What constitutes an obesogenic environment in rural communities?

Purpose. To identify perceived indicators of the physical environment associated with obesity in rural communities. Design. Cross-sectional telephone survey. Setting. Thirteen communities in rural Missouri, Tennessee, and Arkansas, 2003. Subjects. A total of 2510 adults completed the survey and 2210 respondents were included in the analysis (74% female, 93% white, and 27% obese). Measures. The 106-item survey measured perceptions of the neighborhood environment (recreational facilities, land use, transportation/safety, aesthetics, and food environment) and health-related behaviors. The primary outcome was obese (body mass index [BMI] ≥ 30 kg/m²) vs. normal weight (BMI = 18.5-24.9 kg/m²). Analysis. Logistic regression was used to control for age, gender, and education. Results. Several indicators of the perceived neighborhood environment were associated with being obese (adjusted odds ratio [95% confidence interval]), including furthest distance to the nearest recreational facility (1.8 [1.3-2.4]), unpleasant community for physical activity (1.8 [1.3-2.6]), feeling unsafe from crime (2.1 [1.5-2.9]) or traffic (1.7 [1.2-2.3]), and few nonresidential destinations (1.4 [1.0-1.9]). Distance to recreational facilities and crime safety remained significant in the multivariate model, along with dietary-fat intake, sedentary behavior, and moderate/vigorous physical activity. Conclusion. This study adds to a growing evidence base of environmental correlates of obesity and makes a unique contribution regarding rural communities. If causality is established, environmental interventions that target obesogenic neighborhood features may reduce the prevalence of obesity on a population level.