Thirty percent of U.S. adults are obese, which increases their risk for health conditions such as hypertension, type 2 diabetes, heart disease and stroke. Rural adults have higher levels of obesity and are less active in their leisure time than urban and suburban U.S. adults, says Brownson, a faculty scholar of Washington University's Institute for Public Health and a professor at the School of Medicine.
From July to September 2005, 1,258 randomly selected adults in 12 rural communities in Missouri, Arkansas and Tennessee completed telephone surveys about their food choices and physical activity. Eligible households were within two miles of a community walking trail.
Researchers asked about their access to produce and low-fat foods, frequency and location of food shopping and frequency and location of restaurant dining. They also were asked how they perceived their community for physical activity.
"It's not that people don't want to get physical activity or eat healthy foods, but we've made it difficult in many communities," says Ross Brownson, Ph.D., senior author of the study and a professor at the George Warren Brown School of Social Work at Washington University in St. Louis. "People in small towns spend a great deal of time in cars, and they also may not have easy access to fresh fruits and vegetables in their markets."
The findings revealed that respondents who ate out often, especially at buffets, cafeterias and fast food restaurants, were more likely to be obese. Those with a high school education or less reported limited access to fruits and vegetables and were more likely to shop at convenience stores.
Additionally, obese participants tended to have less education and lower annual incomes than normal weight respondents. They also were more likely to view their community as unpleasant for physical activity, such as lacking sidewalks for walking or biking or to have few places to be active.
"Although obesity rates are higher in rural areas, this is one of the first studies to look at food choices and exercise in this population," says Alicia Casey, first author of the paper and now a doctoral student in health communications at Penn State University. "Determining how much these factors increase the risk of obesity in rural areas can help us determine methods to help this group."
Brownson points out that a lot of travel planning focuses on how to increase the numbers of automobiles on our roadways, not on how to make travel friendly by foot or bicycle.
Possible interventions to enhance safety for people who want to walk or bicycle along rural roads include widening the shoulders, using signage to identify pedestrian and cycle areas and reducing speed limits. Options to increase availability and affordability of healthy foods could involve working with food outlet owners and changes in state or federal taxation and agricultural policies to reduce the relative price of healthy foods compared to unhealthy foods.
Society, Brownson stresses, will be better off finding ways to prevent obesity instead of trying to treat the condition. "We need to take these issues into account when we're making transportation and city planning decisions," he says. "Everyone will benefit if we make the healthy choice the easy choice."
This study was the third part of a larger intervention research program that promotes walking among overweight rural adults. Called Walk the Ozarks to Wellness, this research program partnered with local health agencies and health professionals to implement promotions that focused on physical activity and prevention of Type 2 diabetes. Some of these promotions included fun walks, walking clubs and charity walks. More than 1,000 residents also were recruited to receive a health newsletter. Findings from other aspects of the program are forthcoming.
This study was funded by the National Institutes of Health and the Centers for Disease Control and Prevention.
About Obesity
Obesity is a condition in which the natural energy reserve, stored in the fatty tissue of humans and other mammals, exceeds healthy limits. It is commonly defined as a body mass index (BMI) (weight divided by height squared) of 30 kg/m2 or higher. Although obesity is an individual clinical condition, some authorities view it as a serious and growing public health problem.
A large number of medical conditions have been associated with obesity. Health consequences are categorized as being the result of either increased fat mass (osteoarthritis, obstructive sleep apnea, social stigma) or increased number of fat cells (diabetes, cancer, cardiovascular disease, non-alcoholic fatty liver disease). Mortality is increased in obesity, with a BMI of over 32 being associated with a doubled risk of death. There are alterations in the body's response to insulin (insulin resistance), a proinflammatory state and an increased tendency to thrombosis (prothrombotic state).
Disease associations may be dependent or independent of the distribution of adipose tissue. Central obesity (male-type or waist-predominant obesity, characterized by a high waist-hip ratio), is an important risk factor for the metabolic syndrome, the clustering of a number of diseases and risk factors that heavily predispose for cardiovascular disease. These are diabetes mellitus, Type 2 diabetes, high blood pressure, high blood cholesterol, and triglyceride levels (combined hyperlipidemia).
Apart from the metabolic syndrome, obesity is also correlated with a variety of other complications. For some of these complaints, it has not been clearly established to what extent they are caused directly by obesity itself, or have some other cause (such as limited exercise) that causes obesity as well. Health complications may include from this condition may include:
- Cardiovascular: congestive heart failure, enlarged heart and its associated arrhythmias and dizziness, varicose veins, and pulmonary embolism
- Endocrine: polycystic ovarian syndrome (PCOS), menstrual disorders, and infertility
- Gastrointestinal: gastroesophageal reflux disease (GERD), fatty liver disease, cholelithiasishernia, and colorectal cancer
- Renal and genitourinary: erectile dysfunction, urinary incontinence, chronic renal failure, hypogonadism (male), breast cancer (female), uterine cancer (female), stillbirth
- Integument (skin and appendages): stretch marks, acanthosis nigricans, lymphedema, cellulitis, carbuncles, intertrigo
- Musculoskeletal: hyperuricemia (which predisposes to gout), immobility, osteoarthritis, low back pain
- Neurologic: stroke, meralgia paresthetica, headache, carpal tunnel syndrome, dementia, idiopathic intracranial hypertension
- Respiratory: obstructive sleep apnea, obesity hypoventilation syndrome, asthma
- Psychological: Depression, low self esteem, body dysmorphic disorder, social stigmatization.
About Washington University School of Medicine
Washington University School of Medicine's 2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children's hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked third in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children's hospitals, the School of Medicine is linked to BJC HealthCare.