March is National Nutrition Month, a time to recognize how we can live and eat better to fight against obesity. Not only does obesity triple the risk of COVID-19 related hospitalization but also reduces quality of life.

The personal-finance website WalletHub has released a report on  2022’s Most Overweight and Obese Cities in the U.S. to call community attention to weight-related health problems where they are most prevalent in the United States. WalletHub compared 100 of the most populated U.S. metro areas across 19 key metrics. The data set ranges from the share of physically inactive adults and projected obesity rates by 2030 to healthy-food access.

Most Overweight & Obese Cities
1. McAllen, TX	11. Chattanooga, TN
2. Memphis, TN	12. Lafayette, LA
3. Knoxville, TN	13. Myrtle Beach, SC
4. Mobile, AL	14. Youngstown, OH
5. Jackson, MS	15. Huntsville, AL
6. Birmingham, AL	16. Winston-Salem, NC
7. Little Rock, AR	17. Wichita, KS
8. Shreveport, LA	18. Nashville, TN
9. Augusta, GA	19. New Orleans, LA
10. Baton Rouge, LA	20. Fayetteville, AR

U.S. Facts on Obesity

• McAllen, Texas, metro area has the highest share of obese adults, 44.90% , which is 2.4 times higher than in Asheville, North Carolina, the metro area with the lowest at 18.50%.
   
• The McAllen, Texas, metro area has the highest share of physically inactive adults, 36.90%, which is 2.7 times higher than in Grand Rapids, Michigan, the metro area with the lowest at 13.90%.
   
• El Paso, Texas, metro area has the highest share of diabetic adults, 16.00%, which is 2.6 times higher than in Reno, Nevada, the metro area with the lowest at 6.20%.
   
• Jackson, Mississippi, metro area has the highest share of adults with high blood pressure, 40.60%, which is 1.8 times higher than in San Jose, California, the metro area with the lowest at 22.80%.

Over 40 percent of American adults are obese due to the availability of fast-food and grocery items that have negatively altered our diets. In fact, the extra pounds have inflated the costs of obesity-related medical treatment to approximately $190.2 billion a year and annual productivity losses due to work absenteeism to around $4.3 billion.

Being obese is bad for a person’s health in general, but it’s especially dangerous during the COVID-19 pandemic, according to the CDC, as it increases the risk of serious symptoms and may even triple the risk of hospitalization.

Here are quicks tips to help you fight obesity:

What are some tips for eating healthy without breaking the bank?

Kathleen Davis

Ph.D., RDN, LD – Assistant Professor, Nutrition and Food Sciences – Texas Woman’s University

Eating healthy may feel impossible if you are on a budget, especially as the price of food has increased. But there are many healthy foods available that are relatively inexpensive:

• Dried beans and lentils, which are rich sources of protein, fiber, and folate.
• Canned tuna in water and store-brand peanut butter. They are affordable protein options. An alternative peanut butter option is sunflower seed spread.
• Whole chicken. You can use chicken for severals meals, including making broth.
• Whole grains, brown rice, oatmeal, and barley are fairly cheap and because the grains are whole (not processed), you get more fiber and phytochemicals.
• Fruits and vegetables in season such as Clementines, other oranges, and grapefruit. It is also a good season to buy pears, greens, and sweet potatoes. For products you want year-round, buy pre-packaged bags of potatoes, apples, or pears rather than assembling a bag yourself. Do not forget that frozen, canned, and dried fruits and vegetables also have good nutritional value. If you buy frozen vegetables without added salt and frozen fruits without added sugar, you get almost all of the nutrients of fresh produce but may pay less and the food will last longer. Remember to buy store brands to save money. Even canned produce comes in lower salt and lower sugar versions and has good nutrition value. For good sources of calcium and vitamin D, you can choose fluid milk or bulk yogurt over individually packaged items. Not only do they cost less, but they are more environmentally friendly.

William J. McCarthy

Adjunct Professor, Department of Health Policy and Management, Fielding School of Public Health – University of California, Los Angeles

To offset the increased low-grade inflammation associated with COVID-19 infection, people should choose foods that are anti-inflammatory, such as fatty fish (e.g., salmon), minimally processed fruits, vegetables and whole grains, and non-tropical nuts (e.g. walnuts, pecans), and seeds (e.g., flaxseed) rich in polyunsaturated fatty acids, especially omega-3 fatty acids.

Sherry Pagoto

Ph.D. – Professor in the Department of Allied Health Sciences; Director, UConn Center for mHealth & Social Media – University of Connecticut

Eat apples, carrots, kale, tofu, bell peppers, squash, lentils, oatmeal, barley, and sweet potatoes. Some of the healthiest foods are pretty inexpensive. If you are not sure how to cook with any of these foods, put the “food” word into a Pinterest search, and tons of delicious recipes will appear.

The biggest mistakes people make when trying to achieve and maintain a healthy lifestyle: they focus too much on what to eat and not enough on why they are eating the way they eat. Losing weight is largely about changing habits. This means most of the effort involves understanding the steps to create new habits which includes an understanding of how current unhealthy habits are formed and what makes them so hard to break.

Put attention towards habit-building strategies. If you are truly on the road to a healthier lifestyle you should be actively addressing why you eat the way you eat. If you do not know why, then getting the answer to this question is the work you have ahead of you.

Preventive services like lifestyle interventions should be accessible and free to all. Public schools should provide healthy lunches and many opportunities for physical activity throughout the day. Pushing back the start time for high schools could also have an impact on obesity now that we know how much adequate sleep affects body weight. Generally, we have too few obesity prevention policies, so we end up paying for that with high rates of chronic disease.

Casey Colin

DCN, RDN, LD/N, CNSC, ACSM-CPT, FAND – Assistant Professor, Department of Nutrition & Dietetics, Brooks College of Health – University of North Florida

Preparing more meals at home can be a great way to improve the nutrient content of meals while also saving money.

Explore creative ways to add vegetables to meals such as soups, casseroles, salads, and burrito bowls. Increasing vegetable content will increase the nutrient content and the number of servings from that meal. Canned, frozen, and fresh vegetables are all great options, so choose whichever makes the most sense for your budget and lifestyle.

Opt for more plant-centered meals, as animal proteins tend to be some of the most expensive parts of our grocery bill. Some examples of protein-rich plant foods are lentils, beans, nuts, seeds, nut butter, and peas. Canned fish such as salmon, tuna, and sardines are also nutrient-rich sources of protein and healthy fats.

The healthiest lifestyle is the one that incorporates sustainable changes and enjoyable. If we start an exercise routine we hate, we are unlikely to sustain it, much like most of us will not “give up sugar” forever. Find ways to merge healthy living with responsible indulgences for a more balanced approach.

Julie Garden-Robinson

Ph.D., R.D., L.R.D. – Professor and Food and Nutrition Specialist – North Dakota State University Extension

These are some strategies to help meet current recommendations and can save money as grocery prices rise.

• Stock up your cupboards and refrigerators with ingredients that you regularly use. Some people opt to choose convenience foods or foods that are ready to assemble at home. These can save time and may cost less than restaurant foods. However, they may cost more than home-prepared foods.
• Plan meals. Planning takes a little time but can have major cost-saving and nutritional benefits. For example, if you do not have a plan in place, you might be enticed to stop at the drive-through on the way home.
• Make a grocery list and be sure to organize it according to the store layout. Buy fresh fruits and vegetables in season and use canned and/or frozen during months they are not in season. Look for canned vegetables with less sodium and canned fruit packed in juice.
• Look up and down the store shelves at the store. The middle shelf often has higher-priced items.
• Consider store brands and generic brands. These may be less expensive than brand-name products.
• Use coupons to purchase food you were intending to buy. Many people enjoy cost-saving coupons, but coupons may entice you to buy items you do not normally eat.
• Take a mental note of the costs of groceries as you shop. Watch the scanning process to be sure the sale items show the correct price. Be sure to check your receipt after your purchase to be sure you received the sale price. For more information about healthful eating, see this and click on “Food Preparation” then “Cooking 101” or “Pinching Pennies in the Kitchen” for more details.

Some people think that skipping breakfast is a way to skip calories. However, researchers have shown that breakfast skippers more than make up for the calories they did not eat for breakfast. Eat breakfast every day, and include some protein and fiber, such as eggs and whole-grain toast or cereal.

Others may skip lunch and eat a large dinner. Be sure to maintain your energy throughout the day with regular meals and snacks. That will keep your energy levels high and help you avoid overeating later in the evenings.

Other people may think of “snacks” as bad, but snacks can help fill nutrition gaps. Keep healthful snacks, such as whole-grain popcorn and nuts, on hand for occasional snacks. Have apples, carrot sticks, and other veggies in containers or plastic bags in your refrigerator ready to grab.

Remember that 100 extra calories per day can add up to a 10-pound weight gain in a year.

Maintaining our nutritional status is very important. Consume your veggies and fruits, adequate protein, whole grains, dairy, or other calcium sources to keep your body nourished. Most adults need a total of at least 4 1/2 cups of fruits and vegetables daily. Fruits and vegetables are naturally rich in vitamins A and C, and a variety of natural disease-fighting antioxidants. Antioxidants include beta-carotene (in deep orange and gold vegetables), lutein in green leafy vegetables (such as kale and spinach), and lycopene (in tomatoes and watermelon).

Although the results are not conclusive, vitamin D status may have an impact on our body’s ability to fight viruses. Researchers have found vitamin D helps promote a healthy immune system, so be sure you are having milk and other vitamin D-fortified foods and beverages, and oily fish such as tuna and salmon. Consider a vitamin D supplement especially if you live in areas with a long winter season that prevents being outdoors. In sunny months, a short stroll outside in the summer sun also helps your body make vitamin D.

What policies should federal and/or state governments pursue to combat obesity and lower the cost of healthcare?

Combating the ongoing issues associated with childhood and adult obesity is complex but extremely important. Obesity rates have doubled since 1980, with one-third of U.S. adults considered obese. Obesity is associated with the development of type 2 diabetes, high blood pressure, heart disease, some types of cancer, joint issues, and other health issues. All of these potential outcomes of obesity carry great costs in healthcare and quality of life. Public health practitioners promote the implementation of policy, system, and environmental (PSE) changes to support healthy behavior among adults and youth.

Federal, state, and local regulations and policies can play a role in combating obesity. For example, nutrition labeling is required on most packaged or processed foods according to the Food and Drug Administration. The newest labels show calories in the largest font. Serving sizes and other nutrition recommendations were updated to be consistent with recent research; however, labels alone probably will not reduce obesity. Many restaurants currently provide nutrition information on menus. Education and promotional strategies that promote the understanding of nutritional information could help in combating obesity.

Other entities have promoted placing taxes on less-healthy foods such as sweetened beverages. The taxation practice has been used for cigarettes but requires more study on the application in foods.

In the effort to reduce childhood obesity, federally funded school foodservice programs and childcare food programs have been revamped through the years according to current nutrition standards. To promote physical activity, states and school districts can implement school policies related to physical education.

As another potential policy, private insurance companies could cover the costs of nutrition counseling. This counseling may help people get the education and support needed to make dietary changes that promote health.

Some communities are taking steps to create built environments that promote physical activity. When a community is more “walkable” and safety measures are in place on walking paths, the level of fitness of the residents may increase.

Policymakers must weigh the pros and cons of cost savings in one area vs. increased costs in other areas as they study changes in policies. Promoting change in the level of obesity among adults and children requires a multifaceted, ongoing approach.

According to the CDC, obesity worsens the outcomes from COVID-19. What measures can individuals take to prevent severe complications in the event they contract COVID-19?

Like most acute and chronic conditions, prevention is key. Maintaining regular physical activity and a nutrient-rich eating style can help to manage weight while also strengthening the immune system.

What policies should federal and/or state governments pursue to combat obesity and lower the cost of healthcare?

As a registered dietitian nutritionist, one of the biggest ways to combat obesity and reduce healthcare costs would be for federal and/or state governments to expand reimbursement of medical nutrition therapy services from a registered dietitian nutritionist for obesity and other chronic conditions. Increasing reimbursement can significantly impact the affordability and accessibility of nutrition care for those most in need, especially for communities of color. The Medical Nutrition Therapy Act was introduced to Congress in 2021 to expand coverage for medical nutrition therapy; more information can be found here.

We very little control over how our own bodies respond to COVID-19. You may be very healthy and have a response that is much worse than expected. You may not be very healthy and have a much easier time than expected. Because studies show that those with obesity and diabetes or pre-diabetes tend to be more likely to have worse outcomes, you can try to improve the quality of your lifestyle now. If you are not active, find ways to become more active, aiming for at least 30 minutes of moderate activity like walking most days of the week. If you eat lots of processed food, think of whether you could start cooking at home 2-3 days a week or if you might set a goal of eating 2 fruits and 3 vegetables every day. These small changes will not make you immune to COVID-19, but they will make you healthier and may help you stay healthier if you get COVID.

To read the full report and your city’s rank, please visit: 
https://wallethub.com/edu/fattest-cities-in-america/10532