Obesity affects rural Americans the most—especially in the South, Northeast

A new report from the Centers for Disease Control and Prevention (CDC) suggests 5.5 percent more rural Americans are obese than their metropolitan counterparts.

The disparities were especially significant in the South and Northeast regions, where the absolute differences were 5.6 and 5.4 percent, respectively.

Lead report author Elizabeth A. Lundeen, PhD, and colleagues analyzed telephone survey responses from 438,479 adults from all 50 states plus Washington, D.C., who were asked to self-report their height and weight. Obesity was defined as body mass index (BMI) of at least 30 kilograms per square meter.

The authors acknowledged that many people—particularly those that are overweight—are likely to underestimate their BMI. Still, they found 34.2 percent of residents in nonmetropolitan counties reported measurements consistent with obesity, while 28.7 percent of metropolitan residents reported obesity.

Previous research has demonstrated that rural Americans are less likely to meet physical activity recommendations and have less access to healthy food options.

“In addition, several social determinants of health that are risk factors for obesity, such as persistent poverty and food insecurity, are more prevalent in rural than in urban areas,” Lundeen et al. wrote.

The authors discovered obesity prevalence was significantly higher among rural residents in about half of the states. The difference wasn’t statistically significant in most states, and Wyoming was the only state which showed a higher prevalence of obesity among city-dwellers.

States varied widely in their obesity burden, even when broken down along urban/rural lines. About 21 percent of adults living in nonmetropolitan counties in Colorado were obese, compared to 39.1 percent of those living in Louisiana. Among those living in metropolitan counties, percentages ranged from 22.5 in Colorado to 36.9 in West Virginia.

“Increasing the availability of healthier food and beverage choices is challenging to implement in rural areas because of the long distances between food suppliers and retailers and between retailers and consumers, which can influence food cost and the availability of fresh foods,” the researchers wrote. “Approaches to overcoming this challenge include strengthening networks between food producers, distributors, and retail food outlets, as well as reducing the distance customers need to travel, for example, by increasing access to nearby farmers’ markets.”

Strategies to increase physical activity in rural areas include improving access to public buildings such as schools for after-hours workouts and adding paved sidewalks, bicycle trails and public parks to facilitate walking and other activities, Lundeen et al. said.