A National Study of Obesity Prevalence and Trends by Type of Rural County


  • This University of Washington Rural Health Research Center study was funded by the Office of Rural Health Policy, Health Resources and Services Administration, Department of Health and Human Services (Cooperative Agreement U1CRH00035-03). We gratefully acknowledge Catherine Veninga for her assistance in preparing the manuscript.

For further information, contact: J. Elizabeth Jackson, Department of Family Medicine, University of Washington, Box 354696, Seattle, WA 98195-4696; e-mail bjackson@u.washington.edu.


ABSTRACT: Context: Obesity is epidemic in the United States, but information on this trend by type of rural locale is limited. Purpose: To estimate the prevalence of and recent trends in obesity among US adults residing in rural locations. Methods: Analysis of data from the Behavioral Risk Factor Surveillance System (BRFSS) for the years 1994–1996 (n = 342,055) and 2000–2001 (n = 385,384). The main outcome measure was obesity (body mass index [BMI] ≥30), as determined by calculating BMI from respondents' self-reported height and weight. Results: In 2000–2001, the prevalence of obesity was 23.0% (95% confidence interval [CI] 22.6%-23.4%) for rural adults and 20.5% (95% CI 20.2%-20.7%) for their urban counterparts, representing increases of 4.8% (95% CI 4.2%-5.3%) and 5.5% (95% CI 5.1%-5.9%), respectively, since 1994–1996. The highest obesity prevalence occurred in rural counties in Louisiana, Mississippi, and Texas; obesity prevalence increased for rural residents in all states but Florida over the study period. African Americans had the highest obesity prevalence of any group, up to 31.4% (95% CI 29.1%-33.6) in rural counties adjacent to urban counties. The largest difference in obesity prevalence between those with a college education compared with those without a high school diploma occurred in urban areas (18.4% [95% CI 17.9%-18.9%] vs 23.5% [95% CI 22.5%-24.5%], respectively); the smallest difference occurred in small, remote rural counties (20.3% [95% CI 18.7%-21.9%] versus 22.3% [95% CI 20.7%-24.0%], respectively). Conclusions: The prevalence of obesity is higher in rural counties than in urban counties; obesity affects some residents of rural counties disproportionately.