Logan hardest hit by diabetes

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 USC Annenberg California Endowment Health Journalism Fellow Kate Long, the multi-part series is running 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 2: A growing problem

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 6: "Get kids moving"

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 11: What happened?

Part 12: 'Everyday heroes' saving own lives

Part 13: W.Va. ranks first in heart attack, diabetes, eight other categories

Part 14: Success from scratch

Part 15: Great Kanawha food fight

Part 16: Better focus

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

LOGAN, W.Va. --  Once a week, Anise Nash drives to Logan County, home of Gov. Earl Ray Tomblin, Landau Eugene Murphy, Jr., and at least 6,000 diabetics.

At Chapmanville's Coalfield Health Center, she meets with one diabetic after another. Grandmas, young mothers and coal miners spill out questions about foods, symptoms, medicines, and the high cost of blood-test strips.

"I have never been anywhere where I've seen people so hungry for information about diabetes or so receptive to information," Nash said. "These are very genuine people, and they just soak up any information you give them."

One in six of Logan County's 36,700 residents is a diabetic, according to the Centers for Disease Control. "And there are many more who don't know they have it," she said.

"So many people say they're afraid they'll go blind or have heart attacks or maybe go into kidney failure," she said. "I tell them they can keep it from happening or slow it down. I can't tell you the number of times people have said, 'Nobody ever told me that.'

"Almost everyone in Logan County knows of somebody who has lost a leg or gone blind," she said. "People say things like, 'My mom lost her leg to it, so I guess I will too.' That really gets to me, because type 2 is so preventable."

Despite the need, Logan County has no public classes to help people learn how they can avoid the disease or control it. "We have the highest rate of diabetes in the nation, but no diabetes education at all, as far as I know," said Patricia Mullins, staff nurse at the Logan County Health Department.

In 2010, ABC News said Logan County had the highest diabetes rate of any county in the nation. Logan County's rate is now nearly 18 percent, according to CDC, more than double the 2010 national rate of 8.3.

Yet Logan Countians must drive to another county if they want a class. "Lots can't afford the gas or don't have a car," said Dana Wright, WVU Extension agent. "They need help here, where they live."

Nash is a certified diabetes educator. She works for Marshall University, part sponsor of the Coalfield Center. "A prevention campaign could make a huge difference here," she said.

A high number of Logan County children have symptoms of future diabetes. By the latest West Virginia University screening measurements:

  • Thirty-eight percent of Logan fifth-graders have high blood pressure, compared with 24 percent statewide.
  • Forty-five percent - almost half  - are obese, the highest percentage in the state. The statewide average is an already-alarming 28 percent.

"I wish we had some classes around here"

Logan resident Missy Rein is one of the county's 6,000 diabetics. Her twin sister is diabetic, and so is her mother. "It's all through our family," she said. "I don't want my kids getting it."

She tries to keep her kids active, she said. "I've read that physical activity helps keep them from getting diabetes," she said.

Friday night, Rein's son Joshua played left field for the Logan County High School Wildcats baseball team. Missy and four-year-old Zachary Rein were in the stands. Zach, baseball glove in hand, pitched and caught imaginary balls the entire game. "Zach just started T-ball," his mother said. "He's crazy about baseball."

She wants to learn a lot more about ways diabetics react to different foods, how to cook healthy meals and "all the things you have questions about."

WVU Extension is going to offer a diabetic cooking class in the fall. "But there's lots of questions I have besides cooking," she said.

She has tried to learn as much as she can from the Internet and other sources, but "I wish we had some kind of diabetes classes around here people could go to," she said. "There's lots of people I know would come."

So what can Logan County do?

Two years ago, neighboring Mingo County formed a diabetes coalition of doctors, pharmacists, school people, churches, and WVU extension agents. Working together, they got a five-year grant this year for $50,000 a year through Marshall University.

They plan to create more classes, expand their community walking program, work in the schools, and target isolated areas of the county for public awareness.

"People in Logan want a coalition too," WVU's Wright said. She and Nash have started meeting with a small Logan group to try to make that happen.

"We don't know exactly how we're going to do it yet, but we know we've got to pool our efforts if we want to get anywhere," said Shannon Meade, Family Resource Network coordinator.

"There's a lot of energy for this," Wright said. "People see the impact diabetes is having on their health and the health of people they love, and they're saying, 'You know what? We don't want to be this terrible statistic. We are good people, and we can reverse this if we work together."

At their first meeting in January, at the United Mine Workers headquarters, ideas flew around the table. Classes and a public awareness top the list. Billboards cost money, but maybe a billboard company would donate space.

Radio and TV and a Website might be doable. "Maybe Southern [Community and Technical College] could help," Wright said. Maybe the local cable TV station would run ads as a public service. "We could plaster the county with fliers that say 'Did you know you can prevent diabetes?' " somebody said.

They talked about walking groups that compete or challenges to see which group can lose the most weight. Maybe the newspaper would run stories about local people beating diabetes. Maybe they could get the schools and the nursing students at Southern involved.

Anise Nash said she would mentor local young people who want to become Logan County diabetes educators. "I'd want to find people who grew up here and plan to stay," she said.

"Once you start talking together, you realize there are lots of possibilities," Meade said.

Since January, more people have come to meetings, including representatives of the hospital, health department, Logan Chamber of Commerce, the Chapmanville town council, the Recreation Center. A local radio host has started doing interviews with Logan Countians about their struggle with diabetes.

They have started testing people's blood pressure and blood sugar free at public events. Soon, they will meet with Marshall's Richard Crespo, who helped the Mingo coalition get organized.

Crespo has helped more than 60 counties in nine Appalachian states organize diabetes coalitions. "We can help guide Logan through the organization process and tell them what other counties have done, but they've got do the community organizing themselves," he told the Gazette.

Coalitions offer a wide range of activities, he said. Besides the things the Logan coalition mentioned, they have built walking trails, offered free weight-loss groups or yoga, and summer camps for kids at risk. In a few states, local coalitions have joined forces into a statewide coalition.

The Logan group plans to apply for Logan Healthcare Foundation funding next fall, Meade said. Crespo's program has a $2.6 million grant from Bristol Myers Squibb Foundation to help launch coalitions in ten more counties. Mingo County got one of their first grants. Next fall, they will award $50,000 a year to five more counties. "Logan could certainly apply," he said. 

Crespo's staff can also train local people to lead the evidence-based, four-week Diabetes Self-Management class. That training is free, since the state funds the group to offer it. After local people are trained, Crespo said, "they can offer the course to the public."

The class follows a prescribed curriculum, he said. People who take it learn how diabetes works in the body, how medication works, and what various foods do to the body. They plan specific ways to weave physical activity into the realities of their day and adjust what they eat. The course has been taught in churches, senior centers, volunteer fire departments, and community health centers.

"But everyone won't come to a class," Crespo said. "A coalition can attack diabetes from many directions."

"This is something that's needed to happen in Logan County for a long time," Meade said. "It's starting to feel like we've got a chance to make this into something."

"As soon as they get some classes going, I'll sign up," Missy Rein said.