Researchers looked at what Americans eat based on where they live—in big cities, smaller towns, or rural areas. They found that adults living in rural areas eat significantly more ultra-processed foods (like packaged snacks and fast food) and fewer whole foods compared to people in cities. Interestingly, this pattern wasn’t as clear for young people. The study used information from over 27,000 Americans collected between 2013 and 2020. Understanding these differences could help explain why health outcomes vary between rural and urban communities and might guide where to focus nutrition improvement efforts.

The Quick Take

  • What they studied: How much ultra-processed food (highly manufactured foods with lots of additives) people eat compared to whole foods, depending on whether they live in rural areas, small towns, or big cities.
  • Who participated: Over 27,000 Americans of all ages—including kids ages 2-19 and adults 20 and older—from different regions across the United States. The researchers made sure the group represented different races, ethnicities, and income levels.
  • Key finding: Adults in rural areas ate about 20-30% more ultra-processed foods and significantly fewer whole foods than adults in big cities. This difference was measured both by calories and by weight of food. Young people showed much smaller differences based on where they lived.
  • What it means for you: If you live in a rural area, you might naturally have more access to ultra-processed foods and fewer options for fresh, whole foods. This isn’t a personal choice issue—it’s about what’s available where you live. Understanding this gap could help communities work on improving food access.

The Research Details

This study looked at real-world eating data from a large government health survey called NHANES (National Health and Nutrition Examination Survey). Researchers didn’t try to change anyone’s eating habits—they just observed and recorded what people actually ate over a 7-year period from 2013 to early 2020. They divided the country into three types of areas: rural areas (non-metropolitan), small-to-medium sized towns, and large cities. Then they compared how much ultra-processed food people in each area consumed.

The researchers used a special system called NOVA to classify foods into four groups: whole foods with no processing, foods with minimal processing, foods with added ingredients like salt and oil, and ultra-processed foods. They measured both how many calories came from each food type and how many grams of each type people ate.

To make sure the results were fair, they adjusted their analysis to account for differences in sex, age, race, ethnicity, and income level between groups. This helps ensure that differences in food choices were really about where people lived, not just these other factors.

This research approach is important because it shows real eating patterns in actual communities rather than what people say they eat or what happens in controlled experiments. By looking at where people live, researchers can identify environmental and access issues that affect nutrition. This information helps policymakers understand whether nutrition problems in rural areas are due to personal choices or lack of access to healthy foods.

This study is based on a large, nationally representative sample of Americans, which means the results likely reflect the whole country fairly well. The data comes from a well-established government survey with trained staff who collect dietary information carefully. However, because this is a snapshot in time (cross-sectional), it shows associations but can’t prove that living in rural areas causes people to eat more ultra-processed foods—there could be other explanations. The study adjusted for several important factors like income and race, which strengthens the findings.

What the Results Show

The most striking finding was the difference between rural and urban adults. Adults living in rural areas (non-metropolitan areas) consumed significantly more ultra-processed foods compared to adults in large cities. When measured by calories, rural adults got about 5-10% more of their daily energy from ultra-processed foods. When measured by weight, the difference was even more noticeable. At the same time, rural adults ate fewer whole and minimally processed foods.

In contrast, young people (ages 2-19) showed very little difference in ultra-processed food consumption based on where they lived. Whether a teenager lived in a rural area or a big city, their ultra-processed food intake was similar. This suggests that the rural-urban food gap develops mainly in adulthood.

When researchers adjusted their analysis to account for differences in income, race, ethnicity, age, and sex, the pattern for adults remained strong and clear. This means the difference wasn’t simply because rural areas have different income levels or demographic makeup—it was genuinely related to urbanization level.

The study found that adults in urban areas ate more whole and minimally processed foods (like fresh vegetables, fruits, and grains) compared to rural adults. This makes sense because ultra-processed food consumption and whole food consumption are related—when people eat more of one, they typically eat less of the other. The study also noted that processed culinary ingredients (like cooking oils and salt) showed different patterns, but these differences were smaller and less consistent across groups.

This research adds to growing evidence that where people live affects what they eat. Previous studies have suggested that rural areas have fewer grocery stores with fresh produce and more fast-food restaurants, which could explain these findings. This study confirms those patterns exist in a large, recent sample of Americans. The finding that young people show fewer differences is somewhat surprising and suggests that either young people have more similar eating patterns regardless of location, or that the rural-urban food gap develops as people get older.

This study shows what people ate at one point in time, so it can’t tell us whether living in a rural area causes people to eat more ultra-processed foods or whether people who already eat that way choose to live in rural areas. The dietary information came from just one or two days of eating records, which might not represent someone’s typical eating patterns. The study also couldn’t measure some important factors that might explain the differences, like the actual number of grocery stores or restaurants in each area, or people’s knowledge about nutrition. Finally, the study relied on people remembering and accurately reporting what they ate, which can be imperfect.

The Bottom Line

If you live in a rural area, be aware that you may have fewer convenient options for whole foods, and this isn’t a personal failing—it’s an access issue. Try to: (1) Plan ahead and buy fresh foods when you can access them, (2) Look for frozen and canned vegetables and fruits, which are nutritious and last longer, (3) Connect with local farmers markets or community gardens if available, (4) Consider online grocery delivery options if available in your area. These recommendations are supported by this research but should be combined with guidance from your doctor or a nutritionist. (Confidence: Moderate—this research shows the pattern exists but doesn’t test whether these specific actions help.)

This research is most relevant to adults living in rural or non-metropolitan areas who want to improve their diet. It’s also important for policymakers, public health officials, and community leaders working to improve nutrition access in rural communities. Parents and educators should note that young people show fewer differences, suggesting that food environment changes might be especially important for adults. People in urban areas can use this as a reminder that they may have advantages in food access that others don’t have.

Changes in eating habits typically take 2-4 weeks to become noticeable in how you feel, and 8-12 weeks to see measurable health changes. However, improving food access in a community is a longer-term project that might take months to years. Don’t expect overnight changes, but consistent small improvements add up.

Want to Apply This Research?

  • Track the percentage of your daily calories that come from ultra-processed foods versus whole foods. You can do this by logging meals and noting which foods are packaged/processed versus fresh. Aim to gradually increase whole foods from your baseline by 5-10% per month.
  • Set a specific goal like ‘Buy one new fresh vegetable or fruit each week’ or ‘Replace one ultra-processed snack with a whole food alternative.’ Use the app to log these purchases and track your progress. If you live in a rural area, use the app to research and locate the nearest farmers markets, food co-ops, or stores with fresh produce.
  • Weekly check-ins on your ultra-processed food percentage and monthly reviews of your whole food intake. Use the app to identify your most common ultra-processed foods and brainstorm whole-food alternatives. Track not just what you eat, but also where you shopped and how easy it was to find healthy options.

This research describes patterns in food consumption but doesn’t prove that where you live causes you to eat certain foods. Individual results vary based on personal choices, income, transportation, and other factors. Before making significant changes to your diet, consult with your doctor or a registered dietitian, especially if you have health conditions, take medications, or have dietary restrictions. This information is for educational purposes and should not replace professional medical advice.