Combatting obesity in rural communities

The Rural Obesity Prevention Toolkit – a comprehensive tool for practitioners.

Perceptions of rural, American life usually include things that promote health – open fields for physical activity, access to bountiful vegetable gardens and leisurely lifestyles with home cooked meals. These common images of rural lifestyle are not always accurate. It may surprise many to learn that multiple studies have shown higher obesity rates among adults and children in rural communities compared to their urban counterparts.

An analysis of data from the 2005-2008 National Health & Nutrition Examination Survey (NHANES) found nearly 40 percent of rural adults were considered obese, compared to 33 percent of urban adults. A report by the National Association of Counties notes common challenges between metropolitan and rural communities, but according to their survey of rural leaders, found unique factors among rural settings. Lack of transportation infrastructure, poor access to healthcare, older population and high rates of food insecurity are just some of the issues that contribute to reduced health status among rural Americans.

The economic and health impacts of obesity are daunting. Obesity is cited as the leading cause of preventable deaths in the United States with related care costs estimated over $147 billion in 2012. Health impacts include heightened risk for developing chronic disease such as Type 2 diabetes, heart disease and stroke, as well as complications during pregnancy.

There is no doubt that focused prevention efforts among this population are needed to help treat and prevent this growing health threat – so where to begin? Researchers from the University of Chicago and University of Minnesota found the need to provide support to rural health practitioners. The Rural Obesity Prevention Toolkit helps rural communities identify and apply evidence-based, or the best available research and promising models for obesity prevention. The toolkit includes seven modules and uses a question and answer format to prompt and guide thinking among partners. Authors of the toolkit encourage a diverse partnership that may include representatives from local public health departments, health care institutions, schools, chamber of commerce, Cooperative Extension, academic institutions and community residents. Deliberative, collaborative efforts that rely on multi-sector participation to address complex problems, like obesity, have utilized a collective impact approach to reach greater progress.

Strategies identified within the toolkit include intervention approaches that have been tested in health care, school and community settings. Examples of interventions within these settings from several rural communities can be found through Rural Action Center.

As a result of the research, authors of the toolkit suggest considering the following factors when deciding on an intervention strategy: Availability of resources, community or social capital, existing networks and whether the program is designed to address individual-level, or policy, systems and environmental-level strategies (see Table 1).

Table 1 – Individual and Population Strategies


Strategies to Reach Individuals

Individual-level (Behavior Change)

Strategies to Reach Populations

Policy, Systems and Environmental (PSE)- Level


Help individuals reach or maintain a healthy weight by balancing calories taken in through food with calories spent through physical activity

Help populations maintain a healthy weight by “making the healthy choice the easy choice”


Reduce calories taken in through food and increase calories spent through physical activity

Lower the likelihood of a chronic imbalance between calories consumed and calories spent; avoid chronic, low-level excess of calories that leads to weight gain

What is Measured?

Weight loss

Change that support healthy eating and physical activity

K. Harris Brewer and H. Langerman. Promising practices to prevent and address obesity in rural communities. The Walsh Center for Rural Health Analysis and Rural Health Research Center. June 2013.

Michigan State University Extension offers educational programs in rural communities. For more information please visit

Additional resources:

  • Michigan Strategic Opportunities for Rural Health Improvement, 2008-2012 Final Report

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