Rural America struggles with obesity epidemic

Americans living outside of large metropolitan areas are much more likely to be obese than those who live in cities and suburbs, a public health challenge that could be shortening the lives of rural residents.

New data from the Centers for Disease Control and Prevention find more than a third of rural residents, 34.2 percent, qualify as obese, while the obesity rate in metropolitan counties is a significantly lower at 28.7 percent.

Rural Americans struggle with obesity more than those who live in urban areas in every part of the country. The highest obesity rates are in rural counties in Southern states; in Louisiana and Texas, the number of obese residents approaches 40 percent.

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The gaps between metropolitan and rural counties are most pronounced in a broader range of states including New York, Florida and Virginia. In those states, urban residents are far less likely to be obese than their rural neighbors.

Public health experts said the higher rates of obesity in rural areas is a long-term trend that highlights the socioeconomic differences between urban areas, where density means better access to higher quality food and parks, and rural areas, where residents are more likely to spend a greater percentage of their time in the car.

“This is a troubling trend that’s been present in the data for a number of years,” said Elaine Waxman, a senior fellow at The Urban Institute. “As a country, we don’t move as much as we need to and we don’t eat as well as we need to.”

Tyrone Borders, an expert in rural health policy at the University of Kentucky, said economics and education levels are big reasons the South has struggled to maintain a more healthy lifestyle.

“The South on average is poorer, it’s less educated than other areas of the United States. And we know that education status and income status are correlative with health outcomes,” Borders said. “When we think about rural health in general, it does appear that the gap [between urban and rural communities] is getting a little bit bigger in some regards.”

Demographics play a role in rural America’s struggles, too: Rural communities tend to be older, and older generations by nature suffer more adverse health consequences than do younger Americans. Conditions like coronary heart disease, diabetes and arthritis — all exacerbated by obesity — are more common among older people too.

And, Borders said, rural Americans simply don’t always have the same access to recreational opportunities as do those in urban communities. Gyms are much more prevalent in cities than in rural areas.

Public health experts say there are plenty of ways to address the obesity epidemic — the CDC recommends 24 obesity-prevention policies and environmental strategies, it said in the paper released Thursday — but policymakers have not done as well as they could to implement those practices in real terms, especially in rural communities.

“What [the data] tells us is we’re not making any progress,” Waxman said. “A lot of the strategies that people talk about for addressing obesity are not always rural-friendly. For instance, when they talk about food deserts, they’re talking about urban areas, but they don’t always consider that everyone in rural areas has to drive everywhere.”

“It is a multi-faceted problem, and unfortunately that means a sustained commitment to multiple solutions, and we’re not particularly good at that in public policy,” Waxman said.

Borders pointed to medical services, which are frequently harder to obtain in rural communities far away from medical centers and hospitals. He said technological advances in the future, like tele-health, will bring down costs and increase access.

African Americans in rural communities, 44 percent, are most likely to be obese, the new CDC data finds, while Asian Americans in urban communities are the least likely to be obese. Obesity rates are much higher among lower-income households than among high-wage earners, a reflection of the sometimes prohibitive cost of fresh produce. And those who have a college degree are far less likely to be obese than those who did not complete high school.

Rural residents are less likely to be obese than their urban neighbors in only five states — Colorado, Montana, Utah, Wyoming and California, all among the states with the most active populations.