I visited the fattest place in America, where fresh fruit is a 12-mile trip away

Telegraph

6 hours ago

Clyde Anderson has a thick, raised scar, three centimetres wide, that runs down the centre of his chest where his ribcage was cut open.
In 2020, surgeons extracted veins from Anderson's leg and grafted them to his heart in a quadruple bypass. His original coronary arteries had become so clogged with fat that he had had a heart attack.
'I was truck-driving and eating when I could, eating fast food,' says Anderson, 54. At the time, he weighed around 19 stone (120kg). 'Then my health checked up on me.'
But by many accounts, Anderson, who has since sworn off fried food and is several stone lighter, is one of the luckier residents of Holmes County in rural Mississippi.
'I have classmates who died from diabetes and heart attacks in their 30s,' says Roneda Lowe, 42, another local.
This is the reality of living in the fattest place in America.
Of the 3,140 US counties with comparable statistics in the 2023 US Health Census, five have an obesity rate of more than 50pc. In Holmes County, Mississippi, 53.2pc of all adults are obese, meaning they have a body mass index (BMI) of 30 or more.
It is a microcosm of the problems plaguing rural America, as residents are on the frontline of an obesity crisis that is destroying the nation's health.
How long this malaise has left is another matter. Robert F Kennedy Jr has vowed to wage war on America's expanding waistlines.
Kennedy, appointed US health secretary by Donald Trump, has claimed that something in the food supply is 'poisoning the American people', with fast food giants largely to blame.
'The problem is, [the] industry is making money on keeping us sick,' he said in April.
His Make America Healthy Again (Maha) report last month claimed the ultra-processed foods (UPFs) that make up nearly 70pc of children's calorie intake are 'detrimental' to their health.
This crackdown has drawn support from many of America's leading food experts, who have been won over despite Kennedy's reputation for spreading conspiracy theories.
'His rhetoric is fantastic,' says Marion Nestle, emerita professor of nutrition, food studies, and public health at New York University. 'I've just never heard anybody in government take on the food industry in this way.'
If he follows through with his ambitions, Kennedy will engage in all-out war with a $2.4 trillion (£1.8 trillion) food industry that has held sway in America for decades.
However, to achieve his health revolution, he faces a gargantuan fight.
Food desert
In the darkened gymnasium of an abandoned school six miles outside Tchula, Holmes County, an irrigation system for a new hydroponics farm is being prepared.
When Calvin Head flicks a switch, LED lights hum and water spurts from the tubes looped around the metal trays.
They do not yet hold any plants, but Head hopes to grow microgreens, bok choi and strawberries once he receives grant funding for the necessary renovations.
Head, 63, is the director of the Mileston Farmers Cooperative Association, which is focused on regenerative farming and training local young people. Elsewhere, he is growing corn, squash, watermelon, purple hull peas, and 'every green you can imagine'.
As part of the group's mission, Head and his colleague Tom Collins, 70, are battling to address a paradox.
Despite their base in the Mississippi Delta, which boasts some of the richest soil in the state, many Holmes County residents live in what are known as 'food deserts'.
Agriculture is Mississippi's number one industry. There are more than 31,000 farms across the state covering a combined 10.3m acres. And Holmes County itself is unbelievably lush.
Everything is green, apart from the flaming yellow black-eyed susans that grow wild in banks at the side of the road.
Things grow well here, but grocery stores in Holmes County are few and far between. In most, the fresh food sections are tiny, and many have empty shelves.
For example, in Tchula's Dollar General store – a discount chain with a small grocery section – the crates supposed to house fresh tomatoes and bananas are barren.
The closest supermarket is 12 miles away in Lexington, the nearest city. But that does not mean it is plentiful or cheap. 'The closest reasonably good supermarket is about 30 miles away,' says Collins.
Even the healthy food available in stores isn't always tasty or nutritious.
'They use preservatives,' says Collins. 'Maybe it takes a week before it gets here. You take a bite of an apple, and it tastes like beeswax.
'We live in a community where you have fields of traditional crops like cotton, corn, and soybeans, but that's not going to actually put food in your belly. Holmes County is a desperate area for nutritional food.'
Like many places in rural America, there is no public transport whatsoever in Holmes County. There are no pavements beside 55mph roads, no cycle lanes and no public pathways through the countryside.
This makes it difficult to exercise and impossible to get anywhere without a car. Lack of access to healthy food is also compounded by poor healthcare services.
Holmes County's economy was built by slaves, defined by agriculture and has long-standing inequalities.
But farming jobs have now long been lost to machines.
'We were really dirt poor and educationally destitute,' says Sylvia Gist, who grew up in the county in the 1950s and 60s during the Civil Rights movement and now runs a scholarship programme called the Migration Heritage Foundation.
'If you were black, you were poor, but for whites it was booming.'
Sixty years on and everyone is struggling.
Median household income in Holmes County is just $29,434 – the lowest of any county with a population of more than 10,000. Every single child is eligible for free school meals.
'Real poverty in America is defined by access,' says Jason Coker, who grew up in the Mississippi Delta and is president of Together for Hope, a rural development coalition.
'People might have access to a gas station, but they don't sell fruits and vegetables. They sell fried food and that food is cheaper. The cheapest food is the worst food.
'So you get a full diet of the worst foods that make you obese and prone to diabetes, which kills your health outcomes.'
'I grew up on Pop-Tarts'
But even when healthy food is available, people often do not choose it. It can be more expensive and less convenient. And it is not omnipresent in TV commercials.
Dennis Horton, 65, was born and raised in the small town of Goodman and opened Christine's Restaurant here seven months ago.
He drives an hour each way to buy the produce he needs from markets in the Mississippi towns of Grenada, Philadelphia and Jackson.
When he started, Horton and his partner tried offering dinners with vegetables on the menu, but that didn't last long.
'We had to stop about three months ago,' he says. 'It was wasting food. We weren't selling them.'
Price is also key.
He charges around $14 for a more nutritionally complete meal, whereas Horton's hamburgers cost $10. This can often make all the difference.
'People like to eat cheap,' he says.
This reflects the loss of autonomy over food in Holmes County.
On Tuesday in Goodman, families gathered around barbecues under pavilions at the side of the main street.
Over the generations, the residents of Holmes County have noticed a dramatic change in their relationship with food.
'My mom grew up here with their family's own food gardens,' says Roneda Lowe.
Her mother, Nellie Scott, 71, recalls how she 'could eat all day long'.
'But it was fruit,' she says. 'We had apple trees, figs and peas from our garden. We didn't get cake until Sundays and we didn't have problems with obesity.'
For Lowe, the contrast was stark. 'Between my mum's generation and mine, something got disconnected,' she says.
'I grew up on Pop-Tarts. The things we eat are different. People eat a lot of French fries and chicken wings. We should go back to whole foods.'
This is where 'big food' comes in.
'Years back, when the grandparents and extended family all lived under one roof, there was somebody to cook and prepare food,' says Robin McCrory, the outgoing mayor of Lexington.
'Now we live in the age of fast food and instant gratification and drive-ins and drive-throughs.'
Marion Nestle argues that much of this shift has been driven by profits.
'The food industry made an enormous concerted effort in the 1950s to convince women in particular that cooking was a chore, difficult, complicated,' she says.
'They said, 'We're going to make it easy for you. We're going to produce TV dinners. We're going to produce packaged foods. All you have to do is open them and heat them up.''
Food companies pursuing higher profits for shareholders are quite naturally geared towards encouraging people to eat more.
That means companies seek to manufacture food that is cheaper, tastier and has a longer shelf life. Cue the rise of ultra-processed foods.
UPFs are industrially manufactured food items that have undergone intense processing and contain ingredients not found in home kitchens, such as stabilisers and emulsifiers. They include fizzy drinks, sausages, mass-produced bread and most packaged snacks.
These foods now make up more than half of America's calorie intake.
UPFs typically have very high levels of refined sugars, unhealthy fats and salt. They are typically high in calories and low in nutrients. But they are convenient and cheap.
'For people who are poor, who are working two or three jobs and are absolutely exhausted, they don't have money to buy expensive things for their kids,' says Nestle, the emerita professor of nutrition.
'But they can give their kids food as treats, and their kids want fast food because it's marketed. These are kids who have no idea what real food is like.'
UPFs have been linked to increased risk of conditions such as heart disease and cancer. And what is particularly clear from scientific studies is that UPFs make people eat more.
'It's the processing, the texture, the flavour. These foods are deliberately designed so that you keep eating them,' says Nestle.
'These products are advertised, that's what you think you're supposed to eat. That's extremely profitable for companies.
'There's a real problem, and RFK has hit on that problem.'
UPFs are a key flashpoint in Kennedy's Maha report, which describes them as 'detrimental to children's health' and draws a direct link between the higher prevalence of UPFs in America and the nation's higher rate of obesity compared to Europe.
It also states that UPFs have led to 'nutritional depletion' in children and points to studies that various additives have been linked to an increase in mental disorders.
The rise of UPFs and fast food marketing has coincided with fewer young people learning how to cook.
'We've forgotten how to grow our own food and cook it,' says Coker.
Nestle adds: 'If you don't know how to cook, you can't go around the periphery of the supermarket, pick up real, unprocessed foods and turn them into something that your family is willing to eat in a short amount of time.'
Making America healthy again
Poor health extends far beyond Holmes County. Around two in five American adults are obese, by far the highest rate in the Organisation for Economic Cooperation and Development (OECD) of rich nations. Another third are overweight.
When Kennedy spoke at his Senate committee hearing back in January, his diagnosis of the problem was not dissimilar to Lowe's, but he was far more aggressive.
'When my uncle [John F Kennedy] was president [in 1961-63], 3pc of Americans were obese. Today, 74pc of Americans are either obese or overweight,' he said.
'No other country has anything like this. In Japan, the obesity rate is still 3pc. And epidemics are not caused by genes. Genes may provide the vulnerability. But you need an environmental toxin.
'Something is poisoning the American people and we know that the primary culprits are changing food supply, the switch to highly chemical-intensive processed foods.'
Even Donald Trump, a loyal McDonald's customer, has come out fighting.
At the launch of the Maha report in May, he said: 'Unlike other administrations, we will not be silenced or intimidated by the corporate lobbyists or special interests, and I want this group to do what they have to do. It won't be nice or won't be pretty, but we have to do it.'
Rarely has a previous administration been so overt in its criticism of America's food industry.
Alexia Howard, a senior food industry analyst at Bernstein, says: 'I've covered the space for 20 years, and in that time frame, I haven't seen anything quite like this in food.
'It's interesting to see how far and how fast things are moving right now.'
Kennedy has promised comprehensive policy plans in August, while one of his first steps has been to announce measures to phase out petroleum-based synthetic food dyes.
This was low-hanging fruit. Food producers will not need to reformulate a product if the dye is changed. Flavourings, by contrast, will be more complicated.
'I think that over time, that will expand into other additives and ingredients that are not demonstrably safe,' says Howard. 'Things like preservatives and additives used to bulk ingredients up.'
Kennedy has begun the process of closing the 'generally recognised as safe' (Gras) loophole, which allows food companies to secure approval for additives without applying to the Food and Drug Administration (FDA).
The FDA is in a consultation period on proposals to introduce a new mandate for front-of-package nutrition labels to highlight salt, added sugar and saturated fat contents of foods.
'I don't want to take food away from anybody,' Kennedy said at his committee hearing earlier this year.
'If you like a McDonald's cheeseburger or a Diet Coke, which my boss [Trump] loves, you should be able to get them. But you should know what the impacts are on your family and on your health.'
Holmes County is one of the bluest hubs in a state that voted red at the last election, although Kennedy's war on fast food is winning over local voters.
'I'm really not a Trump fan, but as far as Robert F Kennedy is concerned, I agree with him to a great extent,' says Gist, who voted Democrat in November.
The first task for Kennedy will be gaining influence over the US Department of Agriculture (USDA), which is responsible for many of the policy areas the health secretary wants to tackle.
In particular, USDA oversees the Supplemental Nutrition Assistance Program (Snap), which provides what are effectively food stamps to one in eight Americans.
Kennedy says he wants to change Snap so that unhealthy foods do not qualify for taxpayer cash.
Currently, the scheme is dominated by UPFs.
Analysis by Bernstein shows that sweetened beverages are the second-largest category of expenditure for Snap recipients, accounting for nearly a tenth (9.3pc) of all benefits.
This is double what is spent on fruit (4.7pc). A further 19.4pc is spent on frozen ready meals, shop-bought desserts, salty snacks and sweets combined.
Kennedy has encouraged states to apply for individual waivers. Texas has already passed a bill to make fizzy drinks, crisps and sweets no longer eligible for Snap benefits, while nine other states are drawing up similar plans.
But federal rule changes will depend on the USDA, which is being lobbied hard by some of America's biggest companies.
There are already signs that big agriculture has achieved some success, particularly as the Maha report fell far short of an anticipated attack on pesticides.
There are also questions over Kennedy's credibility. His Maha report has been widely panned for referencing scientific studies that do not exist and for evidence it was written with the help of AI.
It has also drawn scrutiny for raising doubts about children's vaccines, a longstanding bugbear for Kennedy, who recently made a false claim that prescription medicines were the third leading cause of death in the US.
'It's very difficult to take this seriously,' says Nestle.
As for big food, it is not only Kennedy who poses a threat. It is also under pressure from big pharma.
Over the past year, weight-loss drugs such as Wegovy, known as GLP-1s, have exploded across the US.
Between 8pc and 10pc of the US population are using these drugs, while analysts expect this figure will soon rise to 15pc.
Taking GLP-1s means patients reduce their calorie consumption by 27.5pc, potentially slashing obesity rates across the country.
'The food industry is terrified because they make people eat less,' says Nestle.
However, while politicians and lobbyists wage war in Washington, the residents of Holmes County are crying out for change.
Before he ran the farm, Head was Holmes County's transportation director.
It was during this role that he was confronted with the bleak reality that Mississippi is the only state in America where more than a quarter of children (26.1pc) are obese.
Head knows that fixing such damning statistics is the only way to prevent another era of obesity in America.
'The school buses were overcrowded because some of the kids were so big that only two of them could be where three ought to sit,' he says.
'We just want to work hard to make life better for ourselves.'