Rural–urban differences in body mass index and obesity-related behaviors among low-income preschoolers

Background With one in eight preschoolers classified as obese in the USA, childhood obesity remains a significant public health issue. This study examined rural–urban differences in low-income preschoolers’ body mass index z-scores (BMIz), eating behaviors, dietary quality, physical activity (PA) and screen time. Methods Pre-intervention data from 572 preschooler-parent dyads participating in a randomized, controlled obesity prevention trial in the Midwest USA were analyzed. We examined the associations among living in rural versus urban areas, child BMIz and child obesity-related behaviors, including eating behaviors, dietary quality, PA and screen time. Results Rural children had higher BMIz, more emotional overeating behaviors and more time spent playing outdoors compared with urban children. We found no associations between children living in rural versus urban areas and dietary quality and screen time. Conclusions The study found that rural–urban differences in BMIz may start as early as 3–4 years of age, if not earlier. To reverse the weight-related health disparities between rural and urban low-income preschoolers, structural changes in rural locations and family supports around coping skills may be needed.