Skip to main content
SpringerLink
Log in

Rural and Remote Food Environments and Obesity

  • Etiology of Obesity (T Gill, Section Editor)
  • Published:
Current Obesity Reports Aims and scope Submit manuscript

Abstract

Within most developed countries, rural residents are more likely to be obese and overweight compared to their urban counterparts. Studies of specific rural communities have found that the limited availability of healthy foods in the community and home as well as individual characteristics and preferences contribute to poor diet and overweight. The rural food environment is varied and may be affected by climate, regional and cultural preferences, transportation access, and remoteness among other factors. Given this diversity and the vulnerabilities of rural residents, who are more likely to have low-income, substandard housing or low educational attainment compared to their urban counterparts, policy and programmatic interventions should target specific needs and communities. This review will describe the rural community, home, and individual food environments and what is known about their roles in healthy eating.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Lutfiyya MN, Lipsky MS, Wisdom-Behounek J, et al. Is Rural Residency a Risk Factor for Overweight and Obesity for U.S. Children? Obesity. 2007;15(9):2348–56.

    Article  PubMed  Google Scholar 

  2. McMurray RG, Harrell JS, Bangdiwala SI, et al. Cardiovascular disease risk factors and obesity of rural and urban elementary school children. J Rural Health. 1999;15(4):365–74.

    Article  CAS  PubMed  Google Scholar 

  3. Befort CA, Nazir N, Perri MG. Prevalence of obesity among adults from rural and urban areas of the United States: findings from NHANES (2005–2008). J Rural Health. 2012;28(4):392–7. This study uses nationally representative data to examine rural and urban obesity prevalence based on clinical markers.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Patterson PD, Moore CG, Probst JC, et al. Obesity and physical inactivity in rural America. J Rural Health. 2004;20(2):151–9.

    Article  PubMed  Google Scholar 

  5. Jackson JE, Doescher MP, Jerant AF, et al. A national study of obesity prevalence and trends by type of rural county. J Rural Health. 2005;21(2):140–8.

    Article  PubMed  Google Scholar 

  6. Kegler MC, Alcantara I, Veluswamy JK, et al. Results from an intervention to improve rural home food and physical activity environments. Prog Community Health Partnersh. 2012;6(3):265–77.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Hosler AS. Retail food availability, obesity, and cigarette smoking in rural communities. J Rural Health. 2009;25(2):203–10.

    Article  PubMed  Google Scholar 

  8. Satia JA, Galanko JA. Comparison of Three Methods of Measuring Dietary Fat Consumption by African-American Adults. J Am Diet Assoc. 2007;107(5):782–91.

    Article  PubMed  Google Scholar 

  9. Stroehla BC, Malcoe LH, Velie EM. Dietary Sources of Nutrients among Rural Native American and White Children. J Am Diet Assoc. 2005;105(12):1908–16.

    Article  PubMed  Google Scholar 

  10. Hartley D, Anderson N, Fox K, et al. How does the rural food environment affect rural childhood obesity? Childhood Obesity. 2011;7(6):450–61.

    Google Scholar 

  11. Yousefian A, Leighton A, Fox K, et al. Understanding the rural food environment–perspectives of low-income parents. Rural Remote Health. 2011;11(2):1631.

    PubMed  Google Scholar 

  12. Lucan SC, Gustafson A, Jilcott Pitts SB. The concept of “rural food deserts” is still meaningful. Childhood Obesity. 2012;8(5):484–5.

    PubMed  Google Scholar 

  13. Maine Food Strategy. Consumer Survey Report. Portland, ME: Maine Food Strategy, Edmund S. Muskie School of Public Service, University of Southern Maine, 2014.

  14. Larson NI, Story MT, Nelson MC. Neighborhood environments: disparities in access to healthy foods in the U.S. Am J Prev Med. 2009;36(1):74–81.

    Article  PubMed  Google Scholar 

  15. Hartley D. Rural health disparities, population health, and rural culture. Am J Public Health. 2004;94(10):1675–8.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Eberhardt M, Ingram D, Makuc D, et al. Health, United States, 2001: Urban and rural chartbook. National Center for Health Statistics.: Hyattsville, MD; 2001.

    Google Scholar 

  17. Pleis JR, Lethbridge-Cejku M. Summary health statistics for U.S. adults: National Health Interview Survey, 2006. Vital Health Stat. 2007;10(235):1–153.

    Google Scholar 

  18. Agency for Health Care Research Quality. Health Care in Urban and Rural Areas, Combined Years 2004–2006. Requests for Assistance on Health Initiatives: Update of Content in MEPS Chartbook No. 13 [2012/03/01]. Available from: http://www.ahrq.gov/data/meps/chbook13up.htm.

  19. Larson SL, Fleishman JA. Rural–urban differences in usual source of care and ambulatory service use: analyses of national data using Urban Influence Codes. Med Care. 2003;41(7 Suppl):III65–74.

    PubMed  Google Scholar 

  20. Lenardson JD, Ziller EC, Coburn AF, et al. Profile of rural health insurance coverage: A chartbook. Portland: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center; 2009.

    Google Scholar 

  21. Wang MC, Kim S, Gonzalez AA, et al. Socioeconomic and food-related physical characteristics of the neighbourhood environment are associated with body mass index. J Epidemiol Community Health. 2007;61(6):491–8.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Longacre MR, Primack BA, Owens PM, et al. Public directory data sources do not accurately characterize the food environment in two predominantly rural states. J Am Diet Assoc. 2011;111(4):577–82.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Casey AA, Elliott M, Glanz K, et al. Impact of the food environment and physical activity environment on behaviors and weight status in rural U.S. communities. Prev Med. 2008;47(6):600–4.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Coburn A, MacKinney AC, McBride T, et al. Choosing rural definitions: implications for health policy. Rural Policy Research Institute Health Panel, 2007.

  25. Glanz K, Sallis JF, Saelens BE, et al. Nutrition Environment Measures Survey in stores (NEMS-S): development and evaluation. Am J Prev Med. 2007;32(4):282–9.

    Article  PubMed  Google Scholar 

  26. Gustafson AA, Lewis S, Wilson C, et al. Validation of food store environment secondary data source and the role of neighborhood deprivation in Appalachia. Kentucky BMC Public Health. 2012;12:688.

    Article  Google Scholar 

  27. Creel JS, Sharkey JR, McIntosh A, et al. Availability of healthier options in traditional and nontraditional rural fast-food outlets. BMC Public Health. 2008;8:395.

    Article  PubMed Central  PubMed  Google Scholar 

  28. Leone AF, Rigby S, Betterley C, et al. Store type and demographic influence on the availability and price of healthful foods, Leon County, Florida, 2008. Prev Chronic Dis. 2011;8(6):A140.

    PubMed Central  PubMed  Google Scholar 

  29. Liese AD, Weis KE, Pluto D, et al. Food store types, availability, and cost of foods in a rural environment. J Am Diet Assoc. 2007;107(11):1916–23.

    Article  PubMed  Google Scholar 

  30. Findholt NE, Michael YL, Jerofke LJ, et al. Environmental influences on children's physical activity and eating habits in a rural Oregon County. Am J Health Promot. 2011;26(2):e74–85.

    Article  PubMed  Google Scholar 

  31. Sharkey JR, Horel S. Neighborhood socioeconomic deprivation and minority composition are associated with better potential spatial access to the ground-truthed food environment in a large rural area. J Nutr. 2008;138(3):620–7.

    CAS  PubMed  Google Scholar 

  32. Sharkey JR, Horel S, Dean WR. Neighborhood deprivation, vehicle ownership, and potential spatial access to a variety of fruits and vegetables in a large rural area in Texas. Int J Health Geogr. 2010;9:26.

    Article  PubMed Central  PubMed  Google Scholar 

  33. Walker JN, Del Rosso JM, Held AK. Nutrition and Physical Activity Field Assessment of Children in Rural America. Westport: Save the Children; 2005.

    Google Scholar 

  34. Smith C, Miller H. Accessing the Food Systems in Urban and Rural Minnesotan Communities. J Nutr Educ Behav. 2011;43(6):492–504.

    Article  PubMed  Google Scholar 

  35. O'Connell M, Buchwald DS, Duncan GE. Food access and cost in American Indian communities in Washington State. J Am Diet Assoc. 2011;111(9):1375–9.

    Article  PubMed Central  PubMed  Google Scholar 

  36. Novotny R, Vijayadeva V, Ramirez V, et al. Development and implementation of a food system intervention to prevent childhood obesity in rural Hawai'i. Hawaii Med J. 2011;70(7 Suppl 1):42–6.

    PubMed Central  PubMed  Google Scholar 

  37. Dean WR, Sharkey JR, St John J. Pulga (flea market) contributions to the retail food environment of colonias in the South Texas border region. J Am Diet Assoc. 2011;111(5):705–10.

    Article  PubMed Central  PubMed  Google Scholar 

  38. Valdez Z, Dean WR, Sharkey JR. Mobile and home-based vendors’ contributions to the retail food environment in rural South Texas Mexican-origin settlements. Appetite. 2012;59(2):212–7.

    Article  PubMed Central  PubMed  Google Scholar 

  39. Morton LW, Blanchard TC. Starved for Access: Life in Rural America’s Food Deserts. Rural Realities. 2007;1(4):1–10.

    Google Scholar 

  40. Bustillos B, Sharkey JR, Anding J, et al. Availability of more healthful food alternatives in traditional, convenience, and nontraditional types of food stores in two rural Texas counties. J Am Diet Assoc. 2009;109(5):883–9.

    Article  PubMed  Google Scholar 

  41. Dean WR, Sharkey JR. Rural and urban differences in the associations between characteristics of the community food environment and fruit and vegetable intake. J Nutr Educ Behav. 2011;43(6):426–33.

    Article  PubMed Central  PubMed  Google Scholar 

  42. Sallis JF, Glanz K. Physical activity and food environments: solutions to the obesity epidemic. Milbank Q. 2009;87(1):123–54.

    Article  PubMed Central  PubMed  Google Scholar 

  43. Hosler AS, Rajulu DT, Fredrick BL, et al. Assessing retail fruit and vegetable availability in urban and rural underserved communities. Prev Chronic Dis. 2008;5(4):A123.

    PubMed Central  PubMed  Google Scholar 

  44. Gibson DM. The neighborhood food environment and adult weight status: estimates from longitudinal data. Am J Public Health. 2011;101(1):71–8.

    Article  PubMed Central  PubMed  Google Scholar 

  45. Boehmer TK, Lovegreen SL, Haire-Joshu D, et al. What constitutes an obesogenic environment in rural communities? Am J Health Promot. 2006;20(6):411–21.

    Article  PubMed  Google Scholar 

  46. Gittelsohn J, Vijayadeva V, Davison N, et al. A Food Store Intervention Trial Improves Caregiver Psychosocial Factors and Children's Dietary Intake in Hawaii. Obesity. 2010;18(S1):S84–90.

    Article  PubMed  Google Scholar 

  47. Williamson DA, Champagne CM, Harsha DW, et al. Effect of an environmental school-based obesity prevention program on changes in body fat and body weight: a randomized trial. Obesity (Silver Spring). 2012;20(8):1653–61.

    Article  Google Scholar 

  48. Wrigley N, Warm D, Margetts B. Deprivation, diet, and food-retail access: findings from the Leeds ‘food deserts’ study. Environ Plan. 2003;35:151–88.

    Article  Google Scholar 

  49. An R, Sturm R. School and Residential Neighborhood Food Environment and Diet Among California Youth. Am J Prev Med. 2012;42(2):129–35. This study examines the relationship between the community food environment and its relationship to diet among California children and adolescents.

    Article  PubMed Central  PubMed  Google Scholar 

  50. Lee H. The role of local food availability in explaining obesity risk among young school-aged children. Soc Sci Med. 2012;74(8):1193–203. This study examines the relationship between the community food environment and obesity risk for children using national survey data and national data describing retail food sources.

    Article  PubMed  Google Scholar 

  51. Morland K, Diez Roux AV, Wing S. Supermarkets, other food stores, and obesity: the atherosclerosis risk in communities study. Am J Prev Med. 2006;30(4):333–9.

    Article  PubMed  Google Scholar 

  52. Jilcott SB, Wade S, McGuirt JT, et al. The association between the food environment and weight status among eastern North Carolina youth. Public Health Nutr. 2011;14(9):1610–7.

    Article  PubMed  Google Scholar 

  53. Glanz K, Sallis JF, Saelens BE, et al. Healthy nutrition environments: concepts and measures. Am J Health Promot. 2005;19(5):330–3. ii.

    Article  PubMed  Google Scholar 

  54. Todd J. Changes in Eating Patterns and Diet Quality Among Working Age Adults – 2005–2010. Washington, D.C.: U.S. Department of Agriculture, Economic Research Service; 2014.

    Google Scholar 

  55. Martin-Biggers J, Spaccarotella K, Berhaupt-Glickstein A, et al. Come and get it! A discussion of family mealtime literature and factors affecting obesity risk. Adv Nutr. 2014;5(3):235–47.

    Article  PubMed  Google Scholar 

  56. Hermstad AK, Swan DW, Kegler MC, et al. Individual and environmental correlates of dietary fat intake in rural communities: a structural equation model analysis. Soc Sci Med. 2010;71(1):93–101.

    Article  PubMed  Google Scholar 

  57. Arcan C, Hannan PJ, Fulkerson JA, et al. Associations of home food availability, dietary intake, screen time and physical activity with BMI in young American-Indian children. Public Health Nutr. 2013;16(1):146–55.

    Article  PubMed  Google Scholar 

  58. Neumark-Sztainer D, Wall M, Perry C, et al. . Correlates of fruit and vegetable intake among adolescents. Findings from Project EAT. Prev Med. 2003;37(3):198–208.

    Article  PubMed  Google Scholar 

  59. Jahns L, McDonald L, Wadsworth A, et al. Barriers and facilitators to following the Dietary Guidelines for Americans reported by rural, Northern Plains American-Indian children. Public Health Nutr. 2014; FirstView (Supplement −1):1–8.

  60. Brown BD, Harris KJ, Harris JL, et al. Translating the diabetes prevention program for Northern Plains Indian youth through community-based participatory research methods. Diabetes Educ. 2010;36(6):924–35.

    Article  PubMed Central  PubMed  Google Scholar 

  61. Wenrich TR, Brown JL, Miller-Day M, et al. Family members' influence on family meal vegetable choices. J Nutr Educ Behav. 2010;42(4):225–34.

    Article  PubMed Central  PubMed  Google Scholar 

  62. Blanchard TC, Matthews TL. Food Disadvantaged Communities in Rural America. In: Hinrichs CC, Lyson TA, editors. Remaking the North American Food System: Strategies for Sustainability. Lincoln, NE: University of Nebraska Press; 2007.

    Google Scholar 

  63. Webber CB, Sobal J, Dollarhite JS. Physical Disabilities and Food Access Among Limited Resource Households. Disability Studies Quarterly. 2007;27(3).

  64. Stuff JE, Casey PH, Szeto KL, et al. Household Food Insecurity Is Associated with Adult Health Status. J Nutrition. 2004;134(9):2330–5.

    CAS  Google Scholar 

  65. Nanney MS, Johnson S, Elliott M, et al. Frequency of eating homegrown produce is associated with higher intake among parents and their preschool-aged children in rural Missouri. J Am Diet Assoc. 2007;107(4):577–84.

    Article  PubMed  Google Scholar 

  66. Jilcott SB, Laraia BA, Evenson KR, et al. Perceptions of the community food environment and related influences on food choice among midlife women residing in rural and urban areas: a qualitative analysis. Women Health. 2009;49(2–3):164–80.

    Article  PubMed Central  PubMed  Google Scholar 

  67. Maley M, Warren BS, Devine CM. Perceptions of the environment for eating and exercise in a rural community. J Nutr Educ Behav. 2010;42(3):185–91.

    Article  PubMed  Google Scholar 

  68. Escoffery C, Kegler MC, Alcantara I, et al. A qualitative examination of the role of small, rural worksites in obesity prevention. Prev Chronic Dis. 2011;8(4):A75.

    PubMed Central  PubMed  Google Scholar 

  69. U.S. Department of Agriculture Economic Research Service. Food Security in the U.S. Washington, D.C.: U.S. Department of Agriculture 2014 [July 22, 2014]. Available from: http://ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us.aspx#.U86KyhClvB9.

  70. Dinour LM, Bergen D, Yeh M-C. The Food Insecurity–Obesity Paradox: A Review of the Literature and the Role Food Stamps May Play. J Am Diet Assoc. 2007;107(11):1952–61.

    Article  PubMed  Google Scholar 

  71. Casey PH, Simpson PM, Gossett JM, et al. The Association of Child and Household Food Insecurity With Childhood Overweight Status. Pediatrics. 2006;118(5):e1406–13.

    Article  PubMed  Google Scholar 

  72. U.S. Department of Agriculture Economic Research Service. Rural Children at a Glance. Washington, D.C: U.S. Department of Agriculture; 2005.

    Google Scholar 

  73. National Association of Counties. Rural Obesity: Strategies to Support Rural Counties in Building Capacity. Washington, D.C.: National Association of Counties; 2008. Available from: http://www.leadershipforhealthycommunities.org/images/stories/ruralobesity_naco.pdf.

    Google Scholar 

  74. Zenk SN, Odoms-Young A, Powell LM, et al. Fruit and vegetable availability and selection: federal food package revisions, 2009. Am J Prev Med. 2012;43(4):423–8.

    Article  PubMed  Google Scholar 

  75. Rickman JC, Barrett DM, Bruhn CM. Nutritional comparison of fresh, frozen and canned fruits and vegetables. Part 1. Vitamins C and B and phenolic compounds. J Sci Food Agric. 2007;87(6):930–44.

    Article  CAS  Google Scholar 

  76. Graves A, Haughton B, Jahns L, et al. Biscuits, sausage, gravy, milk, and orange juice: school breakfast environment in 4 rural Appalachian schools. J Sch Health. 2008;78(4):197–202.

    Article  PubMed  Google Scholar 

  77. Dutko P, Ver Ploeg M, Farrigan T. Characteristics and Influential Factors of Food Deserts. U.S. Department of Agriculture Economic Research Service: Washington, D.C; 2012.

    Google Scholar 

  78. Holsten JE. Obesity and the community food environment: a systematic review. Public Health Nutr. 2009;12(03):397–405.

    PubMed  Google Scholar 

  79. Ver Ploeg M. Access to Affordable, Nutritious Food is Limited in “Food Deserts”. Amber Waves. 2010

  80. Hartley D, Anderson N, Fox K, et al. Redirecting the conversation on rural food deserts: reply to Lucan et al. Childhood Obesity. 2012;8(5):492–3.

    Google Scholar 

  81. Ver Ploeg M, Breneman V, Farrigan T, et al. Access to Affordable and Nutritious Food: Measuring and Understanding Food Deserts and Their Consequences: Report to Congress. U.S. Department of Agriculture Economic Research Service: Washington, D.C; 2009.

    Google Scholar 

  82. Smith C, Morton LW. Rural food deserts: low-income perspectives on food access in Minnesota and Iowa. J Nutr Educ Behav. 2009;41(3):176–87.

    Article  PubMed  Google Scholar 

  83. Hamilton LC, Hamilton LR, Duncan CM, et al. Place Matters: Challenges and Opportunities in Four Rural Americas. Durham, NH: University of New Hampshire Carsey Institute; 2008.

    Google Scholar 

  84. Barnidge EK, Radvanyi C, Duggan K, et al. Understanding and addressing barriers to implementation of environmental and policy interventions to support physical activity and healthy eating in rural communities. J Rural Health. 2013;29(1):97–105. This study describes barriers to healthy eating interventions in rural communities based on key informant interviews.

    Article  PubMed  Google Scholar 

  85. Fleischhacker SE, Rodriguez DA, Evenson KR, et al. Evidence for validity of five secondary data sources for enumerating retail food outlets in seven American Indian communities in North Carolina. Int J Behav Nutr Phys Act. 2012;9:137.

    Article  PubMed Central  PubMed  Google Scholar 

  86. The Nemours Foundation. Childhood Obesity Prevention Strategies for Rural Communities. Wilmington, DE: The Nemours Foundation, 2014.

  87. Rural Assistance Center. Rural Obesity Prevention Toolkit Grand Forks, ND: Rural Assistance Center; 2012 [July 22, 2014]. Available from: http://www.raconline.org/communityhealth/obesity/files/obesity-prevention-toolikit.pdf.

  88. Carney PA, Hamada JL, Rdesinski R, et al. Impact of a community gardening project on vegetable intake, food security and family relationships: a community-based participatory research study. J Community Health. 2012;37(4):874–81.

    Article  PubMed Central  PubMed  Google Scholar 

  89. Ries AV, Blackman LT, Page RA, et al. Goal setting for health behavior change: evidence from an obesity intervention for rural low-income women. Rural Remote Health. 2014;14:2682.

    CAS  PubMed  Google Scholar 

  90. Cohen JF, Kraak VI, Choumenkovitch SF, et al. The CHANGE study: a healthy-lifestyles intervention to improve rural children's diet quality. J Acad Nutr Diet. 2014;114(1):48–53.

    Article  PubMed  Google Scholar 

  91. Cohen JF, Rimm EB, Austin SB, et al. A food service intervention improves whole grain access at lunch in rural elementary schools. J Sch Health. 2014;84(3):212–9.

    Article  PubMed  Google Scholar 

  92. Smith LH, Holloman C. Piloting ‘Sodabriety’: A School-Based Intervention to Impact Sugar-Sweetened Beverage Consumption in Rural Appalachian High Schools. J Sch Health. 2014;84(3):177–84.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to thank Mark Lapping, Kim Fox, and Karen Pearson of the University of Southern Maine.

Compliance with Ethics Guidelines

ᅟ

Conflict of Interest

Jennifer D. Lenardson, Anush Y. Hansen, and David Hartley declare they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Maine Rural Health Research Center, University of Southern Maine, 432B Wishcamper Center, 34 Bedford Street, Portland, ME, 04104, USA

    Jennifer D. Lenardson

  2. Maine Rural Health Research Center, University of Southern Maine, 404G Wishcamper Center, 34 Bedford Street, Portland, ME, 04104, USA

    Anush Y. Hansen

  3. Maine Rural Health Research Center, University of Southern Maine, 418 Wishcamper Center, 34 Bedford Street, Portland, ME, 04104, USA

    David Hartley

Authors
  1. Jennifer D. Lenardson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anush Y. Hansen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David Hartley
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jennifer D. Lenardson.

Additional information

This article is part of the Topical Collection on Etiology of Obesity

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lenardson, J.D., Hansen, A.Y. & Hartley, D. Rural and Remote Food Environments and Obesity. Curr Obes Rep 4, 46–53 (2015). https://doi.org/10.1007/s13679-014-0136-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13679-014-0136-5

Keywords

Search

Navigation