Jason Henderson

Sarah Low

English

Research Papers in Economics

10
12
14
16
18
20
22
24
10
12
14
16
18
20
22
24
Large central
MSA
Large fringe
MSA
Small MSA Micropolitan Town 
Percent of Adults 18 and older, 1997 - 98
Metro areas
Nonmetro Areas
mericans consume calories at an alarming pace. 
According to the Center for Disease Control 
and Prevention, the obesity rate for adults has 
nearly doubled since 1990, reaching 22.1% in 2002.1 As 
our waistlines swell, so do our medical bills and insurance 
premiums. Worker productivity suffers as we lose time on 
the job due to obesity-related illnesses. And we die younger. 
Excess weight threatens all of us. But rural Americans,  
appear to be more at risk. People in counties without a city 
of more than 10,000 suffer the highest obesity rates in the 
nation (Chart 1). But perhaps our most endangered group 
is America’s youth. In 2000, their obesity rate reached 
16.1%—nearly triple the rate in 1980. 
Healthcare and educational institutions are helping 
us battle the bulge. They are mobilizing resources, 
developing programs to raise awareness, and providing 
more opportunities for us to exercise. But the serious work 
has just begun, and not all Americans are even aware that 
the war is being waged. 
The eaTing epidemic
In an age of prepackaged meals, restaurant chains, and 
microwave ovens, today’s Americans have changed what 
we eat, where we eat it, and how we prepare it. We have 
A
2006
more money than ever before and spend much of it on 
unhealthy food. We lead less-active lives, and so our need 
for calories is less than it used to be. Mix these ingredients 
together and we end up with a recipe for gaining 
unwanted and dangerous pounds. 
In the past, Americans prepared their own meals 
and ate at home. Today, we eat salty snacks—32 pounds 
per person each year.2 And we eat out often. In 2004, 
households spent more than half of their food budgets on 
meals away from home—twice what we spent in 1960.  
Obesity: AmericA’s ecOnOmic epidemic
Jason Henderson, Senior Economist, and Sarah Low, Research Assistant
C e n t e r   f o r  t h e   St u dy   o f   Ru r a l   A m e ri c a                 2 0 0 6   •  Vo l   I       Is s u e   I I  
Source: Health, United States, 2001, Urban and Rural Chartbook, Center for 
Disease Control. Micropolitan counties are nonmetro counties that contain 
a city with more than 10,000 residents. Town counties are nonmetro 
counties that contain no city with more than 10,000 residents.
Chart 1
Obesity Rates by Metro Status1500
2000
2500
3000
3500
4000
1500
2000
2500
3000
3500
4000
World USA EU Canada Mexico Australia China India Africa
Calories per capita per day
Source: FAO-STAT
C e n t e r   f o r  t h e   St u dy   o f   Ru r a l   A m e ri c a
Our rising incomes have enabled us to fuel our 
growing appetites. At 3,800 calories per day, we consume 
more high-calorie foods than any other people in the world 
(Chart 2). At the same time, our less strenuous lifestyles 
have slashed our need for calories. Simply put, we eat more 
calories than we burn. And so obesity rates have surged. 
In 1994, not a single state had an adult obesity rate above 
20% (Map 1). In 2004, just ten years later, only a handful 
of states had adult obesity rates below 20% (Map 2). 
pag e   2
Chart 2
Global Caloric Consumption
Map 1
Adult Obesity Rates, 1994
                             
Source: Center for Disease Control and Prevention
No Data <10% 10% - 14% 15% - 19%
Map 2
Adult Obesity Rates, 2004
       
Source: Center for Disease Control and Prevention
15%–19%    20%–24%    =25%   
  The heavy cosTs of our growing appeTiTes
As obesity rates soar, so do the costs. In 2000, the 
Surgeon General estimated that obesity costs had reached 
$117 billion a year. Half of these costs emerged directly, 
through healthcare spending. The other half emerged 
indirectly, through higher insurance premiums, time off 
work, and even premature death.
At the end of the 20th century, the direct costs of 
obesity reached $61 billion. The Center for Disease 
Control and Prevention reported that in 1998 obesity and 
overweight costs accounted for 9.1% of all U.S. medical 
expenses. Taxpayers picked up the tab for more than 
half of our obesity-related healthcare bills in the form 
of Medicare and Medicaid spending (Chart 3). Private 
insurance companies picked up a third of the tab. 
Chart 3
Share of Obesity-Related Medical Spending by 
Insurance Status
Medicare
29%
Medicaid
23%
Private
33%
Out-of-pocket
15%
Calculations based on Center for Disease Control and Prevention dataA large part of the direct costs stems from how obesity 
exacerbates other serious diseases, such as type 2 diabetes, 
hypertension, and heart disease. Over their lifetime, obese 
patients spend $10,000 more on medical bills for these 
health problems than people who are not obese.
The indirect costs of obesity reached $56 billion at the 
turn of the century. These costs included higher insurance 
premiums, lost productivity from time off work, and 
premature death. Private insurance companies pay billions 
in obesity costs each year, leading to higher insurance 
premiums. Evidence shows that obesity accounts for 39 
million days off work each year, in addition to 368 million 
restricted workdays and 63 million visits to the doctor.3  
And premature death, of course, is the greatest cost of 
obesity. The Center for Disease Control and Prevention 
warns that, based on current obesity trends, today’s youth 
may become the first generation in history to have a 
shorter life expectancy than that of their parents.4 
 
The harsher cosTs of rural obesiTy
The problems of obesity are even more acute in rural 
places. In the late 1990s, the more rural a county was, the 
higher was the obesity rate of its people (Chart 1). Obesity 
rates for counties with at least one city were less than 20% 
on average. The rates for counties with towns of 10,000 or 
more were more than 20% on average. Counties without a 
town of 10,000 or more had rates above 22% on average. 
For rural and metro counties alike, the highest obesity rates 
occurred in the South and Midwest.
Given the higher obesity rates in rural places, obesity 
costs per capita were also likely to be higher there. At 
the state level, per capita spending on obesity-related 
healthcare was not only higher in rural states, but also 
accounted for a greater share of the states’ total spending 
on healthcare.5 In the “most rural” states (where more 
than 40% of the people are rural), per capita obesity costs 
amounted to nearly $270 per year. In the “least rural” 
states (where less than 15% of the people are rural), per 
capita costs were just $243 per year. 
Obesity costs in the late 1990s also accounted for a 
greater share of total healthcare spending in rural places. 
In the most rural states, 5.8% of healthcare costs were 
obesity-related, compared to 5.1% in the least rural states.
why are rural obesiTy raTes higher?
Rates for obesity are high in rural areas for the same 
reasons that they are high elsewhere—consumption 
behavior has changed in the wake of technological 
advances and gains in income. Certain demographic and 
geographic characteristics of remote places may have also 
contributed to weight gain among rural Americans. 
Three demographic features appear to be likely 
suspects. First, older people tend to have higher obesity 
rates, and the population in rural America is older than in 
the rest of the country.6 As people age, they tend to engage 
in less physical activity, reducing the number of calories 
they need. They also face the cumulative effect of multiple 
years of consuming more calories than they burn.
Second, research shows that people with less 
education consume more calories than other people, and 
rural populations often fall into this category. People with 
lower levels of education typically have less exposure to 
dietary, nutritional, and health information.7
Third, research shows that people with lower incomes 
often have a problem with obesity. 8 Rural populations fall 
into this category as well. At lower income levels, people are 
less able to afford healthier foods, which typically cost more, 
and are reluctant to pay for access to exercise facilities.
Two features of geography may also be a factor in 
rural obesity. First, the remoteness of rural areas often 
limits people’s access to healthier foods. Dieticians suggest 
that without easy access to supermarkets, people face a 
greater risk of diet-related diseases.9 From 1997 to 2002, 
rising health consciousness led to a 29% surge in health 
food stores—but most of the new stores opened in cities.10  
Similar access issues arise for rural people who might 
want to visit exercise facilities. Rural areas average two 
exercise facilities per county. 11 Metro areas average 25. 
combaTing rural obesiTy 
A confluence of forces underlies rural America’s 
obesity epidemic—requiring a multifaceted approach 
to combat it. The first step, say healthcare advocates, is 
to educate rural Americans about obesity and its costs. 
According to the U.S. Department of Agriculture, 40% 
of those who are classified as overweight do not consider 
themselves overweight.12
C e n t e r   f o r  t h e   St u dy   o f   Ru r a l   A m e ri c a pag e   3In West Point, Mississippi, the local hospital 
and county extension service developed a weight-loss 
program.15  The 780 people who took part lost a combined 
5,612 pounds. Local restaurants, after hearing about the 
program, began to offer more healthful items on their 
menus. People started a walking club. And local leaders 
worked together to turn seven miles of abandoned railroad 
tracks into a walking trail. 
Initiatives such as these highlight the importance 
of partnerships in fighting the epidemic. As obesity 
gains prominence as a national concern, education and 
healthcare institutions can team up with public health 
officials to raise awareness—clearly the most important 
step in winning the battle of the bulge.
C e n t e r   f o r  t h e   St u dy   o f   Ru r a l   A m e ri c a pag e   4
The second step is to broaden access to exercise 
facilities. While rural communities usually lack private 
facilities, such as a YMCA, they do have exercise rooms in 
public schools. Finding ways to allow more access to gyms 
or weight rooms may be one way to promote exercise in 
rural places. Another way would be to encourage group 
exercise, such as walking clubs. Many urban hospitals offer 
wellness and exercise programs, which could serve as a 
model for rural hospitals.13  
Some rural healthcare and educational institutions are 
already working together to improve nutritional awareness 
and encourage exercise. In southeastern Iowa, the Iowa 
State Extension helped establish a coalition of nutrition, 
health, and physical fitness professionals to promote 
healthy lifestyles in children.14 The coalition is serving 
as a resource for local school districts and is gathering 
information for walking paths and trails. 
Measuring Obesity
Health officials use the Body Mass Index (BMI), which accounts for both a person’s weight and height, to determine 
excess body weight. People with a BMI between 25 and 30 are considered overweight. People with a body mass index 
(BMI) over 30 are considered obese.
  Healthy Weight  Overweight  Obese
BMI  18.5 to 25  25 to 30  > 30
Height     
6’  137 to 185 lbs.  185 to 220 lbs  > 220 lbs
5’ 6’’  115 to 155 lbs.  155-185 lbs  > 185 lbs
Body Mass Index (BMI) definition and classification
Body Mass Index (BMI) = Weight (Kilograms)
  Height 2 (Meters)
Source: Mancino, Lisa, Biing-Hwan Lin, and Nicole Ballenger. “The Role of Economics in Eating Choices and Weight Outcomes.” 
Agriculture Information Bulletin Number 791, Economic Research Service, USDA, September 2004.
Edited by Bob ReaganC e n t e r   f o r  t h e   St u dy   o f   Ru r a l   A m e ri c a pag e   5
EndnotEs
1  National and state data obtained from the Centers for Disease Control 
and Prevention (CDC). Behavioral Risk Factor Surveillance System 
Survey Data. Atlanta, Georgia: U.S. Department of Health and Human 
Services, Centers for Disease Control and Prevention, http://apps.nccd.
cdc.gov/brfss/Trends/TrendData.asp
2   Kuchler, Fred, “ Taxing Snacks to Reduce Obesity,” Amber Waves 
Economic Research Service, U.S. Department of Agriculture. November 
2004. 
3   Current Estimates of the Economic Cost of Obesity in the United States, 
Obesity Research, 1998.
4   The National Advisory Committee on Rural Health and Human 
Services. The 2005 Report to the Secretary: Rural Health and Human 
Service Issues, April 2005.
5   Health, United States, 2001, Urban and Rural Chartbook, Center for 
Disease Control and Prevention.
6   Health, United States, 2001, Urban and Rural Chartbook, Center for 
Disease Control and Prevention.
7   Tai-Seale, Tom and Coleman Chandler. “Nutrition and Overweight 
Concerns in Rural Areas: A Literature Review,” Rural Healthy People 
2010: A Companion Document to Healthy People 2010 Volume 2. 
Southwest Rural Health Research Center, Texas A&M University, 2005.
 
8  The National Advisory Committee on Rural Health and Human 
Services. The 2005 Report to the Secretary: Rural Health and Human 
Service Issues, April 2005.
9   www.todaysdietician.com, May 2004, vol 6., no. 5 p. 38.
10   Calculations based on Census Bureau, County Business Patterns data.
11   Calculations based on Census Bureau, County Business Patterns data.
12   Kuchler, Fred and Jayachandran N. Variyam. “Misperceptions in Self-
Assessed Weight Status Vary Among Demographic Lines,” Food Review, 
Economic Research Service, U.S. Department of Agriculture, Winter 
2002, pp. 21-27.
13  Tai-Seale, Tom and Coleman Chandler. “Nutrition and Overweight 
Concerns in Rural Areas: A Literature Review,” Rural Healthy People 
2010: A Companion Document to Healthy People 2010 Volume 2. 
Southwest Rural Health Research Center, Texas A&M University, 2005.
14   For more detailed information on Iowa State University Success Stories, 
see www.extension.iastate.edu/families/success/.
15   The National Advisory Committee on Rural Health and Human 
Services, The 2005 Report to the Secretary: Rural Health and Human 
Service Issues, April 2005.

Obesity : America’s economic epidemic

http://www.kansascityfed.org/Publicat/mse/MSE_02_06.pdf

Obesity : America’s economic epidemic

Abstract

Similar works

Full text

Available Versions

Research Papers in Economics