The resources and support available to a community can dictate our ability to maintain a healthy lifestyle. Individuals in urban settings have improved dietary and fitness outcomes if they have access to well-resourced physical activity and healthy food environments. However, a recent study shows the reverse is true for individuals in rural environments.
Obesity is linked to difficulties with accessing healthy food environments, such as supermarkets and farmers’ markets, and physical activity environments, such as recreational facilities and safe walkways.Difficulties include having to travel long distances, limited resources, poor access, and safety concerns. Diet and physical activity interventions encouraging a healthy lifestyle to combat obesity are more successful in urban areas with better access to physical activity and healthy food environments. A recent study published in the Journal of the Academy of Nutrition and Dietetics looked at whether this was also true in rural areas.
A total of 249 participants were recruited through the Heart Healthy Lenoir Project in rural North Carolina between September 20, 2011, and April 27, 2012. Participants attended 4 counselling sessions that discussed healthy diets, focussing on a Mediterranean-style diet and ways to increase physical activity, such as walking ≥ 7500 steps per day or walking ≥ 30 minutes for at least 5 days per week. Participants also received guides about local community food and exercise resources. Participants were asked to score 6 perceived barriers to healthy nutrition and 13 perceived barriers to physical activity within their neighbourhood. The number of supermarkets, farmers’ markets, fast-food outlets, and physical activity venues located within a 1-mile zone of each participant’s address were also objectively measured, as were crime rates and neighbourhood walkability.
Associations between perceived nutritional and exercise barriers or objective measurements and diet, physical activity, and weight were calculated, taking into account age, race, education, and sex. Diet, physical activity, and weight all improved in participants living in areas with poor access to healthy food sources and physical activity venues compared to those with better access. Specifically, diet improved more in participants who perceived more nutrition-related barriers. Participants living in less healthy food environments or in neighbourhoods with higher crime rates lost more weight. Physical activity also increased in participants living further away from gyms and in areas with fewer gyms.
These results are in direct contrast to those found in urban settings. It is possible that the lack of resources available in rural areas encourages greater motivation and persistence. On the other hand, the results may reflect this study’s limitations. It is possible that the intervention targeted behaviours that were easy to influence. In addition, the objective measurements did not consider alternative physical activity venues or the fact that participants may access food and physical activity environments outside their 1-mile zone. Finally, only one county was studied, which makes it difficult to transfer these results to countries with different geographical, cultural, and sociodemographic properties. Regardless of the reasons, further studies are needed to confirm these paradoxical findings and to determine why lifestyle interventions have different results in rural and urban settings.
Written by Natasha Tetlow, PhD
Jilcott Pitts SB, Keyserling TC, Johnston LF, Evenson KR, McGuirt JT, Gizlice Z, Whitt OR, et al. Examining the association between intervention-related changes in diet, physical activity, and weight as moderated by the food and physical activity environments among rural, Southern adults. J AcadNutr Diet. 2017. Available at: doi:10.1016/j.jand.2017.04.012.