For Rural U.S. Residents, More Is Often Less When It Comes to Health

Photo of Christina M. Shay, PhD, FAHAGetting all Americans healthy — regardless of their race/ethnicity, income, education or geography — is a lofty goal. But our attention, our resources and, most importantly, our actions are needed now more than ever.

Although obesity has historically hit upper socioeconomic classes obesity harder, that reality has changed. The previous effects of poverty — including food scarcity and high energy demands of physically laborious tasks for daily survival — no longer “protect” against obesity. 

As the United States has become more urbanized and our food production and distribution systems more modern, it’s easier to get inexpensive, energy-dense foods — and easier to consume too many calories. Those calories aren’t always getting burned either. In part, we can thank the shift to less physically demanding jobs and more widespread access to screens for work and play, promoting a sedentary lifestyle.

Digging deeper, our colleagues at the Centers for Disease Control recently looked at the higher prevalence of obesity in children and adults living in rural areas compared to those living in urban areas.1-3

In rural areas, overabundance and easy access to high-calorie foods are common, while easy access to grocery stores with affordable and healthy food options is limited. Consequently, rural areas are increasingly becoming “obesogenic” environments.

Elizabeth A. Lundeen, PhD, MPH, Epidemic Intelligence Service Officer and colleagues at the Centers for Disease Control1 have outlined strategies to improve the health of all Americans, with a particular focus on rural America. We know it will take concerted efforts to tackle healthier foods and beverages, and physical activity, in rural areas. States and counties must make health a priority and fund effective policies.

The work doesn’t end there. Governments and organizations like the American Heart Association should continue to facilitate community-based initiatives that support the healthy development of children into adults. Working together, we can build healthier environments for everyone.


  1. Lundeen EA, Park S, Pan L, O’Toole T, Matthews K, Blanck HM. Obesity Prevalence Among Adults Living in Metropolitan and Nonmetropolitan Counties — United States, 2016. MMWR Morb Mortal Wkly Rep 2018; 67:653–658. 
  2. Ogden CL, Fryar CD, Hales CM, Carroll MD, Aoki Y, Freedman DS. Differences in Obesity Prevalence by Demographics and Urbanization in US Children and Adolescents, 2013-2016. JAMA, 2018;319(23):2410-2418.
  3. Hales CM, Fryar CD, Carroll MD, Freedman DS, Aoki Y, Ogden CL. Differences in Obesity Prevalence by Demographics and Urbanization in Adults in the United States, 2013-2016. JAMA, 2018;319(23):2419-2429.