The prevalence of obesity is higher in rural counties than in urban counties; obesity affects some residents of rural counties disproportionately.

Interventions to improve breast cancer screening are needed for rural women. Such efforts should target older women and those with low socioeconomic status.

Smoking remains a refractory public health problem. Better ways to curb smoking in rural America are needed.

Context: Obesity is a fast‐growing threat to public health in the U.S., but information on trends in professional advice to lose weight is limited. Objective: We studied whether rising obesity prevalence in the U.S. was accompanied by an increasing trend in professional advice to lose weight among obese adults. Design and Participants: We used the Behavioral Risk Factor Surveillance System, a cross‐sectional prevalence study, from 1994 (n=10,705), 1996 (n=13,800), 1998 (n=18,816), and 2000 (n=26,454) to examine changes in advice reported by obese adults seen for primary care. Measurements: Self‐reported advice from a health care professional to lose weight. Results: From 1994 to 2000, the proportion of obese persons receiving advice to lose weight fell from 44.0% to 40.0%. Among obese persons not graduating from high school, advice declined from 41.4% to 31.8%; and for those with annual household incomes below $25,000, advice dropped from 44.3% to 38.1%. In contrast, the prevalence of advice among obese persons with a college degree or in the highest income group remained relatively stable and high (>45%) over the study period. Conclusions: Disparities in professional advice to lose weight associated with income and educational attainment increased from 1994 to 2000. There is a need for mechanisms that allow health care professionals to devote sufficient attention to weight control and to link with evidence‐based weight loss interventions, especially those that target groups most at risk for obesity.