I was reading a June 27th blog on diaTribe called "Mapping America’s Health – NHANES Data Continues to Illuminate," which revealed that obesity rates in rural (country) areas are actually higher than those in urban (city) communities.
In this blog, the authors, Emma Ryan and Kelly Close of diaTribe, comment on the complexities of understanding these very recent findings of the National Health and Nutrition Examination Survey (NHANES).
It was initially troubling for me to understand since I have been focused on obesity and diabetes rates in highly populated cities. One of my recent blogs shed some light on "food swamps" (i.e. the prevalence of corner stores, gas stations and fast-food restaurants) as the primary reason for the health crisis in these communities, and not the commonly accepted "food desert" phenomenon (i.e. the lack of grocery stores and health food access in urban neighborhoods).
How could it be that in the rural communities, which define America’s heartland, obesity rates for men and women are higher than in our urban communities? For women, we see almost a 10 percent increase (47%) over urban populations (38%). For men, there is a 7% difference in rural communities (39%) over urban populations (32%).
In trying to figure out this rural dilemma, I came up with the following questions:
- Is it a matter of affordable healthier choices?
- Is the education about what we are genuinely consuming that inefficient?
- Are activity levels drastically reduced as compared to 20-30 years ago?
- Could it be related to how our food is currently packaged, as well as what is present in our food versus what it was like 30-40 years ago (increased added sugars, sodium, and chemicals)?
- How are wealthier communities approaching diet and exercise versus lower-income communities?
Levels of Income
In pondering these questions, I considered the one factor that these two demographic areas have in common – income levels.
I've been saying for quite some time now that diabetes is an epidemic often associated with income level, and recent data shows urban and rural poverty rates running neck and neck, with both geographic areas being the highest in the nation.
- Urban poverty rates are 19.6%, while rural rates are 17.6%.
- Suburban rates are on the rise but are still at only 11.2%.[i]
To further support this argument of the difference in levels of income, when we look at life expectancy rates between wealthy areas and lower income communities, the statistics are staggering.
Consider the urban environment of New Orleans: Figures from the Robert Wood Johnson Foundation show that life expectancy varies by as much as 25 years between neighboring zip codes. The defining difference in life expectancy is the relative wealth of the community.
The Correlation Between "Food Deserts" & Being "Food Insecure"
According to the Rural Health Information Hub (RHIhub), many of these rural communities are "food deserts." What is troubling is that some of these food deserts are physically located in the areas where food is grown![ii]
The RHIhub (a clearinghouse of the Federal Office of Rural Health Policy) contends that the presence of food deserts in these rural areas is because many of these communities lack the population to support a local grocery store. Also, some rural residents do not have access to reliable transportation to grocery stores. For many of these towns, residents are stuck with more expensive and less nutritious options, like gas station convenience stores.
The RHIhub also describes many rural families as being "food insecure," which means that they do not have consistent access to sufficient and affordable healthy food. Data for food insecure households in rural households and inner-city households are quite comparable, at 15% and 14.2% respectively.[iii]
When it comes to physical fitness, research indicates that rural adults are less active than their urban and suburban counterparts.[iv] Factors influencing this trend are limited access to exercise facilities, lower income and less available information on the benefits of physical activity.
What distinguishes those with lower income in a rural setting versus an urban environment is that in the rural communities we see smaller populations, increased vacant houses and more geographic separation from infrastructure and the legitimate economy.
Yet, the suburban lifestyle environment is not what you would call "light years ahead" of the urban and rural experiences. While there are higher income populations and greater access to exercise facilities and affordable healthcare, we must consider that common factors like stress, extended working hours and other lifestyle habits suggest that there is significant room for improvement about proper diet and physical activity.
The Link Between Our Health & Our Environment
What is going on in our rural communities is perhaps an excellent lesson for all of us regarding the importance of available nutrition, healthcare providers, and physical fitness; and as the diaTribe blog indicates, there are still a lot of questions to be answered in better understanding the obesity trends across different demographic groups.
For our part, I encourage everyone to check out the free resources on our website, especially concerning Nutrition Tools, Exercise, and Diabetes Resources. Also, like our friends at diaTribe, I strongly recommend using the AADE Diabetes Educator Search Tool to find Certified Diabetes Educators in your area.
Finally, if you have unique resources for proper nutrition, healthier living, and diabetes care management in your area, we would love to read your comments on this blog.