Growing anecdotal and statistical evidence show that rural people are no longer better off in terms of physical activity, nutrition and weight compared to urban residents. Recently, a comprehensive review of several studies that examine nutrition, physical activity and obesity in rural areas found a significant body of research documenting problems in nutrition and activity. Further, rural residents generally fare worse than their urban counterparts in regards to obesity, opposite to the situation that existed prior to 1980.

National and state studies have found rural children to have higher rates of obesity than do urban children. National studies have found rural adults more physically inactive than urban adults. And rural children engage in behaviors that result in less healthy lives. Nearly half of rural children report not participating in any after school sports/activities, and nearly half of rural children report spending at least two hours per day with electronic entertainment media, slightly higher than the number of urban children reporting the same behavior.

Why should we be concerned about these findings and the trend for rural people, particularly children, to be more obese than urban residents? Approximately $100 billion annually is spent on obesity-related illness, six to seven percent of total health care expenditures. Obesity is second only to tobacco as a cause of death in the United States and might soon overtake tobacco. Obesity puts people more at risk for many serious and often fatal conditions – coronary heart disease, diabetes, hypertension, stroke and some cancers, along with myriad health problems.

There are likely numerous culprits for obesity and related health conditions to be on the rise in rural America. Changes in the rural economy with fewer people employed in physical occupations like farming and more people employed in more sedentary, service jobs is one. An environment and culture that often does not allow for a healthy food system or access to physical fitness is another. For example, less than 15 percent of rural children walk or bike to school; 40 years ago, half of rural children did so. Strong social networks, a strength of rural communities, may reinforce unhealthy eating and sedentary behaviors. Finally, rural communities contain more elderly, less educated residents and lower income residents, all factors in obesity and less healthy lifestyles.

While these findings are discouraging – particularly for the long-term health of rural communities – there is optimism since many of these issues can be addressed through individual, family and community action. All of us can take responsibility for our health and the health of our community through education and action. We can work through our social networks to change patterns of eating and physical activity. We can teach and implement healthy living attitudes in our families. We can make walking and biking to school safe and accessible. We can help create community-based nutrition and exercise programs.

We can also take up larger, public policy efforts to change these patterns. Nutrition in the school environment can be promoted. We can create healthier food systems. And health, wellness, and physical activity should be promoted in health care reform legislation. As the new administration and the new Congress begin to debate health care reform, they need to keep in mind that the best long-term way to reform the health care system is to help create healthier people and healthier communities.

If we only make health insurance more affordable and accessible – as important as that is – we have turned reform into reform of a “sick care system” in the words of Senator Tom Harkin. Instead, we must truly begin to promote a “health care system” that creates a healthier society. Each rural family and each rural community has a stake in creating such a society, and everyone has responsibility to do so.

Visit www.cfra.org/08/health to add your voice to our rural health care reform effort.

* The comprehensive review of studies mentioned at the outset of this article was conducted by Tom Tai-Seale and Coleman Chandler of Texas A&M Univeristy. This report, Nutrition, Physical Activity, and Obesity in Rural America, is the first in a series of Center for Rural Affairs papers and reports on important rural health care issues. The full report is available at: www.cfra.org/09/01/healthreport

Contact: Jon Bailey, jonb@cfra.org or 402.687.2103 x 1013 for more information.