Catherine Templeton says she likes to concentrate on a problem and find ways to fix it, and the new director of the S.C. Department of Health and Environmental Control has focused on a doozy – obesity.

Templeton sounded almost evangelical in her determination to reduce the state’s multitude of health problems by cutting fat from waistlines at the July 12 DHEC board meeting. Templeton said she had her “hallelujah moment” as she talked with experts about the state’s various major health bugaboos – diabetes, high blood pressure, heart disease, many forms of cancer – and saw one commonality.

“It’s obesity, it’s obesity, it’s obesity – everything is fed by it,” Templeton said. “We need to concentrate on what kills the most South Carolinians, what makes the most South Carolinians sick and what would, if prevented, save the state the most money.”

Like a new coach joining a sports team, Templeton suggests a change in strategy to focus on the epicenters of fat. She referred to a map based on Medicaid and Medicare cases that shows pockets of extreme obesity and diabetes in the state, mostly in poor, rural areas.

“If we could paratrooper in – sort of the obesity SWAT team – just focus on those areas with a surgical approach, I think we can make a difference in those pockets,” she said. “And if you knock out the most critical areas, you’ve made a difference for the whole state.”

Nearly two-thirds of adults and a third of children in the state are obese or overweight, according to various measurements. Health officials recognized the problem long ago, creating the S.C. Obesity State Plan in 2005 as a battle plan.

A second plan came out in 2008.

Another update was done this year.

But progress has been slow and results, difficult to quantify.

In fact, the rate of obesity in adults rose in every county in the state from 2005 through 2009, going along with the national trend, according to the Centers for Disease Control. The 2010 adult obesity rate in the state was 31.5 percent, better than only three states – Mississippi (34), West Virginia (32.5) and Alabama (32.2).

At the DHEC meeting, board member Kenyon Wells cautioned that health leaders have been preaching about the evils of obesity for years, with little impact.

“It is hard to get people to change,” Wells said. “We can throw as much as we can at it, but it still gets down to personal values and personal responsibilities. And I, honestly, don’t know how you do that today.’’

Wells’ words didn’t temper Templeton’s resolve. After the meeting, she began talking with others with more experience in the war on obesity.

Drilling down

The focus on obesity is something of a coming-out party at DHEC for the controversial Templeton.

Originally appointed by Gov. Nikki Haley to head the state’s Labor, Licensing and Regulation Department, the first-term governor moved Templeton to DHEC after its director retired. There, Templeton’s initial reviews – including her plans to work in a DHEC office near her Mount Pleasant home, rather than from DHEC’s Columbia headquarters, and her hiring of highly paid lieutenants – were not all favorable.

But obesity is a pressing problem in South Carolina.

Dr. Vincent Degenhart, a Columbia anesthesiologist who chairs the S.C. Medical Association’s Childhood Obesity Task Force, heard about Templeton’s remarks at the DHEC meeting and emailed her to welcome her to the fight.

“She emailed me right back and asked when the next meeting was and said, ‘I will be there,’ ” Degenhart said.

The doctors group, formed only last year, has the advantage of the participation of a large number of physicians on the front line. Earl Hunter, who preceded Templeton at DHEC, backed the agency’s various obesity efforts, but he let Erika Kirby, director of the agency’s Division of Nutrition, Physical Activity and Obesity, represent DHEC on the medical association’s task force. Degenhart praised Kirby, but he also hopes the personal attention from Templeton will be a boost.

Degenhart, like Templeton, is ready to move past years of forming committees, setting agendas and studying the issue.

“We know (about a third) of children are obese,” he said. “We don’t need another study to tell us that.”

He did note the scattered success stories.

One program in Charleston called the Lean Team appears to be working, though results are difficult to measure. The Lean Team, an initiative backed by the Medical University of South Carolina and Boeing, concentrates at the school level. Pediatricians, dietitians and health educators go into schools and preach the 5-2-1-0 message – five servings of fruits and vegetables per day, no more than two hours of screen time a day, at least one hour of exercise a day and zero sugary beverages a day.

Doc-Adopt, an offshoot of Lean Team, paired 55 physicians with schools in a program similar to the Adopt-A-Highway program.

Degenhart also is excited about another program, still in the formative stages, called Prescription for Parks. Doctors will write a prescription for overweight children that provides free admission to a state park or to a program at a state park.

Kirby sees progress, too.

She lauds the Farm to School Initiative, which encourages schools to use produce from local farms, and a joint DHEC-Department of Social Services child-care nutrition and activity program. Grants helped to set up Farm to School programs in 52 schools. The nutrition and activity program was tested in 19 child-care centers and is ready to be rolled out statewide.

Because of programs at MUSC, Charleston is out front on anti-obesity efforts.

But the more concentrated centers of obesity in the state are in rural areas. Hampton, Allendale, Bamberg, Orangeburg, Calhoun, Clarendon, Lee, Williamsburg, Fairfield and McCormick counties each have large chunks where more than 110 people per 1,000 are obese and/or have diabetes, according to Medicaid and Medicare records.

Templeton wants to focus efforts in one of those areas. She has asked for the numbers to be broken down to areas with even higher rates of obesity, maybe 200 per 1,000. “We need to drill it down,” she said.

She wants to find the most obese areas, go into the schools and churches and help establish healthy eating initiatives that work and exercise programs that encourage participation. Templeton thinks that would be more effective than current statewide programs. She cited one program that she particularly can’t understand – a grant pays to provide poor DHEC clients with plastic bags that encourage them to buy fresh fruits and vegetables at farmers markets.

Many of those clients live in rural areas, perhaps close to farms but far from a farmers market. Templeton wondered what good the bags do if the clients don’t have transportation to the markets.

Focusing resources

Amy Splittgerber, director of Eat Smart, Move More South Carolina, hopes Templeton doesn’t try to reinvent the wheel.

She said several groups in Colleton County, for example, already have started the kind of focused effort that Templeton seems to want. Colleton County’s obesity rates are in the middle of the pack in the state, but it is a poor county with plenty of challenges. Not a single registered dietitian lives in the county, Splittgerber said.

But with money from a 2009 BlueCross BlueShield of South Carolina grant, Colleton County’s dormant farmers market in Walterboro was revitalized, given a permanent home.

Local schools adopted a program called CATCH, for Coordinated Approach to Child Health, which encourages healthier eating in the schools. A healthy breakfast program now is offered to all students.

The exercise and recreation possibilities in the area also were surveyed, and the results were publicized.

“We’ve had some successes, and we’ve had some flops,” said Splittgerber, who added it’s unrealistic to see a noticeable drop in obesity numbers just three years into the program. “What we’re creating in Walterboro is a replicable model.”

Splittgerber and Templeton both see schools as one of the best battlegrounds in the war on obesity.

Templeton said she is prepared to butt heads with S.C. Education Superintendent Mick Zais and support legislation that increases current requirements for physical education in schools and requires healthier school lunches.

She also plans to look more closely at her own agency’s response, though she hasn’t spoke in depth about her ideas with Kirby, whose division deals with the issue.

Templeton thinks DHEC should consider shifting staffers from areas where the residents are less fat and send them to the real problem areas. She is confident a concentrated effort is better than a diluted one.

“Lexington County doesn’t need the same resources to fight obesity that Calhoun County does,” she said. “So why give them the same resources?”