Tackling obesity

Two communities in southeastern Virginia, one in a rural part of the Eastern Shore, and another in an urban section of Hampton Roads, are trying to make environmental changes to improve the health of residents. Both have health indicators the compare poorly with the rest of the state. Both communities also recently received grants from the Centers for Disease Control and Prevention to make changes to the environment to help citizens improve their health. This story is a look at some of the obstacles to be overcome, and some of the ideas brewing to make changes.

Danny Vestal didn't worry so much about the health of the people inside the YMCA where he works on the Eastern Shore. Most had already made the decision to move more and eat less.

It was the people zipping by in their cars on the way to fast-food restaurants up and down the highway outside who sparked his concern.

A look at the statistics confirmed his hunch that health was not a priority for everyone on this rural strip of land that runs along the Chesapeake Bay.

Seventy-two percent of the adults were overweight, compared with 62 percent across the state. More than half were physically inactive. Rates of diabetes and high blood pressure were higher than state norms.

That's why Vestal, executive director of the Eastern Shore Family YMCA in Onley, applied for a federal grant to improve his community's health.

"I wanted to reach outside the walls of the YMCA," he said.

Meanwhile, 80 miles away in a community that's as urban as the Eastern Shore is rural, Amy Paulson and a group of Portsmouth leaders had the same concerns. Paulson is the director of the Consortium for Infant and Child Health at Eastern Virginia Medical School, which is a health coalition.

In Portsmouth, 61 percent of adults were overweight. Rates of death from cancer and heart disease were higher, and the overall life expectancy shorter, than in Virginia as a whole.

The health statistics made each community ripe for change, and in February, Portsmouth and the Eastern Shore became two of about 100 localities across the country to snag a federal ACHIEVE grant funded by the Centers for Disease Control and Prevention. The acronym stands for Action Communities for Health, Innovation, and EnVironmental changE.

Portsmouth received $75,000 and the Eastern Shore $50,000 to make policy and environmental changes to promote health in places that touch people's daily lives: schools, workplaces, parks, neighborhoods, faith communities, grocery stores, community centers.

Since then, Paulson and Vestal have pulled together coalitions that include church pastors, health advocates, city leaders, parks and recreation officials, school officials and health advocates to come up with a plan of action for the next two years.

Both communities have high rates of minorities and poverty. Lots of convenience stores and fast-food joints, but fewer full-service grocery stores and places to get healthy food. One is a community where crime can keep people from exercising outdoors, the other a place with towns strung out across such long distances that it's hard to reach a fitness facility.

Each community faces the same challenge during the next two years: Get people to move more, eat better and pay closer attention to their health.

On the Eastern Shore

Vestal joined forces with Patti Kiger, an instructor in the Department of Pediatrics at EVMS.

Kiger lives in Norfolk but owns a house with her husband and others on the Eastern Shore. She loves the natural beauty there and the lush agricultural land but also was familiar with the area's health statistics: "I couldn't come and enjoy the beauty without knowing there was a ticking time bomb underneath."

They put together a board that included county administrators, superintendents of the school divisions, ministers, educators and outreach workers.

An early enthusiast was the Rev. Gary Miller, an Eastern Shore native who leads St. John's United Methodist Church in the town of Atlantic. Over the years, it had bothered Miller that so many children on the Eastern Shore lacked safe places to play.

When St. John's built a new church in the 1990s, it included a gym where children and adults can play basketball, volleyball and other sports. The church also hosts health screenings in the gym.

Outside, church members have measured distances in the church's parking lot for walking clubs.

Those are the kind of environmental changes the coalition would like to see other faith-based groups make.

Although it's an agricultural area, access to fresh fruits and vegetables is limited in some places. The coalition hopes to talk with restaurants about incorporating more locally grown produce into their menus, "so french fries are not the default vegetable," Kiger said.

At Miller's church, they're going to start including a healthy option when there's a potluck or church social that involves food.

"That's what I could do and still live here," Miller said with a laugh.

In the spring, the coalition will launch a fitness challenge in which participants will get weigh-ins and health assessments and be eligible for prizes such as iPods by pledging to do a certain amount of exercise.

The challenge will include online resources where people can find places to exercise such as church parking lots and school running tracks.

"We want people from Cape Charles to Chincoteague to come out," Vestal said. "We want to help people be successful."

In Portsmouth

One of the early watchwords of the Portsmouth effort is "walkability."

A lack of safe places for people to walk surfaced when a group of city leaders and health advocates came together to figure out how to use the ACHIEVE grant.

Paulson said the coalition took a bus tour of the city after the grant was awarded and had community forums where people brought snapshots of their neighborhoods.

"One of the major reasons people do not walk places is because it's either too hard or too dangerous," Paulson said.

The photographs, discussion and bus tour pointed out barriers:

Too much traffic. Sidewalks that disappear partway to a destination. Pavements overgrown with grass and routes through places that felt unsafe because of crime and poor lighting.

Training helped coalition members look for the so-called "goat trails," paths that people walked along so much that grass had stopped growing. That's an indication of a place that could use a sidewalk.

Coalition members came up with the idea to create "destination-oriented walkways." They're going to identify routes, work with police to ensure safety there, make sure there are adequate crosswalks, and fill the gaps in sidewalks to make them reach a desired end point. They will put up signs listing destinations and distances, and post maps on line.

The coalition secured a grant from the Virginia Foundation for Healthy Youth to help pay for sidewalk improvements.

"People are more likely to walk if there's a reason to, and particularly if it's easier to walk than to drive," Paulson said.

The "Portsmouth Walks" project will begin in Port Norfolk, where coalition member Keisha Cutler has already teamed up with civic league members to begin a survey of sidewalks.

The coalition also is working with organizations to suggest healthy meeting practices. For instance, meetings that include walking around the agency or faith-based facility for small-group discussion.

"Healthy Portsmouth" promotional messages, such as taking stairs instead of the elevator, also will be posted in a variety of places to remind people to make the healthy choice.

"It's the 'drop in a bucket' theory," Paulson said. "If you make one change, it wouldn't make that much of a difference. But if you make lots of changes in lots of places, soon the bucket will overflow."

Elizabeth Simpson, (757) 446-2635, elizabeth.simpson@pilotonline.com