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 access 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 prevention programs.
Frequently Asked Questions
- How do rural areas compare to urban areas regarding obesity rates?
- Are rural children at greater risk of obesity and overweight?
- What are some factors contributing to rural obesity?
- How does obesity impact health?
- What can rural healthcare providers do to address obesity and overweight?
- How can local public health agencies help prevent obesity?
- What role can rural schools play in encouraging healthy weight?
- What can rural communities do to help reduce obesity?
- Where can I find examples of obesity prevention or weight control programs that work in rural areas?
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.
A 2018 JAMA article, Differences in Obesity Prevalence by Demographic Characteristics and Urbanization Level Among Adults in the United States, 2013-2016, examined rural obesity based on measured rather than self-reported height and weight. This study reported that the prevalence of obesity among nonmetropolitan adults was 43.1%, compared to 42.4% for adults from small metropolitan areas and 35.1% for adults from large metropolitan areas.
Are rural children at greater risk of obesity and overweight?
Differences in Obesity Prevalence by Demographics and Urbanization in US Children and Adolescents, 2013-2016 reports a higher prevalence of obesity among youth aged 2 to 19 years old in nonmetropolitan statistical areas (21.7%) compared to youth in large metro areas (17.1%) and medium or small metro areas (17.2%). This report also found that severe obesity was more prevalent among youth in nonmetro areas (9.4%) than among youth in large metro areas (5.1%) and medium or small MSAs (5.3%).
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?
Obesity and overweight have long been considered causes 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 2022: Better Policies for a Healthier America also reports that rural counties have a higher prevalence of obesity for adults and children than their counterparts in urban counties. Some contributors to rural obesity identified in these reports 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
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 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:
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
- Liver disease
- 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, 2019 Table 13 reports higher rates of heart disease and cancer within non-metropolitan areas. The following rates are for 2017-2018:
|Metropolitan Area||Outside Metropolitan Area|
|Source: Health, United States, 2019. Table 13|
For more information about chronic disease prevalence and treatment in rural areas, see the 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. The 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 that 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 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 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, placing 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 been shown to help address childhood obesity in schools. These policies and strategies include:
- 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 CDC Guide to Strategies to Increase Physical Activity in the Community provides information for program managers and policymakers to help them select action plans that will increase physical activity within their communities.
- 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.
- The Community Preventive Services Task Force's Built Environment Recommendation to Increase Physical Activity: Real-World Examples identifies examples of a combined approach of incorporating “activity-friendly routes” consisting of pedestrian, bicycle, and transportation systems with “everyday destinations” such as schools, parks, and city centers to increase physical activity within a community.
- The Rural Obesity Prevention Toolkit section How Can Rural Communities Address Obesity? identifies and describes a variety of evidence-based programs for rural communities.
- Promoting 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.
Examples of successful programs for rural obesity prevention are also available in the Rural Obesity Prevention Toolkit.
In addition, NACCHO's Model Practice Database identifies and describes many promising approaches public health agencies have used to address obesity, including examples from rural communities.
- High blood pressure.
- Coronary heart disease.
- Certain cancers.
- Bone and joint disorders.
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.What is a good research question about obesity? ›
Create Research Questions to Focus Your Topic
What factors cause obesity? Is obesity hereditary? Is obesity harmful to your health? Is obesity a physical or mental health issue?
- Lack of physical activity. ...
- Unhealthy eating behaviors. ...
- Not getting enough good-quality sleep. ...
- High amounts of stress. ...
- Health conditions. ...
- Genetics. ...
- Medicines. ...
- Your environment.
High blood pressure (hypertension). High LDL cholesterol, low HDL cholesterol, or high levels of triglycerides (dyslipidemia). Type 2 diabetes. Coronary heart disease.How can we prevent obesity in rural areas? ›
- Promote the availability of affordable healthy food and beverages.
- Support healthy food and beverage choices.
- Encourage breastfeeding.
- Encourage physical activity or limit sedentary activity among children and youth.
- Create safe communities that support physical activity.
Obesity affects children as well as adults. Many factors can contribute to excess weight gain including eating patterns, physical activity levels, and sleep routines. Social determinants of health, genetics, and taking certain medications also play a role.What are 5 factors that contribute to obesity? ›
Many factors influence body weight-genes, though the effect is small, and heredity is not destiny; prenatal and early life influences; poor diets; too much television watching; too little physical activity and sleep; and our food and physical activity environment.What are 3 keys to preventing obesity? ›
The most important strategies for preventing obesity are healthy eating behaviors, regular physical activity, and reduced sedentary activity (such as watching television and videotapes, and playing computer games).What is the most effective solution to the problem of obesity? ›
The best way to treat obesity is to eat a healthy, reduced-calorie diet and exercise regularly. To do this you should: eat a balanced, calorie-controlled diet as recommended by your GP or weight loss management health professional (such as a dietitian) join a local weight loss group.
- Approximately 15 million Americans have life-threatening obesity.
- Life-threatening obesity is defined as 100 pounds above ideal body weight or a BMI (body mass index) greater than 40.
- America is the heaviest nation in the world.
- 25 percent of U.S. children are overweight.
According to BMI, general population is classified in five categories: underweight (BMI < 18.5 kg/m2), normal weight (BMI 18.5-24.9 kg/m2), class I obesity - overweight (BMI 25.0-29.9 kg/m2), class II obesity - obesity (BMI 30.0-39.9 kg/m2), class III obesity - extreme obesity (BMI > 40 kg/m2).What are 6 foods that cause obesity? ›
- Sugar-sweetened beverages (soda, fruit drinks, sports drinks)
- Fruit juice (no more than a small amount per day)
- Refined grains(white bread, white rice, white pasta) and sweets.
- Potatoes (baked or fried)
- Red meat (beef, pork, lamb) and processed meats (salami, ham, bacon, sausage)
The fundamental cause of obesity and overweight is an energy imbalance between calories consumed and calories expended. Globally, there has been: an increased intake of energy-dense foods that are high in fat and sugars; and.What are 2 complications of obesity? ›
People with obesity are more likely to develop a number of potentially serious health problems, including: Heart disease and strokes. Obesity makes you more likely to have high blood pressure and abnormal cholesterol levels, which are risk factors for heart disease and strokes. Type 2 diabetes.Which foods cause obesity? ›
- Soda. Soda is high in calories and added sugar, yet it lacks important nutrients like vitamins, minerals, fiber, and antioxidants ( 1 ). ...
- Sugar-sweetened coffee. ...
- Ice cream. ...
- Pizza. ...
- Cookies and doughnuts. ...
- French fries and potato chips. ...
- Sugary breakfast cereals. ...
- Class I obesity: BMI 30 to <35 kg/m².
- Class II obesity: BMI 35 to <40 kg/m².
- Class III obesity: BMI 40+ kg/m².
As BMI increases, so do blood pressure, low-density lipoprotein (LDL, or “bad”) cholesterol, triglycerides, blood sugar, and inflammation. These changes translate into increased risk for coronary heart disease, stroke, and cardiovascular death: Obesity and Coronary Artery Disease.What are 3 strategies for maintaining a healthy weight? ›
- make healthy living a priority for yourself and your family.
- choose to eat good, healthy food.
- think '2 fruit and 5 vegies' every day.
- drink water instead of sugary drinks.
- shop to be healthy – and help your budget too.
- Genetics. Obesity has a strong genetic component. ...
- Engineered Junk Foods. Heavily processed foods are often little more than refined ingredients mixed with additives. ...
- Food Addiction. ...
- Aggressive Marketing. ...
- Insulin. ...
- Certain Medications. ...
- Leptin Resistance. ...
- Food Availability.
Choosing healthier foods (whole grains, fruits and vegetables, healthy fats and protein sources) and beverages. Limiting unhealthy foods (refined grains and sweets, potatoes, red meat, processed meat) and beverages (sugary drinks) Increasing physical activity.What government can do to reduce obesity? ›
Calorie reduction, marketing restrictions and sugar taxation are examples of government interventions.What are the treatment tools to prevent obesity? ›
- Healthy eating plan and regular physical activity.
- Changing your habits.
- Weight-management programs.
- Weight-loss medicines.
- Weight-loss devices.
- Bariatric surgery.
- Special diets.
Class 1: BMI of 30 to < 35. Class 2: BMI of 35 to < 40. Class 3: BMI of 40 or higher. Class 3 obesity is sometimes categorized as “severe” obesity.Which hormone is responsible for obesity? ›
The hormones leptin and insulin, sex hormones and growth hormone influence our appetite, metabolism (the rate at which our body burns kilojoules for energy), and body fat distribution. People who are obese have levels of these hormones that encourage abnormal metabolism and the accumulation of body fat.What are the 3 main components of weight control? ›
The key to losing weight is paying attention to the right combination of three components: good nutrition, physical activity and behavior modification.What is obesity in simple words? ›
At their most basic, the words “overweight” and “obesity” are ways to describe having too much body fat. The most commonly used measure of weight status today is the body mass index, or BMI.What is class 2 obesity called? ›
|Normal weight||18.5 – 24.9|
|Overweight||25.0 – 29.9|
|Obese (Class I)||30.0 – 34.9|
|Obese (Class II)||35.0 – 39.9|
Obesity is a main risk factor for developing type 2 diabetes, but it has not been previously seen as a major complication in type 1 diabetes. In type 1 diabetes, the body completely stops making insulin.What is the difference between being obese and morbidly obese? ›
Obesity is determined by your body mass index (BMI). This score is calculated by finding your height and weight on the BMI chart. Morbid obesity is defined by a BMI of 40 or greater.
- plenty of fruit and vegetables.
- plenty of potatoes, bread, rice, pasta and other starchy foods (ideally you should choose wholegrain varieties)
- some milk and dairy foods.
- some meat, fish, eggs, beans and other non-dairy sources of protein.
- just small amounts of food and drinks that are high in fat and sugar.
Eating eggs, particularly for breakfast, can be an excellent addition to a healthy weight loss diet. Eggs do not aid in weight gain; what aids in weight gain is a caloric surplus. If you consume more eggs than your maintenance calories, you will be in a caloric surplus and will gain weight.What is the main food for weight loss? ›
Vegetables of all kinds can assist with weight loss, says Feit. For example, cruciferous vegetables like broccoli, cauliflower, Brussels sprouts and cabbage are high in fiber and vitamins and help reduce digestive issues.
Obesity is simply defined as having too much body fat for your particular weight or height. An average figure from the relevant research estimates that obesity is about 40% genetic and 60% due to environmental factors.Where is obesity as its highest? ›
The most obese country by percentage of obese adults is Nauru, with 61% of adults falling in the obese category. Cook Islands fllows with 55.9%, and Palau just under that at 55.3%.Does stress gain weight? ›
The question of whether excess amounts of cortisol can lead to weight gain is essentially the same as asking if too much stress can cause you to put on unwanted pounds. The answer in both cases is yes.Why is obesity considered a risk factor? ›
Obesity makes you more likely to have high blood pressure and abnormal cholesterol levels, which are risk factors for heart disease and strokes. Type 2 diabetes. Obesity can affect the way the body uses insulin to control blood sugar levels. This raises the risk of insulin resistance and diabetes.What is obesity HPB? ›
guidelines recommend BMI cut-offs of 25 and 30 kg/m2 to define. overweight and obesity respectively. Based on body fat equivalence and. comorbid disease risk, BMIs of 23 kg/m2 and 27.5 kg/m2, respectively, have.Is obesity a CV risk factor? ›
Obesity contributes directly to incident cardiovascular risk factors, including dyslipidemia, type 2 diabetes, hypertension, and sleep disorders.What are three health risks associated with an elevated total fat range? ›
Obesity, defined as an excessive amount of body fat, is a common and expensive medical condition in the U.S., strongly associated with an increased risk of heart disease, stroke, type 2 diabetes, and certain types of cancer, as well as premature deaths from these diseases.
Many factors influence body weight-genes, though the effect is small, and heredity is not destiny; prenatal and early life influences; poor diets; too much television watching; too little physical activity and sleep; and our food and physical activity environment.What are 5 risks of obesity? ›
As BMI increases, so do blood pressure, low-density lipoprotein (LDL, or “bad”) cholesterol, triglycerides, blood sugar, and inflammation. These changes translate into increased risk for coronary heart disease, stroke, and cardiovascular death: Obesity and Coronary Artery Disease.What are the two types of obesity? ›
- Class I obesity: BMI 30 to <35 kg/m².
- Class II obesity: BMI 35 to <40 kg/m².
- Class III obesity: BMI 40+ kg/m².
BMI is an inexpensive and easy screening method for weight category—underweight, healthy weight, overweight, and obesity.What is the main factor for obesity? ›
Obesity is generally caused by eating too much and moving too little. If you consume high amounts of energy, particularly fat and sugars, but do not burn off the energy through exercise and physical activity, much of the surplus energy will be stored by the body as fat.What are the 9 cardiometabolic risk factors? ›
- Central obesity, or increased waist circumference.
- Raised triglycerides.
- Reduced HDL-cholesterol.
- Raised blood pressure, or hypertension.
- Raised fasting plasma glucose.
Leading risk factors for heart disease and stroke are high blood pressure, high low-density lipoprotein (LDL) cholesterol, diabetes, smoking and secondhand smoke exposure, obesity, unhealthy diet, and physical inactivity.What is the difference between obesity and overweight? ›
For adults, WHO defines overweight and obesity as follows: overweight is a BMI greater than or equal to 25; and. obesity is a BMI greater than or equal to 30.Where does fat accumulate in the belly? ›
Subcutaneous fat is the belly fat you can feel if you pinch excess skin and tissue around your middle. Visceral fat is belly fat that accumulates in your abdomen in the spaces between your organs. Too much visceral fat is strongly linked with a greater risk of serious health problems.