Differences in Overweight/Obesity Among Youth in a Midwest State by Rural-Urban Continuum Codes

A disparity in overweight/obesity prevalence exists between rural and urban youth; however, definitions of 'rural' vary widely and the degree to which rurality impacts overweight/obesity prevalence is unclear. Therefore, the purpose of this study was to examine the school height and weight data in a rural Midwest state to determine differences in overweight and obesity prevalence among youth by using Rural-Urban Continuum (RUC) codes to define county-level degree of urbanization.

De-identified statewide data were obtained in electronic format from the state Department of Health. Height, weight, sex and age were used to calculate body mass index (BMI) z-scores, which were used to determine BMI percentile and categories. The county variable was used to assign a RUC code to each individual. Logistic regression was used to examine binary weight classifications by rural status while controlling for age, sex and race/ethnicity.

Odds of obesity and of overweight/obesity were higher among rural youth compared to non-rural. Odds of overweight/obesity increased with increasing rurality. Compared to youth who lived in counties with a RUC code of 3, youth who lived in counties with RUC codes of 5, 7, 8 and 9 had greater odds of overweight/obesity. The number of youth classified as 'rural' ranged from 11-48 percent, depending on how 'rural' was defined. Likewise, overweight/obesity prevalence differed by 4.6 percent depending on how 'rural' was defined.

Consistently defining 'rural' and determining degree of rurality is important in understanding how geographic location plays a role in overweight/obesity among youth. Future research should work to assess the physical and social environments of these different types of rural areas to better understand the role that rurality plays in contributing to overweight/obesity among youth. Assessing social determinants of health and its impact on health in rural youth is essential for designing effective public health interventions that can be implemented to address the issue.