Obesity Education and Prevention in Rural Pediatric and Adult Populations in the U.S.

Authors

Keywords:

Obesity, Physical Activity, Obstructive Sleep Apnea, rural and urban population, pro-opiomelanocortin (POMC)

Abstract

Background: With the ever-increasing incidence of obesity in pediatric and adult populations nationwide, the need to find impactful and long-term solutions to the epidemic is paramount. Urban and rural populations both show climbing rates of obesity, with significantly more children and adults being affected in rural areas. Many of the most prominent factors leading to obesity are related to socioeconomic status, behavior, lack of access to quality food resources, and lack of knowledge of healthy food groups.  Obesity increases the risk of disease in nearly every organ system in the body.

Methods: The authors conducted a narrative review by searching for relevant articles written in English in electronic databases such as PubMed/MEDLINE, Web of Science, Semantic Scholar, and Google Scholar.  A total of 88 articles were studied, and finally, 47 articles were included.

Results: Environmental factors such as low access to fresh produce and living in a rural areas increase the risk of adults and children developing obesity.  Early intervention in pediatric obesity cases have shown promising effectiveness on obesity prevention and it is suggested that stepwise, realistic goal-setting can lead to greater success in weight loss and management.

Conclusion: With the rates of obesity amongst children and adults continuing to climb in rural areas, addressing the causes is paramount.  Biological, behavioral and social factors all contribute to obesity rates in rural areas, often due to the challenges of accessing healthy food and fewer spaces for physical activity.

References

1. Bean MK, Stewart K, Olbrisch ME. Obesity in America: implications for clinical and health psychologists. J Clin Psychol Med Settings. 2008;15:214–224.

2. Cali AMG, Caprio S. Obesity in children and adolescents. J Clin Endocrinol Metab. 2008;93(11):31–36.

3. Xu S, Xue Y. Pediatric obesity: causes, symptoms, prevention and treatment. Exp Ther Med. 2016;11(1):15–20.

4. Davis AM, Bennett KJ, Befort C, Nollen N. Obesity and related health behaviors among urban and rural children in the United States: data from the National Health and Nutrition Examination Survey 2003–2004 and 2005–2006. Journal of pediatric psychology. 2011 Jul 1;36(6):669-76.

5. Yoon PW, Bastian B, Anderson RN, Collins JL, Jaffe HW; Centers for Disease Control and Prevention (CDC). Potentially preventable deaths from the five leading causes of death—United States, 2008–2010. MMWR Morb Mortal Wkly Rep. 2014;63(17):369–374.

6. Cohen SA, Cook SK, Kelley L, Foutz JD, Sando TA. A closer look at rural–urban health disparities: associations between obesity and rurality vary by geospatial and sociodemographic factors. J Rural Health. 2017;33(2):167–179.

7. Rey-López JP, Vicente-Rodríguez G, Biosca M, Moreno LA. Sedentary behaviour and obesity development in children and adolescents. Nutr Metab Cardiovasc Dis. 2008;18(3):242–251.

8. Wellman NS, Friedberg B. Causes and consequences of adult obesity: health, social and economic impacts in the United States. Asia Pac J Clin Nutr. 2002;11(Suppl 7):S705–S709. Available from: https://apjcn.nhri.org.tw/server/APJCN/11/s7/S705.pdf

9. Wadden TA, Brownell KD, Foster GD. Obesity: responding to the global epidemic. J Consult Clin Psychol. 2002;70(3):510–525.

10. World Health Organization. Obesity and overweight [Internet]. Geneva: World Health Organization; n.d. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight .

11. Emmerich SD, Fryar CD, Stierman B, Ogden CL. Obesity and severe obesity prevalence in adults: United States, August 2021–August 2023. NCHS Data Brief. 2024;(508). Hyattsville (MD): National Center for Health Statistics. Available from: https://www.cdc.gov/nchs/products/databriefs/db508.htm

12. Centers for Disease Control and Prevention. Childhood obesity facts [Internet]. Atlanta (GA): CDC; n.d. Available from: https://www.cdc.gov/obesity/childhood-obesity-facts/childhood-obesity-facts.html. [cited 2024 Apr 2].

13. Centers for Disease Control and Prevention. About body mass index (BMI) [Internet]. Atlanta (GA): CDC; n.d. Available from: https://www.cdc.gov/bmi/about/index.html. [cited 2024 Nov 24].

14. Centers for Disease Control and Prevention. Adult BMI categories [Internet]. Atlanta (GA): CDC; n.d. Available from: https://www.cdc.gov/bmi/adult-calculator/bmi-categories.html. [cited 2024 Nov 24].

15. Ichihara S, Yamada Y. Genetic factors for human obesity. Cell Mol Life Sci. 2008;65:1086–1098.

16. Bell CG, Walley AJ, Froguel P. The genetics of human obesity. Nat Rev Genet. 2005;6(3):221–234.

17. Serra-Majem L, Bautista-Castaño I. Etiology of obesity: two “key issues” and other emerging factors. Nutr Hosp. 2013;28(5):32–43.

18. Clément K, Ferré P. Genetics and the pathophysiology of obesity. Pediatr Res. 2003;53(5):721–725.

19. Rosen ED, Spiegelman BM. What we talk about when we talk about fat. Cell. 2014;156(1):20–44.

20. Ortiz VE, Kwo J. Obesity: physiologic changes and implications for preoperative management. BMC Anesthesiol 2015;15:97..

21. Friedman JM. The function of leptin in nutrition, weight, and physiology. Nutr Rev. 2002;60(Suppl 10):S1–S14.

22. Kumar RB, Srivastava G, Reid TJ, Aronne LJ. Understanding the pathophysiologic pathways that underlie obesity and options for treatment. Expert Rev Endocrinol Metab. 2021;16(6):321–338.

23. Apovian CM, Aronne LJ, Bessesen DH, McDonnell ME, Murad MH, Pagotto U, et al. Pharmacological management of obesity: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2015;100(2):342–362.

24. Berthoud HR, et al. Blaming the brain for obesity: integration of hedonic and homeostatic mechanisms. Gastroenterology. 2017;152(7):1728–1738.

25. Centers for Disease Control and Prevention. The health effects of overweight and obesity [Internet]. Atlanta (GA): CDC; n.d. Available from: https://www.cdc.gov/healthy-weight-growth/food-activity/overweight-obesity-impacts-health.html. [cited 2024 Nov 24].

26. Moya M. Pediatric overweight and obesity: comorbidities, trajectories, prevention, and treatments. 1st ed. Cham (CH): Springer; 2023.

27. Kumanyika SK. Environmental influences on childhood obesity: ethnic and cultural influences in context. Physiol Behav. 2008;94(1):61–70.

28. Johnson JA III, Johnson AM. Urban–rural differences in childhood and adolescent obesity in the United States: a systematic review and meta-analysis. Child Obes. 2015;11(3):233–241.

29. Pirgon Ö, Aslan N. The role of urbanization in childhood obesity. J Clin Res Pediatr Endocrinol. 2015;7(3):163–170.

30. Tai-Seale T, Chandler C. Nutrition and overweight concerns in rural areas: a literature review. Rural Healthy People. 2010;2:115–130.

31. Trivedi T, Liu J, Probst J, Merchant A, Jones S, Martin AB. Obesity and obesity-related behaviors among rural and urban adults in the USA. Rural Remote Health. Trivedi 2015;15(4):3267, “Jhones S”.

32. Leeper J, Hullett S, Wang L. Rural Alabama health professional training consortium: six-year evaluation results. Fam Community Health. 2001;24(2):18–26.

33. Befort CA, Nazir N, Perri MG. Prevalence of obesity among adults from rural and urban areas of the United States: findings from NHANES (2005–2008). J Rural Health. 2012;28(4):392–397.

34. Schaap R, Bessems K, Otten R, Kremers S, van Nassau F. Measuring implementation fidelity of school-based obesity prevention programmes: a systematic review. International Journal of Behavioral Nutrition and Physical Activity. 2018 Aug 13;15(1):75.

35. Lombard CB, Deeks AA, Teede HJ. A systematic review of interventions aimed at the prevention of weight gain in adults. Public Health Nutr. 2009;12(11):2236–2246.

36. Keating MK, Woodruff RK, Saner EM. Management of obesity: office-based strategies. Am Fam Physician. 2024;110(2):145–156.

37. Maffeis C, et al. The treatment of obesity in children and adolescents: consensus position statement of the Italian Society of Pediatric Endocrinology and Diabetology, Italian Society of Pediatrics and Italian Society of Pediatric Surgery. Ital J Pediatr. 2023;49(1):69.

38. Hampl SE, et al. Clinical practice guideline for the evaluation and treatment of children and adolescents with obesity. Pediatrics. 2023;151(2):e2022060640.

39. Müller MJ, Mast M, Asbeck I, Langnäse KA, Grund A. Prevention of obesity—is it possible? Obes Rev. 2001;2(1):15–28.

40. Welsh JA, Lange SJ, Figueroa J, Walsh S, Gooding H, Cheung P. Impact of a brief training on motivational interviewing and the 5 A’s approach on weight-related counseling practices of pediatricians. Obes Sci Pract. 2022;8(4):466–473.

41. Kao TSA, Ling J, Vu C, Hawn R, Christodoulos H. Motivational interviewing in pediatric obesity: a meta-analysis of the effects on behavioral outcomes. Ann Behav Med. 2023;57(8):605–619.

42. Centers for Disease Control and Prevention. What can families do to prevent overweight and obesity? [Internet]. Atlanta (GA): CDC; n.d. Available from: https://www.cdc.gov/obesity/family-action/index.html. [cited 2024 Nov 24].

43. Centers for Disease Control and Prevention. About sleep and sleep disorders [Internet]. Atlanta (GA): CDC; n.d. Available from: https://www.cdc.gov/sleep/about/index.html. [cited 2024 Nov 24].

44. Wills-Ibarra N, Chemtob K, Hart H, Frati F, Pratt KJ, Ball GD, Van Hulst A. Family systems approaches in pediatric obesity management: a scoping review. BMC Pediatr. 2024;24(1):235.

45. Johns Hopkins Medicine. Preventing obesity [Internet]. Baltimore (MD): Johns Hopkins Medicine; n.d. Available from: https://www.hopkinsmedicine.org/health/conditions-and-diseases/obesity/preventing-obesity. [cited 2024 Nov 24].

46. Fastenau J, Kolotkin RL, Fujioka K, Alba M, Canovatchel W, Traina S. A call to action to inform patient-centred approaches to obesity management: development of a disease–illness model. Clin Obes. 2019;9(3):e12309.

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Published

2026-02-23

How to Cite

Yokoyama, J., Kadam, S. J., & Mariscal, P. (2026). Obesity Education and Prevention in Rural Pediatric and Adult Populations in the U.S. International Journal of Medical Students, 95–102. Retrieved from https://ijms.info/IJMS/article/view/3439

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