Obesity and overweight are ongoing health concerns nationwide. They are risk factors for a range of chronic
diseases, including heart disease, stroke, some cancers, 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. Additionally, the distance that many rural residents must travel to
healthcare facilities, exercise facilities, and healthy food is an ongoing barrier.
To address these challenges, rural communities can invest in facilities and infrastructure that support access
to healthy food, fitness, and healthy lifestyles. Communities may also choose to develop programs and services
that help rural residents learn about the health risks of overweight and obesity, as well as adopt healthy
lifestyle behaviors to control their weight.
The Rural Obesity Prevention Toolkit provides resources to help rural
communities develop an obesity prevention program, building on best practices of successful obesity
How do rural areas compare to urban areas regarding obesity rates?
Obesity Prevalence Among Adults Living in
Metropolitan and Nonmetropolitan Counties — United States, 2016 reports that, based on self-reported
height and weight responses to the 2016 Behavioral Risk Factor Surveillance System (BRFSS) survey, obesity is
more prevalent among adults residing in nonmetropolitan areas (34.2%) than among adults residing in metropolitan
areas (28.7%). The largest nonmetropolitan and metropolitan differences in obesity prevalence occurred in the
South (5.6%) and Northeast (5.4%) Census regions.
This report also found obesity to be more prevalent among nonmetropolitan Hispanic (36.0%), non-Hispanic Black
(44.2%), and non-Hispanic White (33.2%) populations, compared to metropolitan Hispanic (32.9%), non-Hispanic
Black (37.7%), and non-Hispanic White (27.5%) populations.
The context a child grows up in can influence the potential for a child becoming overweight or obese. A
childhood obesogenic environment index (COEI), created by the Rural & Minority Health Research Center,
combines 10 factors related to obesity, including exercise opportunities and access to healthy foods, into an
overall score. Based on this index, Development of a
National Childhood Obesogenic Environment Index in the United States: Differences by Region and Rurality
reports a higher average score for rural counties (52.9 points) compared to metropolitan counties (46.5 points),
with greater values assigned to environments with an increased risk of childhood obesity. This map shows
county-level data on average COEI scores in the United States.
What are some factors contributing to rural obesity?
Limited access to obesity prevention programs and weight management services
Fewer opportunities for children to be physically active in afterschool sports or events
Scarcity of parks, recreational areas, sidewalks, bike trails, and exercise facilities that promote physical
Reliance on automobiles to meet transportation needs, rather than walking or biking
The USDA Food
Environment Atlas shows metro and nonmetro data on issues such as food access, socioeconomic
characteristics, food assistance programs, and built environment. The map below, from a 2015 Preventing Chronic
article, shows county-level access to parks and recreation facilities, based on data collected for the
2014 County Health Rankings and Roadmaps. Darker counties indicate areas where fewer residents have adequate
access to exercise opportunities:
The higher prevalence of obesity and overweight among rural residents may be a contributing factor for higher
rates of chronic diseases in rural communities. The Centers for Disease Control and Prevention’s Health,
United States, 2019Table 13 reports
higher rates of heart disease and cancer within non-metropolitan areas. The following rates are for
Prevalence of Heart Disease and Cancer Among Adults by Location of Residence
What can rural healthcare providers do to address obesity and overweight?
To address obesity and overweight, rural clinics and hospitals can offer wellness classes and activities that
encourage healthy diet and exercise, such as sessions on nutrition, preventing heart disease, and controlling
diabetes. Hospitals that have exercise equipment for rehabilitation may want to make their workout areas
available to the entire community. The Rural
Prevention Toolkit identifies a range of evidence-based programs for healthcare providers to address
How can local public health agencies help prevent obesity?
Local public health agencies may find that by developing community partnerships with schools, healthcare
providers, local businesses, and community groups, they can strengthen their mission to create opportunities for
healthy living and reduce obesity and overweight in their communities. No one intervention or activity alone may
solve the problem of obesity. However, when a variety of activities and programs are offered collaboratively,
they can encourage and reinforce lifestyle changes that support healthy behaviors and reduce obesity. Projects
or programs that can be conducted by public health agencies and their partners may include:
Creating a community food policy council focused on healthy food choices as well as their availability and
Providing nutrition education and wellness classes for the community and schools to increase the consumption
of fruits and vegetables and increase physical activity
Working with local grocery stores and restaurants to help consumers make healthier choices by offering
affordable and healthier foods
Developing or expanding farm-to-institution programs in schools, hospitals, and workplaces
Developing or expanding a farmers' market that is easily accessible within the community
Partnering with schools to establish policies offering healthier food choices in the school cafeteria and in
Promoting the maintenance of parks and recreational areas for walking, biking, and other physical activities
for the entire community
Collaborating with healthcare services, wellness centers, food vendors, and local businesses to support
wellness events or health fairs
Supporting community projects that make neighborhoods safer for outside activities including bicycle riding
and walking to school
To guide public health practitioners and program managers in developing obesity prevention programs, the Centers
for Disease Control and Prevention's (CDC) Overweight & Obesity Prevention
Strategies and Guidelines provides a variety of resources and describes strategies to increase physical
activity and the consumption of healthy food.
What role can rural schools play in encouraging healthy weight?
Schools can play a key role in encouraging healthy weight of children and adolescents by developing programs and
policies supporting healthy lifestyle behaviors, such as good eating habits and regular physical activities.
Schools can begin by offering healthy choices in school lunches, placing nutritious snacks in vending machines,
by providing learning opportunities that promote healthy eating and an understanding of good nutrition. Schools
can also design physical education programs to encourage children to develop an active lifestyle.
Integrating school health services with nongovernmental entities
Supporting the formation of health councils and use state and local data to guide decisions
Supporting wellness policies and professional development opportunities for local leaders
Investing in physical education and nutrition standards in schools
Promoting student input and engagement regarding wellness policies
The most effective school programs are comprehensive ones that address food service, physical education,
classroom education in the importance of healthy lifestyles and decision-making, and include community/parent
involvement. The CATCH Program (Coordinated Approach to Child Health) is
an example of a comprehensive obesity prevention program. For other examples of evidence-based programs schools
can implement, see How Can Rural
Schools Address Obesity? in the Rural Obesity Prevention Toolkit.
For additional information about the role rural schools can play in children's wellness, including nutrition and
physical activity, see the Rural Schools and Health topic guide.
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, and/or work with neighboring
communities to expand opportunities. Facilities may already exist in some communities that could serve the
public as a community resource. For example, rural communities could enter into shared user-agreements with a
local high school or community college opening their pool to the community for swimming, or gymnasium for early
morning or after-hour community activities.
Several resources are available to help rural communities identify a suitable program to meet their needs:
The Community Guide developed by CDC is a collection of
evidence-based interventions in community settings to improve health and prevent disease. Searchable topics
include obesity, nutrition, and physical activity.
Active Living in Rural Communities summarizes the characteristics of rural communities that may
affect obesity and overweight, discusses observations from the field, and examines lessons learned from
rural active living interventions.
Where can I find examples of obesity prevention or weight control programs that work in rural areas?
The Rural Health Models and Innovations
section features examples of programs and interventions that have shown to be successful in preventing
and reducing obesity and improving participation in healthier lifestyles. Examples include:
Healthy Early Learning Project (HELP) – An integrated program
addressing childhood obesity developed for public school preschool sites and Head Start sites in the rural
Kansas counties of Marshall and Nemaha. Each site implemented a research and evidence-based program to
increase physical activity and healthy food consumption of preschoolers ages 0 to 5.
Win with Wellness – A partnership of county health departments,
local healthcare providers, a regional nonprofit, and a medical school organized to develop weight-loss
support groups and health education classes addressing obesity and chronic disease in rural Stephenson and
Carroll counties of Illinois, where a large portion of the adult population in this rural area is overweight
or obese, and the rates of diabetes, heart disease, and smoking are higher than in other parts of the state.