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United States Department of Agriculture

Agricultural Research Service

Obesity: An issue for rural America, North Dakota
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By Gerald Combs

Obesity in the U.S. is now termed an epidemic, meaning that it affects many people and is spreading. Sixty-five percent of Americans are overweight or obese, and the highest rates occur in small towns and rural communities of the Midwest and the South. Compared to their urban counterparts, rural adults tend to be older, less physically active, have lower incomes and have declining access to local grocery stores. These factors set up a predisposition to being overweight and obese.

Obesity is actually a technical term defined in terms of body mass index, which is a measure of body fat based on height and weight that applies to adults. BMI is not easy to calculate; therefore, it is easiest to consult an online BMI calculator, such as the one found at the National Institutes of Health Obesity Education Web site, Adults with BMIs of 25 to 29.9 are considered overweight; those with BMIs 30 or more are considered obese.

Obesity is not about appearance — it’s about public health. Obese individuals face increased risks of several chronic illnesses — type 2 diabetes, coronary heart disease, stroke, osteoarthritis, depression, gall bladder disease and several types of cancer. The U.S. health care costs attributable to obesity were more than $117 billion in 2005, according to NIH estimates. Obesity-related productivity losses cost another $3.9 billion. These costs, when considered on a per capita basis, fall disproportionately to rural states where they are several times greater than those in the most densely populated states.

The North Dakota Health Department reports that the number of obese adults in the state has more than doubled since 1990. One out of every four North Dakota residents is obese. Only 37 percent of North Dakota residents have a healthy body weight. And even fewer American Indian residents have a healthy body weight. In North Dakota’s American Indian communities, obesity prevalence is rising even more rapidly among young people.

Having a healthy body weight is all about balancing calories consumed with those expended. Research indicates that missing this balance by only 50 excess calories each day can, over two years, result in a 16-pound increase in body weight. This means that small changes in the ways we eat and how physically active we are can be effective in achieving and maintaining healthy body weight.

This is very good news for all of us because small changes are easy to take. For example, to reduce your caloric intake, try some small, but proven, steps: drink water before a meal; choose fat-free milk over whole milk, diet soda over sugared sodas; cut out late-night snacks; skip seconds but don’t skip meals; choose fruit for dessert or eat only half your dessert; remove the skin from poultry; use salad dressing “on the side.”

To increase your caloric expenditure, small increases in physical activity can be important. For example, whenever possible, walk or bike instead of drive. When driving, park at the far end of the parking lot. Sit up straight at work. Take stairs instead of elevators. Choose an activity that fits into your daily life. Join an exercise group or fitness center. Regular physical activity is one of the most useful ways to maintain healthy body weight, while also maintaining strength, agility, flexibility and cardiovascular fitness.

Exercise can positively affect mood, too. Studies at the University of Texas Southwestern Medical Center showed that burning 350 calories three times a week during sweat-inducing exercise can reduce symptoms of depression.

Greater Grand Forks has more opportunities than most communities to be physically active year-round. Parks and open public recreation areas comprise 12 percent of the land within the city limits — that’s twice the national average. In addition, we have a large array of health and fitness programs, including the “Y”, Center Court Fitness Club, the UND Wellness Center, Curves, Anytime Fitness, Select Therapy and Fitness, Altru Health and Fitness Center and Complete Athlete. Some 10,000 area residents are members of one or more of these facilities — that’s in addition to the students who use UND facilities.

Smart dietary choices and regular physical activity are the key elements of achieving and keeping a healthy body weight. You can find useful information about both at To learn more “small steps to healthy living,” go to the U.S. Department of Health and Human Services Web site, For resources and information about health and wellness in the Grand Forks community, check the Healthy Greater Grand Forks Coalition Web site ( Learning from these Web sites may seem like a small first step, but isn’t that the way every important journey begins?

Last Modified: 3/5/2008
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