How churches could help address the lowland South’s obesity and physical inactivity crises

In a new American Nations-powered study in the American Journal of Medicine, researchers find an opportunity to reach people where they are in the Deep South and Tidewater regions

Congregations per 100,000 residents – Credit: John Liberty/Motivf for Nationhood Lab

By Colin Woodard

We’ve previously written here about the stark regional differences in U.S. health indices, from obesity, diabetes and physical inactivity to gun suicides, disabilities, sleep problems, Covid-19 vaccinations, and overall life expectancy. In most cases, people in “southern” U.S. regions — Deep South, Tidewater, Greater Appalachia and New France – fare substantially worse than their northern and southwestern counterparts, sometimes dramatically so. Greater Appalachia’s gun suicide rate is nearly seven times higher than New Netherland’s and almost twice that of Yankeedom.

In research published recently in the American Journal of Medicine, my health research partners at the University of Illinois-Chicago and HealthPartners Institute and I sought and found novel opportunity to mitigate the problem using community resources already on the ground: churches.

Lead author Ross Arena, head of UIC’s physical therapy department, knows something about leveraging community partnerships to improve people’s health. Starting in 2015 his department partnered with elementary schools in an area of Chicago with distressing health and nutrition metrics to create an after-school community health academy. Educators developed and led classes and programs to improve physical education and eating habits backed by faculty and students from the university’s nutrition, physical therapy, and kinesiology departments who had the technical knowledge. The school provided the physical space, the students got real life experience, and kids and their parents got fitter and healthier.  No money changed hands but the program is sustainable and expanding, providing a model for effective, community-led health lifestyle interventions.

This is super important because the U.S. is in the throes of a worsening, long-term physical inactivity pandemic, one that’s driving obesity, diabetes, and cardiovascular problems. “The current approaches to addressing [this] have not been successful,” Arena noted in the paper. “There is an urgent need to rethink both our healthy lifestyle messaging and type/location of programs focused on behavior change.”

Arena had a hunch that churches might be well positioned to help their parishioners. The “Bible Belt” might overlap with the areas facing the most severe inactivity and obesity problems – in Deep South, Greater Appalachia and New France. What if church congregations are thickest on the ground in places where the need for community health and wellness interventions are greatest? Could there be a “win-win synergy” whereby churches could host and lead programs on site?

Together with our co-author Nico Pronk, president of the Minneapolis-based HealthPartners Institute, we parsed health data for 2021 and matched it up with my American Nations model and detailed congregations-per-capita information from the Association of Statisticians of American Religious Bodies’ latest decadal US Religion Census. We then looked at county-level statistical correlations between congregation density and various health factors and sorted them by regional cultures.

The takeaway: in almost all regions, counties with lots of churches per capita also tend to have less access to exercise opportunities and higher rates of inactivity and obesity. But the association was extremely strong in the two lowland southern regions, Tidewater and Greater Appalachia, which had bivariate correlations two and three times greater than in Yankeedom, El Norte, the Midlands or Far West. In other words, in those two regions churches are densely clustered exactly where the health lifestyle crisis is most acute.

Physical inactivity – % of population


Congregations per 100,000 residents by county

“This is not an issue of church attendance influencing lifestyle behaviors,” Arena wrote in the paper, published online in late November and in currently in press. “Rather, we have identified a potential community partner to help address a pressing health crisis.”

“Churches should strongly consider offering their own in-house programs,” he added, noting that the University of South Carolina’s Faith, Activity and Nutrition initiative has already developed an evidence-based model for how to do this. As in Chicago, academic health professional programs could consider partnering with churches to offer pro bono lifestyle programs, with their students able to earn course credit.

Incidentally, we also found pretty strong overlap between church density and both inactivity and obesity rates in Left Coast; for churches and inactivity in New Netherland and Greater Appalachia; and for churches and obesity in Far West and Yankeedom. We also didn’t find strong relationships between either health factor and the number of individual church adherents per 100,000 people, which ruled out that church attendance is “the reason” why these health indices are poor.

The research is one of two of our papers recently accepted at the American Journal of Medicine, the official journal of the Alliance of Academic Internal Medicine, which started publishing in 1946 and is currently part of Elsevier and has an impact score of 5.98.           

Thanks to Nationhood Lab’s partners at Motivf, where John Liberty produced the maps you see here. Versions of some of these maps appeared in the American Journal of Medicine, from which we obtained permission for reuse.

— Colin Woodard is director of Nationhood Lab at Salve Regina University’s Pell Center for International Relations and Public Policy.