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CDC Obesity Prevalence Higher in the Rural USA

MMWR reports that approximately 46 million persons (14%) in the United States live in nonmetropolitan counties, where there is a higher prevalence of obesity-associated chronic diseases such as diabetes, coronary heart disease, and arthritis. (Citation source: http://bit.ly/2lj5yql)

The 2005–2008 National Health and Nutrition Examination Survey (NHANES) found a significantly higher obesity prevalence among adults in nonmetropolitan (39.6%) than in metropolitan (33.4%) counties. When the CDC examined state-level 2016 Behavioral Risk Factor Surveillance System (BRFSS) data they found that the prevalence of obesity (body mass index [BMI] ≥30 kg/m2) was 34.2% among U.S. adults living in nonmetropolitan counties and 28.7% among those living in metropolitan counties (p<0.001).

Obesity prevalence was significantly higher among nonmetropolitan county residents than among metropolitan county residents in all U.S. Census regions, with the largest absolute difference in the South (5.6 percentage points) and Northeast (5.4 percentage points). In 24 of 47 states, obesity prevalence was significantly higher among persons in nonmetropolitan counties than among those in metropolitan counties; only in Wyoming was obesity prevalence higher among metropolitan county residents than among nonmetropolitan county residents. Both metropolitan and nonmetropolitan counties can address obesity through a variety of policy and environmental strategies to increase access to healthier foods and opportunities for physical activity.

In 2016, overall obesity prevalence was 29.6% and was highest among persons residing in the South (32.0%) and Midwest (31.4%) regions and the East South Central (35.3%) and West South Central (33.9%) divisions. Overall, obesity prevalence was significantly higher among adults living in nonmetropolitan counties (34.2%) than among those living metropolitan counties (28.7%) (p<0.001), and the same was found in all Census regions and Census divisions. Among Census regions, the largest difference in obesity prevalence between persons living in nonmetropolitan and metropolitan counties was in the South (5.6 percentage points) and Northeast (5.4 percentage points); among Census divisions, the largest difference in obesity prevalence between nonmetropolitan and metropolitan residents was in the Middle Atlantic division (6.6 percentage points). Obesity prevalence was also significantly higher among nonmetropolitan county residents than among metropolitan county residents for all sociodemographic categories except Hispanics and persons with less than a high school education.

Among adults living in nonmetropolitan counties, obesity prevalence ranged from 20.8% in Colorado to 39.1% in Louisiana; among those living in metropolitan counties, prevalence ranged from 22.5% in Colorado to 36.9% in West Virginia. In 24 (51%) of the 47 states with both metropolitan and nonmetropolitan counties, obesity prevalence was significantly higher among adults living in nonmetropolitan counties than among those living in metropolitan counties; in 22 (47%) states, no difference was observed. Wyoming was the only state where obesity prevalence was significantly higher among metropolitan county residents (32.8%) than among nonmetropolitan residents (25.4%; p = 0.002).

Both nonmetropolitan and metropolitan counties can address obesity through a variety of policy and environmental strategies to increase access to healthier foods and opportunities for physical activity.

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