The DOI matches its Crossref record; 33 of the 33 references it cites were found in a registry or an index.
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, 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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
Citations
Cites
Prevalence of obesity and trends in body mass index among US children and adolescents, 1999-2010.
Ogden, C., Carroll, M., Kit, B., & Flegal, K. (2012) · Journal of the American Medical Association (JAMA) · doi:10.1001/jama.2012.40 · Cited by 4,128
Wang, Y., & Beydoun, M. A. (2007) · Epidemiologic Reviews · doi:10.1093/epirev/mxm007 · Cited by 2,854
Health Consequences of Obesity in Youth: Childhood Predictors of Adult Disease
Dietz, W. H. (1998) · Pediatrics · doi:10.1542/peds.101.s2.518 · Cited by 2,700
Tracking of childhood overweight into adulthood: a systematic review of the literature
Singh, A. S., Mulder, C., Twisk, J. W. R., van Mechelen, W., & Chinapaw, M. J. M. (2008) · Obesity Reviews · doi:10.1111/j.1467-789x.2008.00475.x · Cited by 2,495
Preventing Childhood Obesity: Health in the Balance
Koplan, J. P., Liverman, C. T., & Kraak, V. A. (2005) · PsycEXTRA Dataset · doi:10.1037/e407782005-001 · Cited by 1,717
The medical care costs of obesity: An instrumental variables approach
Cawley, J., & Meyerhoefer, C. D. (2011) · Journal of Health Economics · doi:10.1016/j.jhealeco.2011.10.003 · Cited by 1,517
Han, J. C., Lawlor, D. A., & Kimm, S. Y. S. (2010) · The Lancet · doi:10.1016/s0140-6736(10)60171-7 · Cited by 1,401
Assessment of Child and Adolescent Overweight and Obesity
Krebs, N. F., Himes, J. H., Jacobson, D. M., Nicklas, T. A., Guilday, P., & Styne, D. M. (2007) · PEDIATRICS · doi:10.1542/peds.2007-2329d · Cited by 1,007
Rural Definitions for Health Policy and Research
Hart, L. G., Larson, E. H., & Lishner, D. M. (2005) · American Journal of Public Health · doi:10.2105/ajph.2004.042432 · Cited by 968
Accuracy of Teen and Parental Reports of Obesity and Body Mass Index
Goodman, E., Hinden, B. R., & Khandelwal, S. (2000) · PEDIATRICS · doi:10.1542/peds.106.1.52 · Cited by 724
Flagged first, then by citations
Research works printed but not linked: 11
- National Center for Health Statistics. Health, United States 2006: With chartbook on trends in the health of Americans. 2007 Nov; DHHS Pub No. 2006-1232:1–543.
- Gauthier BM, , Hickner JM, , Noel MM. High prevalence of overweight children in Michigan primary care practices: An UPRNet study. J Fam Pract, 2000; 49:73–76.
- Neal WA, , Demerath E, , Gonzales E, et al. Coronary artery risk detection in Appalachian communities (CARDIAC): Preliminary findings. W V Med J, 2000; 97:102–105.
- Kuczmarski RJ, , Ogden CL, , Guo SS, et al. 2000 CDC growth charts for the United States: Methods and development. Vital Health Stat, 11 2002; 246:1–190.
- Office of Management and Budget. Final report and recommendations from the metropolitan area standards review committee to the office of management and budget concerning changes to the standards for defining metropolitan areas. Federal Register, 2000; 65:51059–51077.
- Office of Management and Budget. Standards for delineating metropolitan and micropolitan statistical areas. Federal Register, 2010; 75:37246–37252.
- Bureau of the Census. Geographic Areas Reference Manual. US Department of Commerce: Washington, DC, 1994.
- Ingram DD, , Franco S. NCHS urban-rural classification scheme for counties. Vital Health Stat, 2 2012; 154:1–65.
- 10.1089/chi.2011.0090 · DOI
- Blumberg SJ, , Olson L, , Frankel MR, et al. Design and operation of the National Survey of Children's Health, 2003. Vital Health Stat, 1 2005; 43:1–131.
- Zipf G, , Chiappa M, , Porter KS, et al. National Health and Nutrition Examination Survey: Plan and operations, 1999–2010. Vital Health Stat, 1 2013; 56:1–37.
Cited by
Sorted by citations
Items 301–360 of 360
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Jones, S. A., Danze, G., Price, A., Merianos, A. L., & Smith, M. L. (2022) · Health Behavior Research · doi:10.4148/2572-1836.1147 · Cited by 1
“A systematic review revealed that children living in rural areas are 26% more likely to be obese, in comparison with children residing in urban locations (Johnson & Johnson, 2015).”
Lim, C. S., Dodd, C. A., Rutledge, L., Sandridge, S. W., King, K., Jefferson, D., & Tucker, T. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20032373 · Cited by 1
“However, providing consistent and efficient care is more difficult when health care providers treat children and families from underserved and under-resourced backgrounds [8,9].”
BackgroundAhmmad, M. R., & Faruque, F. (2023) · medRxiv · doi:10.1101/2023.02.04.23285474 · Cited by 1
Warnick, J. L., Darling, K. E., Jelalian, E., & Goldschmidt, A. B. (2023) · Elsevier eBooks · doi:10.1016/b978-0-323-96023-6.00054-3 · Cited by 1
Rathomi, H. S. (2024) · Preprints.org · doi:10.20944/preprints202402.1492.v1
Fidler, J., McLaughlin, P. A., Bubela, D. J., Scarneo‐Miller, S. E., McGarry, J. E., Evanovich, J. M., & DiStefano, L. J. (2016) · Journal of Childhood Obesity · doi:10.21767/2572-5394.100019
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Lyson, H. C. (2017) · eScholarship (California Digital Library)
Arfianti, A. (2019) · Kesmas National Public Health Journal · doi:10.21109/kesmas.v13i4.2639
Roth, T., Kozikowski, C. B., & Nelson, T. D. (2019) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsz059
Halpin, K. L., Noel‐MacDonnell, J., & Yan, Y. (2018) · Digital Scholarship - UNLV (University of Nevada Reno)
Korani, M. F. (2019) · Cronfa (Swansea University) · doi:10.23889/suthesis.50752
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Emmert, D. (2020) · ACS symposium series · doi:10.1021/bk-2020-1343.ch011
Corona, A. E. J., Hernández, C. Y. D. L. C., Hernández, G. H., & Santos, L. R. M. (2020) · Mexican Journal of Medical Research ICSA · doi:10.29057/mjmr.v8i16.4744
Yuhas, M. (2019) · VTechWorks (Virginia Tech)
Zoellner, J., You, W., Hill, J. L., Brock, D. P., Yuhas, M., Price, B. E., Wilson, J. A., Montague, D. R., & Estabrooks, P. A. (2020) · doi:10.21203/rs.3.rs-35413/v1
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Ortiz, M. D. P. (2011) · DOAJ (DOAJ: Directory of Open Access Journals)
Beech, B. M. (2017) · Family & Community Health · doi:10.1097/fch.0000000000000167
chegini, F. R., Eskandari, Z., & Sangari, M. (2022) · Shenakht Journal of Psychology and Psychiatry · doi:10.32598/shenakht.9.4.95
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Ishikawa, N., Koyama, Y., Doi, S. K., Isumi, A., & Fujiwara, T. (2023) · Frontiers in Pediatrics · doi:10.3389/fped.2022.938139 · Cited by 1
Obesity and Related Health Conditions
(2023) · American Academy of PediatricsItasca, IL eBooks · doi:10.1542/9781610026628-ch20
Reexamining the complex issue of obesity in childhood
Shreve, M. D., Scott, A. L., & Davis, R. L. (2024) · The Nurse Practitioner · doi:10.1097/01.npr.0000000000000150
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Sørensen, K. K., Andersen, M. P., Møller, F. T., Wiingreen, R., Broccia, M., Fosbøl, E. L., Zareini, B., Gerds, T. A., & Torp-Pedersen, C. T. (2024) · PLoS ONE · doi:10.1371/journal.pone.0297386 · Cited by 1
Vazquez, C. E., Brown, F. A., Ohri, F., & Baiden, P. (2024) · PLoS ONE · doi:10.1371/journal.pone.0305638
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BackgroundRose, I. D., Merlo, C. L., Dorleans, C., McConnell, L., Murray, C. C., Pampati, S., Lee, S. L., & Applebaum, M. (2024) · The Journal of School Nursing · doi:10.1177/10598405241267020
“Students living in rural communities often face multiple barriers to consuming healthier diets due to limited access to healthy foods, increasing their risk of obesity in comparison to their urban and suburban peers (Johnson & Johnson, 2015; Steves et al., 2021).”
Choi, J., Kofie, P., & Lee, M. (2024) · Journal of Global Health Science · doi:10.35500/jghs.2024.6.e11
Kim, D., & Park, H. (2024) · American Journal of Health Behavior · doi:10.5993/ajhb.48.4.10
Marchello, N. J., Chrisman, M., Hastert, M. C., Skarbek, A. J., Endsley, P., & Hagen, J. (2024) · Health Promotion Practice · doi:10.1177/15248399241296105
“Obesity rates and cardiovascular disease risk for rural children are higher than their urban counterparts (Johnson & Johnson, 2015).”
Heidl, A. J., Gierc, M. S. H., Saputra, S. T., Waliwitiya, T., Puterman, E. M., & Cohen, T. R. (2024) · Childhood Obesity · doi:10.1089/chi.2024.0374
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Machado‐Rodrigues, A. M., Rodrigues, D., Nogueira, H. G. D. S. M., Gama, A., Fernandes, H. M., Neto, A. S., & Padez, C. M. P. (2025) · Healthcare · doi:10.3390/healthcare13050462
“…10 studies examining urban and rural differences in childhood obesity in the United States, revealing that among a combined sample of over 74,000 children aged 2 to 19 years, those residing in rural regions exhibited a 26% higher likelihood of being obese compared to their urban counterparts [35].”
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Bel‐Serrat, S., von der Schulenburg, A., Marques-Previ, M., Mullee, A., & Murrin, C. M. (2024) · Figshare · doi:10.6084/m9.figshare.26557595
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Children’s weight status and parental perception in Croatia
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Wang, J., Liang, Y., Wu, S., Guo, S., Yang, Y., Zhu, Z., Liu, Y., Zhenbo, C. A. O., Tang, Y., Chen, P., et al. (2026) · BMC Public Health · doi:10.1186/s12889-026-28484-w
“…students, which may indicate that parental support is more action-able in environments with greater access to facilities, parks, and active transport infrastructure; rural contexts may be shaped more by unmeasured occupational activity, commuting constraints, or fewer organized opportunities [25].”
Mersky, J. P., Janczewski, C. E., Pollard, J., Amphlett, A., Lee, C. P., Walther, A. K., & Liu, X. (2026) · The Journal of Rural Health · doi:10.1111/jrh.70201
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“Youth from rural areas are 26% more likely to experience obesity compared to more urban youth [ 10 ].”
Fulkerson, J. A., Horning, M. L., Friend, S. E., Kramer-Kostecka, E., Barr‐Anderson, D. J., Lindberg, R., FREESE, R. L., Flattum, C. F., & Martin, C. (2026) · Appetite · doi:10.1016/j.appet.2026.108763
Martin‐Wagar, C. A., Attaway, S. E., Melcher, K. A., Penwell, T. E., Hahn, S. L., & Davis, H. A. (2026) · Body Image · doi:10.1016/j.bodyim.2026.102196
Davis, K., Abshire, D. A., Monroe, C. M., Rudisill, A. C., Al-Sabti, R., & Kaczynski, A. T. (2026) · Childhood Obesity · doi:10.1177/21532176261496080
Metadata
- 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 › Medicine › Public Health, Environmental and Occupational Health › 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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