An initiative of the Robert Wood Johnson Foundation

Cultivating Healthy Communities in Appalachia

West Virginia


May 16th, 2019


The Appalachian Region stretches across more than 200,000 miles of the United States—from the Appalachian Mountains in southern New York, through the Blue Ridge Mountains of Virginia, down to the Great Smoky Mountains of Tennessee and North Carolina, and ending in Mississippi—comprising 13 states total and more than 25 million people. While the Region has evolved immensely over the last decade, it continues to fight many of the same battles as other parts of the country and some even more so, including economic distress and poverty, and high mortality rates.

Obesity and obesity-related chronic illnesses are significantly higher in Appalachian counties than in non-Appalachian counties (31% versus 27.1%). And obesity-related chronic conditions such as cardiovascular disease, stroke, and diabetes are far more common in the Appalachian Region than in the rest of the country. Moreover, about a third of the counties known as “the diabetes belt” fall within Central and Southern Appalachia.

That means that if you’re living in Appalachia, you’re more likely to die from obesity-related chronic conditions than if you live elsewhere. And that’s why researchers at the Appalachian Regional Commission (ARC), with funding from the Robert Wood Johnson Foundation (RWJF) and support from the Foundation for a Healthy Kentucky, came together to develop a health research initiative called Creating a Culture of Health in Appalachia: Disparities and Bright Spots with the goal of understanding and addressing health in the Region, and identifying factors that support a culture of health in Appalachian communities.

We asked Kostas Skordas, Director of Research and Evaluation at ARC, to tell us about the findings from an April 2019 report: Health Disparities Related to Obesity in Appalachia: Practical Strategies and Recommendations for Communities.


Why is obesity such a problem in the Appalachian Region?

Kostas Skordas

There are lots of complex factors that contribute to communities dealing with obesity and obesity-related diseases—including environmental factors that impact the type of food that’s accessible, marketing practices by the food industry, and whether the built environment supports physical activity. For example, we found that people in Appalachia are less likely to be physically active. Across the Region, 28.4% reported not being physically active, compared to 22.6% of those living outside of Appalachia. More specifically, physical inactivity was highest among residents of Central Appalachia (33.8%), those living in the rural counties of Appalachia (31.8%), and among economically distressed counties in the Region (33.9%).

But it is also important to note that the national obesity epidemic of the past two decades has shown signs of stabilization, as increased understanding and visibility of the issue has led communities across the country to develop and adopt multiple strategies aimed at reversing the trend.


What are some strategies for improving the state of obesity in Appalachia?

Kostas Skordas

One of the most important things we can do is to start young to support healthy eating and living habits in early childhood. One way is to ensure that daycares, preschools and other early education settings help children establish healthy behaviors. These settings are uniquely positioned to influence children’s nutrition, physical activity, and screen time habits, since they see them at a critical time in their development. This includes offering a variety of fresh, healthy fruits and vegetables, limiting consumption of sugary drinks, and making sure kids have opportunities to be physically active.

And of course, on the community level, we know that where people live, work, and play makes a huge difference in their eating habits and ability to be physically active. It’s critical that Appalachian communities not only promote healthy eating by providing access to affordable, healthful foods and beverages, but that they are safe places for residents of all ages to exercise and be active.

Many communities are already doing this. For example, in Sequatchie County, TN, residents started Step Up Sequatchie to practice healthy habits and make exercise a community affair. And in Haywood County, NC, ASAP Connections is expanding opportunities for kids to get to know their food with its Growing Minds Farm to School Program.

We also need to consider the role that the workplace can play in improving our health, especially since most of us spend more than a third of our day at work.

"One of the most important things we can do is to start young to support healthy eating and living habits in early childhood."

Kostas Skordas, Director of Research and Evaluation at Appalachian Regional Commission.


What can/should policymakers in the Region be doing to prevent obesity?

Kostas Skordas

First of all, it’s essential that policymakers, community organizations, and funders work collaboratively to ensure that both kids and adults have opportunities to make healthy choices. Supporting policies and programs that increase access to affordable, healthful foods and beverages are critical. These policies can be targeted at encouraging and incentivizing different groups to participate, including farmers, retailers, and consumers.

Another important thing is making sure it’s safe and convenient for residents of all ages to walk, bike, and play outside. And that means that policymakers should ensure equitable access to transportation and public land, such as parks, greenways, trails, and playgrounds.

Finally, policymakers can support legislation and tax incentives for worksite wellness programs.


Why is this research important—not just for scientists and health practitioners, but for Appalachian residents themselves?

Kostas Skordas

Obesity-related chronic diseases are primary drivers of poor health, disability, and death—problems that are particularly acute in Appalachia. If we’re going to make serious improvements in quality of life, then we have real challenges to overcome—not just in Appalachia, but in every community across the country.

At ARC, our mission is to boost economic growth and build capacity in Appalachia so that Appalachia achieves socioeconomic parity with the rest of the country. The building blocks include a healthy, educated, and skilled population; increased entrepreneurship, investments in critical infrastructure, and communities with the capacity to plan for their own future.

And while we have challenges to overcome, fortunately, there are dozens of innovative programs in Appalachia already that can serve as models for other communities—especially other rural and economically distressed ones that face additional challenges. The problem is acute, but there are some great potential solutions we can replicate and expand.

Ultimately, we hope that residents, advocates, practitioners and decisionmakers will use this brief, as well as the others in this series, to inform changes that will improve the quality of life throughout our communities.