Inside the fattest state in the US
By Matthew Davis
BBC News, Jefferson County, Mississippi
Jefferson County is said to be the fattest part of the fattest state in the United States after a 2003 study found it had the highest proportion of obese residents in Mississippi.
The BBC News website went to find out why the area is a symbol of one of the country's fastest growing health problems.
It is lunchtime in Fayette, a tiny, sleepy town in the Mississippi Delta.
The patrons of Dude Burger - the only restaurant for miles - are buying hot dogs, dripping with chilli relish.
At the adjacent Supermarket and Deli, a customer walks through the car park, encumbered by two gallon tubs of ice cream.
Near a row of boarded-up shops, two men sit on the steps of the town courthouse, chewing jerky.
Apart from a few cars on Main Street, Fayette is broodingly silent. But it is a place that screams out poverty.
The taste of the individuals in this area comes from their experiences during slavery, the food that is eaten is of poor quality and rich in calories
Dr Frank McCune
Average household incomes here are just $13,500 (£7,662) a year, and unemployment almost 20%.
Mayor Rogers King does not believe Jefferson County is the fattest place in Mississippi, but he knows there is a problem.
"It is not something we have realised is upon us for many years, but we are trying to do something about it," the mayor tells the BBC.
Home of the mud pie
Tiny Jefferson County Hospital sits on top of a hill on the outskirts of Fayette, opposite a school.
It has a nutrition clinic, but it is conspicuously empty.
A poster advertising a weight loss class is taped to a one wall, urging participants to "Drop them pounds like they hot".
But this is not a message many people want to hear, according to Dr Frank McCune, the county's only obesity expert.
Mississippi is the home of the mud pie, of cajun fried pecans, sweet potato crunch, of fried shrimp and catfish - and Dr McCune says overeating is ingrained into the culture of the area.
"Some deny the fact that obesity is a problem," he says. "Many don't know what it is. Some of them think that being 5'4" (1.64m) tall and 225 pounds (102kg; 16st 1lb) is a normal weight.
"They deny the fact that certain foods are not healthy, they deny the fact that there are choices. Exercise has been viewed with scepticism."
"Some women who have entered the weight loss programme have been asked to leave by their husbands who say that they like them the way they are."
Jefferson County - population 6,700 - is the kind of place where drivers wave to you on the long, isolated country roads that link small towns like Fayette.
There simply aren't many places to stop and buy good food.
There are no fitness clubs at all in the county. At least a third of people here are said to take no exercise.
Yet poverty and inactivity are not the only explanations proffered for Jefferson's - and the Mississippi Delta's - problem with obesity.
Legacy of slavery
A few miles down the road is Rosswood Plantation, a historic cotton plantation mansion, now run as a guest house serving "full plantation breakfasts" on fine china, linen and silver.
Back in the 1850s more than 100 slaves worked the cotton fields on the 1,250-acre Rosswood farm, one of many such plantations along the Mississippi Delta.
Then the working day was long and arduous, the food basic but filling - gumbos, or stews thickened with okra, cornbread, beans and fish from the Mississippi.
Dr McCune's grandfather was born into slavery. His father saw mechanisation make redundant the harsh old jobs in the cotton fields.
But the doctor says the dietary legacy of those times persists.
We want our schools and our communities to buy into the idea that we must change our environment, but that will not happen overnight
Regina Ginn
Office for Healthy Schools
"The taste of the individuals in this area comes from their experiences during slavery, the food that is eaten is of poor quality and rich in calories.
"The food that is eaten is highly satisfying, highly filling but the food... that they eat in general is not balanced.
"The slaves had to eat the poorest quality food - they were maintained cheaply, therefore through years of eating that type of food, the people not only in this area, but in areas up and down the Mississippi River and where people migrated from have the same taste in food."
Ticking time bomb
For Regina Ginn, head of the state Office for Healthy Schools, the problem is not of the past, but of the future.
Nationally the problem of childhood obesity is seen by some as a ticking time bomb that the US has been slow to address.
Again, problems are particularly acute in Mississippi.
"We are having to take baby steps," Ms Ginn told the BBC.
"We want our schools and our communities to buy into the idea that we must change our environment, but that will not happen overnight."
Dr McCune is finishing a three-year study on obesity in middle schools in Jefferson. He fears the rate will be higher than anyone anticipates.
"I see people I first met as children having health problems now because of their weight, and I am afraid that unless we change our attitudes then the situation will only be worse for their children."
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