In a world of Big Macs and super-size skillet-fried portions, how do people in small towns get healthier?
Healthier habits passed from one person to the next are "contagious," according to Microclinic International, which works worldwide to improve health outcomes by using the power of small groups.
The Microclinic idea worked in Kentucky's Bell County, where high rates of Type II diabetes and obesity and limited access to medical specialists such as dietitians and endocrinologists made changing habits difficult.
People simply weren't getting the information they needed to change their ways.
"It's proven when people are in groups together they do better," said Leigh Ann Baker, the program manager of the program, called Team Up 4 Health, at the Bell County Health Department. "They set an individual goal, and then they set a group goal ... anybody that is together in an office, in a church group. ... You can set a goal like, 'I'm going to increase my water intake eight ounces a day.' "
Microclinic tackles health risks one person at a time. If a health risk, such as fatty fast food, can be socially contagious, so, it figures, can healthy behaviors such as exercise, reading food labels, cooking healthy meals and raising tasty fresh vegetables.
The tiny groups of people are called "micro clinics": They may be no larger than a married couple, or as large as 20 to 30 people on a field trip to learn that so-called healthy foods that contain high-fructose corn syrup may not be so healthy after all.
In July 2011, Microclinic International launched its Bell County project with Humana, the Louisville health care giant providing a $2.5 million grant, and Citizen Effect, a group that helps individuals raise money for humanitarian projects worldwide. There is no cost to participants, who receive T-shirts, instruction, field trips, water bottles and pedometers.
Baker, the manager overseeing the project, said when she first sought volunteers to participate, she went to stores, schools, "right down to the front porch of the Cracker Barrel."
Criteria to participate weren't hard for many participants to muster: They had to have Type II diabetes, heart disease or cholesterol with a body mass greater than 25 (that's 150 pounds for a person 5 feet, 5 inches tall). Or they could have a body mass great greater than 30 (180 pounds at 5-foot-5).
For the first 10-month cycle, 100 people signed up; for the second cycle, 150. Classes are held in Pineville, Middlesboro and the Henderson settlement in Frakes.
Participants come to class once a week for the first month, then one time every two weeks. They receive screening for blood sugar, cholesterol, blood pressure, and waist and weight measurement.
A control group also comes in to get its blood work done and gets a $20 Wal-Mart card for its time.
At the end of the program's first year, 97 percent of the Bell County residents who completed the program saw at least one health improvement in the following areas: reduced body mass index, sustained weight loss, decreased symptoms of diabetes or reduced blood pressure.
In addition to classes and field trips, there's a community garden that started with the healthy lifestyle program.
"All the participants get seed," Baker said. "But it's not just the participants, it's the community. Gardening is a lost art. We need to teach it, grow our own herbs, our own vegetables. It's good exercise, and it's good for the community."
Baker points out to her students high-calorie foods they may not have considered, such as McDonald's sweet tea. A 32-ounce McDonald's sweet tea packs 280 calories. She also brings in sodas and energy drinks to show students their sugar levels and caloric toll.
Participants meet with a fitness instructor, are shown a fitness trail, and have a class on the food pyramid and portion size. They have a field trip to a grocery store where they are taught to read labels and then given a $10 certificate to make healthy purchases.
Because of very large portions many restaurants serve — roughly three times what people should consume during a meal Baker estimates — many people have lost the idea of what reasonable portions should look like.
One who decided to use a small-portion plate was Baker's own mother, Joy Saylor, 65, of Bell County.
Saylor is an example of what making small, incremental changes can do. She started by parking her car further away from her job at Pineville Community Hospital and worked up to more exercise. She ate smaller portions. Saylor lost almost 20 pounds and has kept it off.
"Going to the grocery store was very enlightening," Saylor said. "You just didn't recognize a lot of things, like the saturated fats. Now when I look at something, I look at everything in it. For me it has been a really good thing, because with my blood sugar I was sort of in denial."
Humana is not certain what it will do with the two years of data from Bell County, said spokesman Alan Player, but, "The first-year results show it really does work," he said.
Judy Lefevers, director of the Bell County health department, thinks that when people see their neighbors walking with their pedometers, scrutinizing labels at the grocery store, and working in vegetable gardens, they're seeing contagious behaviors, good contagious behaviors.
"We think that this is contagious health," Lefevers said. "... It's neat to think that this little area is setting the standard for other areas of the United States."
Microclinic International: Microclinics.org
Team Up 4 Health in Bell County: Facebook.com/BellCountyHealthDept#!/TeamUp4Health?fref=ts