Sizing Up Rural … For Sizing Down

Over the past 10 years, the national obesity rate has increased – from less than 15 percent in 1990 to over 30 percent in 2010.  So has the dialogue about what to do about it. While a groundswell of inspiring media stories feature communities taking on obesity through farmers markets and walking trails, few stories focus on rural families or communities.

Unfortunately, obesity is worse in rural America.  Forty percent of adults living in rural areas are obese, compared to 33 percent in urban areas– the findings of a 2012 University of Florida study. Even more alarming, children living in rural areas are 25 percent more likely to be obese than children living in urban areas.

These numbers spell worry for rural families – particularly those struggling to make ends meet. Besides the mental and physical stress of obesity itself, its related health issues can cause individuals to lose focus, or to miss days of work or school – along with critical learning or income. Health problems can also require frequent trips to the doctor with more medical bills – or foregone trips to the doctor and worsening health.  For low-income rural families, such health setbacks negatively affect their ability to Earn more, Keep more of what they earn, and Grow  it into assets over time.

But some rural communities across the country are developing creative strategies to reduce and prevent obesity and help families build a strong, healthy future – more on that in a bit.

What’s different about obesity in rural places? 

Rural communities face a unique set of challenges that likely contribute to higher obesity rates. The Altarum Institute cites the commonly-held misconception that rural places are oases of open space and healthy food – when the opposite is often the case.  In fact, rural communities often lack public spaces for physical activity, such as paved trails, parks and playgrounds – and those that do exist may be far from home. This is particularly tough for children, who typically must rely on adults to drive them to distant places.

Healthy food options can also be difficult to find in rural areas. While farms might abound in some rural places, many grow a small range of commodity crops, not the full range of healthy food people need.  And grocery stores and fresh markets can be few and far between. In low-density rural areas, it is much harder to sustain a large grocery store with fresh food, than it is a fast food restaurant or gas station convenience store on the local main road. The grocery stores that do exist may be further away – meaning families must have reliable vehicles and enough money to pay for gas. When families don’t have those resources, many rationally choose the more convenient, unhealthy options they can afford.

Finally, many low-income children rely on schools for healthy meals and physical activity programming. In rural schools, where resources are limited and budgets tight, there may be less capacity to offer as much phys ed or serve nutritious meals.  And it may be more difficult to offer summer feeding programs for children who receive reduced and free lunches during the school year.

These challenges, in addition to budget and time constraints, make it difficult for hardworking rural families to make positive decisions around diet and exercise.

 What can you do?

Fortunately, innovative rural communities across the country are stepping up the pace to help rural families tackle obesity.  And now tools – and emerging success stories – can help your community or organization get moving. We’ve highlighted just a few here, but follow the links and you’ll find even more resources embedded in each.

• If you’re looking for a quick read, check out this article by the Altarum Institute. Part 1 outlines the challenges rural families face when it comes to eating well and exercising (and backs it up with data). Part 2 provides a list of promising practices (and success stories) that rural practitioners can use.

• The County Health Rankings and Roadmaps website – a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute – offers a great starting point for rural communities interested in tackling obesity and other health problems.  The Rankings section provides a snapshot of county health, with information about obesity rates, access to exercise opportunities, food environment, and more.  The Roadmaps section offers comprehensive guides and step-by-step action tools for taking on health issues locally. They also have stories about how other rural communities—like this small town in Michigan—are helping improve rural family health through changes in diet and exercise.

• The Robert Wood Johnson Foundation developed these practical Rural Active Living Assessment Tools that can help rural places ask and answer questions about how town characteristics, amenities, community programs, physical environment features, and policies affect physical activity among residents in rural communities.

• Earlier this year, Nemours, an international children’s health system, released Childhood Obesity Prevention Strategies for Rural Communities.  The toolkit is organized to show promising childhood obesity prevention strategies across five sectors: Early Care and Education, Schools, Out-of-School Time, Other Community Initiatives, and Health Care. It both describes promising strategies and highlights communities that have successfully put them into action. For example, in Turtle Lake Wisconsin, the Cooperative Educational Service Agency (CESA) #11 Head Start designed wellness activity kits that include nutrition and physical activity components for Head Start home visits.

• In 2012, the Department of Health and Human Services’ Rural Assistance Center released theRural Obesity Prevention Toolkit. The toolkit is available online and as a downloadable PDF and is designed to help rural communities identify health challenges, convene partners, and apply evidence-based strategies to reduce and prevent obesity.