Kansas fitness centers focus on providing exercise care to rural residents with Parkinson's disease

Kansas has the second-highest rate of 
Parkinson's disease cases in the U.S.

Among the nearly 1 million Americans living with Parkinson's disease, rural residents face more challenges accessing the exercise and support programs that could improve their quality of life.

In rural Kansas, some fitness centers have opened or expanded care to help area patients work out more regularly, according to Bek Shackelford of NPR. Regular exercise is one of the few proven ways Parkinson's disease sufferers can lessen the muscle stiffness, tremors, sleep problems and brain-health issues that often accompany the disease.

The Parkinson's Exercise and Wellness Center in Leawood, Kansas, which offers "gym services to around 280 people and offers classes ranging from Pilates and boxing to theater" serves as an example, Shackelford adds. The head coach and co-founder of the center, Sarrisa Curry, told Shackelford that the center's enrollment has been on the rise as more baby boomers are diagnosed with the disease.

Medical scientists are still unsure what causes Parkinson's disease to develop. Some studies indicate that the disease may have a genetic basis. Other research suggests that exposure to pesticides, such as those encountered in rural farming communities, could be partially to blame. Shackelford reports, "Recent data shows Kansas has some of the highest rates of Parkinson's diagnosis in the country." Only Nebraska has a higher rate.

Elaine Ptacek, who founded the Parkinson's Families of Northwest Kansas, a nonprofit that "offers things like physical therapy and art classes, says about 90% of her group's participants live on farms and are exposed to pesticides," Shackelford adds. "Ptacek's organization serves a rural area she says desperately needs Parkinson's support."

To reach as many patients as possible, Parkinson's Families of Northwest Kansas offers exercise classes to "groups in eight counties [who can] join Zoom calls and follow along with a fitness instructor," Shackelford adds.

Changes to Social Security disability benefits will affect 50 to 60-year-old applicants

ProPublica graphic, with data from SSA, Master Beneficiary Record, 100% data; USPS geographic data; and Census Bureau, Population Division, 2023 estimates of resident population.

Changes made to Social Security disability benefits by the Trump Administration could harm 50 to 60-year-old applicants “without a high school or college education who have, for decades, toiled in physically grueling jobs,” Eli Hager reported for ProPublica.

“The five states where the highest proportions of people rely on these benefits are West Virginia, Arkansas, Kentucky, Mississippi and Alabama,” Hager wrote.

Currently, applicants who are at least 50 years old are given priority to redeem disability benefits due to their age. The changes made to the program would mean that age would no longer be a factor in determining eligibility for the benefits.

A senior administration official (who requested anonymity) explained that the current rules reflected the job economy of the 1970s, which mostly relied on manual labor. Now that the internet has created more sedentary jobs, 50-year-olds have more options.

Another change would “modernize the job listings that Social Security’s disability adjudicators and judges use to decide if there’s work available in the U.S. economy that a manual laborer could do despite physical impairments — like a low-skilled desk job at a computer or driving for Uber or DoorDash,” Hager wrote.

But Hager added that Michelle Aliff, who provides expert testimony for Social Security disability hearings, said in an interview that “an oil field roustabout in his 50s isn’t going to just sit down at a computer for work without additional training.”

Listening to holiday music can help runners improve their mood and speed; even non-runners benefit from music

Maybe Santa is a runner.
(Photo by Artem Maltsev, Unsplash)

Running with holiday tunes crooning in your ears can improve your mood and your stride. "It's the most wonderful time of the year for 'music doping,'" reports Mallory Arnold of Outsider. "One study had 20 male participants perform two six-minute running tests, one with and one without music. Researchers measured mean running speed, blood lactate, total distance covered, heart rate, and rate of perceived exertion. The results concluded that runners who listened to their music of choice were significantly faster and had lower blood-lactate concentrations."

No wonder Santa can get so much done in one night -- he's obviously knee-deep in snow and Dean Martin. Erin Hannon, director of the University of Nevada Las Vegas Music Lab, told Arnold, "You may not realize this, but when you listen to music, the part of your brain you're using doesn't just process sound. It's also the part that controls movement, so you're actually engaging the motor system of the body when you listen to music."

It makes sense that Santa would need to be fit.
(Photo by RawKim, Unsplash)

It's true that an individual has to enjoy holiday music for their run to improve while listening. "Those who have positive feelings around the holiday season will benefit from listening to carols while running, as the brain becomes stimulated (or aroused), hyper-focused, and releases endorphins that can not only create that 'runner's high,' but can promote short-term psychoactive effects like feelings of calm and elevated mood," Arnold explains. "Excess endorphin release has also been studied for its pain-relieving properties, which can be extremely beneficial during a run, like a natural ibuprofen."

Of course, listening to carols after the holiday may not have the same impact. Then, what's a person to do after Dec. 25? Keep listening to music -- even if you're not running or listening to holiday tunes. As Henkjan Honing points out in her report for The MIT Press Reader, a study showed "newborns possess the ability to discern a regular pulse – the beat – in music. It's a skill that might seem trivial to most of us, but that's fundamental to the creation and appreciation of music," Honing writes. "The discovery sparked a profound curiosity in me, leading to an exploration of the biological underpinnings of our innate capacity for music, commonly referred to as 'musicality.'"

Newborn babies participating in a listening experiment.
(Courtesy Eszter Rozgonyiné Lányi, MIT Reader)

"Alongside psychology and neuroscience, the realms of biology and genomics now offer effective toolkits for empirically testing theories on the origins of music in the present day," Honing reports. "Consequently, musicality research is gaining scientific respectability, coherence, and maturity. The once-speculative nature of the origins of musicality research is giving way to a more concrete and scientifically rigorous approach, making it an exciting and promising avenue" for discovery.

The pandemic and the internet changed how rural seniors exercise; now their 'online classes are here to stay'

Virtual exercise classes offer options to rural or homebound seniors. (Photo by Christina Saint Louis/KHN)

To stay fit no matter where they live, older Americans have put remote fitness options more in play: "After widespread lockdowns began in March 2020, agencies serving seniors across the U.S. reworked health classes to include virtual options," Christina Saint Louis reports for Kaiser Health News. "Isolation has long since ended, but virtual classes remain. For older adults in rural communities who have difficulty getting to exercise facilities, those virtual classes offer opportunities for supervised physical activity that were rare before the pandemic. And advocates say online classes are here to stay."

Jennifer Tripken, associate director of the Center of Healthy Aging at the National Council on Aging, told Saint Louis, “We found that remote programming, particularly for rural areas, expanded the reach of programs, offering opportunities for those who have traditionally not participated in in-person programs to now have the ability to tune in, to leverage technology to participate and receive
the benefits.”

Saint Louis writes: "Since April 2020, the National Council on Aging has organized monthly conference calls for service providers to discuss how to improve virtual programs or begin offering them. . . . In 2022, at least 1,547 seniors participated in an online fitness program through Juniper, part of a Minnesota Area Agency on Aging initiative. More than half were from rural areas. Because of grant funding, participants pay little or nothing. . . . AgeOptions, an Illinois agency serving seniors, said last year that their operations 'may have changed forever' in favor of a hybrid model of virtual and in-person classes."

Options for technologically challenged seniors also exist. "A fall-prevention program licensed by Western Kentucky University combines exercise and health education with bingo — can use a printed copy of the game card mailed to them by AgeOptions if they lack the proficiency to play on the game’s app," writes Saint Louis. "Either way, they’re required to participate on video." Jason Crandell, the creator and international director of Bingocize, told Saint Louis, "From when the pandemic began to now, we’ve come light-years on how that is done, and everybody’s getting more comfortable with it."

People in wealthy states get more exercise; people in rural areas tend to get less, but income is the big driver

Washington Post map; click on the image to enlarge it.

A new report by the federal Centers for Disease Control and Prevention shows some interesting predictors of physical fitness. Only 23 percent of American adults under 65 meet federal guidelines for weekly physical activity, which say adults should perform at least 150 minutes of moderate physical activity or 75 minutes of vigorous physical activity each week, as well as some muscle-strengthening activity like calisethenics or weight-lifting twice a week, Christopher Ingraham reports for The Washington Post.

Other factors that have a positive correlation to adequate physical activity: living in an urban area (but not a strong correlation), drinking heavily (higher income individuals tend to drink more), working in a managerial or professional role, having a high household income, and not following a religion. Factors that have a negative correlation with physical activity: high average daily temperatures, voting for Donald Trump in 2016, and being in fair or poor physical health. Here are nine scatter-plots of the states, showing the nine factors the study examined, based on statewide rates; the steeper the trend line, the stronger the correlation:

Rural Kentucky hiking club is changing local attitudes about health and the community

The Breathitt County Hiking Club in the nearby Red River Gorge. (Photo by Josh Mauser)

Central Appalachia is the unhealthiest place in the country by most metrics, but 45-year-old librarian Stephen Bowling is trying to help Breathitt County buck the trend with a hiking club. An avid hiker, Bowling has been hosting monthly hiking trips one Sunday a month since the beginning of the year, Lyndsey Gilpin reports for Outside Online. His employer, the Breathitt County Public Library, sponsors the club and serves as a meeting place for members that range in age from 14 to 74.

Bowling says the monthly trips usually attract about 20 people, most of whom don't have much experience hiking. But he believes that even something as small as a hiking club can affect not just attitudes about fitness, but about the long-suffering community's ability to improve. “It’s a depressed area economically, but also emotionally and physiologically,” Bowling told Gilpin. “We’re told constantly that we’re the least healthy people, we are this, we are that, and people don’t feel empowered to change that. Some people aren’t willing, and some people aren’t able.”

Breathitt County, Kentucky
(Wikipedia map)

Appalachia is a prime example of the wellness divide between rural and urban America. Eight of the top 10 counties in the U.S. with the largest recent declines in life expectancy are in Kentucky, and one of them is Breathitt. About 14,000 people live in the county, most are white, and most are over 40. "Nearly half the population is obese, about a third smoke, and a third are physically inactive. The unemployment rate is almost 12 percent," Gilpin reports.

Most outdoor adventure spaces are under private control in rural areas, leaving people with far fewer options for outdoor recreation than residents of urban areas. "Most Southeastern states have less than 5 percent federal public land. In Kentucky, less than 4 percent of land is federally owned, and there are only a few state parks, most of them a half-day’s drive from Breathitt," Gilpin reports. "Only 17 percent of Breathitt County residents live within a half-mile of a park or within three miles of an accessible recreational facility; meanwhile, 98 percent of New York county [Manhattan] residents and 100 percent of San Francisco county residents have such access to a park within a half-mile or a recreational facility within just one mile."

Private landowners rarely create trails, and those that are created are mostly for all-terrain vehicles and aren't used by hikers and bikers, Gilpin reports. The area's walking trails are not often safe and well-marked, and local gyms are usually small with limited hours. Most exercise buffs instead rely on using local high schools' running tracks.

The rural South is studying how states like North Carolina and Colorado have boosted outdoor recreation to figure out how to make public lands accessible and profitable. "In July, legislation will go into effect to create the Kentucky Mountain Regional Recreation Authority, a group run by community members from around the state that will develop, maintain, monitor, and promote local trails," Gilpin reports. Republican State Rep. Chris Fugate introduced the bill, and says he wants to connect 17 counties through a walking trail system. "“Some of the most beautiful places are hidden away,” Fugate told Gilpin. “We haven’t done a good enough job of promoting and taking care of ourselves here.”

Older Americans happiest in Hawaii, Ariz., least happiest in W.Va., Ky. says Gallup well-being index

Older Americans are happiest in Hawaii and least happy in West Virginia, says the annual index of well being by The Gallup Organization. Following Hawaii, other states with high well-being scores for people 55 and older were Arizona, New Hampshire, North Dakota and Colorado. At the other end of the spectrum, Kentucky was next to West Virginia, with Oklahoma, Ohio and Indiana nearby.

The data come from 115,000 interviews are are based on five categories: Purpose (liking what you do each day and being motivated to achieve your goals); Social (having supportive relationships and love in your life); Financial (managing your economic life to reduce stress and increase security); Community (liking where you live, feeling safe and having pride in your community); and Physical (having good health and enough energy to get things done daily).

Hawaii was No. 1 for Purpose, Community and Physical; Arizona was tops for Social, and North Dakota led for Financial. West Virginia was last for Purpose, Social and Physical. Mississippi had the lowest score for Financial and New Jersey was lowest in Community.

"There is one cluster of states with high rankings in a section of the Midwest, but for the most part, the high- and low-ranking states are evenly distributed," Tara Bahrampour reports for The Washington Post. Dan Witters, research director for index, told her, “The 55-and-over crowd in those top states … report always making time for regular trips and vacations with family and friends, reaching their goals in the last 12 months, using their strengths and aptitudes as a human being, in other words, doing things that are a natural right fit for them." (Post graphic showing states colored by quintiles, or fifths of 50)

Drones are being used in many new ways, including wildlife research and preservation

Drones are being used in a variety of new ways, such as wildlife research and preservation, elder and end-of-life care, fitness and catching rogue drones, Steven Overly reports for The Washington Post. (National Marine Fisheries Service photo: Scientists fly drones over humpback whales to collect breath samples.)

A Samford University biology professor used drones to discover two species of endangered fish in Alabama’s waterways, "in part because the unmanned aircraft can reach areas not easily accessible by boat and can survey the water from a closer distance than a helicopter," Overly writes. Also, the Woods Hole Oceanographic Institution, a private research facility in Massachusetts, "has used the flying devices to collect photographs and breath samples from humpback whales for scientific research. A drone affixed with petri dishes hovers over the animal’s blowhole as it exhales, then returns to a ship where the sample is immediately frozen, said assistant scientist Amy Apprill. Scientists then study the microbes in each breath sample, and compare them across different species and environments."

A Cleveland-based business is using drones "to show people with terminal illness and living in hospice their beloved locations, such as a childhood hometown or favorite vacation spot, one final time," Overly writes. Drones are being used to enhance athletics, such as one "that monitors the path of blind runners using a pair of cameras and emits sound to guide those runners as they make their way around a track." In Japan, officials are using drones to use nets to catch rogue drones. (Read more)

Rural areas may need collaboration to create places for residents to get exercise

"Many rural mothers, who rely on outdoor activities to promote health and well-being for themselves and their families, face obstacles in accessing publicly available outdoor recreation resources." So says a study at the University of Illinois, Carleen Wild reports for HealthZette, an online publication.

Research professor Ramona Oswald told Wild, “The moms in this study know about health and what to do to be healthy. It’s not a lack of education. It has to do with barriers and access to resources. Especially in rural communities, you struggle with distance between people and resources. . . . You could walk down a county road or a highway, but unless there was community investment in a park or a playground, a walking trail, or some kind of a facility at a local school, moms didn’t have access to nature, even though they were surrounded by it.”

Many rural residents are like Heidi Baltezore, who lives in a rural area about 30 miles north of Sioux Falls, S.D. She told Wild, “My biggest struggle is finding ‘safe’ places to run or walk. I can go up and down my driveway, but I get bored with that,” and “The road that runs by my house has no shoulder — in fact, years ago my neighbor was biking and was hit and killed, so there is a worry about distracted drivers, plus normal driving hazards. The hills and the setting or rising sun also make it not an option unless I’m absolutely desperate to run on the road. And for sure, it’s never an option with the little ones or our pets.”

In Marshall, Minn., the city, a neighboring town, the county and the state parks and transportation agencies collaborated to "create an extensive bike trail system, a new ice arena, gym access to local health care providers, and more," Wild reports. Doug Goodmund, the city's assistant community services director, told her, "It's really getting used — from pedestrians, to moms with strollers, to bicyclers, young and old. It's a win-win all around and we're just getting started."

Churches add fitness facilities as part of ministry outreach and community service

More churches are beginning to see health and fitness facilities as potential ministry niches, which can positively influence surrounding communities. Walnut Street Baptist Church in Louisville was a pioneer, building a six-story health facility including bowling alleys in the late 1950s and early 1960s, church consultant George Bullard told Jeff Brumley of Baptist News Global.

Now health ministries have been "making a comeback as a variety of social and religious trends in America converge," Brumley reports. "There is absolutely an opportunity for new forms of church centered around fitness," said Travis Collins, the director of mission advancement and Virginia regional coordinator for Fresh Expressions US.

Creative Commons photo by jerronlife

Secular organizations that promote fitness often promote health-focused ministries and programs. For example, Houston-based nonprofit Health Fitness Revolution released a list of the 20 Fittest Churches in Texas. Samir Becic, the organization's founder, said, "Spiritual awareness is one of the key components of healthy lifestyle that impacts the whole body and rejuvenates the spirit." Many of the churches on the list have fitness classes, nutrition and senior programs and sports leagues. Some also have facilities for fitness and health.

Second-Ponce de Leon Baptist Church in Atlanta has a 70,000-square-foot facility with a indoor pool and track, weight room, cardio center and even personal trainers. The church website says, "It is our desire that all who use our facility or participate

in our activities will have the opportunity to hear that Jesus Christ loves them and desires to have a personal relationship with them," the church website says.

Besides building fitness centers, churches are promoting good health in other ways. "Another wave in recent years is that of church members, often led by pastors, uniting to lower blood pressure, drop pounds and tone up as a team," Brumley writes. Christianity Today reported in 2013 that churches from Indiana to Virginia were making fitness pledges, and 250 members of Central Baptist Church in Northern Virginia said they lost 12,000 pounds collectively. (Read more)

Rural communities in West Virginia, New Mexico awarded for creating a culture of health

A pair of rural communities were among the six winners of the 2014 Culture of Health prizes given by the Robert Wood Johnson Foundation to areas that most exemplified innovative efforts to build healthier communities, says the foundation. Williamson, West Virginia, in Appalachian coal country, and Taos Pueblo, a Native American community in northern New Mexico, received the $25,000 award, along with Durham County, North Carolina; Buncombe County, North Carolina; Brownsville, Texas; and Spokane County, Washington. More than 250 communities entered the contest.

Sustainable Williamson

Williamson, which leads the state in obesity, hypertension and diabetes, has created initiatives to get residents involved in fitness and eating healthy. That includes running and walking groups like Tuesday Night Track, which allows people of different fitness levels to compete in races for fun, Lydia Nuzum reports for the Charleston Gazette. Williamson also began a farmers market three years ago, has plans for a food hub for locally grown food, and created Sustainable Williamson, which has already identified 22 farmers within a 70-mile radius who are willing to work with the community on its goals.

The local high school, which teaches agriculture, greenhouse and horticulture classes, sells plants they grow at the farmers market, Nuzum writes. The school, which recently completed work on its high tunnel and has even installed chicken coops, received a grant to participate in the Farm-to-School program next year.

Another program, Prescription Vegetables, "partners local physicians, farmers and diabetes patients," Nusum writes. "Doctors participating in the program actually prescribe vegetables to their patients as a treatment for managing their diabetes and give them vegetable vouchers, which can be exchanged for produce at the Williamson farmers’ market. The more health goals a patient meets, the more vouchers they earn." The town's next step is to create a community kitchen that can incubate healthy restaurants and other initiatives. (Read more)

Robert Wood Foundation photo/
Taos Red Willow Farm

In Taos Pueblo in 2010 the Red Willow Community Growers Cooperative’s mission was created "to revitalize the community’s agricultural-based heritage, which includes food production in fields, gardens, raised beds and greenhouses, as well as grassroots economic development through the Red Willow Farmers Market," says the foundation. "The goal of the Farmers Market and Co-op is to produce fresh and organic fruits and vegetables for families in the community, as well as the schools and senior programs. The Market also employs a number of high school students, reconnecting a younger generation with the cycles of planning, preparing the fields and the art of growing crops to supply markets with produce."

The pueblo has also made an effort to get the community involved in exercise through a fitness program, says the foundation. In a state where 30 percent of kidnergarten students are obese, 37 percent of those Native American, Taos Pueblo has sought to teach children about health, including using an indoor organic garden room, where students, parents and staff grow fresh produce, says the foundation.

Another key has been improving medical services, says the foundation. "Up until the last several years, if there was a medical emergency, Taos Pueblo residents had to wait 24 minutes or longer for first responders from the Town of Taos to arrive at the Pueblo to transport them to the nearest hospital. Three years ago, however, the Pueblo Health and Community Services created the Public Health Nursing Department in Taos Pueblo to address immediate community health needs. Now, the Pueblo’s public health nurse or two lay health workers provide first responder services when emergencies arise." (Read more)

Rural children are more likely to be obese, but rural communities have several strategies to fight it

Children living in rural areas are about 25 percent more likely to be overweight or obese than children in urban areas, studies show. Rural communities have come up with several strategies to battle childhood obesity, Sarah Lifsey and Karah Mantinan report for the Altarum Institute, a nonprofit health-systems research and consulting organization.

Many people are surprised to hear that childhood obesity is a rural phenomenon, because they assume that rural kids have more access to the outdoors and physical activity. However, studies have found that there is little open public space in rural areas, often because of a lack of a robust local government to provide and maintain such public spaces, Lifsey and Mantinan write. They also cite research showing that rural families don't use public activity areas partly due to fear of crime in public spaces, even though crime is less likely in rural areas.

Other causes: Rural children are also at increased risk of poverty compared to children in cities or suburbs and face lower access to health care, lower levels of physical activity, lower-quality food and limited options for transportation.

Poorer food and lower levels of activity are often the result of the distance it takes to get to a physical-activity venue or a grocery store in rural areas, the authors write. The time and fuel it takes to get to and from a venue can discourage commitment to transport children or to travel to groceries with better food options, Lifsey and Mantinan write.

Many rural families who lack access to fresh and healthy foods live in "food deserts," Generally defined as those with no grocery with fresh produce within 10 miles. Studies have found poverty and childhood obesity are more likely in rural food deserts.

Rural communities are using several school-based strategies to fight obesity, Lifsey and Mantinan report. They include making sure school-bus schedules and family transportation schedules coordinate to encourage after-school activities; ensuring that schools provide gym class and recess; allowing recreational areas of school grounds to be available to the community after hours; providing alternative transportation options to students who need rides home in order to participate in after school activities; improving school meals to include more whole grains, fruits and vegetables; and improving the choices available in soda and vending machines.

Engaging programs and groups that are already in existence, such as 4-H Youth Development and telemedicine programs that focus on childhood obesity intervention, are great places to start when initiating childhood obesity programs, the authors write. Having local farmers teach gardening skills can also improve access to healthy food.

Noting that African-American children are the most likely to be obese, Lifsey and Mantinan say communities must keep minority populations in mind. They also suggest working with employers to start employee wellness programs that encourage parents to model healthy behaviors for their children.

Also, It's important for rural communities to observe, measure and decide how each of them want to attack this issue to increase the probability of success, they say.

Tools are available to help with this planning such as the Rural Active Living Assessment Tools, developed by the Robert Wood Johnson Foundation.  Other resources include the Rural Assistance Center, funded by the U.S. Department of Health and Human Services Rural Initiative, which features a Rural Obesity Prevention Toolkit developed by the& Nutrition Obesity Research Center’s Walsh Center for Rural Analysis, as well as a resource guide for rural areas developed by the University of North Carolina’s Active Living by Design.

North Dakota tops Gallup-Healthways Well-Being Index; West Virginia last for fifth straight year

North Dakota might be the happiest place to live in the U.S. The state topped the Gallup-Healthways Well-Being Index for 2013, displacing Hawaii, which had held the top spot for the past four years. On the other end of the spectrum, folks in West Virginia and Kentucky are living the least happy, healthy and prosperous lives; West Virginia ranked last, hitting the bottom of the list for the fifth straight year. But the numerical differences are not very large.

States are scored on a scale of 0 to 100 based on interviews with residents about emotional health, work environment, physical health, healthy behaviors and access to basic necessities, Witters writes. The national average was 66.2, down 66.7 from 2012. North Dakota had a score of 70.4, while West Virginia scored 61.4.

North Dakota scored the highest for work environment, 60.7, and physical health, 79.6. Alaska was highest for emotional health, at 82.9. Vermont was first for health behaviors, at 71.7. Massachusetts was first for access to basic necessities, at 86.9. West Virginia was last in every category except work environment, with Mississippi holding that spot.

After North Dakota, the rest of the top 10 were: South Dakota, 70; Nebraska, 69.7; Minnesota, 69.7; Montana, 69.3; Vermont, 69.1; Colorado, 68.9; Hawaii, 68.4; Washington, 68; and Iowa, 68.2; After West Virginia and Kentucky, the other states at the bottom of the list were: Mississippi, 63.7; Alabama, 64.1; Ohio, 64.2; Arkansas, 64.3; Tennessee, 64.3; Missouri, 64.5; Oklahoma, 64.7; and Louisiana, 64.9. (Read more) (Gallup graphic)

Child obesity persists among the poor and less educated; early-life factors also matter

Although youth obesity has become slightly less prevalent, most of the improvement has been restricted to children in families with higher salaries and educations, according to a Harvard University Kennedy School of Government analysis by Robert Putnam and colleagues. They examined data pertaining to education and income from the 1988-2010 National Health and Nutrition Examination Surveys and the 2003-2011 National Survey of Children's Health, Joe Rojas-Burke writes for Covering Health, published by the Association of Health Care Journalists. Rural children are more likely to be obese than those in cities and suburbs.

Obesity in children whose parents have a college degree began falling about 10 years ago, but increased among children whose parents have a high-school degree or less. There were similar findings among income levels, and the trend was also found in non-Hispanic whites. Although calorie intake did not vary much by education or wealth, physical activity varied greatly. "Children of college-educated parents became more active than they were a decade ago, while children of less educated parents showed no improvement. One factor in this trend is that children from families with high education and incomes are playing increasingly more high-school sports, and children from poorer, less educated families have been playing fewer high-school sports.

Some believe that obesity is an issue in low-income neighborhoods because their lack of parks, recreational centers, outdoor trails and safety discourage physical activity. However, there isn't much evidence to support that claim, and "The effects of income and education tend to trump the influence of neighborhood characteristics," Rojas-Burke writes. Does an outdoor environment convenient for physical activity always pull children away from their video games and Internet?

People often seem to forget that factors from very early in life can influence and individual's likelihood of becoming obese. According to the Early Childhood Longitudinal Study, which followed 7,738 kindergarteners for 10 years beginning in 1998, half the children who became obese were already overweight in preschool, and that doesn't include the 12 percent who were already obese in kindergarten, researchers reported in the New England Journal of Medicine. "Overweight 5-year-olds were four times as likely as normal-weight children to become obese by the end of the study," Rojas-Burke writes.

Sometimes factors before a person is born can make a difference. According to the authors of the NEJM paper, children with high birth weights were only 12 percent of the population but represented more than 36 percent of people who were obese at age 14. A pregnant mother's undernourishment or overnourishment can alter fetal metabolism and brain development, which may contribute to obesity. "Observational studies have linked bottle-feeding rather than breast-feeding to weight gain," Rojas-Burke repots. Societal changes have made it more difficult for children to stay healthy. Food companies are making more and more high-calorie, low-nutrient foods. A common concern—insufficient sleep—even affects toddlers, and it can interfere with the regulation of hormones. These factors and others likely vary depending on family income, education and cultural background. (Read more)

Magazine picks best U.S. mountain biking towns

Where are the best towns in America to go mountain biking? The Active Times compiled a list of its top 10 mountain-biking towns, based on trail systems, parks and pump tracks, Kristin Butcher reports. The list: East Burke, Vt.; Park City, Utah; Harrisonburg, Va.; Santa Fe, N.M.; Marquette, Mich.; Bend, Ore.; Asheville, N.C.; Grand Junction, Colo.; Louisville; and Tuscon. (Read more) (Flickr photo: Mountain biking in East Burke, Vt.)