Rural America Fatter Than Urban America

Sept. 14, 2012— -- City slickers are slimmer than their country counterparts, according to a new study that suggests rural obesity is a bigger problem than we realized.

A national study in the Journal of Rural Health of over 8,800 Americans showed that country folks were nearly one-fifth more likely to be obese compared to those living in cities. In other words, the findings suggest, where you live is important in obesity.

"The rates of obesity were much higher than previously reported based on self-report, with 39 percent of rural Americans being obese compared to 33 percent of urban Americans," said study lead author Christie Befort, an assistant professor in the Department of Preventive Medicine at the University of Kansas Medical Center in Kansas City, Kan.

Past studies have asked people about their weight, but researchers in this study were more precise. They carefully collected their data on obesity through a national database based on adults who stepped on a scale and had their height measured. "We know people tend to overestimate how tall they are and underestimate how much they weigh," said Befort. The authors were astounded to discover that the rates of obesity in rural populations were nearly double compared to prior studies based on self-reported estimates.

This study defined obesity as a body mass index equal to or greater than 30 kg/m2. To figure out your body mass index, click here to use a calculator from the Centers for Disease Control and Prevention.

So who is obese in rural America? Apparently, the problem is greatest among young people.

"The differences between rural and urban were most pronounced for younger adults between the ages of 20 and 39," said Befort. The researchers suspect that the increasing mechanization of rural jobs may be the cause. "The diet hasn't necessarily changed at the same time the manual labor requirements have gone down."

"It's really remarkable that younger adults are sharing more of a burden than older rural adults," said Harold Kohl III, a professor at The University of Texas School of Public Health in Houston, who was not involved with the study. "It's important because they've got longer to live and they will live longer with the consequences of carrying too much weight."

Certain ethnic groups in rural areas are also at greater risk for obesity. Barry M. Popkin, professor of nutrition at the School of Public Health at the University of North Carolina at Chapel Hill, who was not involved with the study, points out that this study also shows that rural blacks and Hispanics are more likely to be obese than urban blacks and Hispanics.

It's also important to understand the root causes of rural obesity. The researchers point to two factors -- diet and physical isolation.

The study found that the overall diet of country people is much higher in fat.

"My own family has rural roots in Kansas," said study author Befort, She told of visiting her grandmother's kitchen as they prepared for a potluck.

"A whole jar of mayonnaise was going into a casserole dish," she said. "I was like, 'Do you know how many calories are in a tablespoon of mayonnaise?'"

The response, Befort recalls, was, "Oh Christie! It tastes good!"

"There is very little awareness and concern about how preparation contributes to calories in the food," she said.

While country diets remain high in fat, rural residents also face challenges to buying healthy food.

"There is some perception that rural areas have better access to fresh vegetables because of farming," said Dr. Joseph A. Skelton of Wake Forest Baptist Health -- Brenner's Children's Hospital in Winston-Salem, N.C., who was not involved in the study. "Many farms practice mono-agriculture, such as corn, and may not get access to a wide variety of vegetables."

There are many studies to show that rural Americans have worse shopping access to healthy food choices, added Popkin.

In addition to the lack of access to healthy food, rural dwellers face barriers to healthy living because of their physical isolation.

"It's tough to get to a gym if you live outside of a town without one," said Befort, "Physical activity is now needed to compensate for diet and technology. That requires cultural change because rural areas typically don't have a culture of physical activity as leisure time."

Nearly 70 million or one-quarter of Americans call rural areas home, according to the study. Rural residents face greater challenges to living healthy lives. As rural communities continue to dwindle in size, rural health issues are often overlooked. This study reminds us that obesity is another challenge that rural Americans face.

"Rural America is fatter than urban America," said Popkin, "We've ignored rural America in public thinking. We do know this is a population with major needs."