Heather Owens looks at the before and after photographs on her cell phone.
The photo on the left shows when she weighed 200 pounds. Owens, the benefits coordinator at the Cherokee Nation Three Rivers Health Center, said she was, according to her Body Mass Index (BMI), considered to be morbidly obese as 47 percent off her body weight was fat.
"I ate and I didn't care what I ate," she said. "I sat a lot at work and wasn't active. I have two kids, but I didn't go out and really do anything with them. I was tired all of the time and I didn't have the energy. I ate a lot of candy as I was a sucker for sugary snacks."
Owens serves as an example of the obesity problem in Muskogee County.
According to the 2017 Oklahoma Department of Health statistics, it ranks second among the 77 counties in the state with 40.6 percent of the population being considered to be obese. Only Adair County, east of Muskogee, ranks higher at 41.3 percent.
Dr. James H. Baker, the medical director of the health center, said obesity is an "overwhelming" problem. But why does a person become obese?
"A lot of factors go into determining why people have certain food choices," he said. "Some people are born with it or genetically inclined to trend toward being overweight. For others, it's environmental and growing up in a family that doesn't sit down and eat together, and they tend to wind up having less healthy food choices."
Oklahoma ranks sixth nationally in the rate of obesity at 32.4 percent, according to statistics provided by the Oklahoma State University Extension Office in Muskogee. The obesity rate among Native Americans is at the highest in the two counties.
Other factors cause obesity.
"We find stress, or behavioral health, such as anxiety and depression lead to obesity," Baker said. "People sit in front of their TV and they likely don't know what they're eating. It comforts them. People in low socio-economic areas are inclined to wind up with less healthy choices."
Obesity also contributes to other health issues, including diabetes, heart disease and cancer. The state ranks sixth, second and fifth nationally, respectively, in those areas, according to the OSU Extension Office.
Baker has seen his share of obese patients.
"It's extremely challenging to see a patient in an examination and you don't have the tools to be able to quickly fix them," he said. "For blood pressure, we've got a pill. For cholesterol, we've got a pill. For diabetes, we have a pill or a shot that with three to six months, we have those patients under control.
"To have a person who is 250 to 300 or 400 pounds come into the office and you can't give them something and tell them that in one, two or three, six months or a year, you're going to have their weight down and they're going to be normal."
Educating people about obesity is where Doug Walton, the coordinator of the Tobacco Settlement Endowment Trust (TSET) Healthy Living Program at the Muskogee County Health Department comes in. That's why he spends a lot of his time at church, schools, businesses and cities teaching people about healthy eating and choices.
"We're trying to change the culture of the environment that healthier options are more normal," he said. "There is no way to reduce obesity other than people wanting to lose weight. We're not addressing personal behavior. It's broader than that.
"We're trying to reshape the environment to make it easier for people. It's easier to be more active and and eat better. Unfortunately, it's a monumental undertaking. It's not going to happen quickly."
Now, Owens has seen the difference. She has lost 7.4 percent of her body fat over the past year.
She now looks at the after picture on the right, which show her loss of 30 pounds. Owens plans to lose more.
"I go to the gym five times a week now," she said. "I've started feeling better and I have more energy than I've ever had. I'm also eating better as I've quit eating fast food for lunch. My kids also want to work out with me and eat better. I feel great."
Body Mass Index chart: Measures body fat and determined by a person's mass and height.
Less than 18.5 — Person is skinny.
18.5-24.9 — Normal.
25.0-29.9 — Overweight.
30.0-over — Obese.
A BMI calculator can be found at www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm