Obesity and Country Life

Many Americans, and maybe even people from other places, have the impression that rural residents in the USA are in great shape, because of all the physical labor that country living implies. There is farm work; property maintenance; dealing with horses or cows; heavy machinery repair; gardening, etc. And likewise, we might even cherish an image of country folk enjoying a bounty of fresh foods, rather than hyper-processed junk.

But no. Part of the reason is, there are very few family farms anymore, because corporations have moved in and muscled everybody out. The stereotypical vision of the family farm growing one crop or a few crops, with a thriving kitchen garden for the family, is rarely seen. People who are still growing food seem to have transitioned to small operations producing fresh sprouts, midget veggies, heirloom tomatoes, or gourmet mushrooms. Some grow legal marijuana in greenhouses, or supply an elite clientele with semi-legal raw milk.

What we think

One of the unconscious assumptions made by many Americans is that rural people are farmers, but that appears to be incorrect. A lot of people live in the country because they can’t afford city rent prices, or have an interest (like rebuilding automobiles) that requires space, and distance from neighbors who object to noise and “eyesore” properties.

Maybe they raise llamas, or run a doggie-sitting establishment where people who go on vacation can leave their pets. Maybe they moved out there to build a dirt bike race track, or so their kids could fly drones, or hold band practice where it doesn’t bother anybody. Some just like the wide-open spaces. But none of that is necessarily connected with the desire, or ability, to raise their own food for the family table, on a regular basis.

Similarity and difference

Out in the sticks, the “food desert” phenomenon is definitely a factor. In 2012, the Robert Wood Johnson Foundation publication “F as in Fat: How Obesity Threatens America’s Future” quoted the U.S. Department of Agriculture figures. Putting some numbers to the food desert concept, they reported that around 2.3 million Americans lived in low-income areas more than 10 miles from a supermarket.

Looking back over the past few years, at the big picture, we see that in 2016, the CDC’s Behavioral Risk Factor Surveillance System showed that “28.7 percent of adults living in urban or metropolitan areas had obesity, compared with 34.2 percent of adults living in rural areas.”

Other research looked at the matter from the perspective of selection and causation, and found that moving from city to country “predicted a within-person increase in body weight,” and that once settled in the country, obese people were less likely to pick up and move again:

Using nationally representative longitudinal data, this study investigates: (1) whether people with obesity select into rural counties, and (2) whether living in a rural area increases body weight after accounting for selection bias… These results suggest that the association between rural residence and obesity in the United States is likely bidirectional.

Contributing factors?

As Childhood Obesity News has pointed out before, the causes of obesity are definitely multifactorial. Amanda Seitz reported on one of them, the steady decrease of available prenatal care in rural areas. This type of service is vital because of the many factors that can contribute to childhood obesity in the womb, or even before conception. Seitz wrote,

Hospitals have been shedding their obstetric services in rural areas, low-income and majority Black communities… More than half of rural counties didn’t have a hospital offering pregnancy care as of 2018…

(To be continued…)

Your responses and feedback are welcome!

Source: “F as in Fat,” RWJF.org 09/01/12
Source: “New Report Shows U.S. Obesity Epidemic Continues to Worsen,” AAFP.org, 10/15/18
Source: “Obesity among U.S. rural adults: Assessing selection and causation with prospective cohort data,” ScienceDirect.com, January 2020
Source: “COVID-19 linked to increase in US pregnancy-related deaths,” SFGate.com, 10/19/22
Image by luvjnx/CC BY 2.0

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About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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