Fannie Charles, 46, lives six miles from the nearest grocery store in rural Orangeburg County, S.C. She doesn't own a car, so she pushes a cart along the side of the highway. (There are no sidewalks.) It's difficult, since she weighs 240 pounds and suffers from asthma and type 2 diabetes. That's why she usually goes only once a month. About once a week she supplements her grocery-store purchases with pricier, less healthy food from the convenience store, just a mile and a half away. At both places she forgoes fruits and leafy greens. "They're too expensive," she says. Skim milk is often unavailable. "I get the whole milk, or I'll get a little can of Carnation evaporated," she says. Though she often worries about going hungry, she is obese. "I'm stressed. That's why I'm eating a lot," she says. "And I've got to eat what I have."
This is the real world of eating and nutrition in the rural United States. Forget plucking an apple from a tree, or an egg from under a chicken. "The stereotype is everyone in rural America lives on a farm, which is far from the truth," says Jim Weill, president of the nonprofit Food Research and Action Center (FRAC). New research from the University of South Carolina's Arnold School of Public Health shows just how unhealthy the country life can be. The study, which examined food-shopping options in Orangeburg County (1,106 square miles, population 91,500), found a dearth of supermarkets and grocery stores. Of the 77 stores that sold food in Orangeburg County in 2004, when the study was done, 57—nearly 75 percent—were convenience stores. Grocery stores, which stock far more fruits and vegetables than convenience stores, are often too far away, says University of South Carolina epidemiologist Angela Liese, lead author of the study, which appeared in last month's Journal of the American Dietetic Association. "Oftentimes a nutritionist will just say, 'Buy more fruits and vegetables,' when, in fact, the buying part is not simple."
Like other rural areas (and some inner-city ones), Orangeburg County is an isolated "food desert." "You are pretty much at the mercy of what's in your neighborhood," says Adam Drewnowski, director of the center for obesity research at the University of Washington. Although only 28 percent of all the stores in Orangeburg County carried any of the fruits and vegetables—apples, cucumbers, oranges, tomatoes—that were part of the survey, Liese and her colleagues found plenty of healthy foods in the county's 20 supermarkets and grocery stores. The situation in the convenience stores was decidedly grimmer. Only 4 percent of them carried high-fiber bread, and only 2 percent carried low-fat or skim milk.
Poverty poses a big barrier to good nutrition in rural areas. "Eating healthier is more expensive," says Jodi Bates, who operates the Compassion in Action food bank in Orangeburg County, where the median household income is just $30,000 and 22 percent of the residents fall below the poverty line. Last year food stamps went to 10.3 percent of rural Americans, versus 7.3 percent of urban ones, and 31 percent of rural grade-schoolers got a free or reduced lunch, compared to 25 percent of urban grade-schoolers.
Rural Americans are at increased risk of what the government calls "low food security," better understood as fear of going hungry. According to new data from the U.S. Department of Agriculture, more than 35.5 million Americans (not including the nation's 750,000 or so homeless people) fell into this category last year. The highest food insecurity rates were in states with large rural populations: Mississippi, New Mexico, Texas and South Carolina. Ironically, people with low food security are often hungry—and fat. The reason: they binge on cheap, high-calorie foods that fill them up. "People don't think of people who are obese as struggling with hunger, when of course many of them are," says Weill of FRAC. "Poverty and food insecurity and obesity are often linked not because poor people are getting too much food from programs but because they're not getting enough resources to obtain a healthy diet." And according to a study published this month in the Journal of the American Dietetic Association by the University of Washington, the cost of fresh fruits and vegetables is increasing faster than the cost of other foods.
Nutritionists and anti-hunger activists know what rural Americans should eat. In an ideal world, says Weill, more people would take advantage of nutrition and financial education programs, like those offered by the USDA, that teach consumers how to make a food budget and use recipes. The 2007 Farm Bill would increase food stamp access and benefits and allocate an additional $2.75 billion over 10 years to buy fruits and vegetables for the USDA's nutrition assistance programs, including the national school lunch and breakfast programs. (The USDA now runs a pilot program that gives kids in 25 schools in eight states fresh fruit during the day.) Jan Probst, director of the South Carolina Rural Health Research Center, has hopes that these new measures could help prevent what may be an oncoming health catastrophe in rural America: "If you start now, these people won't be having heart attacks at 40."