Obesity Management Solutions in Rural Communities

Abstract

Purpose of Review Obesity is more common in rural than in urban areas. The disparities in body mass index (BMI) may be due to growing socioeconomic disparities in rural communities, including limited healthcare infrastructure, lack of access to healthy and affordable food, transportation barriers, financial insecurity, lower educational attainment, and barriers to physical activity. To address these issues, obesity management models are needed in rural areas to promote and sustain weight loss. Obesity interventions for rural populations published in the last 5 years are included in this review. Recent Findings Recent clinical trials report improvements in nutrition knowledge, physical activity, reduced energy consumption, and weight loss in rural populations. Three elementary school-based interventions implemented nutrition, physical activity, or a nutrition plus physical activity interventions ranging in duration from 2 months to 3 years. These interventions observed improvements in nutrition knowledge, daily energy intake, and body mass index (BMI), such that the trial resulted in weight loss or prevented weight gain. Two school-based lunch interventions observed increases in fruit and vegetable intake, reductions in energy consumption, and decreases sugar and sodium intake. Two large cluster randomized controlled trials in the USA showed clinically significant weight loss could be achieved via different lifestyle intervention approaches. Similarly, a 1-year intensive lifestyle intervention in Germany documented reductions in body weight and BMI. Additionally, recent telehealth interventions compared the use of teleconferencing, telephone counseling, and short message service (SMS) interventions to promote weight loss. Overall, findings showed that telehealth interventions can recruit and retain rural adults, and improvements in weight loss were greater than or equal to in-person interventions. Summary Obesity is a serious public health problem associated with cardiovascular disease, type 2 diabetes, osteoarthritis, and certain cancers. Well-designed, geographically tailored interventions with proper control conditions are needed for rural populations. Including data from neighborhood built environment with comprehensive interventions that address barriers to healthy eating, physical activity, and behavior change hold the most promise for the future.

Aligning Behaviour with Physiology: The Potential of Time‐Restricted Eating for Rural Obesity Control

“…Obesity has reached alarming levels globally, with the rising body mass index (BMI) in rural areas being a primary driver of this epidemic in adults [8]. While some studies suggest that the trajectory in many developed countries is starting to flatten, its rise in low-income countries and underprivileged areas is increasing exponentially [5,6,8,24]. One possible cause of this discrepancy is the practice of healthy eating, which depends on various factors including environment and food accessibility [24][25][26].…”

“…This transition of the obesity epidemic to rural areas is likely driven by complex socioeconomic, cultural, and environmental factors. [6] The surge of obesity, particularly in low-and middle-income countries (LMIC), poses a significant concern. In LMICs, this trend is emerging as a formidable threat to global health, surpassing undernutrition and infectious diseases [1].…”

“…It is linked to the development of cardiovascular diseases, diabetes, kidney disease, and neoplasms [30]. Moreover, the COVID-19 pandemic has shown that obesity is linked to various infectious diseases, making patients more vulnerable and eventually associated with increased severity, higher hospitalization, and even mortality rates [6,31]. It is becoming increasingly clear and important to control obesity before it develops and becomes part of the management of these diseases, as handling them within rural settings is very challenging.…”

“…Although initially perceived as an issue predominantly in industrialized nations, obesity has extended its reach to low-and middle-income countries, particularly those undergoing rural-urban transition. [3][4][5][6]. The escalating rates of obesity in developing countries, especially among children, are particularly concerning, with some low-income nations experiencing a prevalence increase of tens of times [5,7].…”

“…In rural areas, high obesity rates and its chronic impacts exacerbate existing burdens, compounded by scarcities of resources such as facilities, medication, and healthcare practitioners [6]. While obesity develops from a complex interplay of genetic, environmental, and lifestyle factors, diet emerges as one of the most significant contributors [9][10][11].…”