Rural Americans Are Fatter Than City Dwellers

A 'rural' type of diet and social isolation factor into the cause

Social isolation may be one reason why Americans who live in rural areas have higher rates of obesity. (Photo: Paul Taylor/Getty Images)

Shari Roan is an award-winning health writer based in Southern California.

Apparently you don't need to live within spitting distance of burger and taco joints to succumb to weight problems. A new study finds that people who live in rural areas are more likely than city folks to become obese.

Those iconic home-cooked meals of fatty meats and rich desserts may be at least partly to blame for the waistline differences, along with other aspects of rural life, lead author Christie Befort told TakePart.

The study, published today in the Journal of Rural Health, is one of the more rigorous examinations of obesity in rural America, regions of the country that have not been a big part of the weight dialog. Befort, an assistant professor of preventive medicine and public health at the University of Kansas Medical Center, analyzed data from the 2005-2008 National Health and Nutrition Examination Survey, which includes body mass index, diet and physical activity. The study involved 7,325 residents of urban areas and 1,490 rural adults.

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While previous studies suggested obesity rates were slightly higher among rural residents, Befort found a bigger gap: a 39 percent rate in rural America compared to 33 percent in urban areas. The study controlled for other factors that impact weight, such as race, income, educational levels and age. Even with those controls in place, more rural Americans were obese than urban residents. We're not talking a small population of Americans—just under one-quarter of the U.S. population lives in areas defined as rural.

Among people ages 20 to 39, the disparity between urban and rural was even greater. More than 38 percent of rural young adults were obese compared to almost 28 percent of their urban counterparts.

The findings counter a stereotypical view of rural life centered on hearty physical activity in the wide-open spaces, fresh food from gardens and farms and less access to the Cheesecake Factories and McDonald's drive-thrus that dot the urban landscape. Instead, the study suggests rural Americans lack many of the tools that can help people maintain a normal weight.

"There is that misconception that people are healthier" in rural areas, Befort says. "People think rural residents are  growing their own food and eating it and that everything is very wholesome and healthy; that they are doing lots of labor on the farm. That just isn't the picture today."

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For example, Befort says, there aren't equipment-packed gyms and boot camps every mile or so. It's even tough to go walking each morning with the next-door neighbor if that neighbor lives three miles down the road.

"Something that we heard from the women who participated in these studies is that they feel isolated," she says. "One woman, because she can't walk, drives 90 miles to get to a pool to swim. They also feel isolated in terms of food resources, such as restaurants and grocery stores."

Life on the farm isn't about hoisting hay bales into a wagon anymore. Many types of rural jobs, including farming, have been highly mechanized, she adds, reducing the need for physical labor.

"Farming and logging aren't as labor-intensive as they used to be," Befort says. Meanwhile, "food preparation just hasn't changed over the years as the level of physical activity has declined. The meals are still large."

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Even the preparation of home-cooked food—something health experts tell urban dwellers to do more of—may backfire when it comes to obesity, since those meals are likely to be high in fat and sugar.

The isolation that characterizes rural life can also keep people from seeing health professionals on a regular basis, she says. Poverty, too, appears to play into the higher rates of obesity in rural settings, setting up the hunger/obesity paradox: Much of the food the poor have access to is high in calories but low in nutrition, such as sugar and starch-filled simple carbs, prompting weight gain.

In recent years, federal and state governments have begun to tailor obesity prevention programs to specific groups—such as particular ethnic or age groups—to meet their unique needs. Even the National Health and Nutrition Examination Survey, from which Befort's data was drawn, ignores a comparison of rural to urban obesity while routinely analyzing differences according to age, race and gender.

Specific obesity prevention programs designed for rural Americans are just beginning to emerge, Befort says.

"I think it has trailed a little bit, but we're starting to see more attention now," she says. "Rural America is 20 percent of our country. It's not a small group."

Why do you think obesity rates are higher in rural areas than in urban areas? Let us know in the comments.

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