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Rural Obesity and Weight Control

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. Further, the distance that many rural residents must travel to access healthcare facilities, exercise facilities, and healthy food is an ongoing barrier.

To address these challenges, rural communities can develop programs and services that help rural residents learn about the health risks of overweight and obesity, and adopt healthy lifestyle behaviors to control their weight. Communities may also choose to invest in facilities and infrastructure that support fitness and health.

Frequently Asked Questions

How prevalent is obesity in rural areas?

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. Obesity and overweight is higher among women in all rural areas, including non-core (small rural) and micropolitan (large rural) areas, as well as in the U.S. as a whole.

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), examined rural obesity based on measured rather than self-reported height and weight. This study reported that the prevalence of obesity among rural adults was 39.6%, compared to 33.5% for urban adults. Obesity was higher for rural residents, even when controlling for demographics, physical activity, and diet. The study also found that rural participants ate a diet higher in fat.

Racial/Ethnic Health Disparities Among Rural Adults — United States, 2012-2015 summarizes a study evaluating self-reported data from the 2012–2015 Behavioral Risk Factor Surveillance System regarding racial and ethnic disparities in rural areas. This report found obesity to be more prevalent among rural Hispanics (35.5%), non-Hispanic blacks (45.9%), and American Indian/Alaska Native (35.5%) compared to rural non-Hispanic whites (32%).

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 a higher prevalence 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 rural white children. Prevalence varies 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 and overweight 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, dedicated a chapter to obesity. In the 2011 NACRHHS Report to the Secretary, the committee focused on rural childhood obesity. The State of Obesity 2019: Better Policies for a Healthier America also reports rural counties have a higher prevalence of obesity for adults and children than their counterparts in urban counties. Some of the factors identified in these reports as contributors to rural obesity include:

  • Influence of poverty
  • Limited access to healthy and affordable food
  • Higher calorie consumption
  • Lack of nutrition education and services
  • 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 activity
  • Reliance on automobiles to meet transportation needs, rather than walking or biking

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 counties indicate areas where 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 the National Institute of Diabetes and Digestive and Kidney Diseases, overweight and obesity increase the risk of several other health problems. These include:

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

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, 2018 Table 13 reports higher rates of heart disease, cancer, and stroke within non-metropolitan areas. The following rates are for 2016-2017:

Prevalence of Heart Disease, Cancer, and Stroke Among Adults by Location of Residence
  Metropolitan Area Outside Metropolitan Area
Heart disease 10.1% 12.6%
Cancer 6.3% 6.6%
Stroke 2.7% 3.0%
Source: Health, United States, 2018. Table 13

For more information about chronic disease prevalence and treatment in rural areas, see RHIhub’s Chronic Disease in Rural America topic guide.

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. RHIhub’s Rural Obesity Prevention Toolkit identifies a range of evidence-based programs for healthcare providers to address obesity.

Primary care providers can serve as an information source to their patients on healthy diet and physical activity. 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 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 task 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, their availability and distribution
  • 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 vending machines
  • 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.

CDC also publishes Healthier Food Retail: An Action Guide for Public Health Practitioners. This publication discusses ways public health agencies can partner and coordinate with food retailers to support healthier eating, and includes examples of obesity prevention initiatives that can be implemented at the local or regional level.

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 and nutritious snacks in vending machines, and 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.

From the Harvard T.H. Chan School of Public Health, the School Obesity Prevention Recommendations: Complete List suggests several strategies for obesity prevention that support healthy lifestyle behaviors among children and adolescents. Suggested strategies include:

  • Incorporating nutrition and physical education as part of the curriculum
  • Offering healthier food choices in cafeterias that meet national nutritional standards
  • Giving adequate time for students to eat their lunch
  • Supplying adequate access to drinking water
  • Encouraging physical activity during recess
  • Developing walking and bicycle routes that are safe
  • Establishing and supporting school gardens
  • Providing wellness programs for faculty and staff
  • Training food service staff on ways to provide healthy food
  • Continuing health education training for teachers
  • Inspiring school employees to model healthier lifestyle behaviors

CDC’s School Health Guidelines to Promote Healthy Eating and Physical Activity provides guidelines for developing, implementing, and evaluating school-based healthy eating and physical activity programs and policies for students in grades K-12. Also, CDC’s School-Based Obesity Prevention Strategies for State Policymakers identifies strategies, as well as policies, that have shown to be helpful in addressing childhood obesity in schools.

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 RHIhub’s Rural Obesity Prevention Toolkit.

For additional information about the role rural schools can play in children’s wellness, including nutrition and physical activity, see RHIhub’s 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:

Where can I find examples of obesity prevention or weight control programs that work in rural areas?

The Rural Health Information Hub’s Rural Health Models and Innovations features examples of programs and interventions that have shown to be successful in preventing and reducing obesity and improving participation in healthier lifestyles.

Examples of successful programs for rural obesity prevention are available in the Rural Obesity Prevention Toolkit. Other 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 non-profit, 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. 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.

Other sources for examples of obesity prevention and weight control programs can be found in NACCHO’s Model Practice Database. This database identifies and describes many promising approaches public health agencies have used to address obesity, including examples from rural communities.

Last Reviewed: 3/26/2018