Purpose Rural residents have higher rates of chronic diseases compared to their urban counterparts, and obesity may be a major contributor to this disparity. This study is the first analysis of obesity prevalence in rural and urban adults using body mass index classification with measured height and weight. In addition, demographic, diet, and physical activity correlates of obesity across rural and urban residence are examined. Methods Analysis of body mass index (BMI), diet, and physical activity from 7,325 urban and 1,490 rural adults in the 2005–2008 National Health and Nutrition Examination Survey (NHANES). Findings The obesity prevalence was 39.6% (SE = 1.5) among rural adults compared to 33.4% (SE = 1.1) among urban adults (P = .006). Prevalence of obesity remained significantly higher among rural compared to urban adults controlling for demographic, diet, and physical activity variables (odds ratio = 1.18, P = .03). Race/ethnicity and percent kcal from fat were significant correlates of obesity among both rural and urban adults. Being married was associated with obesity only among rural residents, whereas older age, less education, and being inactive was associated with obesity only among urban residents. Conclusions Obesity is markedly higher among adults from rural versus urban areas of the United States, with estimates that are much higher than the rates suggested by studies with self-reported data. Obesity deserves greater attention in rural America.

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Obese breast cancer survivors have increased risk of recurrence and death compared to their normal weight counterparts. Rural women have significantly higher obesity rates, thus weight control intervention may be a key strategy for prevention of breast cancer recurrence in this population. This one arm treatment study examined the impact of a group-based weight control intervention delivered through conference call technology to obese breast cancer survivors living in remote rural locations. The intervention included a reduced calorie diet incorporating prepackaged entrees and shakes, physical activity gradually increased to 225 min/week of moderate intensity exercise, and weekly group phone sessions. Outcomes included anthropomorphic, diet, physical activity, serum biomarker, and quality of life changes. Ninety-one percent of participants (31 of 34) attended > 75% of intervention sessions and completed post-treatment data collection visits. At 6 months, significant changes were observed for weight (-12.5 ± 5.8 kg, 13.9% of baseline weight), waist circumference (-9.4 ± 6.3 cm), daily energy intake (-349 ± 550 kcal/day), fruits and vegetables (+3.7 ± 4.3 servings/day), percent kcal from fat (-12.6 ± 8.6%), physical activity (+1235 ± 832 kcal/week; all p’s < .001), as well as significant reductions in fasting insulin (16.7% reduction, p = .006) and leptin (37.1% reduction, p < .001). Significant improvements were also seen for quality of life domains including mood, body image, and sexuality. In conclusion, the intervention produced > 10% weight loss as well as significant improvements across multiple endpoints. The group phone-based treatment delivery approach may help disseminate effective weight control intervention to hard-to-reach breast cancer survivors.

There are modifiable health behavior differences between rural and urban children which may account for the significantly higher obesity rates among rural children.

Compared to other racial/ethnic groups, African American (AA) women are more likely to be obese but less likely to participate in weight loss interventions or to successfully lose weight. Sustained motivation for weight loss may be especially difficult for AA women due to socioeconomic and cultural factors. The purpose of this study was to examine whether the addition of motivational interviewing (MI) to a culturally-targeted behavioral weight loss program for AA women improved adherence to the program, diet and physical activity behaviors, and weight loss outcomes. Forty-four obese (mean BMI = 39.4, SD = 7.1) AA women were randomized to receive a 16-week behavioral weight loss program plus four MI sessions, or the same behavioral weight loss program plus four health education (HE; attention control) sessions. Results showed that participants in both MI and HE conditions lost a significant amount of weight, reduced their energy intake and percent calories from fat, and increased their fruit and vegetable consumption (ps < .05). However, adherence to the behavioral weight loss program and changes in diet, physical activity, and weight did not differ across MI and HE conditions. Future research is warranted to determine the subpopulations with which MI is most effective.

Based on Tinto's (1993) model of academic persistence, this study investigated the relationship of loneliness, social support, and living arrangements with academic persistence decisions of 401 college freshmen. Participants completed a series of standardized instruments during class time. Social support was negatively related to loneliness and positively related to academic persistence decisions. Less loneliness and more social support predicted more positive persistence decisions. Neither social support nor loneliness was related to GPA; however, freshmen living on campus had higher GPAs than those living off campus. Women perceived receiving more social support from both friends and family than did men. These results are discussed in light of what might be done to influence greater persistence.A major area of research in higher education focuses on retention of students from their freshman year to degree completion. Discovering ways to retain students is vital, since attrition rates have been reported as varying from 10% to 345 Ó 2006, Baywood Publishing Co., Inc.50% at colleges and universities around the country (Tinto, 1993). Furthermore, recent statistics indicate that between 20 and 30% of these students leave during their freshman year (Arizona State University (ASU), 2003; National Center for Education Statistics, 2003). Because of these high attrition rates, researchers have tried to identify a causal model for student attrition as well as to find ways to decrease its prevalence.In particular, Tinto's model (1993) of college student attrition has received considerable support in the literature (e.g.). His concept is based on a theory of person-environment fit, where students' experiences in their social and academic environments are influenced by their individual attributes, dispositions, family background, and prior educational experiences. Tinto also added a time dimension to the model, accounting for the shifts that occur at different times during the academic year. He stressed that students who develop satisfying relationships with peers tend to earn better grades and are more inclined to remain in college than are students who fail to develop these significant ties.A limited number of studies have applied Tinto's model to qualitative methods of inquiry. Hemmings, Jin, and Low (1996) used both quantitative and qualitative approaches to determine what influenced high school students to remain in school. The quantitative analyses identified 11 constructs that influenced students' decisions including individual characteristics, family background, peer groups, and societal determinants such as school and neighborhood. The qualitative analyses indicated that students felt their decisions to stay in school were related to a combination of factors, such as family encouragement, school success and enjoyment, peer support, and positive relationships with teachers.Also using qualitative methods, Braunstein and McGrath (1997) examined the assumptions, beliefs, and perceptions of faculty and administrators who...

This study examined the relationships among self-esteem, body image, and health-related behaviors of 267 female and 156 male first-year college students. Data were collected in 23 classrooms. Instruments included a demographic sheet, the Objectified Body Consciousness Scale, the Weight and Appearance Visual Analogue Scales, the Contour Drawing Rating Scale, the Rosenberg Self Esteem Scale, and a measure of physical fitness/health-related behaviors. Self-esteem was consistently related to body image dissatisfaction for women, and women consistently exhibited a more negative body image than did men. Even when both men and women were consistent exercisers, the women had poorer body image. Finally, for both men and women, more positive physical fitness/health-related behaviors were positively related to self-esteem and body image.

Mounting evidence suggests that weight management and physical activity (PA) improve overall health and well being, and reduce the risk of morbidity and mortality among cancer survivors. Although many opportunities exist to include weight management and PA in routine cancer care, several barriers remain. This review summarizes key topics addressed in a recent National Academies of Science, Engineering, and Medicine workshop entitled, "Incorporating Weight Management and Physical Activity Throughout the Cancer Care Continuum." Discussions related to body weight and PA among cancer survivors included: 1) current knowledge and gaps related to health outcomes; 2) effective intervention approaches; 3) addressing the needs of diverse populations of cancer survivors; 4) opportunities and challenges of workforce, care coordination, and technologies for program implementation; 5) models of care; and 6) program coverage. While more discoveries are still needed for the provision of optimal weight-management and PA programs for cancer survivors, obesity and inactivity currently jeopardize their overall health and quality of life. Actionable future directions are presented for research; practice and policy changes required to assure the availability of effective, affordable, and feasible weight management; and PA services for all cancer survivors as a part of their routine cancer care. CA Cancer J Clin 2018;68:64-89. © 2017 American Cancer Society.