A Social-ecological Review of the Rural versus Urban Obesity Disparity

Objective: Rural areas are disproportionally burdened by obesity and obesity-related conditions. To inform future research and intervention development, the current literature review used a social-ecological framework to identify factors affecting the rural-urban disparity in obesity across the individual, interpersonal/relationship, community/physical environment, and societal/policy levels. Methods: We searched the literature across 5 research databases (CINAHL, Google Scholar, ProQuest, PubMed, and Web of Science) to identify studies examining factors influencing the prevalence of obesity in rural communities and to identify rural-based weight loss interventions. Results: We identified a multitude of factors across the social-ecological levels (eg, diet, physical activity, social networks, the built environment, healthcare access, racial/ethnic status, and poverty) contributing to the rural-urban obesity disparity. Despite the existence of influential factors across these levels, a review of existing rural weight management interventions demonstrated that most focused solely on modifying individual level factors. Conclusions: Rural residents face unique barriers to making changes in eating and activity behaviors and in accessing weight management interventions. Future research should investigate whether multilevel interventions can have meaningful impact on obesity prevalence in these communities.