities making a difference,” breastfeeding and “paying for prevention,” mixed with more people profiles.

Some advice for reporters who cover obesity:

  • Don’t think of obesity as a problem to be solved by the health system alone. Show what schools, community groups and all branches of government can do.
  • Sidestep the sensitivity around the subject of obesity by grounding your stories in medical risk, not appearance. Emphasize medical consequences of excess weight. Tell what people can do to avoid them.
  • Before you start writing, interview people who can tell you the history and backstory of each aspect of the problem. Record and transcribe the interviews if you can. They will be invaluable.
  • Don’t assume readers know obesity leads to diabetes, heart attacks, strokes and other disastrous diseases.
  • Look for ways to extend your project’s reach. Assemble an e-mail list of organizations that care about the subject, who will, for instance, send out a heads-up about your upcoming stories.
  • Give readers hope. Combine bad news with profiles of health heroes, ordinary people who took charge of their health, despite lack of health club, tracks, even grocery stores.
  • Choose subjects of varying ages who faced a serious problem, but found ways to overcome it.
  • Avoid the temptation to use jazzy synonyms for excess weight that call up repellant images: flab, fat, blubber, any of those. Even keep the word “obesity” to a minimum. If you can pair the word “obesity” with another medical symptom like “high blood pressure,” do it.
  • Take every opportunity to say – and show – that increased physical activity and better nutrition can prevent a wide range of diseases.
  • Become thoroughly familiar with the resources of the Centers for Disease Control, publications like the New England Journal of Medicine, and other resources listed at http://www.wvgazette.com/News/theshapewerein/201202110047.

I would be happy to talk with any reporter or editor.  Feel free to contact me at kate_long@hotmail.com or (304) 343-1884.