Body and spirit
West Virginia is among the top five on just about every national chronic disease list. The state leads the nation in diabetes and obesity, according to the Gallup Healthways poll.
Surveys show that many West Virginians do not realize obesity is a leading cause of many chronic diseases. Many also feel those diseases are hereditary, and there is nothing a person can do to prevent them.
The state's children raise major red flags for the future. West Virginia University screens thousands of schoolchildren every year. In 2010-11, they found that 24 percent of fifth-graders have high blood pressure, 26 percent have high cholesterol, and 29 percent are obese. Eighteen percent of kindergartners and 23 percent of second-graders are obese.
There has been little public discussion of this problem. "The Shape We're In" project aims to stir up that discussion. Written and photographed by Annenberg fellow Kate Long, it will be divided into three parts in The Charleston Gazette, the state's largest newspaper:
• Children at risk
• Programs that work
• Communities making a difference
Some segments will be accompanied by West Virginia Public Radio pieces.
Part 1: "This is a public health emergency"
Part 3: Putting the pieces together
Part 4: Health officials say W.Va. can reverse its chronic disease numbers
Part 5: W.Va. man: diabetes programs work
Part 7: Daily activity affordable, Department of Education says
Part 8: Wood researchers: Active kids do better academically
Part 9: Rocking the gym at 7:30 a.m.
Part 10: Nebraska school district lowers obesity rate
Part 12: 'Everyday heroes' saving own lives
Part 13: W.Va. ranks first in heart attack, diabetes, eight other categories
Part 15: Great Kanawha food fight
Part 17: W. Va. slammed with sugar
Part 18: Glenda and Jill vs. diabetes
Part 19: This is how bad diabetes can be
Part 20: Recognize diabetes before it's too late
Part 21: Logan hardest hit by diabetes
Part 22: Even if your relatives had diabetes, you don't have to
Part 23: Body and spirit
Part 24: American Diabetes Association is MIA in W.Va.
Part 25: Young people contending with diabetes
CHARLESTON, W.Va. -- Freida Smith lives up Campbell's Creek "on a road where it's so quiet at night, you can hear a bird sing half a mile away.
"Honey, I've got peace now, but I've been through the fire," she said last October. "I was a popaholic and a junk food junky and a battered wife and a heart attack about to happen, and God brought me through it all."
A lay minister at her Belle church, she preaches health. "People keep asking me how I lost all that weight, gone from size 2X to size 12, and I tell them, it's nothing but Jesus, Jesus and Cabin Creek Clinic."
"Eating has just taken over people's lives, and I want to tell people how dangerous that is to the body and the spirit," she said, raising her hands in the air. "The body and the spirit," she repeated.
She paused. "People are sick and tired of being sick and tired," she said. "They want to be delivered from food and diabetes. And I am here as proof that change is possible."
She waited a few seconds, then giggled. "I never thought I'd be this happy," she said.
Been through the fire
Thirty-six years ago, at age 27, Freida Smith left Logan County "with just a skirt and top and flip flops on my feet and two babies in my arms, running from a husband who was beating on me and my babies."
Within months, she got a job in Kanawha County caring for elderly people. For 31 years, she worked as an aide in nursing homes and rehab centers. "I loved the old people, but you have to do a lot of lifting and lugging. My knees wore out. That's when the pain started."
"For comfort, I ate. My husband brought home cases of pop. I was raised on biscuits and gravy, fried potatoes and beans, so that's what I cooked. We ate a lot of junk food. We didn't know a thing about nutrition."
She gained weight, then developed diabetes. She injured her back, lifting a heavy patient. Her weight aggravated the ruptured discs. "That big belly pulled on my spine," she said. "It was excruciating.
"I'm five feet, one, and I weighed over 200 pounds," she said. "My kids were ashamed of me. They didn't want their friends to see me. That right there killed me. I'd drive them to school, and they'd say, about a block away, 'Mom, will you drop me off up here?'
"I was so depressed, it got to where I had no control over my eating. I'd bring my chips and sit and watch television, eat the whole bag, then go get in the refrigerator even when I was full.
"I looked like I was eight months pregnant. I had to shower because I couldn't get in the bathtub. The low point was the day I couldn't go to church because I couldn't reach my feet to buckle my shoes."
Diabetes led to heart problems. She started having chest pains. After several emergency room visits, she learned she had blocked heart arteries. She had two catheterizations, but no insurance.
She was 61 years old. "I didn't know where I could go for care. I'd sit on the side of my bed at night and repeat Bible verses over and over, to calm myself down.
"Finally somebody told me about Cabin Creek Clinic."
'He listened to me'
A federally-funded health center, Cabin Creek Health Systems accepts patients whether they can pay or not. Freida Smith is one of their 14,000 patients. This clinic is nationally known for improving the health of rural patients with complex problems.
In 2010-11, for instance, caring for 400 disabled Medicaid patients, they cut in half the number of times those patients needed to go to emergency rooms and hospitals.
They practice "motivational interviewing:" They try to find what motivates the patient and use that to encourage them to do what they need to do to improve their health -- change their diet or exercise, for instance.
The first time Smith visited Cabin Creek, she saw physician assistant John Rice. "He was so kind," she said, her voice cracking. "I've been to doctors who don't look up from their computers when you talk to them, the kind who make you feel like you're nothing. John Rice looked right at me from the get-go.
"He listened to me. And he let me talk about Jesus without cutting me off.
"He told me my cholesterol was at stroke stage, heart attack stage. Before he handed me the paper with my cholesterol and blood pressure scores on it, he wrote PLEASE START ON A DIET on it and smiled at me so kindly and even gave me a little hug. He said, "It's time to learn to take care of yourself," and I went out of there thinking maybe something could be different."
John Rice sees 80 to 90 patients a week, for about 15 minutes apiece. That's not enough time to give any diabetic or heart patient the information and support they need. But Cabin Creek is a "medical home," meaning they practice medicine in a team. Rice's team includes a doctor, a nurse practitioner, a medical assistant, pharmacist and behavioral health counselor.
During Freida's first visit, he arranged for her to see a Cabin Creek counselor who could help her learn to manage her diabetes. Before she left the building, she had started learning what foods sent her blood sugar skyrocketing.
"I didn't realize what I was doing to my body till I went to Cabin Creek," she said. "For awhile, I couldn't make myself stop. I knew I needed God's help to quit eating. I said, 'If you don't touch me, God, I'm going to die.'"
She kept seeing Rice and the counselor and took the antidepressant pills Rice prescribed. From the medical point of view, she was in intensive care management. From her point of view, she was in spiritual crisis. They talked about it both ways, Rice said.
After a few months, "in June 2011, God finally removed that spirit of gluttony from me," she said. "I know a lot of people won't understand this, but I felt the spirit leaving me, the very second it left. That's what it took. After that, I could stop eating and start losing that weight."
Sharing credit with Jesus
Five months later, in October, she sat in the Cabin Creek lobby, 35 pounds lighter, waiting for a routine checkup with John Rice. "I am a transformed woman," she said, laughing. "I will tell anybody that asks that Jesus and Cabin Creek Clinic delivered me from food!"
She had started walking. "I used to huff and puff, just walking to the mailbox. Not now!" she said. "And I have completely rearranged the way I cook."
She easily reeled off solid advice about fish oil, vitamins, garlic, oatmeal for breakfast. "For your bowels and stuff, you need to eat roughage, shredded wheat, healthy stuff," she says. "Nuts are good for you, and blueberries are good for your eyes."
She learned a lot of that at Cabin Creek and on the Internet, she said. "Drink water, lots of it!" she said. "It washes away the fat. Put non-sugar flavors in it, so it's like pop."
She had dropped from size 2X dresses to size 16. "And still losing!" Her depression had lifted. She was no longer seeing the counselor.
"Dr. Rice is going to be proud of me today!" she said. She had not had any pop or a single potato chip for four months, she said. "Four months without pop! Whooo!"
"The visit after I'd lost 20 pounds, Dr. Rice came in the room, and he said, "Look at you, Freida! You look beautiful!" and I could barely speak. A doctor had told me I was beautiful!"
A big smile crossed her face. "Did you know there's spices and herbs all through the Bible? Cinnamon helps your immune system. I pour the cinnamon on my apples and oats in the morning."
Her name was called. She followed a nurse down the hall. By the time she saw John Rice, the nurse has checked her blood pressure and other vitals. She and Rice laughed and joked. As he checked her heart, she said she wasn't sleeping well. He told her about melatonin. "It's natural. Your body makes it," he said.
John Rice does not mind sharing credit with Jesus. "Freida and I share a belief in a working God," he said. But even if they did not, "The important point is, we listen to people, and we treat the whole person, not just their medical symptoms. We pay attention to whatever is going on in their lives," in terms of how it can either help them or stop them from getting better, he said.
On his laptop computer, he and Freida looked at her chart. "I'm off three of the four pills I used to take," she said. The graph of her blood sugar went steadily down.
"I see those people on TV talking about lap band surgery, and I want to tell them Jesus can help them lose that weight, and they don't need to cut themselves," she said.
Rice listened attentively. They agreed she would get a mammogram and try melatonin. She beamed as Rice walked her down the hall to the lab to get her blood drawn. He asked a nurse to sign her up for a mammogram, gave her a hug, then was off to the next patient. Before his day was over, he would see about 18 patients.
On her way out of the clinic, Freida signed out, then picked up her prescription at the clinic's low-cost pharmacy. She looked around and sighed. "God sent me to the right place, didn't he?" she said.
Epilogue: By May 1, Freida Smith has lost 61 pounds and dropped to a size 12. Her blood sugar, blood pressure and cholesterol are in normal range. She's clearing brush and planting a garden. She's been asked to preach on the spiritual dangers of overeating. "I have so much I want to tell people, that they can escape that food addiction, and they do not need to give up hope."