Residing in economically distressed rural Appalachia is independently associated with excess body weight in college students

Introduction: The prevalence of obesity is greater among adults living in rural compared to urban areas of the USA. Greater obesity risk among rural adults persists after adjusting for obesity-related behaviors and sociodemographic factors. With the rural- urban obesity disparity greatest among younger adults, it is important to examine the complexity of factors that may increase the risk for excess body weight in this population so that effective preventive interventions can be implemented. College students residing in economically deprived rural areas such as rural Appalachia may be particularly at risk for excess body weight from exposure to both rural and college obesogenic environments. The purpose of this study was to determine if living in economically distressed rural Appalachia is independently associated with excess body weight among college students. Methods: College students aged 18-25 years who were lifetime residents of either rural Eastern Appalachian Kentucky (n=55) or urban Central Kentucky (n=54) participated in this cross-sectional study. Students completed questionnaires on sociodemographics, depressive symptoms, and health behaviors including smoking, fruit and vegetable intake, and physical activity. Height and weight were obtained during a brief health examination to calculate body-mass index (BMI). Excess body weight was defined as being overweight or obese with a BMI of 25 kg/m² or greater. Binary logistic regression was used to determine if living in economically distressed rural Appalachia was independently associated with excess body weight. Results: The prevalence of excess body weight was higher in the rural Appalachian group than the urban group (50% vs 24%, p<0.001). Depressive symptom scores and smoking prevalence were also greater in the rural Appalachian group. There were no differences in fruit and vegetable intake and vigorous physical activity between the groups. Residing in economically distressed rural Appalachia was associated with more than a six-fold increased risk of overweight or obesity, controlling for sociodemographics, depressive symptoms, and health behaviors (odds ratio=6.36, 95%CI=1.97-20.48, p=0.002). Conclusions: Living in economically distressed rural Appalachia was associated with excess body weight in college students independent of sociodemographic factors, depressive symptoms, and obesity-related behaviors. Further research is needed to determine other characteristics of this region that are associated with excess body weight so that effective programs to reduce obesity risk can be implemented.