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A Shot in the Dark?
As the number of vaccines mandated for Tennessee's children continues to grow each year, parents and public health officials struggle to weigh risks and benefits.

  Good Eats?

You are what you eat, they say. So what does the East Tennessee diet tell us about who we are?

by Adrienne Martini

As much as local pundits like to define us, there is no such thing as an average East Tennessean. Some of us bleed Vol orange, some of us don't realize there's a game until we try to park on campus. A large chunk of folks feel a kinship with Ralph Stanley, others wouldn't know high-lonesome if it bit us in the ear. For every person who has been to college, there are many who haven't. And every day, born-and-bred Knox Countians knock elbows and attitudes with all manner of foreigners, whether they be Yankees or Canadians.

What we have in common, of course, is the same stuff all humans share. A desire for a comfortable place where we can be warm and dry. A deep-seated urge to feel cherished and of use. And biological compulsions, like the need to sleep, eliminate, and, of course, eat. The most variable of these traits is diet, which makes one wonder if that is the one thing that may bind us together. Is the diet in this area of the country in any way unique from the other 49 states? And what is it doing to our health?

Visions of pinto beans, greens, and granny's cornbread washed down with a pint jar of fresh buttermilk spring to the subconscious when the phrase "East Tennessee eating" is uttered. Other images that rush to mind are vine-ripened tomatoes plucked from the garden or green beans fresh off the vine; the hearty thump of a home-grown watermelon on a hot summer's day or the weighty spoonful of stewed okra dished out to ward off winter's chill.

Sadly, these daydreams don't come close to matching the dietary reality. Even given that garden centers are packed from first hint of spring to the coldest snap of fall, Knox Countians don't eat their vegetables. In a 1998 Community Health Assessment Survey, it was discovered that 87.3 percent of all adults report that they have less than five servings of fruits and vegetables per day, which is the current government recommendation. Women seem to fare slightly better, with 84.8 percent eating fewer than five versus 90.2 percent of men. This data holds true across the county, with no significant variations from, say, Farragut to Vestal.

Knox County Health Department Community Nutritionist Lee Murphy thinks that we actually may be doing better in consuming these items than the rest of the country, however. "We have so many vegetables and fruits that are local around here and people do use them a good deal," she says. "Vegetables are such a part of so many meals."

Even given that slight advantage, which may mostly be due to a climate more conducive to a longer growing season, our diet resembles that of the rest of the South.

"I think East Tennesseans eat like most Southerners eat," Murphy continues, "which includes lots of added fats, fried foods and convenience foods. The whole country is seeing a resurgence in eating a lot of convenience foods—that includes things that are just easy to prepare in the grocery store and, of course, fast foods."

Sadly, despite the wealth of fresh produce, our regional diet seems to have become similar to that of the rest of the country.

"I think it's pretty national," says Karen Balnicki Wetherall, nutritionist of the Lady Vols and director of UT's dietetic internship program. "I haven't seen reports for the last couple of years, but Knoxville was in the top five 'Eating Out' places, like above New York City, in the last report. So we are like the nation but we lead the nation in some aspects like our eating out."

Rather than remaining a region of homegrown eaters, we have become an area full of diners who rely on others to cook our foods for us. On its surface, that doesn't appear to be such a bad thing; after all, to dine out one must have a higher level of disposable income. But the amount—both in portion size and in the number of times per week we buy there—of restaurant food that we eat may in fact be harming our health.

According to Eric Schlosser, author of Fast Food Nation, "Americans now spend more money on fast food than on higher education, personal computers, computer software, or new cars. The spend more on fast food than on movies, books, magazines, newspapers, videos, and recorded music—combined."

As our spending on fast food has increased—from $6 billion in 1970 to $110 billion in 2000—so have our obesity levels. Now, one in three Tennesseans is overweight. One in four is obese—twice as high as it was in the '60s. In kids, 27 percent are overweight with 13 percent obese—twice as high as it was in the '70s.

"Obesity is now second only to smoking as a cause of mortality in the United States," continues Schlosser. "The CDC estimates that about 280,000 Americans die every year as a direct result of being overweight. Obesity has been linked to heart disease, colon cancer, stomach cancer, breast cancer, diabetes, arthritis, high blood pressure, infertility, and strokes. Severely obese children, aged six to 10, are now dying from heart attacks caused by their weight."

Of course, all of the blame shouldn't be heaped upon the nation's purveyors of fries and burgers, but a lot of it can be. The average fast food meal—say a burger, fries and a soda—can weigh in with half to two-thirds of the calories one should consume in an entire day. And that's before you super-size it.

"I've seen, in my experiences," says Murphy, "the growth in portion sizes makes you think you're getting a deal—a super large fry for 99 cents. But that doesn't include the fact that it's going straight to your waistline. We're such an economically minded society that we think it's a deal so we go for it. But it isn't a deal for our bodies.

"Another thing in this area that we see a lot here at the Health Department—and it's true across the country—is that soft drink consumption is really adding to calories. People don't think that a drink is contributing calories but it is. It's been coined 'Liquid Candy.' It adds a lot to the waistline and we don't think about it."

While fast food meals are calorie-dense, they aren't equally nutritional. And, in the quantities that they're eaten—Murphy claims that it's not uncommon for some Knox Countians to drive-thru five times per week—they displace other valuable components of our diets, like whole grains as well as fruits and vegetables.

Fast foods and sodas have even found a strong-hold in our schools, where they are offered in addition to school lunches. Seen as a new income source for cash-strapped schools, these "complementary foods" may not be the harmless solution that administrators hope for.

"Schools say that they have those restaurants in place because that's what the kids want, whereas I would turn that around and say that's what we're offering to our kids and that's why it's what they want," says Teresa Butler, nutritional education coordinator for St. Mary's. "We need to be more assertive in saying that these are not the healthiest food to have. I was really dismayed when I heard that they were putting soda pop machines into schools. It has a lot—mostly all—to do with money. That may be what kids are drinking, but we certainly don't want to encourage it.

"I don't see it stopping anytime soon, and I think it's a bad omen for the state of our health as we age."

With all of the information we now have about diet and nutrition, a shift toward the regional diet of our daydreams might not be such a bad idea. The latest food guide pyramid—a helpful dietary tool issued by the USDA and available at—indicates that most of our daily intake should be whole grains, like whole wheat bread or pasta, which are easily found in almost every Kroger, as well as fruits and vegetables, of which we have a bounty whether they come from our own gardens or the local grocery. And a little sausage every now and again certainly wouldn't hurt.

The biggest question may be, though, why spend the energy to change our diets to take advantage of what the region has to offer? Convenience foods are just so darn, well, convenient, engineered to be tasty, and a huge value to boot.

"Why bother is because of the increase of obesity and overweight in our population," answers Murphy. "Heart disease is the number one killer. Most diseases that you can think of that are not genetic, seem to have some nutritional link—so many cancers, so many cardiovascular problems all seem to have some link somewhere to nutrition. They're releasing new research every day that talks about that."

Of course, unless you have been diagnosed with one of these conditions, you may not realize there's room for dietary improvement, in Butler's opinion.

"It just depends—you might go along your whole life and not realize that what you're putting into your body is affecting you on the inside. You can't see it yet and you won't feel it until you're 60. I often think that people who do have trouble with their weight are actually more fortunate—it's a blessing in disguise—because it forces you to start looking at what you're eating. If you can eat whatever you want and you don't gain weight, it doesn't mean that your body is doing well on the inside."

"And if you're experiencing health problems," she says, "your diet plays a big part in helping you feel better and to prevent illness. As people are more educated, they become more aware of how they can take better care of themselves."

Even armed with knowledge about the hazards of our current eating habits, laden as they are with nutritionally weak meals and sugary sodas, the decision to change ultimately lies with each individual. Some are willing to take small steps toward improving their health through their diet. Others, however, are unwilling to shift their habits.

"Then there's some people who just don't want to change, people who clearly know. That's why you'll have a doctor who may smoke when clearly it has been shown to have a negative impact on your health," Butler says. "And that's why we live in this country and it's wonderful. You can make your own choices."

We all have the ability to make this area's diet one that contributes to better health—all we have to do is decide what we want our food choices to say about who we are.

January 3, 2002 * Vol. 12, No. 1
© 2002 Metro Pulse