Document Type

Thesis - Open Access

Award Date


Degree Name

Master of Science (MS)


Health and Nutritional Sciences

First Advisor

Lacey Arneson McCormack


childhood obesity, food rules, home environment, rural health, rural nutrition, rural vs. non-rural


Background: Childhood obesity is continuing to rise, leading to long-term health consequences. Research shows that rural populations have higher rates of childhood obesity. There is a lack of research on how the home environment may affect this health disparity. Parents often enforce food rules to control their child’s eating habits, but the difference between the rural and non-rural populations in enforcing these rules is unknown.
Purpose: The purpose of the present study was to determine if there is a significant difference in food rules between rural and non-rural school-aged children, and if these differences correlate to BMI categories.
Methods: Secondary cross-sectional data analysis from N=127 3rd, 4th, and 5th grade children at a rural and non-rural school. The children provided anthropometric and survey data. They were measured for weight and height to gather BMI data and screened for dietary data, specifically food rule data, using the Block Kids Food Screener.
Results: There was a significant difference in mean BMI percentile between rural and non-rural populations, with 43.6% of the rural population falling in the overweight or obese BMI category compared to 20% of the non-rural population. There was no significant correlation between specific food rules and BMI percentile. The non-rural group had an average of 6.28 of the 14 food rules while the rural group had an average of 3.81, p = .0005. In rural populations, rules about not eating sweet snacks and fried foods are significantly less likely to be perceived by the children when compared to non-rural populations. “Rural” status was a significant predictor of BMI percentile for only one of the food rules, but it was significant for all of the food rules when Overweight/Obese weight status was the outcome of interest. There was a significant positive association between rules around limiting portion sizes at meals and BMI percentiles when controlling for the relationship between rural status and BMI. When overweight/obese was the outcome, there was a positive association between rules around only having fruit for dessert and not having sweet snacks, even when controlling for the relationship between rural status and weight category.
Conclusion: This study found correlations between specific food rules, the rural population, and weight categories. Rural families have less family food rules than nonrural families, and childhood obesity was more highly associated with the rural population. Specific rules were associated with higher child weight, but it is unknown when these rules were put into place in the home environment. Research in rural areas is just as important as research in non-rural areas if improving the health of children is the ultimate goal. Going forward, research should focus on the home environment as a whole.

Library of Congress Subject Headings

Obesity in children.
Children -- Nutrition.
Rural children -- Nutrition.
Food habits.



Number of Pages



South Dakota State University


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