Small towns share big-city obesity problems

A few years ago public health researchers linked big-city attributes - like safety concerns and too few recreational facilities - to obesity. But residents of rural communities say their small towns also present barriers to staying active and maintaining a normal weight, according to a new study.

The environmental attributes that promote obesity are generally the same in rural communities as those previously found in urban and suburban areas, said lead researcher Tegan Boehmer with the School of Public Health at Saint Louis University in Missouri.

"However we did find that a lot of these environmental barriers were reported much more frequently in the rural population, compared to other studies of urban communities," she said.

Community characteristics that encourage inactivity and unhealthy food choices include neighborhood aesthetics; lack of nearby recreation opportunities like exercise trails, swimming pools or a fitness center; and feeling unsafe from traffic and crime.

The research team gathered information on participants' weight and perceptions of their environment through phone interviews. The study analyzes data from more than 2,200 rural residents of Missouri, Tennessee and Arkansas, mostly people who lived in small towns, as opposed to farming communities or undeveloped, backwoods areas.

"They live maybe a mile or two outside of town at most," Boehmer said. Rural areas include small towns of fewer than 2,500 people as well as larger cities that are not near metropolitan areas.

The study is published in the July-August edition of the American Journal of Health Promotion.

Although "the barriers appear to be more prevalent in rural communities," Boehmer said, she added that the study reports on obese people's perception of their neighborhoods, not the objective, observed environment.

"The perceptions of inactive people and obese people may be incorrect. They may not perceive a recreational facility near their home, when indeed there is one," she said. Her current study doesn't answer the question, but Boehmer asks, "If it's just perception, can we change behavior just by informing people about the walking trail in their neighborhood?"

The Saint Louis University research is the first well-designed study to uncover the obesity-promoting attributes of rural communities, according to Lorraine Ettaro, interim director of the Center for Rural Health Practice at the University of Pittsburgh.

Ettaro, who was not involved with the study, said she'd next like to see Boehmer's research duplicated in other rural areas.

"I think we can say that these findings are generalizeable to rural Midwestern communities," Boehmer said. "They may not be as applicable to agricultural rural communities that you might see in the plains or the northern Midwest. And they may not be as applicable to the Deep South where there is a different racial composition of rural populations."

Obesity research focused on rural communities is important because about 20 percent to 25 percent of U.S. residents live in rural areas, Boehmer said. Those residents also have a greater risk of overweight and obesity because rural people generally have lower incomes and socio-economic status, she added.

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