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About DHEC

Issue: Obesity in South Carolina

Overweight and obesity are significant health issues for children and adults. More than half of Americans are overweight or obese. Excess weight increases the individual’s risk of developing chronic health conditions such as diabetes, heart disease, high blood pressure, stroke and cancer. For the first time in many years, life expectancy for children in the United States is predicted to be lower than that of their parents. This is alarming and a major public health issue. In South Carolina, the rate of overweight and obesity has nearly doubled since 1990. The lack of adequate physical activity and improper nutrition are contributing to the steady increase of obesity in South Carolina. The South Carolina Department of Health and Enviornmental Control’s Division of Physical Activity, Nutriton and Obesity Prevention (PANOP) is working to strategically address this issue by developing, coordinatin and implementing evidence based nutrion and physical activity policy, environmental and system level approaches.

Burden

More than half of all Americans are overweight or obese, and South Carolinians are no exception. In 2009, South Carolina’s had the 14th worst obesity rate in the nation. These chronic conditions result in a significant toll to the health care system. The total cost of obesity in the United States was $117 billion in 2000. Obesity-attributable medical costs for South Carolina alone topped $1 billion in 2003. More than half of these expenses were paid by taxpayer dollars through the Medicaid and Medicare programs.

Adults - Similar to national trends, adult obesity rates in South Carolina have nearly doubled since 1990. Sixty-six percent of all South Carolina adults are now either overweight or obese.

  • When examined across race/ethnicity in South Carolina, a larger proportion of African-Americans in the state are overweight or obese (70.0 percent) as compared with Hispanics (66.8%) and Whites (64.8 percent). Obesity levels are considerably higher among African-American women.
  • More than half of all South Carolinians do not get adequate amounts of physical activity or are totally inactive.
  • More than three-fourths of all South Carolinians do not consume the recommended number of fruits and vegetables per day.
  • South Carolina mothers rank 43rd out of all states in breastfeeding rates.

Children - Nationally, overweight rates in children ages 6-11 have doubled since the late 1970s while rates for adolescents ages 12-19 have tripled in the same time period. Overweight adolescents have a 70 percent chance of becoming overweight or obese adults.

  • South Carolina’s younger citizens are likewise affected, as 31.7 percent of high school students and 28.9 percent of low-income children receiving WIC assistance, ages 2 -5, are overweight or obese.
  • State-level data for children, ages 6-12, is not available.
  • Less than one-fifth of high school students in South Carolina reported eating the recommended 5 or more servings of fruits and vegetables per day.
  • Nearly 50 percent of adolescents in South Carolina do not meet the recommendations for adequate physical activity.
  • If current trends continue, one out of every three children born in 2000 will develop Type 2 diabetes, primarily due to a poor diet and lack of physical activity.

Obesity Trends Among U.S. Adults

SOUTH CAROLINA ADULT OVERWEIGHT AND OBESITY
(BRFSS, 2004, 2007, 2009)

S.C. Adult Overweight and Obesity 2004S.C. Adult Overweight and Obesity 2007S.C. Adult Overweight and Obesity 2009

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Influences

Major shifts in social and environmental conditions have triggered a rise in both inactivity and increased weight. Society has become increasingly suburbanized, and people are more inclined to drive than use active means of transportation. Work environments have shifted from a labor-based to service-based economy, which means that daily work has become more sedentary. The ability to be physically active is partly dependent on how the community environment is designed and supported. The “environment” encompasses the structure and layout of neighborhoods, sidewalks and adequate lighting, walking or biking trails, and safety from traffic and crime. In addition, competing academic priorities have resulted in less time for physical activity during school hours, both at recess and in physical education classes. Thus, children are becoming increasingly sedentary and are spending hours each day in front of televisions and computer screens, rather than playing outdoors. It is important to connect improvements in the environments where people live, work, play, and learn – including bike lanes or healthy school lunches – directly to positive health outcomes. By ensuring we have a strong network of bike and walking paths between residential and business areas, we are increasing walking and cycling to school, to work, and to run errands. These improvements make a community a healthier, more desirable place to live.

In recent years, the availability and accessibility to high-calorie foods has increased significantly. Americans are eating food prepared away from home more than ever. Food eaten outside of the home tends to be less healthy, providing more calories, sugar, sodium and fat than food prepared in the home. In 1970, households spent 26 percent of their total food spending on food-away-from-home; by 2002, this percentage had increased to 46 percent. During this same time period, portion sizes have increased dramatically. The most glaring example is the notorious “super-sizing.” Portion sizes began to rise in the 1970s, increased in the 1980s, and have grown ever since. For example, in 1957, the typical serving of soda was 8 fluid ounces. A typical serving size of soda is now 32 to 64 fluid ounces.

Needed Approaches and Interventions

Because obesity is caused by a complex and interrelated set of individual and community factors, efforts need to focus simultaneously on physical activity and nutrition among individuals as well as on related community and environmental issues. Strategies need to be evidence based and address different settings such as schools, communities, work sites, faith-based organizations and health care services. Monitoring and ongoing surveillance activities of community indicators as well as behavior indicators to identify trends, supports, and challenges to creating places in which the healthy choice is the default choice.

DHEC’s Division of Physical Activity, Nutrition and Obesity Prevention is providing leadership in the implementation of SC’s Obesity State Plan; and collaborating with SC’s Eat Smart, Move More – a statewide public private non-profit entity in addressing in communities all across the state.

Summary

Given an imbalance of active living and healthy eating, a community and culture supportive of healthy behaviors designed to address every aspect of daily life is critical to impact obesity and improve the health and economic well-being of South Carolina. This will require ongoing collaborations, partnerships and a commitment to adoption of evidence based public health policies and the design/re-designs of communities where the healthy choice is the easy choice.