Tide of child obesity rising faster in rural America

WINDBER, Pa. -- When Ray Crawford walks down the hallway of his school, the beefy, 240-pound sophomore says he doesn't stand out much. Many of his classmates are heavy, too.

"We go to the Eat 'n Park to meet and chill, maybe don't eat the right things," he said, referring to a regional chain restaurant famous for its smiley-faced cookies. "There's not much else to do."

Here in his small hometown in the mountains of Western Pennsylvania and in other rural communities like it, many health officials say the tide of obesity is rising faster than anywhere else.

And new research appears to back them up, dispelling a long-held belief that in farm communities and other rural towns, heavy chores, wide expanses of land and fresh air make leaner, stronger bodies.

"Whatever the situation was, rural areas are leading the way now ... they're ahead of the curve," said Michael Meit, director of the University of Pittsburgh Center for Rural Health Practice. "Something's happened."

The Center for Rural Pennsylvania released a study recently that used state health figures to compare the body-mass index of seventh-graders in urban and rural communities -- more than 25,000 students in all.

About 16 percent of urban students qualified as obese, according to the study, which is in line with national average for children ages 6-19. In rural school districts, however, 20 percent of students were considered obese.

More alarmingly, researchers found that during the years of the survey, between 1999 and 2001, the number of obese students in rural school districts rose about 5 percent, more than twice the rate of their urban counterparts.

Nationwide evidence

The same trends are being reported from New Mexico to Michigan to West Virginia.

In Michigan, children in rural areas were 3 percent to 9 percent more likely to be obese, researchers found. In rural North Carolina children had a 50 percent greater chance of being obese.

Mostly rural states have done studies that don't distinguish between urban and rural children, but they have found the incidence of childhood obesity to be far greater than the national average.

More than a quarter of all fifth-graders in West Virginia are obese, where two-thirds of the population is rural. One in four public school children in Arkansas are obese.

"It is accelerating," said Dr. Darrell Ellsworth, director of cardiovascular disease research at the Windber Research Institute.

Ellsworth is trying to start a childhood obesity clinic to stave off a wave of diabetes and heart disease he believes will overwhelm this region if nothing is done. In a room with 14 children doing aerobic exercise at the Windber Medical Center, he nodded toward the teens and adolescents, saying they will have a much higher rate of disease than their parents or grandparents.

Researchers are not ready to point a finger at any one culprit for rural obesity, but they have some theories. For one thing, with fewer family farms and more mechanization, children are not burning many calories, but they're still eating high-calorie meals.

"... Habits are passed vertically from Grandma on down, but the diet of three decades ago just doesn't work today," said Dr. Jeff Holm of North Dakota.

The Center for Health Promotion at the University of North Dakota School of Medicine, where Holm is senior scientist, is following about 500 third- to fifth-graders over three years with hopes of finding a pattern.

Fewer farmers does not explain why Windber, a former coal-mining town named after a coal-mining company, would have the same problem.

One connection might be found in the satellite dishes, computers and game consoles that have popped up in almost every town, regardless of the region's economic engine. The same technology is found in cities and suburbs, but health officials say it arrived later and spread much more rapidly in rural areas, changing behavior dramatically in a very short time.

The only other place where researchers are finding obesity rates similar to rural America is in the poorest, most troubled urban neighborhoods, suggesting that poverty may be the overriding cause.

In Tioga County in northeast Pennsylvania, where farming has declined and poverty has risen to about 20 percent, one in 10 kindergartners were found to be obese in 2001-2002. That number doubled for eighth-graders.

"We've seen it sneaking up on us, we've known it's a problem, and now it's reaching epidemic proportions," said Anne Loudenslager, who heads the Tioga County Partnership for Community Health. "We are using a good portion of our limited resources to stop this."

Wellsboro Area High School, the largest in the county with 580 students, will alter physical education next year to allow student choices: sports team-oriented, wellness classes, and traditional gym classes.

Dr. Ellsworth, in Windber, said he hopes to have several hundred children in a new health program this year. He calls himself an optimist.

During a recent health fair in Connellsville, about 40 miles to the west, Ellsworth found that 60 percent of adults tested had metabolic syndrome, a collection of unhealthy conditions that raise the risk for diabetes and heart disease.

"The numbers for obesity in children were nowhere near what they are today and you can just imagine what we're going to be looking at 10 to 20 years from now if nothing is done," he said. "That 60 percent ... that's going to seem like a pretty low figure."

Ray Crawford, who is 16, lifts weights year-round in preparation for football season. Round-faced and 5-foot-9, he looks every bit the lineman he is for the Windber Ramblers. Now he says he'll also take up cardiovascular exercise, along with the weight-lifting.

"I've started trying to take it easy on the junk food," he says.

Crawford's father died of heart disease about eight years ago. He was 45.