A new report suggests that North Carolina children who live in rural counties or attend schools with high poverty levels are at a greater risk for obesity.

Published in the Journal of School Health, the study examined health data for approximately 75,000 third through fifth grade students across 317 North Carolina schools and determined whether the socioeconomic and racial compositions of each school could predict trends in student obesity. Study co-authors Joy Piontak, a research analyst at the Duke Center for Child and Family Policy, and Michael Schulman, a professor at North Carolina State University, said they analyzed the heights and weights of students and built corresponding statistical models based on the represented schools and counties.

The investigators found that students who live in rural areas were 1.25 times more likely to be obese than their urban counterparts, when the socioeconomic and racial compositions of each county were controlled for. Additionally, students attending high-poverty schools were found to be 1.5 times more likely to be obese than students attending low-poverty schools.

“People tend to think of concentrated poverty as an inner-city problem, but there is deep poverty in rural communities," Piontak said. "We need to better understand how the challenges which rural areas are facing are different from those which urban sectors are facing."

Piontak pointed at food insecurity, poverty, the inability to recover from economic recession and a lack of access to grocery stores as some of the key contributors to the higher obesity levels in rural areas.

Of the students analyzed, 20 percent were determined to be obese—a rate relatively higher than the national average. Students were defined as obese if they had a Body Mass Index at or above the 95th percentile for peers of the same age and sex.

Rural areas can often have trouble funding programs that work to improve health. 

“We know that high poverty schools have had to divert money from physical activity and nutritious food to core subjects," Piontak said. "Social scientists have found that food in schools with higher levels of poverty tends to be of lower quality.” 

However, solutions are within reach. Piontak noted that public schools often serve as critical intervention sites for the prevention of childhood obesity. At the community level, she added, the government should tackle questions related to the resources already available, such as whether food stamps are distributed equally among families.

“We need to support community-level initiatives aimed at improving nutrition, food availability and food access with the idea that communities need to be mobilized and form coalitions to best address these health issues,” Schulman said.

N.C. State recently received new funding from the Centers for Disease Control and Prevention to study the North Carolina counties with the highest obesity rates. Schulman noted that the team plans to direct the funding toward research as well as public initiatives to improve physical activity and food availability within schools and communities.

“Obesity is a complex problem, and no one single study will resolve it," he said. "Studies and interventions can result in evidence based initiatives which can be applied to create a positive impact."