For centuries, male and female bodies have been portrayed through art and literature and popular concept in a wide range of culturally divers depictions: men generally lean and aggressive, mostly clothed; women typically volumptuous, passive, dressed and mostly undressed--as the fulcrum of passion and productivity.

And so, mankind's schizophrenic notions of what a healthy, attractive body is and what it is not continue to this day.

If we are to believe today's reality (and why not?), at least the reality smacking the faces of Tulsans recently, now comes the latest "news" from Self magazine and Men's Health that Tulsa and Oklahoma City are among the least healthy cities in which to live.

Women's lifestyle magazine Self, in its seventh annual national survey of the 100 largest metropolitan cities studied released in November says among "The healthiest cities for women," Oklahoma City ranked 98 and Tulsa 94. But we're doing better than last year's finish at 99 along with a second worst ranking for healthy eating habits.

In case you're wondering, Honolulu, HI, was ranked the nation's healthiest city for women, with Portland, ME; Nassau-Suffolk counties, NY; Orange County, CA; and Burlington, VT, as the top five. The five unhealthiest places are Detroit, MI; Cincinnati, OH; Oklahoma City; Birmingham, AL; and Indianapolis, IN.

Most telling to us is the divergent reaction of the mayors of each of Oklahoma' major Metro cities. According to the Associated Press who broke the story, The results came as no surprise to Oklahoma City Mayor Mick Cornett, who said the state created sedentary citizens by building its communities around the automobile.

"I don't doubt the statistics," Cornett said. "If they show that we are overweight and don't eat correctly, I bet that's right."

The survey singled out Tulsa as having the worst eating habits overall, but Tulsa Mayor Kathy Taylor questioned those findings.

She points to Tulsa's seasonal outdoor produce markets and says her city has one of the most successful organic supermarkets in the nation, which is doubling its size.

Tulsans take advantage of nearly 100 miles of trails, plus the city's low-cost public fitness centers, Taylor said.

Cornett also lauded the ambitious trail-building plan Oklahoma City has adopted, but acknowledged Oklahomans are just now catching up with other cities.

"We went for 21 years without passing any bonds for capital improvements for our public parks," Cornett said. "There has been little priority given to exercise."

You can lead a horse to water, but you can't make her drink.

Tulsa's main mention in this survey is that the city's women rank first for the most "Unhealthiest eaters" category, with Huntington, WV/Ashland, KY; Jackson, MS; Oklahoma City, OK; and Des Moines, IA, as the four runner-ups.

Self's results came from almost 40 categories, combining and crunching more than 6,000 pieces of information, such as air quality in the cities surveys, eating and exercise habits, rates of depression and cancer--all in an effort to determine the cities which offer people a healthy lifestyle.

In addition, Self collected data from the Centers for Disease Control and Prevention (CDC), Environmental Protection Agency and the FBI which were interpreted by a panel of experts to determine which cities offer a healthy environment and what their stats reveal about the current lifestyle.

"We always use the most up-to-date data available," says Sara Austin, Self News Director and writer of the article featured in Self, "which Bert Sperling helps us collect from authoritative sources such as the CDC, the FBI and the EPA."

Often government info can be dated because of the inherent lengthiness in gathering and interpreting data. Austin says, "It does take time for the government to collect and report data, but as we've seen through seven years of ranking cities, changes in areas such as the environment, crime or disease rates tend to be gradual and data does not change wildly from year to year."

Austin reiterates the top criteria. "We ask a panel of experts to weigh in on which factors affect women's health most," she says, "and the happy news is the factors they give the most weight to--including obesity rates, exercise, and smoking--are also some of the things women have the most direct control over in our own lives." She mentions other important factors, such as access to health care, which communities must strive to work on together.

Men's rankings were even worse, at least says Men's Health magazine. For its end-of-the-year survey of the top 100 cities selected, Tulsa is number 96 out of 100. Men's Health had 24 categories which included current lifestyle concerns (crime rates, annual income, college graduation rates and daily commutes); stats also examined were those dealing with cancer, heart disease and stoke, and the intensity and duration of an exercise regimen among men.

The top five city rankings in this survey include San Jose, CA; Honolulu, HI; Madison, WI; San Diego, CA; and Fremont, CA; the bottom five include Tulsa; Louisville, KY; Toledo, OH; Charleston, W. VA; and Memphis, TN. Another order of jelly doughnuts, please.

Immediate response to these studies in Tulsa was expected, with reactions ranging from being a sobering and sublime reality to one that needs debunking.

Pam Listar, Communications Department, City of Tulsa, who works on the Mayor's Fitness Challenge, says some of the data contains discrepancies, such as Tulsa having no health food stores; "this just is not correct information," she contends. She also mentions that the city of Tulsa provides many opportunities for a healthy lifestyle, such as the 100 miles of trails in and around the city; the 140 parks to recreate; and the many other activities to get fit. In addition, she mentions the seasonal outdoor organic produce markets which are a popular and healthy alternative to traditional grocery stories.

Listar also points to the immense success of the annual Tulsa Run and the Tulsa Tough: Ride and Race bike riding, racing and learning for kids. Also, a major project is the Mayor's Fitness Challenge which partners with 46 other organizations to "create a healthier state over the long-term, where residents choose to change and improve their fitness and nutritional habits in order to lead overall healthier lifestyles."

Listar says in this fitness initiative, the "coalition of partners" help by challenging Tulsa and Oklahoma City residents to get fit and healthy; challenging businesses to step up their fitness programs or offer fitness plans and/or facilities for employees as part of overall wellness programs.

Participation is open to everyone--no matter what age or fitness level; whether participants choose to walk, dance, run, skip, bike or swim their way to a healthier self. The intent is to get people to engage in a fun, physical activity every day.

Upcoming events include the Health4Life 2007, which was January 6 and included an incentive prize package of $10,000; the Champions for Healthy Kids Torch Relay, January 15; Get Fit Tulsa/Champions for Healthy Kids Torch Relay, April 14; Blow the Whistle on Asthma Walk, May 19; and the Tulsa Run, October 27.

A few simple tips from the Mayor's Fitness Challenge on fitness, health and nutrition include getting at least on hour of physical activity every day; eat a variety of different colored vegetables three to five times a day as a small meal, and schedule at least one hour of free time for your self and enjoy the moment. More details on these events as well as nutrition tips and more can be obtained at www.mayorsfitnesschallenge.com.

Getting Defensive

Listar mentions that Bob Hendrick, Special Events Coordinator for Tulsa Parks, also took offense to these magazine rankings and reports. Hendrick, who even sent a letter to the editors of Self magazine to challenge the report, says the data the editors pulled from is inaccurate.

"Ninety percent of the information they gathered came from Tulsa yellowpages.com," where he said the information is incomplete, thus skewing the resulting data.

"Absolutely not," says Austin, "we only use the most authoritative primary sources for all of the information in the magazine, including the city rankings."

She continues saying that her hope is that the readers have fun reading the rankings, "but we take our research very seriously, because we know our readers use it to make life-changing decisions."

Hendrick cites two examples from the report, that only one park was listed and no health food stores are mentioned.

"Park data, for instance, includes all park district land in or accessible to the area, and comes from the state parks data, Department of the Interior and ESRI, a map software production company," says Austin. She adds that, in fact, Tulsa ranked slightly above average for access to parks.

"They (Self) also looked at the number of fast food restaurants in Tulsa," Hendrick says, which are plentiful here in the fast food capitol of the world. Self's results stated that "Tulsa has 50 percent more fast food and pizza places per capita than healthy-eating Oakland, as well as local hot spots serving steaks and ribs."

Austin is quick to mention that "no one negative . . . weakness (such as) for fast food can land an area at the bottom of the list." And to those who say healthy meals are available at fast-food restaurants, Austin says, "It's absolutely true that women can eat healthily in almost any restaurant if they make smart choice, and Self tries to help them do that.

"But on average the experts we consults suggest that the availability of fast food, compared to the consumption of fruits and vegetables, is an effective way of judging eating habit."

One thing Tulsa does have going for it, as Hendrick added, is that Tulsa restaurants are now non-smoking.

He said another study conducted by Sports Illustrated recently which gave Tulsa high marks for having more "certified activities (biking events, runs, trails) than other cities our size." Moreover, he says Tulsa has 120 city parks, 20 recreational centers and reiterates Lister's comment about the 100 miles of running tracks throughout the city and beyond.

"There are tracks which go from Tulsa to Skiatook, even Bixby to Skiatook," he says. More information on these and other trails, says Hendrick, may be found at www.incog.org.

In addition, the City of Tulsa manages roughly 6,000 acres of parks including nature centers, golf courses, Tulsa Zoo & Living Museum, Tulsa Garden Center, 21 swimming pools 156 sports fields, 115 playgrounds, 123 tennis courts, 25 water playgrounds, The River Skate Park, 60 picnic shelters, 14 community centers, fitness facilities and gymnasiums.

Healthy Environment, Unhealthy Reality

While Tulsa does provide many ways to be healthy and fit, the reality statistics reveal about the health status of Tulsans is that most people do not take advantage of these opportunities. According to Melanie Christian, Director of Marketing, Creative Services & Media for the Tulsa Health Department, for many years now Oklahoma has ranked low as far as nutrition, exercise and tobacco use are concerned.

"Some general statistics which contribute to our unhealthy status in Tulsa County are these: 22.9 percent use tobacco; 21.2 percent are obese; 11.6 percent live in poverty; and 19.3 percent are uninsured," Christian says, which confirms the data Austin mentions earlier.

Austin also mentions that in Tulsa, women's rates of violent crime, rape, smoking, cancer, heart disease and allergies are all higher than average, while women have less access to doctors, hospitals and insurance compared to other places they looked at.

"Tulsa has the lowest score on our list for healthy eating habits, which means on average women eat fewer fruits and vegetables and more fast food per capita than anywhere else," says Austin.

Christian has the data to support Austin's claim. She states that in Oklahoma, 85.7 percent of the population does not eat five or more fruits and vegetables daily. Austin suggests the eating of vegetables in any fashion--fresh, frozen, basically any way but fried, is a simple and proven way to prevent obesity and disease.

Christian notes that the Centers for Disease Control conduct surveys each year to project this daily consumption of fruits and vegetables, and Oklahomans average 2.4 servings a day; 5-9 are what the CDC recommends. Christian feels that the number is really lower, for in studies she has conducted, many people do not even know what a "serving" constitutes---blueberries in a blueberry muffin do not count as a fruit serving, she says, adding that "a lot of education needs to be done."

"It is important to note that the leading causes of death (heart disease, stroke and diabetes) in our country are, in most circumstances, diseases that can be prevented through proper nutrition (fruits and vegetables), exercise and not using tobacco," Christian says.

Austin's data also confirms "the death rate of women from heart disease in the Tulsa area is 28 percent higher that our list average, and the average body-mass index is nearly 27 (according to the CDC)." Any score over 25 is overweight and unhealthy, she adds.

Austin mentions a few other unhealthy factors, such as the roads in Tulsa are more dangerous than average. "Residents are nearly 50 percent more likely than average to die in an auto accident."

"Living in poverty" can be a factor, according to Christian. What exactly does that mean and why? According to the Federal Poverty Income Guidelines as published in the Federal Register, January 2006, one person whose monthly income is $816.67 or annual income is $9,800 is at the 100 percent poverty level. A monthly income of $1,666.67 for a family of four is at the 100 percent poverty level.

Teach Your Children Well

Why are these people--11.6 percent of the population in Tulsa County--at risk? Dan Arthrell, Director of Public Policy for the Community Service Council of Greater Tulsa, says there is a direct relationship of poverty to malnutrition and obesity: most people in poverty eat foods high in starch and fats. "It's a nutritional thing," he says.

"People who are in poverty buy the foods that they can afford, most of which are products with starch and sugar (and fructose and corn syrup which turn to sugar)." He adds that these are foods which taste good and get that "I like it!" taste and immediate personal gratification.

Changing or modifying behaviors to be healthy adults can be difficult, so it's the children who really need to be educated and helped on the subject.

This is proven in a study Arthrell mentions which reveals the long-lasting effect of early childhood experiences. Psychological issues, says Arthrell, can physically change the brain. He gives an example of women who were victims of child abuse who have a greater chance of being an unhealthy, obese adult. One must follow the logic out to see how this happens.

These women who were abused have a greater possibility (than those who were not abused) to become depressed, depression often leads to overeating, which leads to obesity, diabetes and/or heart disease. Arthrell mentions that Oklahoma ranks in the top 15-20 states in child abuse cases in the nation.

For this study, "adverse childhood experiences" (ACE) categories include three pertaining to personal abuse--recurrent physical abuse, recurrent emotional abuse and sexual abuse; four categories pertained to growing up where the parents were separated, divorced or in some way lost to the patient during childhood; growing up in a dysfunctional household (with an alcoholic person or drug user); growing up where someone was in prison, where someone was chronically depressed, mentally ill or suicidal; and growing up where the mother was treated violently.

The Adverse Childhood Experiences (ACE) Study, Arthrell mentions, is a major research study that compares current adult health status to childhood experiences decades earlier. Some 17,400 adult Health Plan members of the Kaiser Permanente cooperated in this study. The ACE findings show that "adverse childhood experiences are vastly more common than recognized and had a powerful correlation to adult health a half-century later."

The ACE Study reveals "a powerful relation between our emotional experiences as children and our adult emotional health, physical health and major causes of mortality in the United States." Important to note is the fact that in many of these cases, time does not heal some of the adverse experiences--one does not "just get over" some things.

Some of the findings Arthrell has summarized are as follows: current smoking has a high degree of association with what happened decades ago in childhood; depression, chronic obstructive pulmonary disease (COPD) and intravenous drug use have a strong relationship to childhood trauma.

Moreover, this study shows that many other measures of adult health to have a strong, graded relation to what happened in childhood include obesity, diabetes, heart disease, alcoholism, hepatitis, fractures, occupational health and job performance.

"Primary prevention," according to the study summary prepared by the Community Service Council of Greater Tulsa, "is the key--working with families to affect good early childhood experiences and reduce adverse experiences."

This brings the situation back to the education of families, parents and children alike, says Christian. The high percentage of those in poverty and the uninsured will continue to rise, and the ranking of Tulsa being labeled an unhealthy place to live will continue without education and change of behavior.

"With any rankings (such as those in Self and Men's Fitness) there will always be some inaccuracies," says Christian, "but it does bring attention to us as a community. Regardless of this study, we are an unhealthy city and state." Lack of sound nutrition, lack of exercise and high tobacco use are the main contributors leading to death.

Christian says it must be a community effort to change these trends in lifestyles, and great strides are being made within the Tulsa community.

"We are making headway in tobacco use," she says. "No one group can take this on," she says. "It's the legislature, smoke-free restaurants and awareness campaigns that are helping to lower the tobacco use."

Christian says between 1999 (with the beginning of the anti-tobacco initiative in Tulsa County) and 2005 the reduction of tobacco usage among high school students in Tulsa County was 41.3 percent and among middle school students, it was 51.6 percent.

Christian cites many programs and services the Health Department has to educate on being healthy, such as the immunizations, ways to prevent disease, and the routine inspections at all restaurants, but her recommendation as the one which may have long-lasting benefit is the Women, Infant and Children (WIC). With this nutrition program, mothers are offered nutrition classes and receive food vouchers to purchase healthy foods.

"The biggest program we have is 'It's All About Kids' school health program which targets children in elementary schools; currently 22 schools participate in not only Tulsa, but Sand Springs, Union, and Broken Arrow.

"The focus is on healthy eating and exercise," says Christian, but when they initiated this program in the schools, it was immediately discovered from the teachers that other issues needed to be addressed first, such as training teachers how to reward children who improve on their classroom behavior--with something other than candy.

"Other immediate issues were dealing with head lice and children not bathing properly. These issues were addressed and are now part of the program.

"Anything that impacts the health of the child, teacher and parents is covered, such as exercise, nutrition, parenting skills (in the form of classes--even cooking classes), kids' decision-making skills, dental awareness, grooming and more," says Christian. Many children are not receiving these basic health skills in the home.

One other service that is helping to bring Tulsa and the state stats up to a healthy level is the Health Department has partnered with the OU-Bedlam Alliance for Community Health clinic which treats underinsured and uninsured families who otherwise would not have health care. The Health Department does the prevention part while the clinic treats the families. "This is a fantastic service to this population," says Christian.

Silk Purse?

Austin did find a few Tulsa positives in the data collected. "Every community has strengths as well as challenges, though," she says. "On the plus side, Tulsa women have below-average drinking rates and a shorter-than-average commute of 48-minutes round trip," comparing to New York City, which has an average commute of 85 minutes. "Tulsa also scored in the top fifth of the list for air quality, according to the EPA figures."

Pulling up from some of the unhealthy statistics in Tulsa and Oklahoma in general will not happen overnight, especially not even next year if it is again chosen and ranked among other cities in the nation by Self and Men's Health magazines. While Hendrick and Lister laud the city's opportunities to be fit and healthy, it's more than just having these opportunities.

Hendrick says that in many ways Tulsa cannot compete with some of the "healthy" cities listed in Self, such as those with mild climates, their proximity to beaches and mountains. These are added amenities for people in these cities.

Still, Austin, says, people can work with their location to make the best of it. "Certainly some cities such as Honolulu, this year's healthiest place," says Austin, "have built in advantages such as a beautiful, clean environment and year-round warm weather.

"Then again, our fittest city this year is Seattle, which is not known for its fabulous weather. Women we talked to there emphasized embracing their environment instead of fighting against it."

She says these women do that by buying the right all-weather workout clothes, biking to work, being part of a sports league or otherwise making exercise part of their daily routine.

"And Fargo-Moorhead is our 'happiest place,'" Austin adds. This city has the "lowest rates of depression and suicide on Self's list--women there told us the severe winters make them hardy and resilient."

As Austin concludes, "it's all about using the best of what your hometown offers, and working in your own life and with your neighbors to change what isn't so great."

Education is part of this equation, and "intervention early on helps," says Christian. "It is a community effort, and it can be done," believes Christian.