Impact of the food environment and physical activity environment on behaviors and weight status in rural U.S. communities
Introduction
Thirty percent of U.S. adults 20 years of age and older are obese (Ogden et al., 2006), which increases their risk for health conditions such as hypertension, type 2 diabetes, coronary heart disease, and stroke. Obesity is the result of consuming more calories than the body expends, and this energy imbalance can be perpetuated by the individual's built environment, which includes urban design, land use, the transportation infrastructure, and available activity options for people within that space (Booth et al., 2005, Handy et al., 2002). Though biological, psychological, and social factors contribute to obesity, increasing emphasis has been placed on understanding the environmental influences that are considered mostly responsible for population increases in obesity (Hill and Peters, 1998).
Many researchers agree that changes in the environment are responsible for the rapid change in obesity rates (Jeffery and Utter, 2003). Neighborhood environment attributes have been associated with obesity and obesity-related behaviors, particularly physical activity. Living in walkable neighborhoods that promote active transportation (Heath et al., 2006) and having easy access to recreation facilities (Humpel et al., 2002) have been positively associated with physical activity and with lower risk of obesity (Frank et al., 2003, Giles-Corti et al., 2003, Saelens et al., 2003b). Food environments likely affect risk of obesity (Hill and Peters, 1998, Egger and Swinburn, 1997), but few studies have examined the role of both food and physical activity environments in relation to obesity status.
In addition, nearly all studies on obesogenic environments in the United States have been conducted in urban and suburban settings. This is despite the fact that rural adults have higher levels of obesity and are less active in their leisure time than urban and suburban U.S. adults (Eberhardt et al., 2001, Parks et al., 2003, Patterson et al., 2004). Rural adults are also more likely to have poor health outcomes due to low socioeconomic status and reduced access to healthcare (Eberhardt et al., 2001), which would increase their risks of obesity-related health conditions. Thus, it is important to determine the extent to which food and physical activity environments in rural settings can explain risk of obesity because such findings could point toward policy solutions affecting whole populations.
This study builds on previous work (Egger and Swinburn, 1997, Swinburn et al., 1999, Hill and Peters, 1998, Poston and Foreyt, 1999, French et al., 2001, Parks et al., 2003, Patterson et al., 2004) by examining the relationship of weight status to specific indicators of the built environment in rural Midwest communities. The goal of the current research was to examine how perceived physical activity environments, community food environments, and food shopping and dining patterns relate to obesity status among normal weight and obese adults living in rural areas.
Section snippets
Design and sample
As part of an intervention research program, Project WOW (Brownson et al., 2005), 12 rural communities in Missouri (6), Arkansas (2) and Tennessee (4) were identified. Project WOW (Walk the Ozarks to Wellness) aims to promote walking among overweight rural adults by integrating individual, interpersonal, and community-level interventions. Detailed methods of the intervention are described in detail elsewhere Brownson, et al., 2005). These communities ranged in population size for adults
Results
Those with more than a high school education were more likely to report a large selection of fruits and vegetables (83.0% vs 77.8%); often shopping at supermarkets (90.6% vs. 79.1%) and bakeries (17.5% vs 13.2%); and often eating at sit down restaurants (65.4% vs 43.5%), coffee shops (13.1 vs 7.5%), and bars or taverns (8.4 vs 5.2%) than those with less than a high school education (Table 2). Respondents with more than a high school education were also slightly more likely to rate the community
Discussion
This study found that obesity was related to frequency of use of specific food outlets that may encourage overeating, such as buffets, cafeterias, and fast food restaurants. Obese rural adults reported living in communities that were not “activity-friendly” or supportive of physical activity. Characteristics of the perceived physical activity environment associated with obesity among this sample included the perception that the community was not pleasant for physical activity. Thus, both
Conflict of interest statement
The authors have no conflicts of interest to declare.
Acknowledgments
This study was funded through the National Institutes of Health grant NIDDK #5 R18 DK061706 and the Centers for Disease Control and Prevention contract U48/DP000060 (Prevention Research Centers Program).
This study was approved by the Saint Louis University Institutional Review Board.
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