Obesity is a major public health challenge in Kentucky. The Centers for Disease Control and Prevention (CDC) reports over 36% of Kentucky adults live with obesity. Through the CDC’s High Obesity Program (HOP) project, land-grant institutions collaborate with Cooperative Extension Service (CES) to encourage healthy eating and active living to reduce rural obesity prevalence through policy, systems, and environmental (PSE) strategies. Martin County, located in the Appalachian region of the state, is the primary recipient of funding in Kentucky due to an adult obesity prevalence rate greater than 40%.

By implementing multiple community-driven strategies to enhance the food environment and create spaces for safe physical activity, the project has gained momentum over the last two and a half years. As a community-designed project, the team of state CES Specialists and Associates implement HOP strategies in partnership with the county’s CES office and a community health coalition comprised of community members, local elected officials, and non-profit representatives. While the coronavirus pandemic (COVID-19) affected most project efforts, the HOP team persevered with modified PSE strategies. For year 3 of the HOP project, efforts focused on:

1. Behavior nudges at gas stations to promote healthy choices. The installation of shelf wobblers at five local gas stations conspicuously encouraged the purchase of “Smart Snack” food and beverage items. With the slogan “nourish your body, fuel your life,” nudges resulted in an increase in total sales of Smart Snack items at three of five locations over six months.
2. Opportunities for family physical activity. In partnership with the CES 4-H Agent, SNAP-Ed program assistant and local schools, a “Turkey Trot” took place in November 2020 along the Inez Walking Trail. Over 130 adults and children participated, receiving 50 prize bags including health coalition items and educational materials supporting healthy eating and active living.
3. Expanded farmers’ operations and support for local growers. The HOP project provided supplies for the farmers’ market to expand operations to a pre-packaged pick-up model in response to the COVID-19 pandemic in summer 2020. Even during the pandemic, the farmers’ market experienced one of its most profitable years in recent history, reporting $4,500 in cash sales, $2,600 in senior voucher redemptions, and $525 in WIC voucher redemptions. Grant funds also purchased gardening supplies for the Grow Appalachia program, which saw an increase in participation from 23 growers in 2019 to 50 growers in 2020. These local growers harvested over 17,000 pounds of local produce in the 2020 season.

These efforts will continue into year 4 of the project with the long-term outcomes supporting efforts to reduce obesity and decrease the risk of diet-related chronic diseases in this rural Appalachian community. Through collaborative efforts with the county health coalition, CES staff, local elected officials, and community partners, investigators will implement additional PSE strategies to increase access to local foods and create safe spaces for physical activity.