Urban-rural differences in childhood and adolescent obesity in the United States: a systematic review and meta-analysis.
Abstract
Background: A systematic literature review and subsequent meta-analysis were performed to investigate differences in childhood obesity between urban and rural areas in the United States. Methods: A search of published studies comparing childhood obesity in urban and rural settings was undertaken by probing PubMed and Cumulative Index to Nursing and Allied Health Literature (CINAHL) for articles that met predetermined inclusion criteria. A subsequent meta-analysis was conducted to determine the combined effect size and significance of differences in childhood obesity between urban and rural areas. Results: Ten studies were identified for systematic review, five of which contributed to the meta-analysis. All but one study suggested that residence in rural areas was associated with higher prevalence or increased odds of childhood obesity, compared to children living in urban areas. A meta-analysis of 74,168 pooled participants ages 2–19 found that rural children have 26% greater odds of obesity, compared to urban children (odds ratio=1.26; 95% confidence interval, 1.21–1.32). Conclusions: Obesity rates are higher among rural children than urban children in the United States. To ensure successful targeted interventions and effective resource allocation, practitioners and policy makers alike should be cognizant of this disparity in childhood obesity.
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These differences vary by sex, and race and Hispanic origin and may be changing over time.
“These differences, however, vary by sex, and race and Hispanic origin and may be changing over time.5”
From Differences in Obesity Prevalence by Demographics and Urbanization in US Children and Adolescents, 2013-2016 (2018) · cites this paper as [5]
Trends in obesity and severe obesity prevalence by urbanization level have not been well studied.
“Trends over time in obesity prevalence among US youth by age, race and Hispanic origin, income, and education of household head have been published,1,5,13 but trends in obesity and severe obesity prevalence by urbanization level have not been well studied.”
From Differences in Obesity Prevalence by Demographics and Urbanization in US Children and Adolescents, 2013-2016 (2018) · cites this paper as [5]
Differences have also been reported by education and income.
“Differences have also been reported by education and income.5”
From Differences in Obesity Prevalence by Demographics and Urbanization in US Children and Adolescents, 2013-2016 (2018) · cites this paper as [5]
Trends over time in obesity prevalence among US youth by age, race and Hispanic origin, income, and education of household head have been published.
“Trends over time in obesity prevalence among US youth by age, race and Hispanic origin, income, and education of household head have been published,1,5,13 but trends in obesity and severe obesity prevalence by urbanization level have not been well studied.”
From Differences in Obesity Prevalence by Demographics and Urbanization in US Children and Adolescents, 2013-2016 (2018) · cites this paper as [5]
Youth living in households headed by college graduates have a lower prevalence of obesity compared with youth living in households headed by individuals with less education.
“Youth living in households headed by college graduates have a lower prevalence of obesity compared with youth living in households headed by individuals with less education.”
From Differences in Obesity Prevalence by Demographics and Urbanization in US Children and Adolescents, 2013-2016 (2018) · cites this paper as [5]
Youth in higher-income households have a lower prevalence of obesity than youth living in households with less income.
“Similarly, youth in higher- income households have a lower prevalence of obesity than youth living in households with less income.”
From Differences in Obesity Prevalence by Demographics and Urbanization in US Children and Adolescents, 2013-2016 (2018) · cites this paper as [5]
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“On the other hand, undernutrition (85) and PA like active transport and active play (19,86) generally tend to be higher in rural children in sub-Saharan Africa.”
BackgroundAmiri, P., Naseri, P., Vahedi-Notash, G., Jalali‐Farahani, S., Mehrabi, Y., Zarghani, N. H., Azizi, F., Hadaegh, F., & Khalili, D. (2020) · Scientific Reports · doi:10.1038/s41598-020-78048-0 · Cited by 27 · see citing works
Daly, C. M., Foote, S. J., & Wadsworth, D. D. (2017) · Journal of Community Health · doi:10.1007/s10900-017-0343-6 · Cited by 26 · see citing works
“A meta-analysis examining obesity in rural and urban areas found that children living in rural areas have 26% greater chance of being obese [3].”
BackgroundBrown, B. D., Harris, K. J., Heil, D. P., Tryon, M., Cooksley, A., Semmens, E. O., Davis, J. W., & Gandhi, K. (2018) · Pilot and Feasibility Studies · doi:10.1186/s40814-018-0322-4 · Cited by 26 · see citing works
“children [1], even after controlling for sociodemographics [2–5].”
BackgroundPitts, S. J., Wu, Q., Truesdale, K. P., Haynes‐Maslow, L., McGuirt, J. T., Ammerman, A. S., Bell, R. A., & Laska, M. N. (2018) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph15122681 · Cited by 26 · see citing works
Janicke, D. M., Lim, C. S., Perri, M. G., Mathews, A., Bobroff, L. B., Gurka, M. J., Parish, A., Brumback, B., Dumont-Driscoll, M. C., & Silverstein, J. H. (2019) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsz029 · Cited by 26 · see citing works
“Children living in rural areas are more likely to have obesity than their peers living in metropolitan areas (Johnson & Johnson, 2015).”
BackgroundLarson, N., Wang, Q., Berge, J. M., Shanafelt, A., & Nanney, M. S. (2016) · Public Health Nutrition · doi:10.1017/s1368980016000379 · Cited by 26 · see citing works
“…among rural US families as school breakfast participation is lower in rural compared with urban areas (14) and because of the potential for informing interventions addressing dietary patterns and the high prevalence of weight-related problems and food insecurity among rural youth (15 – 19) .”
Castrillón, C. I. M., Beckenkamp, P. R., Ferreira, M., Gregorio, J. A. M. D., Mendes, V. A. D. A., Luscombe, G. M., Stamatakis, E. A., & Ferreira, P. H. (2020) · Journal of Global Health · doi:10.7189/jogh.10.010410 · Cited by 25 · see citing works
Zgodic, A., Eberth, J. M., Breneman, C. B., Wende, M. E., Kaczynski, A. T., Liese, A. D., & McLain, A. C. (2021) · American Journal of Epidemiology · doi:10.1093/aje/kwab176 · Cited by 25 · see citing works
The Family-Home Nutrition Environment and Dietary Intake in Rural Children
Jackson, J., Smit, E., Manore, M. M., John, D. H., & Gunter, K. B. (2015) · Nutrients · doi:10.3390/nu7125495 · Cited by 28 · see citing works
“The most current available evidence indicates that rural children have 26% greater odds of obesity compared to urban children [11], yet evidence to explain this disparity is inconclusive.”
BackgroundResultColes, N., Patel, B. P., Li, P., Cordeiro, K., Steinberg, A., Zdravkovic, A., & Hamilton, J. K. (2018) · Journal of Telemedicine and Telecare · doi:10.1177/1357633x18816254 · Cited by 24 · see citing works
Brown, B. D., Harris, K. J., Dybdal, L., Malich, J. M., Bodnar, B., & Hall, E. (2019) · Health Education Journal · doi:10.1177/0017896918824624 · Cited by 24 · see citing works
“…in the USA, and high among rural minority children, particularly American Indian children, suggesting the need for innovative health promotion strategies that encompass the strengths of rural communities and engage parents (Bolin et al., 2015; Johnson and Johnson, 2015; Phillips and McLeroy, 2004).”
BackgroundInfluentialAlowfi, A., Binladen, S., Irqsous, S., Khashoggi, A. A., Khan, M. A., & Calacattawi, R. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18042142 · Cited by 25 · see citing works
“Further, sedentary activity was correlated with obesity and overweight among both urban and rural residents, thereby necessitating the need to focus initiatives for education, environmental, and policy interventions owing to better access to a wide variety of processed and traditional high-sugar, high-fat snack foods,…”
BackgroundEating disorder risk in rural US adolescents: What do we know and where do we go?
Hahn, S. L., Burnette, C. B., Borton, K. A., Carpenter, L. M., Sonneville, K. R., & Bailey, B. A. (2022) · International Journal of Eating Disorders · doi:10.1002/eat.23843 · Cited by 23 · see citing works
“First, the prevalence of higher body weight is more common in rural than urban areas, meaning individuals within rural communities likely experience disproportionate weight bias and discrimination (Johnson & Johnson, 2015).”
Fulkerson, J. A., Horning, M. L., Barr-Anderson, D., Linde, J. A., Sidebottom, A., Lindberg, R., Friend, S., Flattum, C., & Freese, R. (2020) · Contemporary Clinical Trials · doi:10.1016/j.cct.2020.106160 · Cited by 23 · see citing works
Food insecurity and physical activity insecurity among rural Oregon families
Gunter, K. B., Jackson, J., Tomayko, E. J., & John, D. H. (2017) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2017.07.006 · Cited by 22 · see citing works
Weight outcomes of NU-HOME: a randomized controlled trial to prevent obesity among rural children
Fulkerson, J. A., Horning, M. L., Barr‐Anderson, D. J., Sidebottom, A. C., Linde, J. A., Lindberg, R., Friend, S. E., Beaudette, J. L., Flattum, C. F., & FREESE, R. L. (2022) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-022-01260-w · Cited by 22 · see citing works
Zhou, P., Sun, S., Chen, T., Pan, Y., Xu, W., & Zhang, H. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192114225 · Cited by 22 · see citing works
Arakelyan, M., Freyleue, S. D., Schaefer, A., Austin, A. M., Moen, E. L., O’Malley, A. J., Goodman, D. C., & Leyenaar, J. K. (2024) · The Journal of Rural Health · doi:10.1111/jrh.12827 · Cited by 22 · see citing works
Pitts, S. J., Wu, Q., Truesdale, K. P., Laska, M. N., Grinchak, T., McGuirt, J. T., Haynes‐Maslow, L., Bell, R. A., & Ammerman, A. (2017) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph14101189 · Cited by 22 · see citing works
“In addition, residents of rural and underserved areas are more likely to be affected by obesity, compared to their urban counterparts [13,14].”
BackgroundUllmann, G., Kedia, S., Homayouni, R., Akkus, C., Schmidt, M., Klesges, L. M., & Ward, K. D. (2018) · BMC Public Health · doi:10.1186/s12889-018-5968-6 · Cited by 22 · see citing works
“Furthermore, a meta-analysis including pooled data of 74,168 youth aged 2 – 19 reported that those living in rural areas have 26% higher odds of obesity, compared to urban youth [5].”
Bel‐Serrat, S., von der Schulenburg, A., Marques-Previ, M., Mullee, A., & Murrin, C. M. (2022) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-022-01396-9 · Cited by 20 · see citing works
Food parenting practices in rural poverty context
Sano, Y., Routh, B., & Lanigan, J. D. (2018) · Appetite · doi:10.1016/j.appet.2018.11.024 · Cited by 20 · see citing works
Building a culture of health through research: The role of the physical activity research center
Kauh, T. J. (2019) · Preventive Medicine · doi:10.1016/j.ypmed.2019.105894 · Cited by 20 · see citing works
Lehmann, F., Varnaccia, G., Zeiher, J., Lange, C., & Jordan, S. (2020) · PubMed Central · doi:10.25646/6729 · Cited by 20 · see citing works
Factores de riesgo asociados con sobrepeso y obesidad en adolescentes mexicanas
Medina-Zacarías, M. C., Shamah‐Levy, T., Cuevas‐Nasú, L., Méndez‐Gómez‐Humarán, I., & Hernández‐Cordero, S. (2020) · Salud Pública de México · doi:10.21149/10388 · Cited by 19 · see citing works
Larson, N., Looby, A. A., Frost, N., Nanney, M. S., & Story, M. T. (2017) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2017.06.011 · Cited by 19 · see citing works
Impact on Dietary Choices After Discount Supermarket Opens in Low-Income Community
Pitts, S. J., Wu, Q., McGuirt, J. T., Sharpe, P. A., & Rafferty, A. P. (2018) · Journal of Nutrition Education and Behavior · doi:10.1016/j.jneb.2018.03.002 · Cited by 19 · see citing works
Milanović, S. M. (2020) · Acta Clinica Croatica · doi:10.20471/acc.2020.59.02.14 · Cited by 19 · see citing works
Using Herbs and Spices to Increase Vegetable Intake Among Rural Adolescents
Fritts, J. R., Bermudez, M. A., Hargrove, R. L., Alla, L., Fort, C., Liang, Q., Cravener, T. L., Rolls, B. J., D'Adamo, C. R., Hayes, J. E., et al. (2019) · Journal of Nutrition Education and Behavior · doi:10.1016/j.jneb.2019.04.016 · Cited by 19 · see citing works
Jönsson, F., Goicolea, I., & Sebastiån, M. S. (2019) · International Journal of Circumpolar Health · doi:10.1080/22423982.2019.1640015 · Cited by 18 · see citing works
Linde, J. A., Horning, M. L., Lee, J., Friend, S. E., Flattum, C. F., Arcan, C., & Fulkerson, J. A. (2022) · Appetite · doi:10.1016/j.appet.2022.106007 · Cited by 20 · see citing works
Moxley, E., Habtzghi, D. H., Klinkhamer, N., Wang, H., Donnelly, S., & Dykhuizen, J. (2018) · Journal of Pediatric Nursing · doi:10.1016/j.pedn.2018.12.010 · Cited by 18 · see citing works
Rural Childhood Obesity – An Emerging Health Concern
Premkumar, S., Ramanan, P. V., & lakshmi, J. (2019) · Indian Journal of Endocrinology and Metabolism · doi:10.4103/ijem.ijem_649_18 · Cited by 18 · see citing works
Fiechtner, L. G., Castro, I., Ayala, S. G., Velez, D. S., Lindros, J., Perkins, M. E., Baker, A. E., Salmon, J., Biggs, V., Cannon-Smith, G., et al. (2021) · Childhood Obesity · doi:10.1089/chi.2021.0177 · Cited by 17 · see citing works
“32,33 Thus, efforts to prevent and manage obesity in the South, in non-metropolitan, rural areas could help reduce existing disparities in obesity prevalence found across geographic regions of the United States, by socioeconomic status, and by urbanization.”
Hoffmann, S., Tschorn, M., Michalski, N., Hoebel, J., Förstner, B. R., Rapp, M. A., & Spallek, J. (2022) · Health & Place · doi:10.1016/j.healthplace.2022.102794 · Cited by 17 · see citing works
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“As the prevalence of both physical and internalizing mental health problems continues to increase among adolescents from this population [2,18,19,43], local education and health policies are needed to detect, treat, and prevent physical and mental health problems.”
BackgroundAdolescent depression and anxiety treatment in rural schools: A systematic review.
Berryhill, M. B., Carlson, C., Hopson, L. M., Culmer, N. P., & Williams, N. T. (2021) · Rural Mental Health · doi:10.1037/rmh0000183 · Cited by 20 · see citing works
Beynon, C. (2023) · BMC Public Health · doi:10.1186/s12889-023-15293-8 · Cited by 17 · see citing works
“Childhood obesity has increased worldwide over the last 30 years [3].”
BackgroundSAPUNAR, J., Aguilar-Farías, N., Navarro, J., Araneda, G., Chandía-Poblete, D., Manríquez, V., Brito, R., & Cerda, Á. (2018) · Revista médica de Chile · doi:10.4067/s0034-98872018000900978 · Cited by 17 · see citing works
Walkability indices and children's walking behavior in rural vs. urban areas
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Hart, D. A. (2021) · Frontiers in Sports and Active Living · doi:10.3389/fspor.2021.685845 · Cited by 17 · see citing works
“Thus, in North America, the rate of adult obesity is ∼35 and >70% are overweight, with the rates in children raising as well (discussed in Johnson and Johnson, 2015; Colmenarejo, 2020; Chrissini and Panagiotakos, 2021).”
BackgroundDhanjani, S., Allen, H., Varman, B., Callender, C., Dave, J. M., & Thompson, D. (2024) · Nutrients · doi:10.3390/nu16142201 · Cited by 16 · see citing works
“A meta-analysis from 2015 found that children living in rural US communities have 26% greater odds of obesity in comparison to children living in urban areas [7].”
BackgroundMethodFoster, B. A., Weinstein, K., Mojica, C. M., & Davis, M. M. (2019) · The Journal of Rural Health · doi:10.1111/jrh.12395 · Cited by 16 · see citing works
Zoellner, J., You, W., Hill, J. L., Brock, D. P., Yuhas, M., Price, B. E., Wilson, J. A., Montague, D. R., & Estabrooks, P. A. (2021) · Pediatric Obesity · doi:10.1111/ijpo.12840 · Cited by 16 · see citing works
“evaluate (1) parent health literacy at baseline using the Newest Vital Sign(32) (2) QOL using the Pediatric Quality of Life Inventory for children and Centers for Disease Control (CDC) Healthy Days Core Module for parents,(33,34) (3) nutrition for children and parents with Beverage Intake Questionnaire and CDC Fruit a…”
MethodOishi, K., Aoki, T., Harada, T., Tanaka, C., Tanaka, S., Tanaka, H., Fukuda, K., Kamikawa, Y., Tsuji, N., Komura, K., et al. (2021) · INQUIRY The Journal of Health Care Organization Provision and Financing · doi:10.1177/00469580211055626 · Cited by 16 · see citing works
“Studies have shown that rural areas have more overweight children than urban areas do.(20,21) There are no standard definitions for urban and rural areas.”
BackgroundRETRACTED: Human machine interaction-assisted smart educational system for rural children
Wei, N., Yang, F., Muthu, B., & Shanthini, A. (2022) · Computers & Electrical Engineering · doi:10.1016/j.compeleceng.2022.107812 · Cited by 16 · see citing works
RetractedChildren’s healthy eating habits and parents’ socio-demographic characteristics in rural Texas, USA
Chen, X., Cisse‐Egbuonye, N., Spears, E. C., Mkuu, R. S., & McKyer, E. L. J. (2018) · Health Education Journal · doi:10.1177/0017896917752014 · Cited by 17 · see citing works
Factors associated with overweight/obesity of children aged 6–12 years in Indonesia
Oktaviani, S., Mizutani, M., Nishide, R., & Tanimura, S. (2023) · BMC Pediatrics · doi:10.1186/s12887-023-04321-6 · Cited by 15 · see citing works
“Globally, the prevalence of over-weight and obesity among children and adolescents aged 5–19 years has approximately doubled between 1996 and 2016, from 8.9 to 18.4%, respectively, and it has tripled in LMICs, from 3.8 to 11.2%.”
BackgroundInfluential
- Authors
- Johnson, J. A., & Johnson, A. M.
- Affiliations
- Rollins College (US)
- Stetson University (US)
- Venue
- Childhood Obesity
- Publisher
- SAGE Publications
- Published
- 2015-04-30
- Volume
- 11
- Issue
- 3
- Pages
- 233-241
- ISSN
- 2153-2168 (ISSN-L)
- 2153-2176
- OpenAlex
- W1948287158
- Cited by
- 360
- References
- 33
- Citations by year
- 2026: 20 · 2025: 28 · 2024: 42 · 2023: 33 · 2022: 33 · 2021: 46 · 2020: 42 · 2019: 35 · 2018: 36 · 2017: 26 · 2016: 15 · 2015: 3
- FWCI
- 3.84
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Childhood Obesity (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Health Professions › Pharmacy › Obesity and Health Practices
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Keywords
- adolescent obesity, urban-rural disparities, rural children, obesity prevalence, health disparities, rural health
- MeSH terms
- Adolescent, Child, Diet, Humans, Nutrition Surveys, Risk Factors, Rural Population, Socioeconomic Factors, United States, Urban Population, Exercise, Body Mass Index, Prevalence, Odds Ratio, Pediatric Obesity
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