6 tips for treating rural patients with obesity

It’s tempting to picture life in the country as being all about clean air, fresh food, outdoor activities and abundant good health.

According to the County Health Ranking, however, Americans in major cities live longer, healthier lives overall than do their country cousins. In rural communities, folks face a number of major health challenges, many of which relate to obesity and its chronic comorbidities, including diabetes, stroke, heart attacks and high blood pressure.

According to a report from the CDC in 2018, obesity prevalence was significantly higher among adults living in rural counties (34.2%) than among those living in metropolitan counties (28.7%). The greatest differences in prevalence were in the South and Northeast regions. And the findings held true for adults in most sociodemographic categories, across age, sex and household income.

Social determinants of health

Health care practitioners must therefore consider the social determinants of health when treating people with obesity in rural areas. According to WHO, social determinants of health are the conditions in which people are born, grow, live, work and age. For example, rural America is characterized by a very low population density, older populations, higher rates of poverty and fewer transportation options. Access to healthy and affordable food is lacking in many rural communities, which are often food deserts with few food resources or food swamps that are saturated with fast food outlets and convenience stores.

Rural health care facilities frequently lack nutritionists, dietitians or weight management experts to help patients with obesity attain better health. Many people in these communities are also uninsured or underinsured and would have to pay for treatment out of pocket. In many cases, rural communities don’t have exercise facilities and infrastructure to encourage physical activity. Additionally, the distance, expense and lack of transportation for accessing health care facilities, exercise facilities and healthy food become barriers to better health outcomes.

These factors all take a toll. Compared with their urban counterparts, rural adults engage in less leisure time physical activity; have lower intakes of fruits and fiber; have higher intakes of sweetened beverages; and have 1.19 times higher odds of having obesity, even after adjusting for socioeconomic status, health, diet, sedentary behavior and physical activity. Given these poor outcomes, it is essential that primary care physicians reach out to offer help to patients with obesity and overweight, even if the conversations seem awkward at first.

6 steps to take when talking with rural patients about obesity

Regardless of location, disease or social environment, it is always important for PCPs to meet patients where they are and develop treatment plans that can be executed and sustained. This is especially important when treating rural patients, many of whom already face significant challenges in their daily lives.

To address issues around obesity, practitioners should keep in mind the following six steps:

1. Ask the patient’s permission to discuss obesity. In this way, the PCP begins the conversation by showing respect for their patient’s agency and emotional readiness.
2. Respect the patient’s answer. If the response is no, the physician can offer a handout or a list of websites about the health effects of obesity and let the patient know that the door is always open for a discussion, whenever the patient is ready.
3. Emphasize that obesity is a disease, not a character flaw. If the patient is open to having a conversation, educate them about the disease of obesity and its health consequences. But make sure to underline that obesity is a medical disease, not a moral failing.
4. Convey hope and encouragement. People with obesity have often struggled with the disease on their own for many years. It is important to reassure them that small changes can really reduce the risk of bad outcomes.
5. Brainstorm possible plans. Make sure the patient knows that there are treatments available and help them explore the options.
6. Follow up. Make plans during the initial conversation to follow up frequently and continue to build treatment plans in a step-by-step fashion.

Acquiring and sharing with patients the latest information about obesity research and treatments is the path to healthier rural communities. High-quality continuing education is readily available from organizations like the Obesity Medicine Association for PCPs in rural areas who want to know more about how to treat obesity. If you’re interested in learning more, I invite you to join the Obesity Medicine Association's fall conference, where we will focus on how to treat obesity across the lifespan.

Wickham Simonds, MD, FOMA, received his BS in biology from Campbell University and his MD from East Carolina University. He completed his residency in emergency medicine from York Hospital/Penn State University and is board certified in emergency medicine. He began practicing obesity medicine in 2004. Simonds is an ABOM diplomate and a fellow of the Obesity Medicine Association. He has served on multiple committees and task forces at the OMA and is currently a board trustee.

References:

CDC. More obesity in U.S. rural counties than in urban counties. https://www.cdc.gov/media/releases/2018/s0614-obesity-rates.html. Accessed July 13, 2021.

The County Health Rankings & Roadmaps. 2020 county health rankings key findings report. https://www.countyhealthrankings.org/reports/2020-county-health-rankings-key-findings-report. Accessed July 13, 2021.

Obesity Medicine Association. Diseases related to obesity. https://obesitymedicine.org/diseases-related-to-obesity. Accessed July 13, 2021.

World Health Organization. Social Determinants of Health. https://www.who.int/health-topics/social-determinants-of-health. Accessed July 13, 2021.

Rose V, Warrington V. Treating obesity in socioeconomically disadvantaged communities. Presented at: Obesity Medicine Association fall conference; Oct. 7-11 (virtual meeting).

Wickham Simonds, MD, FOMA, received his BS in biology from Campbell University and his MD from East Carolina University. He completed his residency in emergency medicine from York Hospital/Penn State University and is board certified in emergency medicine. He began practicing obesity medicine in 2004. Simonds is an ABOM diplomate and a fellow of the Obesity Medicine Association. He has served on multiple committees and task forces at the OMA and is currently a board trustee.