For a state whose name is synonymous with fried chicken, it's no wonder a recent study found that more than 1 out of 3 Kentucky's adults are obese.
In fact, Kentuckians' penchant for high fat and cholesterol-soaked diets and the rare exercise regimen have placed the Commonwealth with the seventh highest adult obesity rate in the nation, according to the 14th annual report from the Trust for America's Health (TFAH) and the Robert Wood Johnson Foundation (RWJF).
The study analyzed CDC data on body mass index, a measure of height and weight. People with a BMI of 25 to 29 are considered overweight; 30 and above is obese.
The report, released last month, revealed that Kentucky's adult obesity rate is currently 34.2 percent, up from 21.7 percent in 2000 and from 12.7 percent in 1990.
The state with the highest rates of obesity was West Virginia with 37.7 percent of adults, 17.9 percent of high schoolers, 18.5 percent of 10- to 17-year olds and 16.4 percent of two and four-year old who receive WIC.
West Virginia was followed closely by other southern and mid-western states, such as Mississippi, Alabama, Arkansas, Louisiana, Tennessee, Texas, Oklahoma and Indiana, rounding out the top ten states.
States with the lowest obesity rates included Colorado, District of Columbia, Massachusetts, Hawaii and California.
The State of Obesity: Better Policies for a Healthier America study revealed that your home might be a strong indicator for rates of obesity, heart disease, diabetes, hypertension and other health factors.
Those who reside in the 13-state Appalachian region were found to struggle more with obesity and other related health problems than their peers in other regions.
Carolyn Hacker, chief dietician and diabetes educator at Baptist Health Richmond, sees many of those Kentuckians each day at the hospital.
She acknowledged that culture has a role in the rate of obesity in the state.
"In Appalachia, we like to see everyone eating," Hacker said. "We encourage it and it's a habit to offer foods. Food is a central component of many activities and gatherings — even at meetings, we bring food. We are still doing that and it makes trying to eat a healthy diet very difficult."
The dietician also said many of her patients struggle with changing their eating and cooking habits after they have grown-up watching their grandparents and parents eat and prepare meals a certain way.
"We have so many people who are still using lard and we try to have them switch to canola oil or another plant-based fat. Educating people on the difference between animal fats and plant-based fats helps them make better choices, but old habits are certainly hard to break," Hacker said.
But if Kentuckians are to combat the rising rates of obesity, something must be done.
A separate study by the Robert Wood Johnson Foundation, the Appalachian Regional Commission and the Foundation for a Healthy Kentucky found those states fall behind the rest of the country in 33 of 41 public health indicators, including seven leading causes of death.
In the State of Obesity study, nine of the 11 states with the highest obesity rates are in the South, while sates in the Northeast and the West experienced lower obesity rates.
Other recent health studies have found the state lacking in areas of prevention and health spending, with one study placing Kentucky as the third-worst state in the nation for smoking-cessation spending — a habit often tied to obesity and diabetes.
Where you are isn't the only factor that might contribute to obesity, a person's level of education and annual salary may also help to expand waist sizes in Kentucky, data revealed.
According to the study, obesity rates were higher among adults without a college education or with annual incomes below $15,000.
Kentuckians climb to the seventh obese state might be tied to another study by WalletHub published in April, which ranked the state 46 in the nation as least-educated.
The study used data for a U.S. Census/American Consumer Survey form 2009-2013, the Community and Economic Development Initiative of Kentucky (CEDIK), which revealed while 83 percent of Kentuckians aged 25 or older hold a high school diploma, only 22 percent have a bachelors degree.
Lower education levels generally lead to lower average yearly income, a greater unemployment rate and less attractive benefit packages (like gym memberships) for employees.
In fact, those 25 and older with a high school diploma have a 7.4 percent rate of unemployment versus their peers who hold a bachelors degree at 2.7 percent, according to the Bureau of Labor Statistics.
Hacker noted that income may also factor into healthy eating choices as more rural areas are prone to have very little nutritious options.
"The healthy food choices are just not available," she said. "To have fresh produce costs more and that cost is certainly going to reduce some people's options of eating healthier."
More income and stable employment can help those struggling with obesity as adults with obesity incur about $2,700 more in average annual health care expenses than those who are not obese.
In fact, the State of Obesity study showed that, if the rate of obesity is not addressed in Kentucky, the rate of diabetes (394,029 reported cases in 2010) could explode to 594,058 cases in 2030 if it remains at its current pace.
Obesity costs the nation more than $150 billion in preventable health care costs and contributes to many different health problems, Trust for America's Health President and CEO John Auerbach noted during a conference call in August.
Data from the study also revealed that racial and ethnic disparities persist in Kentucky, with an obesity rate of 42.4 percent among black adults, 25.0 percent among Hispanic adults, and 33.4 percent among white adults.
Gender was less of a factor for obesity rate as 31.6 percent of Kentucky men were found to be obese, compared to 31.2 percent of women.
For high school students, the results are even more grim, as Kentucky is the third highest state with 18.5 percent of high school students who are obese, falling behind only Mississippi and Tennessee in 2015.
The obese rate for that age group is even affecting the military, as one in four young adults who tried to join the service were deemed ineligible due to fitness and weight concerns.
Younger children also have high rates of obesity in Kentucky, with the state ranked as the eighth highest in the nation of obese 10-to 17-year-olds based on data from 2011.
This could be tied to Kentucky's health policies in the school system as it is one of a handful of states who do not have policies requiring participation in physical education in school. Thirty-eight states and Washington, D.C., have policies which require elementary students to participate in physical education, 36 states require physical education in middle school, and 42 states plus D.C. have policies in place at the high school level.
Kentucky does have a screen time policy, along with 29 other states, that sets limits on early childhood education setting or have regulations regarding ECE centers to set limits.
While diets devoid of low fat and low calorie options is one factor, the lack of exercise also contributes to the rate of obesity in the state.
One-third of Kentuckians reported in 2015 that they hadn't had any physical activity or exercise in the 30 days before they were surveyed.
The study, published in the Journal of the American College of Cardiology, examined more than 9,000 people.
"A healthy diet is certainly the starting point for a healthy life, but exercise is also a vital component to that," Hacker said.
The dietician said exercise maximizes the benefits of healthy food choices.
"Those healthy food choices offer all those special nutrients and vitamins that we need to ward off sickness and disease and exercise boosts that effectiveness. Diet and exercise are the keys to fighting obesity and diabetes. You have to think of them together," she said.
Focusing on low calorie meals, rich in nutrients can assist in making exercise regimens easier to stick too and weigh-ins more successful, said Hacker.
She said many people try to continue to eat high calorie foods filled with fat and believe they can exercise enough to counteract the effects.
"When we are talking about calories and exercises, the food you eat matters. If you decide to eat a hamburger and fries loaded with cholesterol, (the makeup of ingredients) makes it almost impossible to burn that off," Hacker said. "Plus, you are missing out on all those beneficial nutrients of healthier food."
By trying to "exercise out" of healthy diets, Hacker said many people could become frustrated as they can never exercise enough to burn the amount of calories they need, causing them to quit trying altogether.
However, there may be a silver lining to the obesity problem in the country as the report found that rates are showing signs of leveling off.
This is the first time in 14 years of conducting the annual report that any state's rate dropped, and rates of increases in other state have begun to slow, Auerbach said.
The report noted that 25 states had obesity rates about 30 percent, in 2000, no state had a rate about 25 percent.
Reach Ricki Barker at 624-6611; follow her on Twitter @RickiBReports.