By Wil Haygood
Washington Post Staff Writer
Monday, July 12, 2010; A01
MANCHESTER, KY. -- The beautiful thing about this little town, the locals will tell you, is that everyone seems to know everyone. Where the children go to school, where the parents work. Who's engaged to be married, who's joining the military.
How Britney and Carlin -- those would be Scott Robinson's girls -- are doing in school.
Quite well, thank you.
"I just got my report card the other day. Wanna see it?" asks a smiling Carlin, 12. She shows off a row of A's. She's standing in her back yard, high on a hill overlooking a valley below.
Carlin Robinson is a large little girl.
The people of Manchester take for granted knowing one another. "You never run into a stranger here," says Britney, Carlin's older sister.
Britney Robinson, 20, is a very large young woman.
Britney and Carlin: two sweet small-town girls, the pride of their dad.
Scott Robinson, 47, is a very large man.
The residents of this town of 2,100 -- 95 miles southeast of Lexington and deep in the Appalachian foothills -- indeed appear to celebrate the joys of community closeness. The bake sales, the volunteering. But it's what goes uncelebrated, and even ignored, here that has become Manchester's defining feature: In an increasingly unhealthy country, it is one of the unhealthiest places of all.
The national obesity rate for adults is 24 percent; in Manchester and surrounding Clay County, it's been estimated to be as high as 52 percent. In a study of the healthiness of Kentucky's 120 counties, Clay County ranked dead last, with 41 percent of the population classified as in poor or fair health.
In Washington recently, first lady Michelle Obama presided over the unveiling of findings from an obesity task force. Highlights that she presented from the three-month study only deepened what many had come to fear: The number of overweight children is rising; there are not enough places to buy nutritious food in small towns; many places lack recreational venues.
It was as if she were talking about Manchester itself, a friendly town where little thought is given to what the health crisis might mean for its future, and the future of a country with Manchesters from coast to coast.
There is no YMCA or YWCA here.
There is no department of parks and recreation.
There is no fancy dues-paying gym with energy drinks and literature about healthful eating habits.
"I just don't know a lot about obesity," confesses Mayor Carmen Lewis. She ponders what unchecked obesity might mean to the future: "Until you realize it, you're blinded. Then you get to an age where you suddenly say, 'Oh, my God! What have I done to myself?' "
* * *
Scott Robinson was raised in Manchester, where coal mining provided him with steady work -- that is, until the mines shut down or began to lay off large numbers of workers, including him. He took a job with the town of Manchester back in 1996. He does maintenance work. "Took a pay cut," he says, "but I needed a job with health insurance for me and my girls."
Around the time he got his new job, he and his wife split. She moved away. Scott raised the girls with the help of his mother and other relatives. "Wasn't easy," he allows.
Carlin and Britney are his only children. He confesses he has begun to worry about Britney. Scott wonders whether the breakup of his marriage sent Britney into an emotional tailspin, and whether some of that pain manifested itself in her current behavior -- overeating and secluding herself in her bedroom, where she spends hours on her computer.
"She is a borderline diabetic," says Pam Mathis, Scott's girlfriend. "She had to go to the doctor today. They told her she should lose up to 30 pounds."
Scott rubs his chin.
"She's a computer wiz, though," Pam goes on about Britney.
"Now, my little one, Carlin, she at least gets out and plays with the dog," Scott says. "But with Britney, it's all staying on the computer."
If the problem is a lack of exercise, Scott mentions that he has tried to address that issue: "There's a basketball court out back of the house," he says.
"That's not for every child," Pam says. Pam would really like a bowling alley, but there's no bowling alley around.
"We also could use a bicycle trail," adds Scott. "Of course, we growed up riding our bicycles in the street."
The town has a retro, lived-in look. The downtown movie theater is gone, though the marquee is still visible. There has clearly been economic suffering. There is a medium-security federal prison on the edge of town, out past the gas stations that sell fried chicken and pizza.
"You don't have family cooking here in the restaurants," Pam says. "Mostly it's fast foods."
The intersection leading into town features a McDonald's, a Wendy's, an Arby's and a Subway.
And just beyond that, there's a Burger King, a Long John Silver's, a Lee's Famous Recipe Chicken and a Pizza Hut.
Not far from the Pizza Hut, there's a Wal-Mart. At the Wal-Mart, there are snacks -- cotton candy and potato chips and caramel corn -- sold in supersize helpings.
Half a dozen little kids are standing in line at the McDonald's. Four are clearly overweight.
A man and two kids emerge from a pickup, heading into the Arby's. The man is huge, the little girl is not, the little boy is. A little boy, overweight, balances his tray at the Wendy's. A burger. Big fries. Big soda.
At night, most of the lights glowing around town come from the fast-food places at that intersection.
The Pizza Hut seems to do a lively business.
Inside is Britney Robinson. She works at the Pizza Hut. She gets the employee discount.
* * *
Charlie Rawlins loathes every fast-food joint in Manchester.
He might be the town apostate. He used to be "like, way overweight, man," tipping the scales at 251 pounds. He's 5 feet 9 inches tall. He's 20 years old. The weight caused so much pain on his knees that he had to undergo several knee surgeries. Now he's down to 185 pounds, and could a person be any prouder of himself?
Charlie began speaking out about the fast-food places to friends a while ago. "I realized that no one was going to listen to me," he says. He educated himself about nutrition. "I started going in for the fruits, the asparagus, making my own salads." He realized he could live without the large boxes of sweets he used to load up on at Wal-Mart. "The kids around here, they'll eat cornbread and taters for lunch. They'll get a 20-piece chicken meal. It's killing them."
He knows these kids. He waits for them to come see him where he works. They don't. He is a personal trainer at Clay County Physical Therapy, a small space affiliated with a local hospital. It is not advertised as a gym, because it's mostly for physical therapy. He figures there's a reason that people don't come, a lack of resources. It costs $25 a month for individuals and $40 a month for families. "Which is a bargain," he proclaims. "I mean, look how much money these families around here spend on fast food!"
But they don't come.
If Charlie is the town apostate, Regina Stevens is the hard-boiled realist.
She's a pharmacist. She wants to be respectful of the townsfolk. She says they are hugely unaware of the consequences of being overweight.
"A lot of our medications are for 'disease states,' such as Type 2 diabetes, hypertension, things that can be aversely affected by increased weight," Stevens says. As the town pharmacist, she knows how necessary she is to some people, and how unnecessary she could be to others.
"If many of my patients lost weight, they could be totally taken off some of these medications." The result, she says, could be profound: "They would have increased longevity in life."
Stevens thinks part of the problem may lie in a cultural feeling about the food that is set down in front of a child at home at mealtime here. "There is that feeling of 'clean your plate' in many of the homes around here. You don't throw food away. So the child has to eat all of the food, even if they are already full. I know I grew up with that very thing being said to me: 'Clean your plate.' "
* * *
When the budding scholar, home on break from the University of Kentucky in Lexington, looked around Manchester and saw the overweight kids and the overweight adults, and kept seeing them, it dawned on her: The problem would make an interesting academic study.
Jill Day grew up here. She knew the fear that locals harbor about outsiders who come around with pencils and questionnaires wanting to probe personal living habits. Maybe they wouldn't be willing to share confidences with an outsider, but she had her rural Kentucky roots, the familiar accent.
Day, who began studying for her doctorate in kinesiology and health promotion in 2005, got her advisers interested in her idea to conduct a study in Manchester and Clay County, but they cautioned her about the difficulty of getting people to talk about weight and obesity. Day typed out questionnaires for the students and their parents. A good many of the parents -- speaking for their children as well -- wanted no part of the study. But 277 children, from seven elementary schools, did participate. Day's subjects were fourth- and fifth-graders.
Her study would prove to be the first of its kind undertaken in this region of Kentucky that focuses on the underlying causes that may lead to obesity. The students fell into categories of healthy, underweight, overweight and obese. To measure activity -- or in many cases inactivity -- in the form of steps taken, Day equipped the students with pedometers.
"I was estimating in my head that one-third of the kids in Manchester would be overweight or obese," she recalls.
In fact, it was half of them.
Of the 277, eight of those fourth- and fifth-graders were underweight, 135 were healthy, 49 were overweight and 85 were obese.
"It is discouraging to see statistics such as these," says Day, who is now an assistant professor of human development and kinesiology at Campbellsville University, about 2 1/2 hours away. Also discouraging, she says, is the fear here of talking about obesity, a mind-set that can seem as thick and impenetrable as the morning fog in these foothills.
"It's a fear of knowing. A fear of knowing the truth. The families believe it's really not that bad. They believe the time to weigh yourself is when you go to the doctor. But they aren't going to the doctor!"
To those who would proclaim that obesity is largely hereditary, Day disagrees. "Since 1980, obesity has tripled in children, so we can't totally blame genetics for this increase."
By the study's end, the multilayered causes for the rise of obesity rates were clear to Day. "I hate to sound simplistic, but it is a lack of physical activity as well as poor eating habits," she says. She gives an example: "If you go to Wal-Mart, you will see someone circling the parking lot. And circling. They're looking for a closer spot to the front door so they won't have to walk. The attitude is we don't want to work as hard to get anyplace." The effects -- "high blood pressure, heart disease, emotional and psychological issues in children, joint problems" -- all crystallized for her. There were, as well, the issues of poverty and education. In Clay County, Day concluded, "the median per capita income is about $16,000 less than the national average, and less than 50 percent of the adults over 25 have graduated high school."
Day spent two years on her study, and she comes back home occasionally for visits. She knows everyone, including Carlin Robinson, whom she ran into on a Sunday not long ago. She wouldn't dare tell little Carlin what she was really thinking. "I'm worried. She's leaning toward getting big."
* * *
Britney and Carlin are riding around, showing the town. The hills, the curves, the thick groves of trees, the jagged hillsides.
"We usually eat pizza at Pat's Pool Room," says Britney. "It's greasy food. It's a little shack where they grill hamburgers."
"It's very relaxing out here," Carlin says from the back seat, on a road curving up atop the town. "You don't have to listen to the cars."
They pass the little house where they lived with their dad a few years ago.
"Our dad and granny basically raised us," says Britney.
"Dad's really funny to be around," pipes up Carlin.
"Just real grounded," says Britney. "Our dad never whupped us."
Carlin spots another eatery out the window. "There's Mike's Quick Stop. They serve good hamburgers and hot dogs."
There's another restaurant. Carlin points it out. "My dad is a big steak fan," she says.
The sisters stop and eat. Chinese food. They clean their plates.
Britney, who attends the Manchester branch of Eastern Kentucky University, wants to be an elementary school teacher. When it comes to activity, she likes sitting in the woods. She has friends, and they go into the woods and sit around and build a campfire. "Just like we did in high school," she says. "Basically, I work, sleep, hang out with my friends."
Later, at home, Carlin -- her pretty braces gleaming -- will talk about the food at her school. "Sometimes, I think they give us too much food." She says she has started to notice how much bigger she is than the other kids. "Sometimes you get picked on for your size."
Stepping away from Carlin, Britney admits she'd like to talk to her sister about the weight Carlin's been gaining, but she won't. "Talking about her weight just might push her buttons," she says. "You don't really want to bring it up, because you just don't know how the other person will feel. In a way it's uncomfortable. I know I should talk about it."
Instead, in the sweet sunshine out in front of their house, the girls show off Bella, their dog, who was found at an animal shelter with a broken jaw. Their dad is up in his little shed, 30 yards from the house, working his second job, which is packing corn for livestock to eat. "Just started this last December," he says. "Trying to make an extra dollar." Even from afar, his girth is noticeable.
Scott Robinson -- who takes a blood pressure pill daily -- has no idea how much he weighs. "Lord, I couldn't tell you," he says. "Two-seventy, two-ninety. I don't remember the last time I weighed myself."
Carlin is at least 20 pounds overweight. "I won't weigh myself," she says. "No way. I ain't gonna embarrass myself. Why in the world would I want to do that?"
Britney Robinson is at least 30 pounds overweight. She doesn't weigh herself, either.
There are no full-length mirrors in the front rooms of their home that might reveal a full image of anyone.
But outside the house is a beautiful view of a valley, and a town at the edge of the valley, where so much of the population is a reflection of Scott, and Carlin and Britney.
Here is Britney now, taking in the view. "I just love it here," she says.