LUMBERTON — Joanne Cosgriff grew up poor in Ireland; her family didn’t have a car, let alone money for diet foods or fitness centers, nutritionists or trainers. But her family didn’t need specialists to know how to live a healthy life because wellness was cultural.

“There was a culture of ‘get active,’” said Cosgriff, assistant director of Southeastern Lifestyle Center for Fitness & Rehabilitation. “If we ever had a big meal, it was just an inclination: After the big meal, everyone needs to get up and go for a walk. That was just something inherently that we did. It was healthy choices — choices for wellness.”

Recent studies show that despite its wealth of resources, America seems to have devolved from a culture of wellness to a culture of convenience. More than 60 percent of adults in the country are overweight or obese, and only 30 percent exercise regularly. In Robeson County, 36 percent of adults are obese. Data show that health increases with education and declines with poverty, and Robeson is the poorest county in North Carolina. But historically, general wellness — eating right and exercising regularly — is free.

“Everybody has a car, fast food is a lot easier and cheaper to get than going to the grocery store and chopping up vegetables to make a meal,” Cosgriff said. “I think with the age we live in, in this time of convenience, it’s harder for us to take that step back to basic, healthy choices.”

A National Health Interview Survey study released Tuesday by the Centers for Disease Control says that a 10-year information spree aimed at improving Americans’ health fell flat: From 1997 to 2007, obesity increased, and alcohol use, exercise and sleep habits remained unchanged; only cigarette smoking was curbed.

“Despite evidence of the potential harm of some health behaviors and substantial efforts to disseminate this information to the public, many Americans continue to engage in health behaviors that put them at risk of chronic disease and disability,” the study says.

On Feb. 17, the University of Wisconsin Population Health Institute ranked each state’s county-by-county health. Robeson County was ranked 98th of 100 counties in overall health. The county was ranked last for health factors, doing most poorly in socioeconomic factors and health behaviors — smoking, diet and exercise. When the study was released, county officials’ response echoed the CDC’s conclusions: The assistance and education programs are in place, but it’s up to people to change their lifestyles.

“It’s a matter of individual responsibility when it comes to diet and exercise,” Health Director Bill Smith said at the time. “You can only encourage people.”

Local experts say lifestyle changes don’t have to be major hurdles: “Start with everyday choices. I would encourage anybody, especially in Robeson County, just to start small with healthy choices,” Cosgriff said. “Don’t try to get straight to the top of the hill; start at the bottom and work your way up. A lot of people think of fitness and health as a huge obstacle. If you break it down and look at the elements, the small parts, and take one at a time, that’s the best way to reach your goals.”

A lifestyle change starts with two basic elements: healthy diet and regular exercise.

“It’s good to make healthy lifestyle changes anywhere from infant to elderly, throughout your life spectrum,” said Paige Fisher, a dietitian at Southeastern Regional Medical Center. The dietitians — five young women from Ohio, New York, and North Carolina — are charged with teaching patients whose unhealthy habits landed them in the hospital how to eat well.

The key is to take it slowly: “If you change things 180 degrees, they’re not going to stick with it or they’re not going to stick with it very long,” Fisher said.

Fisher says to start with a food diary. A week-long record allows people to see their eating habits and decide what they can change. From there, eliminate empty calories like soda and sweet tea, and start incorporating healthier cooking methods — bake, broil, sauté, steam, boil food rather than fry — and healthier choices when eating out — a grilled chicken burger instead of a cheeseburger, or a small fry instead of a large.

“People often think we’re going to put them on boiled chicken and brown rice. But there’s healthy ways to make a fried chicken — you bake it instead of fry it. It’s just about trying to look at your favorite foods in another light,” said Amber Gordon, a dietitian for children.

And watch portion sizes, which have grown as Americans gain weight. A single serving of chicken breast, worth 150 calories, is the size of a deck of cards. A serving of cereal or pasta, one cup, is the size of a baseball.

Then start incorporating fruits and vegetables. The dietitians recommend the New American Plate method: Half the plate should be filled with non-starchy vegetables like carrots, squash, or anything green; a quarter with protein like a lean meat; and a quarter with starch like brown rice.

“The farmers market is a great resource around here,” said Pattie Ramsaur, who leads the dietitian team. “You can get vouchers from WIC and supplemental foods to the farmers market. We can grow these things — we forget what are resources are in our own back yard.”

A key to reform is planning ahead, dietitians said.

“A lot of times people have 15 extra minutes in the morning, and instead of thinking ‘I’m going to stay at home and have some toast, have a little peanut butter on it or an apple,’ they take that 15 minutes and think, ‘I’m going to go through the drive-through and get my sausage-egg-and-cheese biscuit and I’m going to have hash browns and my giant Mountain Dew,’” Fisher said. “It’s just about using your time wisely. It just takes a little planning.”

The dietitians suggested oatmeal bars and yogurt cups for quick breakfasts, and fozen Lean Cuisine meals for easy lunches and dinners.

“Or think of one healthy meal you can cook, cook a lot of it, and save it as leftovers or freeze it for leftovers,” Ramsaur said.

The concept of healthy eating is ubiquitous in America, but an understanding of what that actually means is not — a problem the dietitians see frequently.

“It’s not something that’s covered in a lot of public schools, and a lot of people just have that K-12 education,” Fisher said. “When you’re trying to get across something as simple as what’s a carbohydrate, what’s a protein, what’s a fat, that might take a little more time with people who don’t have a science background.”

The prevailing theme in the CDC’s study was that education equals health: “Prevalence of healthy behaviors was strongly associated with education,” the study says. “Persons with higher levels of education were more likely than those with less education to have never smoked cigarettes, to be regularly physically active in their leisure time, to be of healthy weight, and to have usually slept seven to eight hours in a 24-hour period.”

According to the county rankings, only 51 percent of Robesonians graduate high school, and only 12 percent have college degrees.

SRMC established Community Health Services in 1995 in an effort to educate Robesonians about healthy living, primarily through free adult health screenings. Health screenings test blood pressure; height, weight and body mass index; and cholesterol and blood sugar, followed by a consultation so people know what their results mean.

Lekisha Hammonds, director of the Robeson County Partnership for Community Health, said the screenings each year garner about 1,000 participants, mostly female, though prostate screenings for men have grown steadily.

“We want for people to be aware of their numbers, to be aware of their health status,” Hammonds said. “Some people don’t know about that until they come to a free screening.”

Community Health Services also has a health library, Community Health Education Center, in Biggs Park Mall where people can check their weight and blood pressure, learn about illnesses and diseases, and borrow cookbooks — all for free. Carole Gavaghan has managed the library for 11 years and helps visitors, around 60 daily, search through brochures, Web sites, and thousands of PDF files that address health concerns.

The library is also the unofficial base for mall walkers. The group of about 30 — from young mothers pushing strollers to elderly men — gathers as soon as the mall opens. They walk laps, all in the same direction; five times around the mall is a mile, and some walk for distance and some for time.

One afternoon last month, an elderly man left his coat in the library while he walked laps. Gavaghan razzed him for not coming around regularly; he said he was getting back into the swing of things.

According to the CDC study, “adults living in the South were least likely to engage in regular leisure-time physical activity compared with adults living in any other region.” Adults in the South are also most likely to be obese. Nationally, men are more likely than women to be overweight, as are most ethnic minorities: currently, 70 percent of American Indians are overweight; 69.2 percent of blacks; 60.2 percent of whites; and 36.9 percent of Asians.

Cosgriff said that at Southeastern Lifestyle Center for Fitness & Rehabilitation, 4,000 people pay for a membership, but only about half of them use the facility.

“We don’t just want to collect money, we want people to come,” she said. “As an organization we have an interest in the community. We want there to be an option for people to take an interest in their health, to live longer and to live better.”

Cosgriff, who is a lifelong athlete, said exercise is not synonymous with gym membership. Walking or biking daily in parks — Lumberton has 11 neighborhood parks and five community parks — is free. The CDC recommends at least 30 minutes of moderate-instensity aerobic exercise five days per week; that means walking or biking hard enough to break a sweat. The CDC also recommends muscle-strengthening activities at least two days per week, which is as simple as push-ups, crunches and lunges.

Southeastern Lifestyle Center for Fitness & Rehabilitation, where half the members are 60 or older, offers low-cost classes for the old and the young.

For $25 monthly, older people can take Aqua for Daily Living water aerobics class; aerobic exercise that is easy on joints, so it’s better for older bodies. An hour-long Fit Kids class three times per week teaches exercise basics through high-activity games to children 5 to 12 years old. The class is free for fitness center members and $20 monthly for non-members.

Community Health Services also has a program aimed at youths: “When you work with kids, you’re really going to be impacting tomorrow, not today,” said Diane Zepaltas, a community dietitian with Project HEALTH.

Project HEALTH, an acronym for “healthy eating and active lifestyles for tomorrow’s health,” focuses health education on children up to fourth grade. The goal is to indoctrinate students with ideas of fitness and nutrition that will make future generations healthier than their parents.

But health officials say in order for children to grow into healthy adults, they need a good example.

“In order to change a culture, it’s got to come down the line: Your children are going to look up to you,” Cosgriff said. “If you don’t do anything about your health or you’re not worried about your lifestyle, then it’s more than likely going to follow your child and they’re going to do the same thing.”

Cosgriff says the key to improving Robeson County’s collective health is education.

“A culture can change,” Cosgriff said, describing how modern conveniences infiltrated Ireland when she was young. Her mother wanted to be healthy but was too poor to afford a gym membership, so “she’d go to a public swimming pool and swim laps — she’d walk there and swim laps and walk home.

“So I’ve come up in a culture where there wasn’t an emphasis on fitness as such, and then once life became more convenient, they did change,” Cosgriff said. “It’s not an easy process because you get so used to living in the culture you’re in, but starting small, with little changes and education ... will help change a culture.”