Rural Canadian adolescents are more likely to be obese compared with urban adolescents.

OBJECTIVE Few studies have examined variations in overweight and obesity by geographic location in youth. The purpose of this study was to investigate the association between urban/rural geographic status and being overweight or obese among Canadian adolescents. METHODS The study involved an analysis of a representative sample of 4851 Canadian adolescents in grades 6 to 10 from the 2001-02 Health Behaviour in School-aged Children Survey. Self-reports of participants' demographics, physical activity, screen time, diet, and body mass index (BMI) were assessed. Adiposity status was determined using the international BMI thresholds for children and youth. Urban/rural status was coded on a five-point scale based on the geographic location of the participants' schools. Logistic regression with generalized estimating equations to adjust for clustering was used to examine the association between urban/rural status and overweight/obesity. RESULTS The population was 53.3% female with a mean age of 13.9 years (standard deviation, SD=1.5). Approximately 22.2% were living in rural areas while 14.4% were living in large metropolitan (metro) areas. After adjusting for age, sex, socioeconomic status, and Region of Canada, there was a trend for increasing overweight (p=0.001) and obesity (p=0.03) among adolescents as the level of "rurality" increased (relative odds for most urban to most rural regions for overweight or obese: 1.00, 0.98, 1.18, 1.57, 1.36; obesity: 1.00, 1.06, 1.39, 1.58, 1.56). Conclusion. This study provides new information about patterns of overweight/obesity among Canadian adolescents by urban-rural geographic status. These findings suggest that obesity prevention interventions should be particularly aggressive in rural areas.