Healthy-lifestyle behaviors associated with overweight and obesity in US rural children

Abstract

BackgroundThere are disproportionately higher rates of overweight and obesity in poor rural communities but studies exploring children’s health-related behaviors that may assist in designing effective interventions are limited. We examined the association between overweight and obesity prevalence of 401 ethnically/racially diverse, rural school-aged children and healthy-lifestyle behaviors: improving diet quality, obtaining adequate sleep, limiting screen-time viewing, and consulting a physician about a child’s weight.MethodsA cross-sectional analysis was conducted on a sample of school-aged children (6–11 years) in rural regions of California, Kentucky, Mississippi, and South Carolina participating in CHANGE (Creating Healthy, Active, and Nurturing Growing-up Environments) Program, created by Save the Children, an independent organization that works with communities to improve overall child health, with the objective to reduce unhealthy weight gain in these school-aged children (grades 1–6) in rural America. After measuring children’s height and weight, we17 assessed overweight and obesity (BMI ≥ 85th percentile) associations with these behaviors: improving diet quality18 (≥ 2 servings of fruits and vegetables/day), reducing whole milk, sweetened beverage consumption/day; obtaining19 adequate night-time sleep on weekdays (≥ 10 hours/night); limiting screen-time (i.e., television, video, computer,20 videogame) viewing on weekdays (≤ 2 hours/day); and consulting a physician about weight. Analyses were adjusted 21 for state of residence, children's race/ethnicity, gender, age, and government assistance.ResultsOverweight or obesity prevalence was 37 percent in Mississippi and nearly 60 percent in Kentucky. Adjusting for covariates, obese children were twice as likely to eat ≥ 2 servings of vegetables per day (OR=2.0,95% CI 1.1-3.4), less likely to consume whole milk (OR=0.4,95% CI 0.2-0.70), Their parents are more likely to be told by their doctor that their child was obese (OR=108.0,95% CI 21.9-541.6), and less likely to report talking to their child about fruits and vegetables a lot/sometimes vs. not very much/never (OR=0.4, 95%CI 0.2-0.98) compared to the parents of healthy-weight children.ConclusionsRural children are not meeting recommendations to improve diet, reduce screen time and obtain adequate sleep. Although we expected obese children to be more likely to engage in unhealthy behaviors, we found the opposite to be true. It is possible that these groups of respondent parents were highly aware of their weight status and have been advised to change their children’s health behaviors. Perhaps given the opportunity to participate in an intervention study in combination with a physician recommendation could have resulted in actual behavior change.

“Reforms Looked Really Good on Paper”: Rural Food Service Responses to the Healthy, Hunger‐Free Kids Act of 2010

“…7-10 Current research suggests that rural children are more likely to be overweight or obese when compared to urban children, the diets of rural children are less nutritious, 11 and their families have less access to healthy food. 12,19 Increased financial burdens were seen as examples of the HHKA implementation being too aggressive and not sufficiently responsive to the needs of a variety of school districts.…”

“…[7][8][9][10] Research suggests rural children are not engaging in behaviors recommended to prevent obesity, such as eating fruits and vegetables and drinking low-fat milk. 11 Rural parents face challenges to promoting healthy eating for their children such as fewer financial resources and the lack of available fresh fruits and vegetables. Moreover, rural Midwestern adults perceive the rural food environment as limited and of low quality: grocery stores are scarce or do not stock a variety of healthy items and fresh fruits and vegetables are difficult to find.…”

Childhood Obesity Perceptions Among African American Caregivers in a Rural Georgia Community: A Mixed Methods Approach

“…Prior obesity studies noted families residing in rural areas are limited in prevention efforts because they do not account for rural challenges [13,17,18]. When rural caregivers attempt to model and maintain a healthy lifestyle for children recreational parks and facilities, grocery stores with fresh produce, and health care resources are unavailable or inaccessible [13,[17][18][19]. African American communities experience more barriers in their environment resulting in higher obesity rates [20][21][22].…”

“…African Americans are disproportionately affected by obesity in rural areas [15,16]. Prior obesity studies noted families residing in rural areas are limited in prevention efforts because they do not account for rural challenges [13,17,18]. When rural caregivers attempt to model and maintain a healthy lifestyle for children recreational parks and facilities, grocery stores with fresh produce, and health care resources are unavailable or inaccessible [13,[17][18][19].…”

Nutritional Intakes of Obese Elementary School Children Residing in the Shimokita Peninsula of Aomori, Japan

“…In adults, vegetable consumption is known to reduce the risk of obesity, cancer, and chronic disease; however, the relationship between vegetable intake and obesity prevention among children remains largely unknown. Some studies have shown that when comparing obeseand non-obese children residing in rural areas, the obese children consume more vegetables [28]. Reports have shown that people who consume vegetables, fruits, fish, and cereals are more likely to have low blood pressure [29].…”