As a portly woman plodded ahead of him on the sidewalk, the obese mayor of America's fattest and unhealthiest city explained why health is not a big local issue.
“It doesn't come up,” said David Felinton, 5-foot-9 and 233 pounds, as he walked toward City Hall one recent morning. “We've got a lot of economic challenges here in Huntington. That's usually the focus.”
Huntington's economy has withered, its poverty rate is worse than the national average, and vagrants haunt a downtown riverfront park. But the city's financial woes are not nearly as bad as its health.
Nearly half the adults in Huntington's five-county metropolitan area are obese – an astounding percentage, far bigger than the national average in a country with a well-known weight problem.
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Huntington leads in a half-dozen other illness measures, too, including heart disease and diabetes. It's even tops in the percentage of elderly people who have lost all their teeth (half of them have).
It's a sad situation, and a potential harbinger of what will happen to other U.S. communities, said Ken Thorpe, an Emory University health policy professor who is working with West Virginia officials on health reform legislation.
“They may be at the very top, but obesity and diabetes trends are very similar” in many other communities, particularly in the South, Thorpe said.
The Huntington area's health problems, cited in a U.S. health report, are a terrible distinction, but the locals barely talk about it.
Culture and history are at least part of the problem, health officials say.
This city on the Ohio River is surrounded by Appalachia's thinly populated hills. It has long been a blue-collar, white-skinned community – overwhelmingly people of English, Irish and German ancestry.
For decades, Huntington thrived with the coal mines to its south, as barges, trucks and trains loaded continually chugged into and past the city. There were plenty of manufacturing jobs in the chemical industry and in glassworks, steel and locomotive parts. Nearly 90,000 people lived in Huntington in 1950.
The traditional diet was heavy with fried foods, salt, gravy, sauces, and fattier meats – dense with calories burnt off through manual labor. Obesity was not a worry then. Workplace injuries were.
But as the coal industry modernized and the economy changed, manufacturing jobs left. The population is now less than 50,000, and chronic diseases – many of them connected to obesity – seem much more common.
Shari Wiley is a nurse at St. Mary's Regional Heart Institute in Huntington. She runs a program that identifies heavy school children and tries to teach them better eating and exercise habits.
“A lot of the patients we were seeing were getting heart attacks in their 30s. They were requiring open heart surgery in their 30s. And we were concerned because it used to be you wouldn't see heart patients come in until they were in their 50s,” Wiley said.
The numbers come from a report on about 150 metropolitan areas by the U.S. Centers for Disease Control and Prevention, based on 2006 data. It was released in August but little-publicized. (Carolinas information wasn't available.)
The Huntington area is essentially tied with a few other metro areas for proportion of people who don't exercise (31 percent), have heart disease (22 percent) and diabetes (13 percent). The smoking rate is pretty high, but not the worst. No other metro area comes close to Huntington's adult obesity rate.
In Huntington and its outskirts, many people think of exercise and healthy eating as luxuries.
Doughnut shops don't help either, of course. But breakfast pastry shops aren't the most common outlets for fatty food. Pizza joints are. They are seemingly on every block in some parts of the city.
Hot dog places also abound, with the city hosting an annual hot dog festival every summer. “I've never seen so many places that are hot dog oriented. I guess it's a cultural thing. Appalachian,” said Mayor Felinton.
Lack of exercise is another concern. The exercise that does occur is mostly confined to a local YMCA, at campus recreation facilities at Marshall University, or at Ritter Park south of downtown.
Some attribute the problem to crumbling sidewalks in the city and a lack of walkways along busy rural roads. Others blame it on lack of motivation, as well as a cultural attitude that never included exercise for health.
Local politicians tend to share the prevailing apathy about improving health, said Dr. Harry Tweel, director of the Cabell-Huntington Health Department.
“People here have an attitude of ‘You're not going to tell me what I can eat.' The cultural attitude is ‘My parents ate that and my grandparents ate that,“' he said.