Rural children are more likely to be obese, but rural communities have several strategies to fight the problem

Children living in rural areas are about 25 percent more likely to be overweight or obese than children in urban areas, studies show. Rural communities have come up with several strategies to battle childhood obesity, Sarah Lifsey and Karah Mantinan report for the Altarum Institute, a nonprofit health-systems research and consulting organization.

 Many people are surprised to hear that childhood obesity is a rural phenomenon because they assume that rural kids have more access to the outdoors and physical activity. However, studies have found that there is little open public space in rural areas, often because of a lack of a strong government to provide and maintain such public spaces, Lifsey and Mantinan write. They also cite research showing that fear of crime in public spaces is a reason rural families don't use public activity areas, even though crime is least likely to occur in rural areas.

 Rural children are also at increased risk of poverty compared to children in cities or suburbs, and face lower access to health care, lower levels of physical activity, lower-quality food, and limited options for transportation.

 Many of Kentucky's children are poor, overweight and sedentary. One in four children in Kentucky lives in poverty according to the American Public Health Association and 37.1 percent of children in Kentucky between the ages of 10 to 17 are considered overweight or obese, according to the Foundation for a Healthy Kentucky. Seventeen percent of Kentucky children reported not getting any physical activity in the seven days prior to a survey given by the federal Center for Disease Control and Prevention and 28.8 percent of children on the same survey watched television three or more hours per day on an average school day. 

Poorer food and lower levels of activity are often the result of the distance it takes to get to a physical-activity venue or a grocery store in rural areas, the authors write. The round-trip time it takes to get there and the cost of gas for these trips adds a time-and-cost burden to families that often creates a lack of commitment to transport children back and forth to after school activities or to travel to groceries with better food options, Lifsey and Mantinan write.

 Many rural families who lack access to fresh and healthy foods live in "food deserts," Generally defined as those with no grocery with fresh produce within 10 miles. Studies have found poverty and childhood obesity are more likely in rural food deserts.

 Rural communities are using several school-based strategies to fight obesity, Lifsey and Mantinan report. They include making sure school-bus schedules and family transportation schedules coordinate to encourage after-school activities; ensuring that schools provide gym class and recess; allowing recreational areas of school grounds to be available to the community after hours; providing alternative transportation options to students who need rides home in order to participate in after school activities; improving school meals to include more whole grains, fruits and vegetables; and improving the choices available in soda and vending machines.

 Engaging programs and groups that are already in existence, such as 4-H Youth Development and telemedicine programs that focus on childhood obesity intervention, are great places to start when initiating childhood obesity programs, the authors write. Having local farmers teach gardening skills can also improve access to healthy food.

 Noting that African-American children are the most likely to be obese, Lifsey and Mantinan say communities must keep minority populations in mind. They also suggest working with employers to start employee wellness programs that encourage parents to model healthy behaviors for their children.

 Also, It's important for rural communities to observe, measure and decide how each of them want to attack this issue to increase the probability of success, they say.

 Tools are available to help with this planning such as the Rural Active Living Assessment Tools, developed by the Robert Wood Johnson Foundation. Other resources include the Rural Assistance Center, funded by the U.S. Department of Health and Human Services Rural Initiative, which features a Rural Obesity Prevention Toolkit developed by the Nutrition Obesity Research Center's Walsh Center for Rural Analysis, as well as a resource guide for rural areas developed by the University of North Carolina's Active Living by Design.