The Obesity Problem in Rural America

Obesity is a touchy subject, it is personal. Being overweight is common, but what is becoming even more common is severe obesity. That is what is propelling these articles. This is part two of “Obesity; The “Second Hand Smoke” of Modern America“ addressing the issue of increased cost of healthcare due to severe obesity. This article will look at how rural patients tend to be more at risk for severe obesity than their urban counterparts. Nurses General Nursing Article

Vulnerable Population

Public health has focused on the vulnerable patients in our society for the past few decades, but now they are looking at how "place" plays a factor. According to the article, "Health in Rural America: Remembering the Importance of Place," In the 19th and 20th century, public health focused on the urban slums. Keeping these patients healthy meant they could continue to work for the industrial machines. Because of outbreaks such as cholera, smallpox, and yellow fever it was necessary to focus on these issues in order to keep the public as healthy and safe as possible. Expanding the horizon of public health awareness to rural areas has made it necessary to address how location plays a part.

Rural America

It is common to picture rural Americans as hardworking and traditional, having chosen to live in a farming small town community. Many rural areas look like small suburban towns with health risks much like those of urban patients such as obesity and smoking. Access to care is important but not always the total solution because as stated in the article mentioned earlier, the patients don't always respond to an increase in the number of health care practitioners. Prevention and education on healthy lifestyle is suggested to help this population in conjunction with access.

Obstacles to Health Care Access

There are many obstacles facing the delivery of healthcare to rural areas such as low population density, lack of access to grant funding, transportation issues, lower public funding, and the possibility of fragmented care. Also, the demographic changes of rural areas such as younger people moving out of the rural settings, leaving an increasingly aged population. Technology has changed the job market, decreasing the need for agricultural jobs. Addressing the needs of the rural population means building on the positive aspects of the community like the close social networks, high quality of life, neighborliness, and reciprocity. Helping these communities means recognizing their unique social qualities.

In a groundbreaking study, author Christie A. Befort PhD et. al. in the article, "Prevalence of Obesity Among Adults From Rural and Urban Areas of the United States: Findings From NHANES (2005 - 2008)," it is found that "rural residents have higher rates of chronic disease compared to their urban counterparts, and obesity may be a major contributor to this disparity." The things measured were body mass index (BMI), height and weight, demographic, diet, and physical activity.

Obesity Statistics

The numbers show obesity is more common among rural residents with 39.6%, and urban 33.4% of the population being obese. Married rural residents were found to have a larger degree of obesity, while urban residents are at an increased risk for obesity related to less education and inactivity. With these numbers, there is reason to give greater attention to obesity in America.

There are more than 70 million rural residents who have higher rates of chronic disease and mortality. The obesity issue is a major contributing factor to these health problems. In the latter mentioned research article, these stats were listed:

Age 20 -39 rural obesity rate - 31.8%, and urban 41.8%, as we can see urban young people have a higher BMI.

Age 60 - 75 rural residents 26.1% obese, while urban had a 15.6%. We can see from the numbers that older rural residents have a higher percentage of obesity.

Gender percentage of obese residents is very similar between the two genders as well as rural versus urban.

Minority women who live in rural areas suffer from a larger rate of cardiovascular disease, which is the number one killer of women in this country. Over the past 30 years, a greater number of rural residents have been affected by CVD according to the article by Herman A. Taylor, et. al., "Cardiovascular Disease Among Women Residing in Rural America: Epidemiology, Explanations, and Challenges."

Rural Life

As mentioned before, the thoughts of rural living evoke images of healthy food, active, less stress, and a strong community and family dynamic. However, there are many factors that inhibit a healthy lifestyle such as high levels of poverty, social isolation, and fractured healthcare. Rural people, according to the study by Taylor, have a higher percentage of diabetes, sedentary lifestyle, obesity especially in rural African-American women.

In the rural health facilities, women are less likely to receive an EKG, even though cardiovascular disease is the number one killer. Treatment to these women is often delayed, or not available. They are less likely to be given cardiac consultation or even a cardiac consult. Not only is good care hard to get, many of these rural residents are self-employed and insurance is too expensive. If they work for a company, these companies are often small and don't offer insurance or medical leave. Other factors that may affect rural residents from living healthier is a lack of trust towards healthcare workers, lack of preventative resources, and access to healthy food.

Need for Education

In the light of recent studies, we see the need for education and prevention among rural residents. There has been a weight management study performed by Michael G. Perri, et. al., and is presented in the article, "Extended-Care Programs for Weight Management in Rural Communities." The researchers performed a six month program in rural counties that had a higher rate of obesity, sedentary lifestyle, and chronic disease. The average weight was 96.4kg and there was an average weight loss of 10kg. They found the participants were more more compliant with the weight loss program when receiving counseling over the whole time period. Participants without counseling tended to regain their weight in the following year, but those who received the extended counseling, usually over the phone improved maintaining weight loss.

In conjunction with all the articles and research presented, we have first hand information from a nurse who works with rural patients named Judi. She listed the problems she sees that inhibit rural patients from getting the proper health care they need to live a healthy lifestyle. First, there are no fitness centers, making it difficult for people to find a place to get away from the house and focus on themselves. The only hospital accessible to her patients is a critical care hospital that runs of bare bones staff. Also, there are few primary care providers, and those are often from the "city." These providers come into the rural area only 1 -2 days a week, and not being a part of the community makes it difficult for them to connect with their rural patients. Specialist are not present in the rural community, forcing the patient to drive 65 miles to see them. On top of that the patients can have difficulty navigating the roads, buying gas, or even having access to a car.

To be more specific, Judi tells us about her dialysis patients:

"I will say that my patients (in nephrology, mostly end stage renal disease) are getting bigger and bigger. It is no longer unusual for me to have patients that weigh 200+kg (440#). Needless to say, their co-morbidities are huge also.

And...they require very long dialysis times and they still don't receive adequate dialysis even with five hours of dialysis. They are uncomfortable in the chairs - we have very few bariatric chairs in most dialysis units. They require extra long needles in order to go thru the additional adipose tissue. They are not eligible for transplant so they have no hope to ever get off dialysis which leads to depression."


As we have seen, rural residents have more obstacles to obtaining health care than to urban residents. Location often limits rural people access to healthy fresh food, and things like gyms that are readily available in cities. Recognizing that there is a problem of increased obesity in rural areas is a large step in getting these residents the help they need to live a healthier lifestyle. Please read my first article addressing how obesity increases the cost of healthcare, and look for the third article that addresses obesity among children.

Thank you to Judi for adding her experience, helping us to see the whole picture for her dialysis patients.


Befort, Christie A. PhD, Nazir, Niaman MD, Perri, Michael G. PhD. "Prevalence of Obesity Among Adults From Rural and Urban Areas of the United States: Findings From NHANES (2005 - 2008). 31 May, 2012. The Journal of Rural Health. 28: 392-397. 1 Jan. 2016. Web.

"Health in Rural America: Remembering the Importance of Place." October 2004, Vol 94: 10. American Journal of Public Health. 1 Jan. 2016. Web.

Perri, Michael G. et. al., "Extended Care Programs for Weight Management in Rural Communities." 24 November, 2008. American Medical Association. 22 Feb. 2016. Web.

Taylor, Herman A. et. al. "Cardiovascular Disease Among Women Residing in Rural America: Epidemiology, Explanations, and Challenges." 2 Jan. 2002. American Public Health Association. 22 Feb. 2016. Web.

Specializes in Emergency, Trauma, Critical Care.

I don't trust anything where BMI is the source of obesity. I expect dry muscular farmers to beaver the BMI. The one time I was under the BMI of people kept asking me if I was sick. I started lifting weights and got a very lean body mass and fit in a size 8 at 5' 11" but my BMI was still 25.5

BMI can suck it.

I will say that in my experience I have found that not all rural areas are alike. Each community has different strengths and challenges. For the most part, rural areas in the Northeast are not really that rural, as other people have pointed out. I grew up in rural Amish country with farms all around. People complained about having to drive "into town" for groceries, pharmacy, etc, but a doctors office was never really more than a half hour away. Now I live in Arizona, and I can say that compared to the East coast, rural towns out West that I've passed through are truly rural. They're not situated along big interstates but dirt or gravel roads. You'll pass one small farming town with maybe a gas station, farms, a restaurant, and a general store every couple of hundred miles. Schools are of the one-room schoolhouse variety. Some don't have primary care offices, let alone hospitals. I'm assuming if they had a true emergency a helicopter would be their only hope. Food options are limited to what they grow and what they can find in a mini-mart. My health department sends us PHNs to one of the Native American reservations, and I can say with 100% certainty that this is a problem for them. Health literacy is poor and they lives hours away from any real grocery stores with healthy food options. They basically live in rural slums. Obesity and diabetes rates are through the roof. It's very sad to see sometimes.

Specializes in LTC, CPR instructor, First aid instructor..

This was me when I was a schools driver. I wore a size 6 then. attachment.php?attachmentid=21440&stc=1 I gained a few pounds during nursing school, but after I graduated, I went to Weight Watchers and took the extra weight off. While I was actively looking for a job in the nursing field, I got extremely ill, and was put on massive doses of Prednisone. I blew up to 305 pounds. I have managed to lose about 35 pounds, but no matter how hard I try now, the weight just will not leave this old body of mine now, so since I'm in a motorized chair and am unable to exercise due to pulmonary disease that takes my breath away upon any type of exertion, I have decided to make the most of my life the best way I am able to. I keep smiling and keep a positive attitude.

Longer drive times to the store can also contribute, and having bus access. If there are car problems, you can't get to the store as efficiently so one either eats what they have or goes to the most convenient place.

I also think that lack of social connections (due to the sporifice population) can contribute. As the article says, it is a little quieter and less dense and you have to drive a ways for any fun/activities.