A national study of obesity prevalence and trends by type of rural county.

CONTEXT Obesity is epidemic in the United States, but information on this trend by type of rural locale is limited. PURPOSE To estimate the prevalence of and recent trends in obesity among US adults residing in rural locations. METHODS Analysis of data from the Behavioral Risk Factor Surveillance System (BRFSS) for the years 1994-1996 (n = 342,055) and 2000-2001 (n = 385,384). The main outcome measure was obesity (body mass index [BMI] > or = 30), as determined by calculating BMI from respondents' self-reported height and weight. RESULTS In 2000-2001, the prevalence of obesity was 23.0% (95% confidence interval [CI] 22.6%-23.4%) for rural adults and 20.5% (95% CI 20.2%-20.7%) for their urban counterparts, representing increases of 4.8% (95% CI 4.2%-5.3%) and 5.5% (95% CI 5.1%-5.9%), respectively, since 1994-1996. The highest obesity prevalence occurred in rural counties in Louisiana, Mississippi, and Texas; obesity prevalence increased for rural residents in all states but Florida over the study period. African Americans had the highest obesity prevalence of any group, up to 31.4% (95% CI 29.1%-33.6) in rural counties adjacent to urban counties. The largest difference in obesity prevalence between those with a college education compared with those without a high school diploma occurred in urban areas (18.4% [95% CI 17.9%-18.9%] vs 23.5% [95% CI 22.5%-24.5%], respectively); the smallest difference occurred in small, remote rural counties (20.3% [95% CI 18.7%-21.9%] versus 22.3% [95% CI 20.7%-24.0%], respectively). CONCLUSIONS The prevalence of obesity is higher in rural counties than in urban counties; obesity affects some residents of rural counties disproportionately.

[1]  David R. Williams,et al.  Measuring social class in US public health research: concepts, methodologies, and guidelines. , 1997, Annual review of public health.

[2]  E L Korn,et al.  Predictive Margins with Survey Data , 1999, Biometrics.

[3]  A. Mokdad,et al.  Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. , 2003, JAMA.

[4]  R. Jeffery,et al.  Group and correspondence treatments for weight reduction used in the Multiple Risk Factor Intervention Trial , 1982 .

[5]  S. Kumanyika,et al.  Minisymposium on obesity: overview and some strategic considerations. , 2001, Annual review of public health.

[6]  A. Mokdad,et al.  Cardiovascular disease risk factor intervention in low-income women: the North Carolina WISEWOMAN project. , 2000, Preventive medicine.

[7]  J. Dixon,et al.  Depression in association with severe obesity: changes with weight loss. , 2003, Archives of internal medicine.

[8]  K. Fontaine,et al.  Impact of weight loss on Health-Related Quality of Life , 1999, Quality of Life Research.

[9]  J. Whelan,et al.  An evaluation of a television-delivered behavioral weight loss program: are the ratings acceptable? , 1996 .

[10]  S. Gortmaker,et al.  Policy tools for the childhood obesity epidemic. , 2002, The Journal of law, medicine & ethics : a journal of the American Society of Law, Medicine & Ethics.

[11]  R J Prineas,et al.  Comparison of self-reported and measured height and weight. , 1982, American journal of epidemiology.

[12]  McGinnis Jm,et al.  Actual causes of death in the United States. , 1993 .

[13]  R. Kuczmarski,et al.  Effects of age on validity of self-reported height, weight, and body mass index: findings from the Third National Health and Nutrition Examination Survey, 1988-1994. , 2001, Journal of the American Dietetic Association.

[14]  A. Rimpelä,et al.  Social mobility and health related behaviours in young people. , 1999, Journal of epidemiology and community health.

[15]  R C Brownson,et al.  Differential correlates of physical activity in urban and rural adults of various socioeconomic backgrounds in the United States , 2003, Journal of epidemiology and community health.

[16]  S. Raudenbush,et al.  Relationship between Urban Sprawl and Physical Activity, Obesity, and Morbidity , 2003, American journal of health promotion : AJHP.

[17]  D. Crooks.  Food consumption, activity, and overweight among elementary school children in an Appalachian Kentucky community. , 2000, American journal of physical anthropology.

[18]  F. Hu,et al.  Overweight and obesity in women: health risks and consequences. , 2003, Journal of women's health.

[19]  A. Mokdad,et al.  The spread of the obesity epidemic in the United States, 1991-1998. , 1999, JAMA.

[20]  Obesity: responding to the global epidemic. , 2002 .

[21]  J. Probst,et al.  Obesity and physical inactivity in rural America. , 2004, The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association.

[22]  G A Colditz,et al.  Economic costs of obesity and inactivity. , 1999, Medicine and science in sports and exercise.

[23]  W. Willett,et al.  Prospective study of body mass index, weight change, and risk of adult-onset asthma in women. , 1999, Archives of internal medicine.

[24]  B. Thompson,et al.  Can community organization strategies be used to implement smoking and dietary changes in a rural manufacturing work site? , 1999, The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association.

[25]  L A Palinkas,et al.  Depressive symptoms in overweight and obese older adults: a test of the "jolly fat" hypothesis. , 1996, Journal of psychosomatic research.

[26]  A. Marcus.  The cancer information service research consortium. , 1998, Preventive medicine.

[27]  R. A. Marlow,et al.  Continuing education in nutrition for rural physicians. , 1986, Family medicine.

[28]  Richard P Troiano,et al.  The association between urban form and physical activity in U.S. adults. , 2002, American journal of preventive medicine.

[29]  G. Oster,et al.  Estimated Economic Costs of Obesity to U.S. Business , 1998, American journal of health promotion : AJHP.

[30]  James R Morrow,et al.  The relationship of body mass index, medical costs, and job absenteeism. , 2003, American journal of health behavior.

[31]  R. Johnson,et al.  Characterizing nutrient intakes of adolescents by sociodemographic factors. , 1994, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[32]  K. Fontaine,et al.  Obesity and health‐related quality of life , 2001, Obesity reviews : an official journal of the International Association for the Study of Obesity.

[33]  M Nestle,et al.  Halting the obesity epidemic: a public health policy approach. , 2000, Public health reports.

[34]  G. Colditz,et al.  The disease burden associated with overweight and obesity. , 1999, JAMA.

[35]  E. Villanueva.  The validity of self-reported weight in US adults: a population based cross-sectional study , 2001, BMC public health.

[36]  K. Flegal,et al.  Prevalence and trends in obesity among US adults, 1999-2000. , 2002, JAMA.

[37]  Susan Curry,et al.  Stages of Change for Increasing Fruit and Vegetable Consumption among Adults and Young Adults Participating in the National 5-a-Day for Better Health Community Studies , 1999, Health education & behavior : the official publication of the Society for Public Health Education.

[38]  K. Fontaine,et al.  Health-related quality of life in obese persons seeking treatment. , 1996, The Journal of family practice.

[39]  R. Jeffery.  Population perspectives on the prevention and treatment of obesity in minority populations. , 1991, The American journal of clinical nutrition.

[40]  M. Nestle,et al.  The contribution of expanding portion sizes to the US obesity epidemic. , 2002, American journal of public health.

[41]  J. Král,et al.  Quality of life assessment in obesity: physical, psychological, and social function. , 1987, Gastroenterology clinics of North America.

[42]  Linda Williams Pickle,et al.  Within-state geographic patterns of health insurance coverage and health risk factors in the United States. , 2002, American journal of preventive medicine.

[43]  G C Hogelin,et al.  The behavioral risk factor surveys: I. State-specific prevalence estimates of behavioral risk factors. , 1985, American journal of preventive medicine.