Assessment of dietary patterns, physical activity and obesity from a national survey: Rural-urban health disparities in older adults

PLoS One. 2018 Dec 5;13(12):e0208268. doi: 10.1371/journal.pone.0208268. eCollection 2018.

Abstract

Background: Obesity is a critical public health issue, affecting over one-third of all Americans, and is an underlying cause of numerous health issues across the lifespan. For older adults, obesity is linked to premature declines in physical and mental health and cognitive functioning. The occurrence of obesity and related health behaviors and chronic diseases are higher in rural areas than in urban areas. Furthermore, rural areas of the United States have a higher proportion of older adults than urban areas. Few studies, to date, have explored rural-urban differences in the relationships between dietary patterns and obesity among older adults. Therefore, the purpose of this study is to assess rural-urban differences in obesity rates in older adults, and the potential for the associations between obesity and physical activity and dietary patterns to vary by rural-urban status.

Methods: Data were abstracted from respondents aged 65 and above from the 2012 Behavioral Risk Factor Surveillance System (BRFSS) database linked to Census-based county-level information on rural-urban status and socioeconomic status. Generalized linear models were utilized to assess rural-urban disparities in obesity, and the potential for associations between obesity and known risk factors (fruit consumption, green vegetable consumption and physical activity) to vary by rural-urban status, accounting for complex sampling and confounders.

Results: Obesity rates were highest and fruit consumption was lowest in the most rural areas. However, for older adults in the most urban areas, there was a significant negative association between obesity and fruit and green vegetable consumption. This association was not observed in more rural older adults.

Conclusion: These findings underscore the need to take into account place-based factors such as rural-urban status, when designing and implementing policies and interventions designed to reduce obesity through risk factor mitigation in older adults. To reduce rural-urban disparities in older adults, all policies, programs, and interventions should address the unique barriers and needs specific to rural and urban older adults.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Diet*
  • Exercise*
  • Female
  • Fruit
  • Geography
  • Healthcare Disparities*
  • Humans
  • Male
  • Models, Theoretical
  • Obesity / epidemiology*
  • Odds Ratio
  • Rural Health*
  • Surveys and Questionnaires*
  • United States / epidemiology
  • Urban Health*
  • Vegetables

Grants and funding

The American Public Health Association awarded a previous version of this manuscript with the “Rural and Environmental Research Award” in aging and health, and the authors received a modest ($200) stipend as a result. The American Public Health Association was not involved in any other capacity other than providing the award stipend, and did not bias the results or interpretation of the manuscript in any manner. Likewise, the American Public Health Association has not published or managed any version of this manuscript. No other sources of funding were utilized in the preparation of this manuscript. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.