On June 15, the CDC released a Morbidity and Mortality Weekly Report (MMWR)(www.cdc.gov) that found the prevalence of obesity was higher, at 34.2 percent, among U.S. adults living in nonmetropolitan counties than the 28.7 percent prevalence among those living in metropolitan counties.
This research was based on state-level data from the 2016 Behavioral Risk Factor Surveillance System (BRFSS), an annual random-digit-dialed telephone survey of adults 18 and older. The CDC and state and territorial health departments conduct the BRFSS to monitor health conditions and related behaviors.
Self-reported weight and height were used to calculate body mass index (BMI); obesity was defined as BMI greater than or equal to 30 kg/m2.
Responses from about 438,500 adults in all 50 states and the District of Columbia were included in the analysis.
- On June 15, the CDC released a Morbidity and Mortality Weekly Report that found the prevalence of obesity was higher, at 34.2 percent, among U.S. adults living in nonmetropolitan counties than the 28.7 percent prevalence among those living in metropolitan counties.
- This research was based on state-level data from the 2016 Behavioral Risk Factor Surveillance System, a state-based, annual random-digit-dialed telephone survey of adults 18 and older.
- 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 seen in the South (5.6 percentage points).
Unadjusted obesity prevalence was presented overall and by sociodemographic characteristics (age, sex, race/ethnicity, education, income and employment status), state, and across four U.S. Census regions and nine divisions: Northeast region (New England and Middle Atlantic divisions), Midwest region (East North Central and West North Central divisions), South region (South Atlantic, East South Central and West South Central divisions) and West region (Mountain and Pacific divisions).
In 2016, overall obesity prevalence was 29.6 percent. The highest figures were seen among residents in the South (32 percent) and Midwest (31.4 percent) regions and the East South Central (35.3 percent) and West South Central (33.9 percent) divisions.
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 seen in the South (5.6 percentage points).
A possible contributing factor to the South's disparity is its high rate of persistent poverty and the poverty gap between metropolitan and nonmetropolitan county residents, the authors noted.
Among census divisions, the largest difference in obesity prevalence between nonmetropolitan and metropolitan residents was in the Middle Atlantic division (6.6 percentage points).
These findings are largely consistent with those published in 2012 using data from the 2005-2008 National Health and Nutrition Examination Survey, which found a significantly higher obesity prevalence among adults in nonmetropolitan (39.6 percent) than in metropolitan (33.4 percent) counties.
About 46 million people (14 percent) in the United States live in nonmetropolitan (rural) counties. Compared with metropolitan residents, nonmetropolitan residents have a higher prevalence of obesity-associated chronic diseases, such as diabetes, coronary heart disease and arthritis.
The 2016 BRFSS data showed that among adults living in nonmetropolitan counties, obesity prevalence ranged from 20.8 percent in Colorado to 39.1 percent in Louisiana. Among those living in metropolitan counties, prevalence ranged from 22.5 percent in Colorado to 36.9 percent in West Virginia.
In 51 percent 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; while 47 percent of states observed no difference between county types.
Wyoming was the only state where obesity prevalence was significantly higher among metropolitan county residents (32.8 percent) than among nonmetropolitan residents (25.4 percent).
Addressing the Issue
The CDC said in an accompanying statement(www.cdc.gov) that understanding regional variation in obesity prevalence by metropolitan/nonmetropolitan residency status can help inform interventions and targeting of obesity prevention resources.
The agency also said there are many obesity-prevention strategies that can be implemented in rural counties to improve public health.
"These include increasing the availability of healthy food by working with schools, worksites and the Cooperative Extension Service; opening public buildings (e.g., school facilities) after hours for physical activity purposes; and including bicycle paths, paved sidewalks and outdoor public recreation facilities in community planning," the statement noted.
One example of these types of efforts is the CDC's High Obesity Program (HOP)(www.cdc.gov), which funds land grant colleges and universities in states with counties that have more than 40 percent prevalence of adult obesity.
"Residents of these communities -- mostly in rural areas -- may have less access to healthy foods and fewer opportunities to be physically active," the statement said. "Grantees work with existing county cooperative extension and outreach services in targeted areas. They use proven public health strategies to help people improve physical activity and nutrition, reduce obesity and prevent or control diabetes, heart disease and stroke."
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