Kansas fitness centers focus on providing exercise care to rural residents with Parkinson's disease

Kansas has the second-highest rate of 
Parkinson's disease cases in the U.S.

Among the nearly 1 million Americans living with Parkinson's disease, rural residents face more challenges accessing the exercise and support programs that could improve their quality of life.

In rural Kansas, some fitness centers have opened or expanded care to help area patients work out more regularly, according to Bek Shackelford of NPR. Regular exercise is one of the few proven ways Parkinson's disease sufferers can lessen the muscle stiffness, tremors, sleep problems and brain-health issues that often accompany the disease.

The Parkinson's Exercise and Wellness Center in Leawood, Kansas, which offers "gym services to around 280 people and offers classes ranging from Pilates and boxing to theater" serves as an example, Shackelford adds. The head coach and co-founder of the center, Sarrisa Curry, told Shackelford that the center's enrollment has been on the rise as more baby boomers are diagnosed with the disease.

Medical scientists are still unsure what causes Parkinson's disease to develop. Some studies indicate that the disease may have a genetic basis. Other research suggests that exposure to pesticides, such as those encountered in rural farming communities, could be partially to blame. Shackelford reports, "Recent data shows Kansas has some of the highest rates of Parkinson's diagnosis in the country." Only Nebraska has a higher rate.

Elaine Ptacek, who founded the Parkinson's Families of Northwest Kansas, a nonprofit that "offers things like physical therapy and art classes, says about 90% of her group's participants live on farms and are exposed to pesticides," Shackelford adds. "Ptacek's organization serves a rural area she says desperately needs Parkinson's support."

To reach as many patients as possible, Parkinson's Families of Northwest Kansas offers exercise classes to "groups in eight counties [who can] join Zoom calls and follow along with a fitness instructor," Shackelford adds.

Quick hits: He's not Santa, he's Belsnickel; 'phantom' towns; how music can reframe memories; going out for a walk

A local constabulary lends the town's Belsnickel
a hand. (Photo via Lancaster Farming)

Belsnickel may not be as famous as Santa (or as clean), but he gives Christmas gifts to children in Manheim, Pennsylvania. A Belsnickel is "a crotchety, fur-clad gift giver related to other companions of St. Nicholas in the folklore of southwestern Germany," reports Dan Sullivan of Lancaster Farming. A Belsnickel is tasked "to carry out duties somewhat similar to Santa, ferreting out the naughty and nice and dispensing just punishment or reward. Traditionally, Belsnickel carried a switch in one hand as corporal punishment for the bad kids and a pocketful of treats for the good ones."

When financial times are tight, not as many Americans buy new cars or repair the vehicles they have. "Pinched by inflation, higher interest rates, and supply-chain woes, Americans just haven’t been buying as many new vehicles lately," reports Spencer Jakob of The Wall Street Journal. U.S. consumers choosing to keep aging autos may sound "like great news for auto parts and repair companies. . . . [but] there are some surprising signs that Americans are choosing cheaper options or even deferring purchases of the goods and services that keep them running. . . . Skimping has rarely made less sense, though. . ."

Cartographic 'phantoms' are mapped towns where there isn't a town. (Illustration by Piper Olsen, L&S)

Most mapped towns exist but not all. "The Wisconsin state map is full of phantoms," reports Alli Watters of Letters & Science at the University of Wisconsin. Cartographer Howard Veregin spends his days scouting possible phantom towns, which includes exploring some of the state's most rural places. On one phantom sleuthing day, Veregin works to verify a mapped town called "Walker." He comes upon a friendly cranberry truck driver and this conversation ensues:

Truck driver: Good morning. Looking for something in particular?
Veregin: Well, I’m looking for cartographic phantoms.
Truck driver: What’s a cartographic phantom?
Veregin: It’s a community that is listed on a map, but it doesn’t exist on the ground.
Truck driver: This place exists.
Veregin: Sure, but it doesn’t really look like a community. What is it?
Truck driver: Well, this is our family cranberry farm. We’ve been farming cranberries here for 125 years. I’m a fifth-generation cranberry grower. Most of this area is private property. . .

"Veregin’s suspicions were confirmed. . . . He had found yet another cartographic phantom."

Beginning the new year a little wiser never hurts. In simplest terms, surviving 2025 is the first goal. Field & Stream experts "weighed in on four survival myths that could get you killed," reports Jim Baird. Many people think humans can live off nature's food and survive -- that's not true. "The myth here is that you can survive off them for an extended length of time. But the reality is if you are only eating 'survival foods,' you’ll start feeling sick and weak after a day or two." Another myth is if you kill large game "you're set" because you'll have all the protein you need. Not true, you can also get sick and die from eating too much protein without adequate fat. Read four debunked survival myths here.

Music may subtly shift emotional memories.
(Adobe Stock photo)

As a new year begins, people often reflect on how life has gone over the past year or years. Sometimes there are memories people wish they could change, and while history isn't alterable, music can help shift how people feel about past experiences. "Listening to music can change how you feel about what you remember – potentially offering new ways to help people cope with difficult memories, writes Yiren Ren, a cognitive brain science researcher at the Georgia Institute of Technology for The Conversation. "Our [research] results suggest that music acts as an emotional lure, becoming intertwined with memories and subtly altering their emotional tone. Memories may also be more flexible than previously thought and could be influenced by external auditory cues during recall."

Walking alone or with a buddy can be great exercise. 
(Adobe Stock photo)

Ernest Tubb twanged about "Walking the Floor over You." Johnny Cash confessed, "I Walk the Line." Aerosmith cranked the amps to "Walk this Way." Besides belting out catchy tracks, these musicians were onto something -- walking is an outstanding activity. "Walking can help meet the U.S. surgeon general’s recommendation that adults get at least 2 1/2 hours of moderate-intensity physical activity every week," reports Laura Ungar of The Associated Press. "This helps lower the risk of heart disease, high blood pressure, dementia, depression and many types of cancer. . . .While it’s not the only sort of exercise people should do, it’s a great first step toward a healthy life."

A first-of-its-kind in the South, 'Bike Tennessee' offers breathtaking views from the state's rural towns

'Bike Tennessee' offers stellar views of the state's rural towns and endless scenery.
(Tennessee Department of Tourist Development photo)

For bike enthusiasts craving more paths, climbs and views, Tennessee opened 52 "newly-curated" road cycling routes, dubbed "Bike Tennessee" for cycling enthusiasts of all ages and levels. The development is the "first of its kind in the South," reports Jacob Beckwith of The Tennessean. It aims to encourage more people to vacation in the volunteer state while "bringing cycling to rural communities. . . . The initiative is so new, it's only offered in one other state, Oregon."

Given the state's topography, Tennessee is a great place to ride a bike. The routes' developer, Shannon Burke, is a cycling tourist expert who chose off-the-beaten-path locations that were still safe. He told Beckwith, "The state has every type of mountain, and you can also ride in all seasons. . . . I would ask myself, ‘If I put this on a bike tour, would they get their money’s worth? The result is a mix of escaping civilization, while still making sure people are comfortable.”

Of course, there's an app for these routes. Tennessee "partnered with Ride with GPS, a navigation platform used daily by thousands of cyclists, for the program," Beckwith explains. "The state's 52 Bike Tennessee routes are accessible to users of the app and are all designed as a loop to simplify parking, while still varying distance and difficulty, officials explained."

Tennessee Department of Tourist Development Commissioner Mark Ezell points to Bike Tennessee as a way for the state to sustainably support smaller rural communities. He told Beckwith, "In 2022 alone, the state welcomed 141 million visitors, who spent a record $29 billion. A big part of that is the Great Smoky Mountains National Park, which is still the most visited national park in America. This initiative gives tourists just another reason to visit our beautiful state."

Many people track the number of steps they take each day, but can increasing the amount lead to weight loss?

Step counting is a good way to measure activity.
(Photo by Arek Adeoye, Unsplash)

Kennesaw State professor Bob Buresh and his team of researchers have been trying to determine if increasing the number of steps you take day can help with the obesity problem in the United States. A condensed version of their findings published in The Conversation is shared below.

"Over the last decade, smartphones have become ubiquitous not just for sending texts and staying abreast of news but also for monitoring daily activity levels. Among the most common, and arguably the most meaningful, tracking method for daily physical activity is step counting.  . . . Counting steps is far more than a fad. The Department of Health and Human Services dedicated a sizable portion of its most recent physical activity guidelines to documenting the relationship between daily step counts and several chronic diseases.

"Unfortunately, the guidelines have little to say about how step counts might be used to aid in weight management, an outcome of critical importance given the high rates of overweight and obesity in the U.S. In the early 1980s, fewer than 14% of adults in the U.S. were classified as having obesity. Today, just over 40 years later, the prevalence of obesity is greater than 40% in the adult population, and current trends suggest that almost half of adults in the U.S. will be obese by 2030.

"I am a professor of exercise science at Georgia's Kennesaw State University, and our lab has been conducting studies examining relationships among step counts and a number of health outcomes.
While the evidence is clear that increasing numbers of adults are living in a chronic energy surplus that leads to weight gain, a key question is – why? What has changed so dramatically since 1980 that could explain why obesity rates have tripled? Although the American diet is likely a key contributor, a wealth of research points to a reduction in physical activity as a major culprit behind the expanding waistlines – and step counts are an excellent indicator of physical activity.

"Step counts may – or may not – lead to weight loss: A number of recent studies have looked at whether increasing step counts can lead to weight loss over a certain period of time. One large-scale study called a meta-analysis concluded that increasing physical activity by way of step counts was effective for attaining modest weight loss. However, many, if not most, studies examining the effect of exercise on weight loss report modest outcomes, with results that are variable and often disappointing.

"When it comes to health, it is important to remember that body weight does not tell the whole story. In fact, body composition is much more predictive of health status than body weight. Someone who weighs more than another person may be in better health if they have more muscle mass and a lower percentage of body fat than the other person who weighs less but has a higher proportion of body fat.

"Parsing the numbers: We have used our data to develop a model that predicts average daily step counts per unit of fat mass from body fat percentage. We believe that this model can be used to determine how much people would need to walk to achieve a specific amount of weight and body fat reduction.

"A person's body fat percentage is every bit as important as their weight. That's because how much muscle you have affects how hungry you get, as well as how many calories you burn. Muscle mass requires energy to maintain, and this requirement leads to increased appetite, which means taking in more calories." 

The Conversation is a platform for journalism by academics.

The pandemic and the internet changed how rural seniors exercise; now their 'online classes are here to stay'

Virtual exercise classes offer options to rural or homebound seniors. (Photo by Christina Saint Louis/KHN)

To stay fit no matter where they live, older Americans have put remote fitness options more in play: "After widespread lockdowns began in March 2020, agencies serving seniors across the U.S. reworked health classes to include virtual options," Christina Saint Louis reports for Kaiser Health News. "Isolation has long since ended, but virtual classes remain. For older adults in rural communities who have difficulty getting to exercise facilities, those virtual classes offer opportunities for supervised physical activity that were rare before the pandemic. And advocates say online classes are here to stay."

Jennifer Tripken, associate director of the Center of Healthy Aging at the National Council on Aging, told Saint Louis, “We found that remote programming, particularly for rural areas, expanded the reach of programs, offering opportunities for those who have traditionally not participated in in-person programs to now have the ability to tune in, to leverage technology to participate and receive
the benefits.”

Saint Louis writes: "Since April 2020, the National Council on Aging has organized monthly conference calls for service providers to discuss how to improve virtual programs or begin offering them. . . . In 2022, at least 1,547 seniors participated in an online fitness program through Juniper, part of a Minnesota Area Agency on Aging initiative. More than half were from rural areas. Because of grant funding, participants pay little or nothing. . . . AgeOptions, an Illinois agency serving seniors, said last year that their operations 'may have changed forever' in favor of a hybrid model of virtual and in-person classes."

Options for technologically challenged seniors also exist. "A fall-prevention program licensed by Western Kentucky University combines exercise and health education with bingo — can use a printed copy of the game card mailed to them by AgeOptions if they lack the proficiency to play on the game’s app," writes Saint Louis. "Either way, they’re required to participate on video." Jason Crandell, the creator and international director of Bingocize, told Saint Louis, "From when the pandemic began to now, we’ve come light-years on how that is done, and everybody’s getting more comfortable with it."

Quick hits: E-bikes, 'old-time socialism', phases of the moon, your brain on music, a pain in the neck and more . . .

Electric bikes are awesome! Until . . .
(Illustration by Anna Haifisch, The New Yorker)

The wind whooshes through your hair,
As nature goes zooming past.
Until the fatal moment,
When your E-bike runs out of gas.

Iowa editor Art Cullen shows us how Americans might be able to get on a plane and actually arrive at their destination without becoming Cuba in his piece "Gimme some of that old-time socialism" in the Storm Lake Times Pilot.

Learn about the phases of the moon, and discover what a murmuration of starlings looks like as it flies over a waxing crescent moon at dusk.

Still working on 2023 resolutions? Oliver Burkeman, author of Four Thousand Weeks: Time Management for Mere Mortals, has some ideas. Here's his interview with Caroline Mimbs Nyce of The Atlantic.

Dumbledore's thoughts on music: “Ah, music," he said, wiping his eyes. "A magic beyond all we do here!” ― J.K. Rowling, Harry Potter and the Sorcerer's Stone. Learn more about your brain on music.

Khan, the rescued ocelot (Photo via Amazon video)

Returning a "most ridiculously cute" ocelot to its home in the Peruvian Amazon.

It's a pain in the neck. That describes a lot of things. This article addresses the actual pain.

Reading is the answer. Here are some New York Times picks.

February is around the bend. Don't get caught without a Groundhog Day celebration plan.

Are you monumentally busy, or just profoundly disorganized? (If that feels like a personal attack, read this.)

Snowshoes get more popular, and it's a good time for them

Snowshoes on the Falls in the River Trail in northern
New Hampshire. (Miles Howard for The Washington Post)

Looking for some calm and quiet at a turbulent time? It's also the snowiest time of the year, and that presents an opportunity: hiking with snowshoes, and it's becoming more popular.

"You can blast through the forest on a snowmobile, like Wile E. Coyote strapped to a rocket. Or you can strap on snowshoes and disappear into the silence of the frozen white woods, floating atop the powder," Miles Howard writes for The Washington Post from northern New Hampshire.

"Because of the pandemic, I’ve been tucked away indoors for too long, every muscle in my body is too tight, and, with hospitals overwhelmed with covid patients, I don’t feel like taking the physical risks of skiing or of scaling mountains with crampons. Snowshoeing is comparably low risk, beyond exposure to frigid weather, and the inherent social distancing of the sport seems to be speaking to Americans weathering the pandemic winter. Back in early spring, the market research firm Snow Sports Insights noted that snowshoeing participation grew by 12 percent."

Outdoor-equipment firm REI told Howard that its snowshoe sales have quadrupled in the past year. “We’re seeing increased enthusiasm in people embracing new outdoor activities (cycling, snowshoeing, running, hiking) and turning to the outdoors to find solace away from the pandemic,” REI’s senior public affairs manager Courtney Gearhart told him.

And it's cheap, Howard writes: "Other than a solid pair of snowshoes ($100 to $250) and a pair of trekking poles ($25 to $75) to stabilize yourself and avoid pitching over into a deep snowbank, there’s not much of an entry barrier to this sport — though first-timers looking to head deep into the outdoors should consider taking a basic introductory lesson on snowshoeing . . . Otherwise, you just pull on your warmest socks and snow boots, toss your snowshoes in the back of your car, and choose your own wintertime labyrinth to explore."

Rural doctor's weight-loss clinic sees big results with old-fashioned methods: eat better food, less of it, and exercise

Dr. Carol Peddicord holds a model representing five
pounds of body fat. (Clinton County News photo)

A doctor and a pharmacist in rural Albany, Kentucky are seeing big results in the fight against obesity after opening a weight-loss clinic. Since The Doctor's Health and Weight Loss Clinic opened in January, its 433 patients have lost a collective 4,079 pounds, and most have maintained their weight loss, Brett Gibson of the Clinton County News reports.

Dr. Carol Peddicord and pharmacist Arica Collins of Dyer Drug Co. came up with the idea for the clinic after seeing how many patients came in looking for a quick fix to lose weight. But the best way to do that is to live a healthier lifestyle, not through a pill or a crash diet, the News notes.

The emphasis is on healthier, Peddicord told the News: "We don’t want people to be skinnier, we want them to be healthy and live longer."

Obesity is a significantly bigger problem in rural areas than in suburban and urban areas, according to the Centers for Disease Control and Prevention. Among adults, 34.2% of rural residents are obese, compared with 28.7% in metropolitan counties.

Though the duo first conceived of the clinic because they were worried about children's health, most of their patients are women between 35 and 58. There are a few high schoolers, though, and they're starting to see more men coming in. That's good, Peddicord told the News, because men typically have heart disease earlier in life.

Albany, in Clinton County, Kentucky
(Wikipedia maps)

The clinic, which takes insurance, offers individually tailored wellness plans for patients, depending on whether they have high blood pressure, diabetes, and/or heart disease. They offer diet plans and will soon have plans for meal replacements such as shakes, the News reports.

Though Peddicord was glad to note that the clinic's patients had lost 680 pounds last month, she told the News that pounds aren't the only thing that matter. Patients have seen other "non-scale victories," such as being able to stop taking insulin for diabetes. "People are losing weight, feeling better and are able to exercise," Peddicord said.

Study shows rural residents are driving global rise in obesity

A newly published study found that rural residents are driving the global rise in obesity, contradicting previous research that linked obesity to sedentary urban dwellers, Doyle Rice reports for USA Today.

That's especially true in high-income and industrialized countries such as the United States, according to the study, which measured body-mass index averages in 200 countries from 1985 to 2017. "Researchers determined that BMI averages are rising for everyone," Rice reports. "However, they were rising more quickly for people who lived in rural areas."

The researchers wrote: "The lower urban BMI in high-income and industrialized countries reflects a growing rural economic and social disadvantage, including lower education and income; lower availability and higher price of healthy and fresh foods; less access to, and use of, public transport and walking than in cities; and limited availability of facilities for sports and recreational activity, which account for a significant share of overall physical activity in high-income and industrialized countries."

Rural Kentucky hiking club is changing local attitudes about health and the community

The Breathitt County Hiking Club in the nearby Red River Gorge. (Photo by Josh Mauser)

Central Appalachia is the unhealthiest place in the country by most metrics, but 45-year-old librarian Stephen Bowling is trying to help Breathitt County buck the trend with a hiking club. An avid hiker, Bowling has been hosting monthly hiking trips one Sunday a month since the beginning of the year, Lyndsey Gilpin reports for Outside Online. His employer, the Breathitt County Public Library, sponsors the club and serves as a meeting place for members that range in age from 14 to 74.

Bowling says the monthly trips usually attract about 20 people, most of whom don't have much experience hiking. But he believes that even something as small as a hiking club can affect not just attitudes about fitness, but about the long-suffering community's ability to improve. “It’s a depressed area economically, but also emotionally and physiologically,” Bowling told Gilpin. “We’re told constantly that we’re the least healthy people, we are this, we are that, and people don’t feel empowered to change that. Some people aren’t willing, and some people aren’t able.”

Breathitt County, Kentucky
(Wikipedia map)

Appalachia is a prime example of the wellness divide between rural and urban America. Eight of the top 10 counties in the U.S. with the largest recent declines in life expectancy are in Kentucky, and one of them is Breathitt. About 14,000 people live in the county, most are white, and most are over 40. "Nearly half the population is obese, about a third smoke, and a third are physically inactive. The unemployment rate is almost 12 percent," Gilpin reports.

Most outdoor adventure spaces are under private control in rural areas, leaving people with far fewer options for outdoor recreation than residents of urban areas. "Most Southeastern states have less than 5 percent federal public land. In Kentucky, less than 4 percent of land is federally owned, and there are only a few state parks, most of them a half-day’s drive from Breathitt," Gilpin reports. "Only 17 percent of Breathitt County residents live within a half-mile of a park or within three miles of an accessible recreational facility; meanwhile, 98 percent of New York county [Manhattan] residents and 100 percent of San Francisco county residents have such access to a park within a half-mile or a recreational facility within just one mile."

Private landowners rarely create trails, and those that are created are mostly for all-terrain vehicles and aren't used by hikers and bikers, Gilpin reports. The area's walking trails are not often safe and well-marked, and local gyms are usually small with limited hours. Most exercise buffs instead rely on using local high schools' running tracks.

The rural South is studying how states like North Carolina and Colorado have boosted outdoor recreation to figure out how to make public lands accessible and profitable. "In July, legislation will go into effect to create the Kentucky Mountain Regional Recreation Authority, a group run by community members from around the state that will develop, maintain, monitor, and promote local trails," Gilpin reports. Republican State Rep. Chris Fugate introduced the bill, and says he wants to connect 17 counties through a walking trail system. "“Some of the most beautiful places are hidden away,” Fugate told Gilpin. “We haven’t done a good enough job of promoting and taking care of ourselves here.”

Life expectancy rates are lower, and are even declining, in some poor, rural counties

Life expectancy varies widely among U.S. counties, and has been decreasing in a few of them, says a study by researchers from the University of Washington and Erasmus University Medical Center in the Netherlands. The study, which used county-level data from 1980 to 2014, found that "life expectancy at birth for both sexes combined was 79.1, but differed by 20.1 years between the counties with the lowest and highest life expectancy." (Study map: Change in life expectancy, by county, from 1980 to 2014; click on image for larger version)

The lowest life expectancy was in counties in South and North Dakota with Native American reservations, the Mississippi Delta and Central Appalachia, researchers said. The highest life expectancies were in counties in central Colorado. Eight of the top 10 counties with the lowest life expectancy are in Kentucky. The other two counties are in Oklahoma and Alabama.

A knot of eight Eastern Kentucky counties had the greatest decline in life expectancy in the United States from 1980 to 2014. In other words, babies born in those counties today are expected, on average, to live shorter lives than their parents, based on recent death certificates. That was true in only five other counties: two in Alabama and one each in Oklahoma, Mississippi and Tennessee.
(Interactive U.S. Health Map by University of Wisconsin Institute for Health Metrics and Evaluation shows that death rates in Breathitt County, Kentucky, are well above the national average. The interactive map can be viewed here.)

Researchers said "people are less likely to live longer if they are poor, get little exercise and lack access to health care," Joel Achenbach reports for The Washington Post. Researchers "said the quality and availability of that health care—for example, access to screening for signs of cancer—has a significant effect on health outcomes."

Annual County Health Rankings are released; can be a great starting point for local coverage

Alabama counties ranked by health factors

The University of Wisconsin's Population Health Institute has released its annual County Health Rankings. Funded by the Robert Wood Johnson Foundation, the rankings are a good resource for assessing a county's overall health status and for comparing counties within the same state. Counties are ranked within each state based on quality of life, length of life, health factors, clinical care, social and economic factors and physical environment.

This year's rankings found that rural counties by far had the highest rates of premature deaths, continuing if not accelerating a recent trend. Nearly one-fifth of rural counties have experienced worsening premature death rates over the past decade, while nearly all large urban areas have seen declines. One reason for the higher rates in rural areas could be an increase in drug use. Drug-overdose deaths have increased 79 percent overall since 2002, but are highest in rural counties, especially Appalachia, the study found.

Rural areas generally rank poorly in adult obesity, adult smoking, teen births, uninsured, preventable hospital stays, childhood poverty, injury deaths and college education. Favorable rankings for rural areas included the lowest amount of violent crime and shortest commutes to work.

Some places have seen big declines in their health status. For example, Luzerne County, Pennsylvania (Wikipedia map), an Appalachian coal community, dropped over the past year from 26th to 40th in health behaviors and from 20th to 34th in physical environment. (The state has 67 counties.) One key may have been physical inactivity, with 28 percent of adults reporting living inactive lifestyles, the sixth worst total in the state, Mark Guydish reports for the Times Leader in Wilkes-Barre.

Dr. Tina George, a local family practice doctor who thinks the county's poverty and excessive drinking levels were under-reported for the rankings, "said part of the problem is simply the physical environment of municipalities built before urban design was a thing," Guydish writes. She told him, “We don’t have cities like they do out west, where communities were planned and laid out to be walkable, to have places for exercise, to have food markets. We didn’t have the advantages of making a community that promotes a healthy lifestyle."

In Iowa, rural Black Hawk County was ranked 85th of 99 counties in health, its lowest spot since the rankings were started in 2010, Christina Crippes reports for The Courier in Cedar Valley. The county ranked low for obesity, lack of physical activity, high rate of sexually transmitted diseases and a rise in violent crime.

Michigan county trying to shed label as state's least healthiest with county-wide health effort

Muskegon County, Michigan
(Wikipedia map)

Muskegon County, Michigan, named the state's least healthiest county in 2011, "is trying something quietly radical: turning the small cluster of towns in the county into a multifaceted support network to help people make healthy changes that stick—like losing weight and keeping it off," David Freedman reports for Politico.

The county "has struggled with job loss, large pockets of poverty, and the raft of health challenges that afflict a disproportionate number of American towns far from the coasts," Freedman writes. "Some of the biggest of these health challenges largely boil down to obesity—a problem that vexes the entire nation and has become particularly acute throughout the Midwest and South, especially in less affluent communities that, like Muskegon, are far from big cities."

"It’s one of a handful of similarly fitness-resistant communities across the U.S. in which a new approach is slowly taking hold," Freedman writes. "With roots in evidence-based medicine rather than diet fads, it's an approach that focuses help where it's needed, is driven by a broad coalition of community members and looks to gradually grind out solutions by seeking tiny victories that can be aggregated and amplified."

"The goal is to form a web of interventions that successfully nudge, tempt, bribe and even scare people into sticking with new, healthier habits," Freedman writes. "The approach offers hope of accomplishing at the community scale what policymakers despair of getting done at the scale of an entire nation. These unflashy, slow-but-sure efforts are in their early stages and have received little attention in the press. But they are being carefully watched and nurtured by some influential national players."

Health of the States project ranks each state on wide range of health outcomes, interactively

The Health of the States study by the Center on Society and Health at Virginia Commonwealth University and the Urban Institute takes a detailed look at the health of each state. The project, which will include eight reports examining each state, ranks states "on 39 health outcomes and correlations between those health outcomes and 123 determinants of health spanning five domains: health care, health behaviors, social and economic factors, the physical and social environment, and public policies and spending." Stateline map ranks each state by mortality rate, from light (good) to dark (poor); other measures are available. Click here for the interactive version.

The report, whose authors say examines more measures than any previous state comparison, "finds a strong correlation between lower spending on public transportation and higher instances of car accidents, and between adult obesity and deaths related to pneumonia," Michael Ollove reports for Stateline. "It also links a shortage of primary care services to higher rates of deaths related to diabetes, heart disease, stroke and pneumonia and to lower life expectancy." It doesn’t offer explanations for the correlations between the 123 factors.

Reports and other interactive maps in the coming months will focus on life expectancy and mortality; birth outcomes; child and adolescent health; sexually transmitted infections; injury fatalities; adult health status; obesity, diabetes and cardiovascular conditions; cancer, lower respiratory disease, influenza and pneumonia, and Alzheimer’s disease.

Older Americans happiest in Hawaii, Ariz., least happiest in W.Va., Ky. says Gallup well-being index

Older Americans are happiest in Hawaii and least happy in West Virginia, says the annual index of well being by The Gallup Organization. Following Hawaii, other states with high well-being scores for people 55 and older were Arizona, New Hampshire, North Dakota and Colorado. At the other end of the spectrum, Kentucky was next to West Virginia, with Oklahoma, Ohio and Indiana nearby.

The data come from 115,000 interviews are are based on five categories: Purpose (liking what you do each day and being motivated to achieve your goals); Social (having supportive relationships and love in your life); Financial (managing your economic life to reduce stress and increase security); Community (liking where you live, feeling safe and having pride in your community); and Physical (having good health and enough energy to get things done daily).

Hawaii was No. 1 for Purpose, Community and Physical; Arizona was tops for Social, and North Dakota led for Financial. West Virginia was last for Purpose, Social and Physical. Mississippi had the lowest score for Financial and New Jersey was lowest in Community.

"There is one cluster of states with high rankings in a section of the Midwest, but for the most part, the high- and low-ranking states are evenly distributed," Tara Bahrampour reports for The Washington Post. Dan Witters, research director for index, told her, “The 55-and-over crowd in those top states … report always making time for regular trips and vacations with family and friends, reaching their goals in the last 12 months, using their strengths and aptitudes as a human being, in other words, doing things that are a natural right fit for them." (Post graphic showing states colored by quintiles, or fifths of 50)

About half of U.S. adults are fatter than they think they are, say Gallup poll and CDC study

One of the biggest problems with the obesity epidemic could be that many Americans think they're not as overweight as they really are, Art Swift reports for The Gallup Organization. An annual Gallup poll conducted earlier this month of 1,019 adults in all 50 states found that 37 percent of adults feel they are somewhat overweight or very overweight, matching the average trend from polls since 2010. Those numbers are down from 41 percent from 2000-2009 and 44 percent from 1990-99.

Centers for Disease Control and Prevention data shows that 56 percent of Americans in 1990 were considered obese or overweight and 48 percent of Gallup poll respondents that year agreed, Christopher Ingraham reports for The Washington Post. Today, 70.4 percent of Americans are obese or overweight, nearly twice as many as said so on the most recent Gallup poll.

Also, the ideal weight and actual weight are on the rise, Ingraham writes. The average weight for men has risen from 180 in 1990 to 194 today, with the ideal weight increasing from 171 to 182. For women, the actual weight has increased from 142 to 158 and the ideal weight from 129 to 140. (Post graphic: Percent of overweight adults vs. those who say they are overweight)

Yale University physician and sociologist Nicholas Christakis, who specializes in biological behavior, told Ingraham, "As a person's social contacts gain weight, it seems to change the person’s idea about what an acceptable body size is. This may result in the person him/herself gaining weight, or, even if it does not, it makes the person more accepting of other people’s weight gain."

Twenty-five states have adult obesity rates over 30 percent, according to the 2016 State of Obesity report. Nine of the 11 most obese states are in the South, and 22 of the top 25 are in the South and Midwest. Louisiana has the highest obesity rate, 36.2 percent. Obesity rates are above 20 percent in every state; in 1991, no state had a rate above 20 percent.

A county's poor health status was, in fact, a strong predictor of its vote for Donald Trump

The Rural Blog reported anecdotal evidence a week after the presidential election of a correlation between counties that swung big to Donald Trump and those with poor health status. The Economist magazine used a weighted index of obesity, diabetes, heavy drinking, exercise and life expectancy as calculated by the Institute for Health Metrics and Evaluation at the University of Wisconsin, and found a statistical correlation with the difference in Trump's vote and the vote for Mitt Romney in 2012.

"Together, these variables explain 43 percent of Mr. Trump’s gains over Mr. Romney, just edging out the 41 percent accounted for by the share of non-college whites" in a county, which has been widely cited as the best statistical predictor of a swing to Trump. "The two categories significantly overlap: counties with a large proportion of whites without a degree also tend to fare poorly when it comes to public health. However, even after controlling for race, education, age, sex, income, marital status, immigration and employment, these figures remain highly statistically significant. Holding all other factors constant—including the share of non-college whites—the better physical shape a county’s residents are in, the worse Mr. Trump did relative to Mr. Romney."

The correlation is indicated by the slope of a scatterplot of counties on a graph with health status as the X axis (across the bottom) and change in Republican margin from 2012 as the Y axis. The county dots were scaled by size and colored by region. The colors showed that the Midwest made the big difference for Trump.

The chart on the Economist website is interactive, with data for each county. Here's a screenshot with the cursor on Pike County, Kentucky, in the heart of the Central Appalachian coalfield:

Counties that swung Republican by more than 30 percentage points, and had a health index below 30 on a 0-100 scale, with their swing and index, were: Adams County, Wisconsin (30.4, 27.2); Grundy County, Tennessee (34.7, 27.3); Washington County, Missouri (36.2, 29.4). Near-misses were Shoshone County, Idaho (29.2, 30.0); Starke County, Indiana (31.4, 30.6); Juneau County, Wisconsin (33.3, 30.6); and Arenac County, Michigan (28.4, 30.3).

Obesity rates beginning to decline, but are still too high: a national report to localize

Some states are finally beginning to see obesity rates decline, according to the State of Obesity report by the Trust for America’s Health and the Robert Wood Johnson Foundation. "This year’s results show that after a decade in which every state’s obese population rose, a few states have finally experienced a decrease," Trudy Lieberman writes for Rural Health News Service. Only two states, Kansas and Kentucky, saw increases. Most states remained steady, while Minnesota, Montana, New York and Ohio saw declines.

"Although rates have dropped in Montana, Minnesota, New York, and Ohio, even those decreased rates are still high," Lieberman writes. "Twenty-six percent of adults in Minnesota were still considered obese, and nearly 30 percent were in Ohio. Even in the states with the lowest rates—Colorado, California, Utah, Montana, Hawaii and Massachusetts—rates remain between 20 and 25 percent." In 1980, no state has a rate above 15 percent, and in 1990, none was above 20 percent, Lieberman notes.

"Many societal changes have conspired to increase obesity rates," said Richard Hamburg, interim president of Trust for America's Health. "Children have less opportunity for physical activities; parents are no longer comfortable sending their kids out to play and telling them to come home by dark." He also credited a rise in obesity with sedentary lifestyles—blamed largely on video games replacing physical activities—a lack of physical education in schools and more kids going to school via bus or car, instead of walking or biking.

Another reason is eating habits, Leiberman writes. Families eat out more often, consuming higher rates of sugar and fat. Also food deserts make it hard for some people, especially in rural areas, to eat healthy, and powerful marketing campaigns from food companies plays a part, especially advertisements that target children.

In North Carolina, the adult obesity rate has remained at about 30 percent for seven years, Richard Craver reports for the Winston Salem-Journal, in a good example of localizing the report. North Carolina, which is tied for 22nd for most obese state, is taking some efforts to try to educate about obesity, Craver writes. Kate Murphy, a senior communications officer with the state Department of Health and Human Services, credits the state's Eat Smart, Move More North Carolina movement with helping the state move up eight places in the 2016 edition of America’s Health Rankings for activity among adults. The movement is part of a seven-year DHHS plan (from 2013 to 2020) to address and reduce the number of obese adults and children.

Also, Novant Health Inc., which has 15 medical centers and 1,380 physicians in 530 locations in North Carolina, Virginia, South Carolina and Georgia, has a "Remarkable You" initiative that focuses on the implications of obesity, pre-diabetes and high blood pressure.

Small, rural county works to improve its children's health and thus change local health culture

Public officials and local leaders in a small, rural county in Southern Kentucky that ranks near the bottom of the state's County Health Rankings have formed a coalition to improve the health of its community, with a focus on its children.

Clinton County (Wikipedia map) ranked 102nd out of 120 Kentucky counties in the 2016 County Health Rankings. “We recognize that, we saw that in our kids,” Lora Brewington, chief compliance officer of Cumberland Family Medical Center Inc., told Kentucky Educational Television in a special about the coalition.“And if we don’t change something now, we’re going to be going to the funeral home for kids a lot younger.”

So, with the help of the Foundation for a Healthy Kentucky they formed the Clinton County Healthy Hometown Coalition to implement a multi-faceted public health program for the community's citizens, that focuses on its children. The coalition recognized that most of the county's health issues stemmed from obesity.

"So we feel like if we can start young and start with our children and teach them healthy habits and healthy lifestyles that when they grow up they won't be faced with obesity and all of those chronic diseases that go with it," Paula Little, assistant superintendent of the Clinton County School District said.

Many of the coalition’s activities are school-based. Teachers have incorporated physical activity into the school day as well as during their morning routines and after-school day care programs; schools have improved their menus to include fruits and vegetables with every meal; schools now offer supper to its students during the school year; and the community now offers breakfast and lunch to low-income children in the summer on a retrofitted school bus called the Bus Stop Café.

The Healthy Hometown Coalition also implemented school-based health clinics, which provides a full range of healthcare services for children while they are at school. The clinics also provide body mass index (BMI) assessments and provide nutrition and obesity counseling.

In addition, Clinton County schools implemented a comprehensive smoke-free policy that will go into effect July 2016.

A full-time coordinator, April Speck, manages the various coalition programs and writes a weekly health column in the local news paper. The coalition sponsors community events, and has built a new playground.

“What makes me feel good about it is that I know there’s a real need here,” Speck said.“There’s a lot of kids who have childhood obesity... And just seeing them start to make changes in what they are doing, how much they are eating, their water intake, I know that we’re making an improvement.”

Rural areas may need collaboration to create places for residents to get exercise

"Many rural mothers, who rely on outdoor activities to promote health and well-being for themselves and their families, face obstacles in accessing publicly available outdoor recreation resources." So says a study at the University of Illinois, Carleen Wild reports for HealthZette, an online publication.

Research professor Ramona Oswald told Wild, “The moms in this study know about health and what to do to be healthy. It’s not a lack of education. It has to do with barriers and access to resources. Especially in rural communities, you struggle with distance between people and resources. . . . You could walk down a county road or a highway, but unless there was community investment in a park or a playground, a walking trail, or some kind of a facility at a local school, moms didn’t have access to nature, even though they were surrounded by it.”

Many rural residents are like Heidi Baltezore, who lives in a rural area about 30 miles north of Sioux Falls, S.D. She told Wild, “My biggest struggle is finding ‘safe’ places to run or walk. I can go up and down my driveway, but I get bored with that,” and “The road that runs by my house has no shoulder — in fact, years ago my neighbor was biking and was hit and killed, so there is a worry about distracted drivers, plus normal driving hazards. The hills and the setting or rising sun also make it not an option unless I’m absolutely desperate to run on the road. And for sure, it’s never an option with the little ones or our pets.”

In Marshall, Minn., the city, a neighboring town, the county and the state parks and transportation agencies collaborated to "create an extensive bike trail system, a new ice arena, gym access to local health care providers, and more," Wild reports. Doug Goodmund, the city's assistant community services director, told her, "It's really getting used — from pedestrians, to moms with strollers, to bicyclers, young and old. It's a win-win all around and we're just getting started."