NUTRITION AND OVERWEIGHT CONCERNS IN RURAL AREAS
by Tom Tai-Seale and Coleman Chandler
·
Diet and activity
patterns have been ranked second only to tobacco as the leading “actual causes
of death” in the
GOALS AND OBJECTIVES
The goal of Healthy People 2010’s nutrition and overweight focus area is to promote health and reduce chronic disease associated with diet and weight.1 According to the Rural Healthy People 2010 survey, nutrition and overweight tied with cancer for 10th and 11th ranks among the Healthy People 2010 focus areas that were rated as rural health priorities; it was nominated by an average of 22 percent of the four groups for state and rural health respondents.3 The Northeast and Midwest produced statistically significantly higher percentages of nominations for nutrition and overweight as a priority than did the South and West.
This summary addresses five of the Healthy People 2010 objectives:
PREVALENCE
Obesity
and overweight in
While
overweight and obesity are prevalent throughout the
IMPACT
Obesity and overweight are associated with a myriad of health-related consequences. It is estimated that obesity accounts for between 6 to 7 percent of our total health care expenditures and costs this nation over $100 billion dollars annually.10, 11
Current estimates are that obesity increases the risk of death from all causes about 1.5 fold and from coronary heart disease about two-fold.12-15 The age-adjusted coronary heart disease death rate in the South is highest in rural areas and second highest (most years) in the rural Northeast.16
Obese children suffer more psychosocial dysfunction, hypertension, abnormal cholesterol metabolism, and orthopedic conditions like Blount’s disease and hip problems such as slipped capital femoral epiphysis.17 Excess weight on an adolescent tends to be carried into adulthood,18-21 facilitating the early beginning of atherosclerosis or buildup of fatty tissue in the arteries.22 For both men and women who were overweight as adolescents, the rates of atherosclerosis, diabetes, coronary heart disease, hip fractures, and gout are increased.14
Overweight and obesity increase the risk of a great variety of serious diseases including heart disease; stroke; hypertension; gallbladder disease; cancer of the endometrium, colon, kidney, gallbladder, and postmenopausal breast.23 Overweight and obesity is also associated with high cholesterol, type 2 diabetes, glucose intolerance, menstrual irregularities, pregnancy complications, stress incontinence, and psychosocial disorders.23 Further, the number of chronic medical conditions increases and the quality of life decreases with increasing body mass index.12
In addition to physical health-related problems, the overweight bear the brunt of severe social criticism that characterizes them as unhealthy, diseased, emotionally immature, weak, lazy, and impulsive.24 Consequently, they face a wide variety of social problems including stigmatization and discrimination.25
BARRIERS
A fair portion of the disproportionate prevalence of obesity in rural areas is caused by the distinctive demographic composition of rural communities. Rural residents are on average older, less educated, and have a lower income than urban residents; and those who are older, less educated, and have a lower income have greater obesity.26-33
There is evidence that rural life presents special cultural and structural challenges to maintaining a healthy weight. Cultural factors contributing to the problem include higher dietary fat and calorie consumption; declining frequency of exercise; increased television watching (including video game use); decreased compliance with dietary recommendations; and differential amounts of exercise among rural residents. Structural factors contributing to obesity in rural areas include lack of nutrition education, decreased access to nutritionists, fewer physical education classes in schools, and fewer exercise facilities. Rural areas, in particular, face other unique challenges such as fewer prevention and treatment facilities, and further distances to reach them.
PROPOSED SOLUTIONS
According to the Surgeon General, the most effective prevention and treatment strategies for obesity are unknown.2 Nevertheless, the outlines of a model program can be discerned from the Surgeon General’s recent suggestions for developing a public health response.2 The Surgeon General calls for communication, action, research, and evaluation to address obesity at each of five social settings: family and community, school, health care, media and communications, and worksites. Thus, the best overall program ensures that there are effective and complimentary interventions at each setting.
More specifically, the best place to start in preventing obesity is with preventing the development of it in young children. Diets for children as early as preschool, for example, should be comprised of no more than 30 percent of their caloric intake from fat and less than 10 percent of the calories from saturated fat. Fat-lowering diet interventions using a variety of techniques (e.g., purchasing food with less fat content, eliminating excess or added fat in food preparation, baking rather than frying food, and increasing the amount of fresh fruits and vegetables) have proven successful.34, 35 Overall, combining fat-lowering school food service programs with enhanced physical activity in physical education classes and classroom-based health education offer effective intervention to obesity among children.
Community or home-based programs have also been found to be successful. One such example, the Children’s Health Project, introduced a self-instruction program consisting of 10 lessons, complete with an audiotape, picture booklet, paper and pencil activities, and a parent manual for guidance.36, 37 Children using this program significantly lowered their total fat and saturated fat intake in comparison to children in control groups. Other community or home-based programs, such as nutrition and physical exercise counseling programs and behavior therapy programs, have also produced positive results over time.23
Numerous programs have been designed to address overweight and obesity among adults, with many mirroring the strategies outlined above. Relatively new innovations such as weight-loss programs broadcast over cable television38 or more traditional correspondence courses39 may well be able to address some of the barriers facing individuals in rural settings with less access to weight-loss programs or centers. Structural changes may be warranted as well to address the growing problem of overweight and obesity in rural settings. Such changes could include increased offerings of continuing education for rural physicians and other care providers related to nutrition and weight management, or developing community incentive programs for worksite weight management and nutrition programs or activities.
SUMMARY AND CONCLUSIONS
It is not clear why living in a rural area increases the odds of being obese and suffering its effects. Certainly, the demographic composition of rural areas accounts for some, perhaps a large portion, of the extra risk. However, individuals residing in rural communities face other challenges as well as those enumerated above. Despite these challenges, designers of interventions are encouraged to remember the basic goals: decrease fat and calorie intake, and increase physical exercise. The Surgeon General’s Call to Action makes it clear that progress can be made if interventions are introduced at multiple levels of society: from individual to community, school to worksite, media to health care. Surely one of the more important steps is to initiate coalition formation in rural communities charged with raising awareness of the growing problem of overweight and obesity in rural settings as well as to martial all available resources to address it to enhance the health of rural America.
MODELS FOR PRACTICE
The following models for practice are examples of programs utilized to address this rural health concern.
REFERENCES
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9. Ogunyemi, D.; Hullett, S.; Leeper, J.; et al. Prepregnancy body mass index, weight gain during pregnancy, and perinatal outcome in a rural black population. Journal of Maternal-Fetal Medicine 7(4):190-193, 1998.
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<http://www.healthypeople.gov/LHI/>2002
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Chapter Suggested Citation
Tai-Seale, T., and
MODELS FOR PRACTICE
FOCUS AREA: NUTRITION AND OVERWEIGHT
Location: Poplar,
Problem Addressed: Nutrition and Diet
Healthy People 2010 Objective: 19
Web Address: None
The
Daya Tibi, “House of Good
Living,”
Initially,
the city of
Blueprint: The
Making a Difference: During the six-week program, the exercise physiologist makes assessments of the individual’s physique and health. A personal wellness profile is used to measure the success of the program. The profile consists of pre- and post-tests of fat levels; blood sugar; cholesterol check; blood pressure; and measurement of arms, biceps, hips, and waist. It also records participation in nutrition classes. The personal wellness profile helps individuals attack their problems through weight loss or by reducing their risks of developing diabetes. The overall goal of the personal wellness profile is to motivate participants in the program to stick with a nutritional diet supporting a healthier lifestyle. One of the USDA grant objectives measured the success of 86 participants’ weight and health improvements. Of the 86 participants, 44 showed improvements in several categories (i.e., weight; blood pressure; blood sugar; and arm, wrist, and chest measurements).
Beginnings:
The Fort Peck Community College
Department of Community Services and several key community leaders observed the
growing trends of obesity and diabetes among the community’s youth and adults.
This recognition led to the development of the
Challenges and Solutions: Implementation of the nutrition awareness program was viewed as a trial to see if the community was ready to change its nutritional habits. The goal of the nutritional program is to change participants’ behavior toward living a better life. Demonstration of the program led to applying for the USDA Nutrition, Diet, and Health Grant for 2001-2002 and 2002-2003.
The
Jeanette Charbonneau
Daya Tibi “House of
Good Living”/
Phone: (406) 768-5630
Fax: (406) 768-5552
MODELS FOR PRACTICE
FOCUS AREA: NUTRITION AND OVERWEIGHT
Program Name: Physical Dimensions/Focus
Location:
Problem Addressed: Lack of Physical Education in the Kansas Schools
Healthy People 2010 Objective: 19
Web Address: None
Physical Dimensions is delivered through a one-year course, divided into nine weeks (three weeks per topic area). Each segment focuses on a particular health topic, achievements, and successful outcomes. One of the advantages of participating in Physical Dimensions is that it offers high school students the chance to be recognized with a certificate for completing the program.
Blueprint: The
following groups were responsible for integrating the Physical Dimensions/Focus
programs in the
The Physical
Dimensions/Focus project is a grant-funded operation, which is housed at
Physical Dimensions/Focus
staff identified several problems focusing on physical education, such as low
enrollment in elective physical education classes, one year physical education
requirement for
Making a Difference: Physical Dimension/Focus started in 1995,
but the models were not fully implemented until 2001. Presently, the two programs are still
growing in the
Beginnings: Educators
in participating
Challenges and Solutions: The Kansas Health Foundation originally funded the program, and now the state universities support the program. The program disseminates information by sending out an annual newsletter to the stakeholders, issuing media releases, and organizing statewide conferences for educators.
Physical
Dimensions/Focus received the National Health Information Gold Award for its
promotional and educational video in 2000. The program has been highlighted in
The Wall Street Journal, Better Homes and Gardens, USA Today, Sports
Illustrated, and several of
Bobbie Harris
Physical Dimensions/Focus
Phone: (316) 978-5957
Fax: None
* Harris, B.; Ermler, K.; and Mehrhof, J.
Physical Focus,