Nearly 40% of rural American men and almost half of rural women are now statistically obese, US Centers for Disease Control and Prevention researchers reported.
And rural men, women and children are more likely to be severely obese than their counterparts from urban areas.
Further, rates of severe obesity in adults grew much faster in rural areas than metropolitan areas during the past decade and a half, said senior researcher Cynthia Ogden.
The studies were published in the Journal of the American Medical Association.
"If you look at the trends in men, severe obesity more than tripled in rural areas," said Ogden, a CDC epidemiologist. "In women, severe obesity more than doubled."
Experts categorise obesity according to body mass index (BMI), a measurement based on height and weight. Severe obesity – a BMI of 40 or more – increased in rural men from less than 3% in 2001–2004 to almost 10% in recent years.
Severe obesity also increased among urban-dwelling men during the same period, but only from 2.5% to roughly 4%.
In non-metropolitan women, severe obesity leapt from about 6% to almost 14%, while creeping up from about 6% to just over 8% among urban women.
Physicians surprised by results
Health experts said they are puzzled by the studies' results, given the popular notion that urban dwellers have less access to healthy food and regular physical labour than rural dwellers.
"I wasn't surprised that obesity was a problem in rural areas. I was just surprised that it was higher than in urban areas. I kind of expected it to be the other way," said Dr Robert Wergin, past president of the American Academy of Family Physicians.
Obesity is linked type 2 diabetes, heart disease and stroke, certain types of cancer and pregnancy complications.
For the reports, the researchers relied on data from the CDC's National Health and Nutrition Examination Survey, which regularly monitors the health and nutritional status of adults and children in the United States.
They found more obesity (a BMI between 30 and 40) in rural areas than urban settings for men (39% versus 32%), women (47% vs. 38%) and children (about 22% vs. 17%).
Differences were even more striking when it came to severe obesity.
Rural men have twice as much severe obesity as urban males, nearly 10% vs. just over 4%. There also are large differences in women (almost 14% vs. a little more than 8%) and children (over 9% vs. just over 5%).
Obesity in children
It's particularly troubling that nearly one in every 10 rural children is severely obese, said Aaron Kelly, co-director of the University of Minnesota's Center for Pediatric Obesity Medicine.
"These kids with severe obesity really need to have access to specialised medical care to treat their obesity, in the form of weight management services," Kelly said. "The severity of the disease makes it such that it can't be effectively treated in the primary care environment."
Unfortunately, those sorts of services are available only in urban settings.
"That's a huge issue," Kelly said. "They just aren't going to be able to reasonably drive to the bigger cities where these obesity specialists are who can help them."
There's no way to tell at this point why rural people seem to struggle more with obesity than city residents, Wergin said.
But rural doctors need to be more proactive in talking with patients about their weight, he added.
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