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Rural Obesity and Weight Control

Obesity and overweight are ongoing health concern nationwide. They are risk factors for a range of chronic diseases, including heart disease and type 2 diabetes. Rural areas experience higher rates of obesity and overweight than the nation as a whole, yet many rural communities do not have the resources to address this critical health concern. Rural healthcare facilities are less likely to have nutritionists, dietitians, or weight management experts available. Rural areas may lack exercise facilities and infrastructure to encourage physical activity. Access to healthy and affordable food is also limited in many rural communities. To address these challenges, rural communities can develop programs and services that help rural residents learn about and adopt healthy habits to control their weight. Communities may also choose to invest in facilities and infrastructure that support fitness and health.

Frequently Asked Questions

How do rural areas compare to urban areas regarding obesity rates?

The 2014 Update of the Rural-Urban Chartbook reports that, based on 2010-2011 data, self-reported obesity and overweight increases by rurality, with the most remote areas having the highest levels. In all regions, obesity and overweight is higher among women.

Rural/Urban Obesity Rates in Adults
Source: The 2014 Update of the Rural-Urban Chartbook, Data Tables

A 2012 Journal of Rural Health article, Prevalence of Obesity Among Adults From Rural and Urban Areas of the United States: Findings From NHANES (2005–2008), examines rural obesity rates based on measured rather than self-reported height and weight. This study reported a rural adult obesity rate of 39.6%, compared to 33.5% for urban adults. Even when controlling for demographics, physical activity, and diet, obesity was higher for rural residents. The study also found that rural participants ate a diet higher in fat.

Are rural children at greater risk of obesity and overweight?

The Health and Well-Being of Children in Rural Areas: A Portrait of States and the Nation 2011-2012 reports higher rates of obesity and overweight in rural children aged 10-17, compared to the U.S. as a whole. Obesity and overweight are more common among rural black and Hispanic children than white children. Rates vary by level of poverty, but generally rural areas fare worse than urban across poverty levels.

Child Obesity by Location and Race/Ethnicity
Source: The Health and Well-Being of Children in Rural Areas: A Portrait of States and the Nation 2011-2012

What are some factors contributing to rural obesity?

Obesity has long been considered a cause for concern in rural areas. The National Advisory Committee on Rural Health and Human Services (NACRHHS), in its 2005 Report to the Secretary, focused a chapter on obesity. In the 2011 NACRHHS Report to the Secretary, the committee focused on rural childhood obesity.  Some of the factors identified in these reports as contributors to rural obesity include:

  • Poverty
  • Limited access to healthy and affordable food
  • Unhealthy diet, higher fat and calories than the average American diet
  • Lack of nutrition information and programming
  • Limited access to obesity prevention and treatment services
  • Fewer opportunities to be physically active
  • More sedentary rural jobs
  • Challenges related to community infrastructure, such as lack of sidewalks, trails, and exercise facilities

This map, from a 2015 Preventing Chronic Disease article, shows county-level access to parks and recreation facilities, based on data collected for the 2014 County Health Rankings and Roadmaps. Darker areas indicate fewer residents have adequate access to exercise opportunities:

Percent of Population with Adequate Access to Exercise Opportunities
Source: Development of a Nationally Representative Built Environment Measure of Access to Exercise Opportunities, Preventing Chronic Disease, 12

How does obesity impact health?

According to Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults, a 1998 National Institutes of Health report, overweight and obesity is associated with higher rates of:

  • High blood pressure
  • Type 2 diabetes
  • Heart disease
  • Stroke
  • Gallbladder disease
  • Osteoarthritis
  • Sleep apnea and respiratory problems
  • Some types of cancer
  • Pregnancy complications
  • Depression

The higher rate of rural obesity may be a contributing factor for higher rural rates of chronic diseases. For example, the Centers for Disease Control and Prevention’s Health, United States, 2016 Table 38 reports the following rates for 2014-2015:

Prevalence of Heart Disease, Cancer, and Stroke Among Adults by Location of Residence
  Metropolitan Area Outside Metropolitan Area
Heart disease 10.3% 13.1%
Cancer 5.8% 6.3%
Stroke 2.3% 2.9%
Source: Health, United States, 2016. Table 38

For more information and resources focused on chronic disease in rural areas, see RHIhub’s Chronic Disease in Rural America topic guide.

What can rural healthcare providers do to address obesity and overweight?

Rural clinics and hospitals can offer classes that encourage healthy diet and exercise, such as sessions on nutrition, how to prevent heart disease, controlling diabetes, and similar topics. Hospitals that have exercise equipment for rehabilitation may want to make their workout areas available to the entire community. RHIhub’s Rural Obesity Prevention Toolkit identifies a range of evidence-based programs for healthcare providers.

Primary healthcare providers can be a good resource for providing information on healthy diet and physical activity to their patients. The Agency for Healthcare Research and Quality offers a toolkit, Integrating Primary Care Practices and Community-based Resources to Manage Obesity: A Bridge-building Toolkit for Rural Primary Care Practices, to help rural primary care practices connect their patients to obesity management resources. In addition to offering a step-by-step process, the toolkit includes sample forms, worksheets and other materials than can be adapted.

How can local public health agencies help prevent obesity?

Local public health agencies could serve by developing community partnerships with schools, healthcare providers and community groups to ensure that exercise and healthy eating classes are being offered, schools and restaurants are offering healthy choices, and to support the development of walking trails and bike paths for the entire community. Many local public health agencies have also become involved in policy development.

The National Association of County and City Health Officials (NACCHO) has undertaken various projects focused on obesity prevention, physical activity, and nutrition. In addition, NACCHO’s Model Practice Database includes many promising approaches public health agencies have used to address obesity, including examples from rural communities.

What role can schools play in encouraging healthy weight?

Schools can support healthy eating habits in children by offering nutritious snacks and lunches and by teaching proper nutrition. Physical education programs are also important to ensure that children develop an active lifestyle. School and community-based gardens are another good approach to encourage healthy eating. Students can benefit from growing their own fruits and vegetables and then consuming them in school and community-supported lunch programs.

The most effective school programs are comprehensive ones that address food service, physical education, classroom education in the importance of healthy lifestyles and health decision making, and include community/parent involvement. The CATCH Program (Coordinated Approach to Child Health) is an example of a comprehensive obesity prevention program. RHIhub’s Rural Obesity Prevention Toolkit identifies additional evidence-based programs for schools.

What can rural communities do to help reduce obesity?

Walking clubs, support groups for weight management, and healthy cooking and exercise classes are a few possibilities for supporting healthy weight throughout the community. Rural communities may want to develop a wellness center, bike trails, or walking paths to encourage healthy lifestyles. Facilities may already exist in some rural communities that could become community resources. For example, a local college might open its pool to community swimming and exercise classes or a school gymnasium might be open after-hours for community use.

RHIhub’s Rural Obesity Prevention Toolkit identifies a variety of evidence-based programs for rural communities. The Community Guide also provides examples of successful obesity prevention activities in community settings.

The CDC's Communities Putting Prevention to Work Resource Center lists tools communities can use to help improve health:

The USDA's National Institute of Food and Agriculture (NIFA) works with land-grant universities and extension agents on a range of issues including obesity:

Last Reviewed: 6/12/2015