Prevalence of Obesity Among Adults From Rural and Urban Areas of the United States: Findings From NHANES (2005‐2008)

May combine two claims.

Using BMI ≥ 25 kg/m2, 70.8% of rural residents were overweight/obese compared to 67.1% of urban residents, a non-significant difference (P = .09).

“Using BMI ≥ 25 kg/m2 as the cut point, 70.8% (SE = 1.9) of rural residents were overweight/obese, compared to 67.1% (SE = 1.0) of urban residents (P = .09).”

May combine two claims.

In the weighted sample, 80.3% were urban residents and 19.7% were rural residents.

“In the weighted sample, 80.3% (SE = 3.7) were urban residents and 19.7% (SE = 3.7) were rural residents.”

May combine two claims.

Rural participants were more likely than urban participants to be older, married, White non-Hispanic, and to report lower income.

“Compared to urban participants, rural participants were more likely to be older, married, White non-Hispanic, and to report lower income (Table 1).”

Probably not a substantial claim: may not pass S3 (load-bearing).

Daily energy intake did not differ significantly between rural and urban participants.

“nor was daily energy intake.”

May combine two claims.

Obesity prevalence was 39.6% among rural adults and 33.4% among urban adults, with rural prevalence significantly higher (P = .006).

“Obesity prevalence significantly differed across rural and urban participants with 39.6% (SE = 1.5) of rural participants being obese compared to 33.4% (SE = 1.1) of urban participants (P = .006).”

• Also stated in: § Findings · plain

  “The obesity prevalence was 39.6% (SE = 1.5) among rural adults compared to 33.4% (SE = 1.1) among urban adults (P = .006).”

May combine two claims.

The rural-urban obesity difference was significant among adults age 20-39 but not for adults age 40-59 or 60-75.

“Rural adults age 20–39 had higher obesity prevalence than their urban counterparts (38.1% [SE = 3.8] and 27.9% [SE = 1.4], respectively; P = .002), but the rural-urban difference was not significant for adults age 40–59 or 60–75.”

May combine two claims.

Rural residents have higher rates of chronic diseases and higher all-cause mortality than urban residents.

“Compared to their urban counterparts, rural residents experience higher rates of chronic diseases and higher prevalence of all-cause mortality.2–4”

• cites [2]Not checked yet

  Not checked in the free run.

• cites [3]Not checked yet

  Not checked in the free run.

• cites [4] sourceNot checked yet

  Not checked in the free run.

May combine two claims.

A recent direct comparison of NHANES, BRFSS, and NHIS physical activity data revealed different prevalence estimates ranging from 30% to 48%, making comparisons across studies difficult.

“However, a recent direct comparison of NHANES, BRFSS, and NHIS physical activity data revealed different prevalence estimates for physical activity across the different surveillance systems, ranging from 30% to 48%,23 making comparisons across studies difficult.”

• cites [23] sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Percent kcal from fat was one of the strongest determinants of obesity and is a likely contributor to the rural-urban obesity disparity.

“Percent kcal from fat was one of the strongest determinants of obesity and is a likely contributor to the rural-urban obesity disparity.”

May combine two claims.

In rural environments with limited resources, education may have less impact on diet and physical activity behavior, whereas marital status may have greater impact.

“In a rural environment where resources for healthy eating and physical activity may be more limited, factors related to access to resources such as education may have less impact on diet and physical activity behavior, whereas marital status (and corresponding lifestyle surrounding family meals) may have greater impact.”

May combine two claims.

Older age and heavier weight are associated with inaccurate reporting of height and weight.

“Rural populations are older8 and appear to be heavier, and both of these factors are associated with inaccurate reporting of height and weight.9,10”

• cites [9] sourceNot checked yet

  Not checked in the free run.

• cites [10] sourceNot checked yet

  Not checked in the free run.

• AssumptionRests on an assumption: Rural populations appear to be heavier than urban populations.

May combine two claims.

Medical factors associated with higher co-morbid diseases among rural adults may play a causal role in their higher obesity prevalence, but the authors believe obesity is more likely driving rural-urban chronic disease disparities.

“Medical factors associated with higher co-morbid diseases among rural adults4 may also be playing a causal role in their higher obesity prevalence; however, we believe the reverse is more likely with obesity being one of the driving forces for rural-urban chronic disease disparities.”

• cites [4] sourceNot checked yet

  Not checked in the free run.

• AssumptionRests on an assumption: Rural-urban differences in obesity may be a major contributor to geographic health disparities.

Classified as probably not a substantial claim.

NHANES uses a multistage, stratified, clustered probability design to assess a representative civilian, non-institutionalized US population.

“NHANES is conducted by the National Center for Health Statistics to assess the health and nutritional status of a representative civilian, non-institutionalized US population using a multistage, stratified, clustered probability design.12”

• cites [12]Not checked yet

  Not checked in the free run.

May combine two claims.

Obesity prevalence estimates from measured height and weight were dramatically higher than self-reported estimates and consistent with overall national obesity prevalence of 34% from NHANES 2007-2008.

“In addition, rates were dramatically higher compared to self-reported estimates and were consistent with overall national obesity prevalence of 34% from NHANES 2007–2008.17”

• cites [17] sourceNot checked yet

  Not checked in the free run.

Classified as probably not a substantial claim.

Multiple logistic regression controlled for demographic, diet, and physical activity variables to examine rural-urban residence as a determinant of obesity.

“Controlling for demographic, diet and physical activity variables, multiple logistic regression was used to examine rural-urban residence as a determinant of obesity.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Younger adults in rural areas may be more susceptible to weight gain due to changes in the environment over the past 30 years.

“Younger adults in rural areas may be more susceptible to weight gain due to changes in the environment over the past 30 years.”

Probably not a substantial claim: may not pass S3 (load-bearing).

In prior studies, rural adults were less likely to meet physical activity recommendations than urban adults.

“In contrast, the 1998 NHIS6 and 2 national physical activity surveys conducted in the late 1990s based on modified BRFSS physical activity items21,22 showed rural adults were less likely to meet physical activity recommendations than urban adults.”

• cites [6] sourceNot checked yet

  Not checked in the free run.

• cites [21] sourceNot checked yet

  Not checked in the free run.

• cites [22] sourceNot checked yet

  Not checked in the free run.

May combine two claims.

The only published analysis of objectively measured rural and urban obesity prevalence is over 3 decades old and used an outdated weight classification.

“The only published analysis of objectively measured rural and urban obesity prevalence is over 3 decades old (NHANES II, 1976–1980) and used an outdated weight classification based on percentile scores.11”

• cites [11] sourceNot checked yet

  Not checked in the free run.

Classified as probably not a substantial claim.

Height and weight were collected in a mobile examination center using standardized protocols.

“Height and weight were collected in a mobile examination center using standardized protocols.”

Classified as probably not a substantial claim.

Analyses used combined sample weights for 2005-2006 and 2007-2008 to provide nationally representative results.

“All analyses were performed using the combined sample weights for 2005–2006 and 2007–2008 to provide nationally representative results.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

NHANES 2005-2008 received ethics approval and written informed consent was obtained.

“NHANES 2005–2008 received approval from the National Center for Health Statistics research ethics review board. Written informed consent was obtained.”

May combine two claims.

Increased mechanization of rural occupations has reduced caloric expenditure, which may impact younger working adults most.

“Increased mechanization of rural occupations has reduced these levels of caloric expenditure, which may impact the younger working adults the most.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The response rate including interview and examination completion across 2005-2008 was 71%.

“The response rate including completion of interview and examination across years was 71%.”

Probably not a substantial claim: may not pass S3 (load-bearing).

By collapsing across 2 NHANES survey years, estimates were stable for the subgroup comparisons conducted.

“The sample size was larger for urban participants; however, by collapsing across 2 NHANES survey years, estimates were stable for the subgroup comparisons conducted.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

NHANES is cross-sectional, and diet and physical activity measures do not necessarily represent usual patterns over time that led to weight status.

“NHANES is a cross-sectional survey, and diet and physical activity measures do not necessarily represent usual patterns over time that led to the individual’s weight status at the time of the survey.”