Diet, physical activity, and sedentary behaviors as risk factors for childhood obesity: an urban and rural comparison.

BACKGROUND The aim of this study was to examine the differences in diet, physical activity, and weight status among children living in rural and urban America and to study the roles of obesity-related behaviors in residence-based differences in childhood obesity. METHODS We performed cross-sectional analysis of the 1999-2006 National Health and Nutrition Examination Survey data, restricted to 14,332 children aged 2-19 years old (2771 rural, 13,766 urban). Residence was measured at the census tract level using Rural-Urban Commuting Areas. Age-specific questions were used to assess physical activity, and the 24-hour diet recall was used to measure dietary intake. RESULTS Among 2- to 11-year-olds, rural children consumed 90 more kcal/day on average than urban children (p < 0.05) and were more likely to consume the recommended two to three cups of dairy per day (p < 0.05). More 2- to 11-year-old rural children also reported participating in exercise five or more times per week than urban children of the same age (79.7% vs. 73.8%). Among 12- to 19-year-olds, rural children were less likely to consume any fruit or meet the recommendation of two cups of fruit. Using measured height and weight data, proportionately more rural than urban children were overweight/obese (35.4% v. 29.3%) and obese (18.6% v. 15.1%). Rural children had 30% higher odds of being overweight and/or obese even after adjustment for sociodemographics, health, diet, and exercise behaviors. CONCLUSIONS The persistently higher odds of overweight and obesity among rural children even after adjustment suggest that rural environments may be "obesogenic" in ways that a person-level analysis cannot discern. Future research should examine disparities in the accessibility and affordability of healthy food and beverage choices and safe physical activity locales in rural areas.