The problem of obesity in children is in the forefront of nationwide research efforts. There are documented physical, mental, and social health outcomes associated with childhood obesity that contribute to lifelong, chronic health problems. Obesity occurs when, over time, over-consumption of high calorie, less nutritious foods and beverages is coupled with low physical activity energy expenditure, resulting in unhealthy weight gain. According to the Centers for Disease Control and Prevention, obesity-related conditions, specifically heart disease, stroke, type 2 diabetes and certain types of cancer, are the leading causes of preventable death – preventable through lifestyles that include healthy dietary and physical activity habits. In the U.S., the estimated annual medical cost of obesity in 2008 was $147 billion with the medical costs for people who are obese $1,429 higher than those of healthy weight.
Rural residency tends to increase the risk of being overweight or obese for both children and adults. Access to, affordability of, and availability of a wide variety of healthy foods, including fruit and vegetables, is limited in rural areas despite the rural agricultural landscape. The location of farmers’ markets, convenience stores, food co-ops, restaurants, and fast food options influences the dietary and physical activity practices of children and families. Rural communities have unique challenges regarding access to healthy foods, including no or limited access to local agriculture or farm-fresh food and full service grocery stores but easy access to convenience stores, drive-through and eat-in restaurants, and school meal programs. Rural residents also have unique perceptions of the barriers to having a healthy food environment, including the affordability of farm-fresh foods.
To date, most research-based strategies to combat the childhood obesity epidemic have been developed and tested in non-rural settings and aim to change either behaviors or environments. Launched in 2011, OSU’s Generating Rural Options for Weight (GROW) Healthy Kids & Communities does both. Working closely with six Oregon rural communities and residents, GROW researchers are gathering information on both real and perceived food and physical activity environments and using it to better understand the factors influencing health behaviors in rural places.
GROW’s overall goal is to prevent obesity in rural children by improving their opportunities –at home, in school, and in the community – to make healthy eating and physical activity an easy and preferred behavioral choice.
The GROW Approach
GROW is a USDA-funded, participatory childhood obesity prevention study conducted by Oregon State University Extension researchers in partnership with rural people and communities. Working at multiple levels and across sectors, local GROW teams – which include county Extension, organizational decision-makers, and community residents – have mapped features of the local environment and learned people’s different perceptions of what helps and hinders a “weight-healthy” lifestyle in their communities.
GROW developed two unique participatory action research tools to facilitate an objective understanding of the rural food environment: Healthy Eating Active Living: Mapping Attributes using Participatory Photographic Surveys (HEAL MAPPS™) and the Rural Community Food and Physical Activity Environmental Resource Audit (R-CFPA). They complement each other but are used to gather different types of information. HEAL MAPPS™ uses participatory photo mapping by community members and facilitated community conversations to reveal community perceptions of what helps or hinders weight-healthy behavior (and readiness to address barriers). R-CFPA engages community stakeholder teams to identify, spatially locate, and map the community’s available food and physical activity resources, including environmental features and amenities, observable influential characteristics, place-based programs, and retail outlets. The real-time data provided by both HEAL MAPPS™ and R-CFPA inform community decision-making and action.
Preliminary Results Related to Rural Community Food Environments
The overall food environment in these rural communities largely consists of convenience stores or small, local grocery stores. When large, national chain grocery stores were present, the produce was perceived as unaffordable. Small local or bargain grocery stores were not perceived as places to buy produce.
Our participatory research revealed that the GROW communities do have a variety of local food resources, including farmers’ markets, farm stands, CSAs, and home-based operations selling products like eggs and vegetables. Yet most of these resources are dispersed and often well outside city limits, likely explaining why so many residents did not know about them. The perceived and real lack of local food options was most strongly evident in communities in less agricultural regions, where fresh fruits and vegetables were considered unaffordable or of poor quality due to being shipped or stored.
With facilitation by the GROW team, communities came up with a variety of potential strategies to improve access to affordable, healthy food and even strengthen the local rural economy:
- Food banks or pantries and community gardens were both identified by communities as two possible ways to improve access to healthy food. Most communities perceived food assistance as supporting healthy eating, though a few communities noted a lack of healthy food at the food bank/pantry. Many communities also have either a community garden or a school garden and expressed interest in working with OSU Master Gardeners to enhance access to community gardens and learn how to grow vegetables.
- A food co-op or food hub could connect local food producers and local consumers; it might also be able to move excess fruits and vegetables from producers to local food pantries and community meal sites. Most of the GROW communities already have community meal events at senior centers, churches, or the local food bank/pantry, and food assistance programs are perceived as supporting healthy eating. Building on these pre-existing relationships by connecting local food producers with community meal providers could improve access to healthy foods.
- Community and school gardens, with integrated education for diverse audiences about growing food, may help low-income people meet their fruit and vegetable needs. All but two GROW communities have a community garden, a school garden, or both, and residents expressed interest in having more garden-based education and activities. Communities could partner with local governments or organizations like Master Gardeners to build on existing gardens and create new ones, with a focus on learning how to grow and prepare healthy food.
- Rural communities with small, local grocers or convenience stores could facilitate partnerships between store owners and local food producers. All six GROW communities in Oregon have convenience stores within easy access of most households. Healthy convenience store initiatives that include local foods could improve access to healthy, locally produced, fresh food in these stores. Many of the stores are SNAP-certified retailers, so this could also help low-income people access healthy foods while providing revenue for local producers. Local restaurants might also be interested in sourcing from local producers.
A rural food desert is defined as a census tract in which at least one half of the population lives more than ten miles from a large food store. This is true for most of the GROW communities. There is a clear need for creative partnerships between communities, businesses, and food producers to bring about easier access – closer to town and more affordable for community members – to local farm/agriculture products. Siting a large food store in a small rural community may not be economically feasible. Utilizing “non-traditional” venues for purchasing fresh foods – like feed stores, convenience stores, or food co-ops – and creating and fostering new partnerships between food producers and retailers are fresh, innovative ways to bring more healthy foods to rural communities, while at the same time increasing economic development. This approach, coupled with efforts to educate the public on the “what, where, and when” of local fresh food availability in their communities – community gardens and gardening classes, farm stands and farmers markets – are a solid foundation for building sustainable rural healthy food environments.