Publication date: Available online 29 November 2019
Source: Health & Place
Author(s): Mark Lee
Rural adults in the U.S. have disproportionately high rates of obesity, but it is unclear whether this association exists because of selective migration or a contextual effect of the rural environment. Using nationally representative longitudinal data, this study investigates: (1) whether people with obesity select into rural counties, and (2) whether living in a rural area increases body weight after accounting for selection bias. Results indicate that people with obesity are less likely to move to a different county than people without obesity even after controlling for individual and household differences. Next, individual fixed effects regression models, which implicitly control for all time-constant variables, are used to produce a more robust estimate of the effect of rural residence on body weight. Rural residence predicts a significant increase in probability of obesity and body mass index. These results suggest that the association between rural residence and obesity in the United States is likely bidirectional.