Diet and Physical Activity in Rural vs Urban Children and Adolescents in the United States: A Narrative Review

Current research suggests that the prevalence of obesity is higher among rural youth than urban youth. Due to the health implications that are associated with child and adolescent obesity, it is critical to understand systematic differences in diet and physical activity (PA) behaviors that may be contributing to this disparity in weight. However, varying definitions of rural and inconsistencies in study tools and methodologies may limit the generalizability of findings from research in this area. The objective of this narrative review was to synthesize and critically evaluate existing literature comparing diet and PA behaviors between rural and urban children and adolescents, providing recommendations for future research. Only five studies were found that reported on measures of diet in rural vs urban youth, whereas 16 were found that reported on measures of PA. Dietary assessment tools were generally standard and acceptable; however, differences existed in how dietary outcomes were defined. Few studies used assessment tools that objectively measured PA, and definitions for meeting PA recommendations varied among studies. Very few studies defined rural using the same criteria. Future research on the rural youth obesity disparity should focus on including a high-quality assessment of both diet and PA (as opposed to one or the other) and on using an appropriate and consistent definition of rural.