A first-ever, county-by-county survey of obesity paints another dim picture for South Carolina and the Southeast.
High rates of obesity and diabetes were seen in about 75 percent of counties in South Carolina, Alabama, Mississippi, Louisiana and Georgia.
Eighty percent of the counties in the impoverished Appalachian region of Kentucky, Tennessee and West Virginia had high rates of the problem, according to new research released by the U.S. Centers for Disease Control and Prevention.
The national obesity rate was roughly 26 percent.
The Palmetto State's rate was 30.1 percent, including a strip of counties running from the lower Savannah River through the lower Midlands to Dillon and Marlboro counties, where the age-adjusted adult obesity rate was 32.8 percent or greater.
Orangeburg County had the highest rate - 38.5 percent - of any S.C. county. Beaufort County had the lowest at 20.5 percent, followed by Greenville County at 24.2.
In the tri-county region, Berkeley County fared the worst with an obesity rate of 33.1 percent and a diabetes rate of 11.4 percent. Dorchester County had an obesity rate of 30.8 percent and a diabetes rate of 9.6 percent, while Charleston County came in a 25.4 percent and 8.4 percent, respectively.
Local health professionals said Monday's report it underscores the need to change habits ingrained in culture.
"It's actually sad," said Dr. Jerry Back, director of the Ladson-based Advanced Centers for Hypertension, Diabetes and Cholesterol Disorders, which is affiliated with Trident Health System.
Back, who trained in Chicago and moved here from Colorado a year ago, said working in South Carolina has been startling in contrast to those other regions.
"The clients here not only are sicker and more overweight, but their disease onset is at a younger age and is more complicated (than in Illinois and Colorado)."
Back and others blame the problem largely on racial and cultural attitudes toward eating and exercise.
Dr. Shanon Honney, a Roper St. Francis Physician Partner who practices with Charleston Internal Medicine, joked she grew up in Charleston and didn't know, until college, that you could cook vegetables without fatback.
"If there's an ache or a pain, we tend to feed it," Honney said of Southerners.
"There's a lot of fad dieting, but what needs to happen is a lifetime modification of eating and exercise. ... People need to know that weight loss is a diet issue while exercise is more about weight management."
It's a cycle that must be broken, said Louis Yuhasz, director of Louie's Kids, a nonprofit dedicated to helping underprivileged obese children lead healthful lifestyles.
"We see so many obese children following in the footsteps of their obese parents who are now following in the footprints of their own diabetic parents," he said. "Only when people really realize that the stakes involved are saving your children's lives will we break this cycle."
The statistics for the CDC report are estimates - based on surveys, Census figures and other information - for 2007, and include a margin of error. The obesity rates in many counties were about the same, so it's difficult to say any county was clearly the single most obese, CDC officials said.
The CDC also released county-specific data for diabetes - Type 2 is closely tied to obesity. There are a range of possible explanations why counties in the South and Appalachia have the highest obesity and diabetes rates, experts said, including a culture that embraces fatty, unhealthful foods and that shuns exercise.
Genetics might be another. Income and education probably have a lot to do with it, too - people living in poor communities might not have the money to eat more healthful, more expensive foods or might not have access to gyms or safe jogging trails, they said.