Inside America's most and least obese counties

Inequality in this country, which should be a bipartisan issue, takes many forms. There is inequality of gender, age, education, and of course, along racial and ethnic backgrounds.

Increasingly, though, I’ve been considering another form that inequality takes, that being geography. More and more it seems we are divided by where we live in our country. This is not entirely new, of course. And there are all kinds of neighborhoods and settings that belie this trend. However, the notion that a marketer can tell your life expectancy by your ZIP code has never been more true. (H/t to better data science, as well.)

Americans’ health and wellness, where we live, and the impact of that on our society is what I will focus on today. Before going there, (as my former colleague Katie Couric might say), I want to point out that this is very much a business matter. Moody’s has warned about inequality and its potential impact on the country's credit rating: “Income and wealth inequality in the U.S. is high relative to other highly rated countries and rising, which could have a negative impact on the U.S.' sovereign credit profile.”

That got your attention, businesspeople?

In his book “Fulfillment: Winning and Losing in One-Click America," author Alec MacGillis examines geographical imbalances and Amazon's (AMZN) impact on communities across the U.S.

During the 100 years prior to 1980, MacGillis writes, “poorer parts of the country had been catching up with richer ones. In 1980, virtually every area of the country had mean incomes that were within 10% of the national average ... But by 2013, virtually the entire Northeast Corridor from Boston to Washington and the Northern California coast had incomes more than 20% above average. Most startlingly; a huge swath of the country’s interior had incomes more than 20% below average—not only the rural South and Southwest but much of the Midwest and Great Plains as well.

“As this regional inequality grew, so did the consequences. Regional inequality was making parts of the country incomprehensible to one another—one world racked with painkillers, the other tainted by elite college admissions schemes. It was making it difficult to settle on nationwide programs that could apply across such wildly disparate contexts—in one set of places, the housing crisis was about blight and abandonment, while in the other, it was about affordability and gentrification.”

Ryan Enos, a professor of government at Harvard University, concurs with MacGillis' assessment. Enos' research has revealed that Democrats and Republicans tend to live apart from each other all the way down to the neighborhood level.

“One thing we know very well in research on segregation more generally, it diminishes things like trust across groups, and it changes the way we think about other people, and our ability to cooperate with them,” Enos says. “It changes our ability to do the type of things that make a democratic society function.”

I thought about all this recently when a couple of 24/7 Wall Street listicles came my way, the 50 most and 50 least obese counties in America. Wow. I haven’t gone through the methodology (here) with a fine tooth comb, but it looks solid and directionally at the very least, it makes a ton of sense.

Health issues in general look to be rife in the most obese counties with the opposite being the case, relatively speaking, in the least obese. Yes, geography comes into play here. With the most obese counties, the article notes: “The majority of counties on this list are located in the South, including 14 counties in Mississippi and six in Alabama.” As for the least obese, that article notes: “The majority of counties on this list are located in the West, including 15 counties in Colorado and 10 in California.”

Then there’s politics. The four states listed above split neatly between two red states, Mississippi and Alabama (most obese), and two blue states, Colorado and California (least obese). However, I should tell you these divides are not as absolute or as pat as you might think.

'I lived in a place called Okfuskee'

Let’s take a look at the 10 most obese counties in the U.S., (and again, please look here if you want to peruse the whole list). Seven out of 10 in the deep South, although the No. 1 is in Oklahoma. (I’ve put up details for the No. 1 county and a few noteworthy points for other counties, as well.)

1. Okfuskee County, Oklahoma, which has an adult obesity rate of 58.9%. The percentage of adults who don’t exercise is 42.4%, or 15th highest of 3,106 counties. Adults with diabetes is 15.3%, or 622nd. And adults reporting poor or fair health is 28.4%, 182nd highest.

2. Sunflower County, Mississippi, (24.6% adults have diabetes)

3. Candler County, Georgia

4. Humphreys County, Mississippi

5. Ziebach County, South Dakota

6. Aleutians East Borough, Alaska

7. Jefferson County, Mississippi (37.9% adults have poor or fair health)

8. Macon County, Alabama

9. Sabine Parish, Louisiana

10. Holmes County, Mississippi

I want to take a deeper look at No. 1 on the list, Okfuskee County, but before I do, some more politics. Turns out that six out of 10 of these counties voted for Joe Biden in the last election; Sunflower County, Mississippi; Humphreys County, Mississippi; Ziebach County, South Dakota; Jefferson County, Mississippi; Macon County, Alabama; and Holmes County, Mississippi. These are all blue counties in red states, and all have majority African-American populations, except for Ziebach County, which is 75% Native American. (NB, according to Wikipedia: “Ziebach County has traditionally been a swing county. Only Ronald Reagan in 1980 and Barack Obama in 2008 have topped 60% for either major party in the past six decades.”) As I said, when you drill down, the picture is more complex.

Now back to Okfuskee County, Oklahoma, pronounced (oak-FUSS-kee), population 12,000 people (down slightly over the past decade), county seat, Okemah. First, I want to be clear about a few things. I’ve never been to Okfuskee, but I've read there's a folk music festival there and some other cool stuff, too. I’m sure many happy people live awesome lives there. Having said that, there are indeed some difficult things about this county.

Here are some quick facts from the Census Bureau’s Quick Facts on Okfuskee 2019: Median household income is $39,265 versus $69,560 for the U.S. that year. Some 24.5% of families live below the poverty line, versus 10.5% overall in the U.S. Life expectancy is 69.6 years versus 77.3 in the greater U.S. And 11.6% of Okfuskee’s citizens have a college degree versus 37% for the U.S. overall.

On the other hand, the unemployment rate is only 3.3%, and the average family dwelling costs $81,000.

The county—which is 63% white, 7% Black, 22% Native American, 4% Latin, and 7% mixed—went overwhelmingly for Donald Trump (by a 53.5 percentage-point margin), and hasn’t gone Democrat since Bill Clinton in 1996.

That’s some quantitative stuff. Here is some of the qualitative. When Europeans came to the land in present day Okfuskee County, it was occupied by the Quapaw and the Osage Indian tribes. The Creek, who had African slaves, came later. After the Civil War, some of those freed slaves reportedly stayed in the county. The county had a minor oil boom back in the 1930s and the population briefly swelled to nearly 30,000.

The most famous person to come from Okfuskee is probably folk singer Woody Guthrie who refers to Okfuskee in one of his lost lyrics, "Way Over Yonder In the Minor Key." The lyrics were set to music by Billy Bragg and Wilco for their 1998 collaboration, "Mermaid Avenue." (It's a great song, actually.)

“I lived in a place called Okfuskee

And I had a little girl in a holler tree

I said, "little girl, it's plain to see

Ain't nobody that can sing like me

Ain't nobody that can sing like me"

Guthrie is inconclusively linked to perhaps Okfuskee’s most heinous chapter. In 1911, Laura and L. D. Nelson, an African-American mother and son, were lynched after being arrested for shooting and killing Okemah's deputy sheriff during a search of the Nelsons' farm for a stolen cow. The folksinger’s father, Charley Guthrie, a real-estate agent, district court clerk and Democratic politician, was reportedly among the group of 40 or so white men who removed the mother and son from jail and hanged them from a bridge over the North Canadian River. Woody Guthrie wrote a number of songs and lyrics that speak to this crime and perhaps seem to try to atone for his father’s alleged sins.

But let’s get back to present-day Okfuskee County and others on this list. Why do they have such health deficiencies? Not an easy question to answer.

“Researchers found that a variety of ZIP code level, census level, city level, and neighborhood level characteristics are associated with obesity, both child and adult, including for example how neighborhood food environment impacts behavior,” says Ruopeng An, an associate professor at Washington University St. Louis Brown School. “Researchers have found if people live closer to the supermarket, they have a better chance of getting healthy options that prevent them from becoming obese. Some others find being close to a variety of convenience stores, fast food, contribute to calorie intake and an increase in the obesity rate.

“We also know that those risk factors are not really something new, not specific to obesity,” An says. “Take a look at prevalence of type two diabetes, cardiovascular disease, cancer—they all have the same geographical pattern. Across ZIP codes, life expectancy changes by up to 20 years. We know all those risk factors: the environment, pollution level, all the factors within these lower income, lower resource neighborhoods so the huge disparity in terms of the environment in general. Lower income is also associated with poor health attitudes, health knowledge, education and health behavior.”

The least obese counties tend to vote for Democrats

Now let’s shift away from Okfuskee and the obese counties and turn to the counties that are least obese—and what different places they are—starting in Wyoming. (NB: I put Okfuskee’s numbers in parentheses here for comparison purposes.)

1. Teton County, Wyoming which has an adult obesity rate of 11.0% (58.9%). The percentage of adults who don’t exercise is 10.8% (42.4%), or 5th lowest of 3,106 counties. Adults with diabetes is 2.4% (15.3%), the lowest of 3,106 counties. And adults reporting poor or fair health: 11.4% (28.4%), 36th lowest.

2. Taliaferro County, Georgia

3. Gunnison County, Colorado, (adults with diabetes: 3.1%)

4. Boulder County, Colorado

5. Summit County, Utah

6. Pitkin County, Colorado, (adults reporting poor or fair health: 9.8%)

7. Summit County, Colorado, (adults who don’t exercise: 10.2%)

8. Mariposa County, California

9. New York County, New York

10. Routt County, Colorado

Some broad brush political points: Eight of the 10 counties are in blue states—the exceptions are one each in Wyoming and Utah, though those counties went for the Democrat in the last presidential election. In fact nine of these least obese counties voted for Biden. Only Mariposa County, (home to part of Yosemite National Park), in blue California, went for Trump.

The counties in Colorado and Utah are homes of high-end ski resorts such as Crested Butte, Aspen, Park City, Steamboat Springs, and Breckinridge, where the healthy and wealthy have flocked in recent years. In Boulder County, rated as the nation’s most physically active in another 24/7 Wall Street story, 91.1% of adults exercise, the highest of 3,106 American counties.

Taliaferro County, Georgia is an outlier. Maybe it has something to do with its tiny population of 1,600, “the second-least populous county east of the Mississippi River (after Issaquena County, Mississippi)” according to Wikipedia.

As I did with Okfuskee at the top of the obese list, I want to focus on Teton County, Wyoming, which leads the least obese list and in many ways is the flip-side of Okfuskee. According to a Bloomberg story from 2019: “Teton had the highest average incomes per capita of any county in the United States, at $252,000. This was partly attributed to the high incomes of Jackson Hole residents, where property owners include Bill Gates.” That’s 6.6 times the average income in Okfuskee. And you can forget about net worth. For instance, Zillow shows the cost of an average home in Teton County is $1,126,215 about 14 times more than Okfuskee. Life expectancy in Teton is 87.5, and only some 7.1% of families live below the poverty line. The county is 94% white and went overwhelmingly to Joe Biden (67% of the votes), and has gone for the Democrat in seven out of the past eight presidential elections.

Qualitatively, you may know that Teton is paradisiacal, containing both Grand Teton, and a big chunk of Yellowstone National, Parks. Teton County has its own checkered history though, including the fact that it had a reputation as “a haven for outlaws and vigilantes, including a horse thief known as Teton Jackson.” More significant was treatment of local Indian tribes and their hunting rights, resulting in a legal case, the implications of which were argued before the Supreme Court as recently as two years ago.

Meanwhile, county seat Jackson has morphed from a sleepy, old-school western town to a home for the jet-set, replete with swanky pilates studios, french bakeries, and fancy bicycle shoppes. Politically, the county is an island of blue in the most red state in the nation. Is there unhappiness and crime in Teton County? For sure. (Even beyond the Gabby Petito story.) And as for finding reasonably-priced housing, that’s next to impossible. Overall,Teton County must be a great place to live. If you can afford it.

Taking a step back when you look at these counties, you have all these factors; race, sex, age, health, and geography all overlapping, some seemingly correlated, some not. That point speaks to “intersectionality” which means that specific factors of a person's existence can’t only be looked at separately, but should be considered in unison. So a Native American woman with poor health living in poverty in South Dakota is shaped by all those things together, and can’t be understood in terms of any one of those characteristics independently. Instead a view of her must include the interactions between those factors, which reinforce each other. Some of this thinking comes from the work of UCLA and Columbia University law professor, Kimberlé Williams Crenshaw, an early proponent of critical race theory who coined the term intersectionality.

Bottom line: The causality here is complicated, and there’s much to figure out. “To the extent that everyone has different interpretations of what even are the problems, we’re going to have a hard time coming to a consensus on the solution,” says Sarah Gollust, professor at the University of Minnesota School of Public Health. “That’s as true in public health as it is around other social problems or electoral or democratic norms.”

I thought again about those lists, the most and least obese counties. About how I’ve been to six of the 10 least obese. About how I’d recently vacationed in the least, (Teton), went to college for a semester in another (Boulder) and lived for the past 37 years in another (New York.) And then how I’ve never even stepped foot in any of the most obese ones, and that I really know nothing about them. And yet here I am writing about them.

And here you are reading this, written by a guy with my perspective and experience. And I wonder how many of you live in, or have even been in those most obese counties. (Maybe a few of you.) I also wonder how many of you have ever heard anything from anyone in one of those counties. Except maybe “This Land is Your Land” by Woody Guthrie.

And finally, I’m thinking our country really does have some pretty big divides to overcome.

This article was featured in a Saturday edition of the Morning Brief on October 9, 2021. Get the Morning Brief sent directly to your inbox every Monday to Friday by 6:30 a.m. ET. Subscribe

Andy Serwer is editor-in-chief of Yahoo Finance. Follow him on Twitter: @serwer

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