Monday, July 18, 2011

Stress catches up to South Carolinians

The recent news about South Carolina's eighth-place ranking among the states for obesity wasn't surprising. Thanks to artificially suppressed wages throughout state history, our working class and chronic poor have never been encouraged to maintain healthy diets; remember, the three M's of the old farmhands' and millworkers' diets were meat, molasses and meal. It's no shock that generations of that forced behavior might have had a deleterious impact on our collective health.

But studies in the most recent generations continue to emphasize the role that stress and anxiety play in eating habits and in our body chemistry. Their finding represent a one-two-three punch: When stressed, many people eat. When given few healthy choices, many stressed people eat unhealthy foods. But thanks to the cortisol created by our bodies when we suffer stress -- and the corollary impacts of too little sleep -- the overeating of unhealthy foods results in more stored body fat.

A lack of shut-eye harms your waistline because it affects two important hormones that control appetite and satiety--leptin and ghrelin--says Kristen L. Knutson, Ph.D., a research associate specializing in sleep and health at the University of Chicago's Department of Medicine.

According to a study published in the Annals of Internal Medicine, people who slept only four hours a night for two nights had an 18 percent decrease in leptin (a hormone that signals the brain that the body has had enough to eat) and a 28 percent increase in ghrelin (a hormone that triggers hunger), compared with those who got more rest. The result: Sleep-deprived study volunteers reported a 24 percent boost in appetite. Short sleep can also impair glucose metabolism and over time set the stage for type 2 diabetes, Knutson notes.
"If you're feeling tired, you want carbs. But go for high-fiber carbs for long-lasting energy," says Keri Gans, R.D., a spokeswoman for the American Dietetic Association (ADA). "Fiber burns slower than simple sugars, and adding in some protein keeps you satisfied longer."
Constant stress causes your body to pump out high doses of hormones, like cortisol, that over time can boost your appetite and lead you to overeat. "Cortisol and insulin shift our preferences toward comfort foods--high-fat, high-sugar, or high-salt foods," says Elissa Epel, Ph.D., an associate professor at the University of California, San Francisco (UCSF), Department of Psychiatry and a leader of the UCSF Center on Obesity Assessment, Study, and Treatment.

Fat cells also produce cortisol, so if you're overweight and stressed, you're getting a double-whammy in terms of exposure. Overweight women gained weight when faced with common stressors such as job demands, having a tough time paying bills, and family-relationship strains, according to a study published in the American Journal of Epidemiology.

Cortisol, together with insulin, also causes your body to store more visceral fat, which is a risk factor for heart attack and stroke, Epel notes. What's more, stress makes it harder to stick with a healthy eating plan. "It's a reason why people go off diets," notes Marci Gluck, Ph.D., a clinical research psychologist at the Obesity and Diabetes Clinical Research Section of the National Institutes of Health in Phoenix, Arizona. Folks who normally restrict their eating, tend to overeat in response to stress.

Do South Carolinians have reason to be stressed? We're the state of "smiling faces, beautiful places," right?

Apparently, South Carolina's millionaires, as a class, are suffering a bit; their numbers dropped slightly from 2009 to 2010. A wealth-management firm ranked us 39th in the nation in the number of "millionaire households," with only 71,114 of them out of the 1,802,904 total households. As a percentage, that's only 3.94 percent, which makes South Carolina a stressful place to live for millionaires, who have to worry about home security systems -- and counting the silver after the help goes home at night.

Of course, there's the additional stress of competing with South Carolina's only billionaire, Anita Zucker of Charleston. With an estimated $1.8 billion, Zucker's the only one to make the Forbes list this year, setting a high bar for all the barely-millionaires among us.

Handling stress is apparently not on the to-do lists of people retiring to South Carolina from elsewhere. Kiplinger's, the magazine for the wealthy, ranks South Carolina the eighth tax-friendliest state in the nation for retirees:

June 2011

State Income Tax: 3%-7%
State Sales Tax: 6%
Estate Tax/Inheritance Tax: No/No

South Carolina extends its Southern hospitality to retirees. The Palmetto State exempts Social Security benefits from state income taxes, and it allows residents 65 and older to deduct up to $15,000 per person ($30,000 per couple) of qualified retirement income when calculating their state income tax. Retired military personnel 65 and older can deduct up to $10,000 of military retirement benefits. Property taxes are very low. Taxes are based on 4% of the market value of a home, and homeowners 65 and older qualify for a homestead exemption that excludes the first $50,000 of their property's fair market value from property taxes. Sales taxes can be high, though. The statewide rate is 6%, and counties can levy an additional 2%. Prescription drugs are exempt.

Unfortunately, if you're already here -- for example, if you're a child growing up in South Carolina, or a woman raising a child here, or a woman generally -- things aren't so rosy.

After all, South Carolina ranks dead last in the number of women serving in elected office, and that includes Governor Nikki Haley. With only 16 women serving in a legislature of 124 members -- including no women at all in the state Senate -- we don't stack up well against, well, against any other states. What do we have against women?

Apparently, a lot.

In 2004, South Carolina ranked sixth in the nation in the number of women killed by male "intimates" -- husbands and ex-husbands, boyfriends and ex-boyfriends.

In 2008, we ranked second in the nation in the number of women killed by men -- not just by male "intimates" but by men generally.

By 2010, something happened -- perhaps the economic downturn nationwide helped crime statistics in other states to catch up to South Carolina -- and we ranked ninth in the nation in highest homicide rate among female victims by male offenders.

Ergo, it may be stressful to be a woman living in South Carolina.

Similarly, it's likely very stressful for children living in our state. The Children's Defense Fund collects and published annual data on quality of life indicators for children living in America, and the news isn't good for South Carolina.

January 2011

1,080,732 children live in South Carolina:
5,623 are American Indian/Alaska Native
16,947 are Asian/Pacific Islander
25,864 are two or more races
81,034 are Hispanic
352,136 are Black
612,761 are White, non-Hispanic

In South Carolina:
-A child is abused or neglected every 41 minutes.
-A child dies before his or her first birthday every 16 hours.
-A child or teen is killed by gunfire every 6 days.

South Carolina Ranks:*
-36th among states in per pupil expenditures.
-47th among states in its infant mortality rate.
-47th among states in percent of babies born at low birthweight.
[*1st represents the best state for children and 51st represents the worst state for children in the country]

Child Poverty in South Carolina
Number of poor children (and percent poor): 259,429 (24.4%)
Number of children living in extreme poverty (and percent in extreme poverty): 122,506 (11.5%)
Number of adults and children receiving cash assistance from Temporary
Assistance for Needy Families (TANF): 43,503
Maximum monthly TANF cash assistance for a family of three: $240

Child Health in South Carolina
Number of children without health insurance (and percent uninsured): 156,000 (13.6%)
Number of children enrolled in the Children’s Health Insurance Program (CHIP)*: 85,046**
CHIP eligibility: 200 percent of federal poverty ($44,100 for a family of four)
Number of children enrolled in Medicaid: 437,550**
Medicaid and CHIP participation rate: 79.1%
Children as a percent of total Medicaid enrollment: 52.1%
Medicaid expenditures on children as a percent of total Medicaid expenditures: 32.0%
Percent of two-year-olds not fully immunized: 33.1%
*States may have a different name for CHIP
**The number of enrolled children throughout the year rather than on a given day

Child Hunger in South Carolina
Number of children who receive food stamps: 271,376
Percent of eligible persons who receive food stamps: 74%
Number of children in the School Lunch Program (free and reduced price only): 322,963
Number of children in the Summer Food Service Program: 58,328
Number of women and children receiving WIC (Supplemental Nutrition Program
for Women, Infants, and Children): 126,956

Early Childhood Development in South Carolina
Percent of children under age 6 with all parents in the labor force: 68.0%
Number of children served by Head Start: 12,464
Number of children served by the Child Care Development Fund/CCDBG: 20,400
Average annual cost of child care for a four-year-old in a center: $4,756
Percent of 3-year-olds enrolled in state pre-k, Head Start, or special
education programs: 15.6%
Percent of 4-year-olds enrolled in state pre-k, Head Start, or special
education programs: 49.0%

Education in South Carolina
Annual expenditure per prisoner: $16,417
Annual expenditure per public school pupil: $8,120

Child Welfare in South Carolina
Number of children who are victims of abuse and neglect: 12,707
Number of children in foster care: 4,938
Number of children adopted from foster care: 513
Number of grandparents raising grandchildren: 51,364

And it turns out that a lot of South Carolina's children are homeless, too, which probably increases their stress levels -- especially since state funding for services to the poor have been cut.

More and more students in South Carolina are becoming homeless or receiving the classification from their school district, but supplemental funds from the federal government don't seem to keep pace with the increase.

Thousands of students across South Carolina deal with more than just peer pressure and bullying every day. Many struggle with the grown-up issue of wondering where or if they'll have a place to go after the last school bell rings.

"It should be the happiest time of somebody's life, growing up and to be in a situation where you don't even have a bed to call your own," said Barbara Grossberg, Richland School District Two's Lead Social Worker. "They don't know where they're gonna be from day to day or where their belongings are gonna be."

The South Carolina State Board of Education released these statistics for the number of homeless students in South Carolina in recent years.
- 2006 - 2007: 6,033
- 2007 - 2008: 7,437
- 2008 - 2009: 8,744
- 2009 - 2010: 10,820

Strangely enough, the national insurance industry issues its own rankings. The bad news is that there, too, we find cause for heartburn, especially for South Carolina's insurance sales force.

South Carolina is ranked as the 41st healthiest state to live in, according to the 2010 America's Health Rankings® by the United Health Foundation, which is a several-spot increase from its 46th place position in 2009.

Challenges facing South Carolina include high rates in violent crime, infant mortality, and infectious disease, all of which place South Carolina among the worst states in the nation with respect to those measures.

It also shows low rates of high school graduation (with only 58.9 percent of entering ninth graders graduating within their expected four years of high school) and early prenatal care (with 65.8 percent of women receiving prenatal care within their first trimester of pregnancy. Obesity has increased in South Carolina since 1990 from 20.6 percent of the overall population to 30 percent.

South Carolina’s best and worst category rankings:
-Prevalence of binge drinking (12.5 percent): 10th
-Children in poverty (17.6 percent): 18th
-Infant mortality: 46th
-Early prenatal care: 48th
-Violent crime: 49th
-High school graduation (58.9 percent): 49th

Many things can be said about these numbers; many things are already said about them. Those who are concerned by them take action; those who aren't, don't. What's disconcerting is that our elected officials -- who represent exceedingly well the interests of the most fortunate among us -- are tasked by our various governing documents with tending to the general welfare of our populace, and they don't.

What's disconcerting is the pervasive and bone-deep sense that the few who wield real power and authority in South Carolina have very little regard for the great numbers of us who do not wield power or authority. Rather, they polish the parts of our state that are pretty to photograph, and they promote those photographs to corporate interests and retirees elsewhere, in hopes that those viewers will choose to relocate here, and thereby expand by a few more individuals the number of those who share the benefits of wealth in our state.

As for the rest of us, there are always potato chips, and cookies, and thick, greasy hamburgers to squelch that gnawing feeling in our bellies that something isn't right.

South Carolina keeps getting fatter and nearly one in every three residents is obese, according to a report released Thursday by two public health groups.

The state's obesity rate rose to 30.9 percent in 2010, and 66.4 percent of people in the state are overweight. South Carolina remained the nation's eighth fattest state while Mississippi topped the list with 34.4 percent of its residents listed as obese, according to the report from The Trust for America's Health and the Robert Wood Johnson Foundation.

All the sweet tea, fried chicken and banana pudding combined with a sedentary lifestyle leads to higher health care costs, as South Carolina also ranks in the top 10 in the U.S. in rates of diabetes and high blood pressure.

"Higher-fat food, more fried foods and things like that certainly play a role. The walkability of the cities and towns - there aren't a lot of continuous sidewalks or places where people can go and be active," said Joshua Brown, director of clinical services at the Weight Management Center at the Medical University of South Carolina.

Brown thinks one of the best way to combat rising obesity rates is more education about the value of exercise and on what the calorie content of food really means.

"People just don't fully appreciate the energy content of the foods they eat," said Brown, who often stuns his patients by pointing out a 1,000-calorie meal will require three hours of walking to burn off.

Thursday's report gives several suggestions, including healthier school lunches and government policies that encourage healthy living.

Our present government's policy about public health and other matters: Let us eat cake.

1 comment:

  1. All of this makes me so sad. I am one of those "retirees" that you spoke of and I am very concerned about the people here as I really love SC.