PROJECT SUMMARY/ABSTRACT – RPL BROWN Obesity, defined as excessive adipose tissue (>30% of body weight for women and >20% of body weight for men), is a national health crisis impacting individuals of all ages. While body mass index (BMI; body weight/height2; kg/m2) is the primary measure of obesity in epidemiological studies and medical practice, this measure fails to identify 50% of those with genuine excess adiposity. Consequently, there is a hidden popula- tion of individuals with high body fat who are misclassified as nonobese via BMI (healthy BMI considered to be 18.5-24.9 kg/m2). These individuals are described as ‘normal weight obese’ (NWO). NWO individuals likely have the same elevated risks for comorbidities (e.g., metabolic syndrome, prediabetes, cardiovascular dis- ease, hypertension, and dyslipidemia) as those correctly classified as obese. The prevalence of body fat mis- classification among females is likely exaggerated in rural communities, where risk of true obesity is elevated above national averages. This is in part because people living in rural areas tend to have limited access to healthcare, fitness facilities, community centers, and evidence-based information regarding nutrition and physi- cal fitness. Much of Idaho is classified as being in the ‘frontier and remote’ (FAR) West with most (80%) coun- ties classified as rural. Currently, 31% of Idahoan women are classified as obese based on BMI, a number that almost certainly underestimates true obesity due to NWO. Our preliminary data show high levels of NWO in physically active college-aged women living in Idaho, and we hypothesize that rates are much higher in the general population of women and that this is associated with poor health outcomes. The aims of the study pro- posed here are significant because they address these important questions and will explore factors associated with NWO risk. Briefly, we will conduct an epidemiological study of premenopausal women documenting rigor- ous measurements of dietary intake, physical activity and exercise behaviors, perceptions of body image, body composition and circumferences, muscular strength and endurance, aerobic fitness, metabolic health, oxida- tive stress, inflammation, and menstrual health. Additionally, we will compare the physical and physiological outcomes between NWO and NWL premenopausal females. Our central hypothesis is that premenopausal females with poor diet quality and avoidance of resistance exercise are more likely to be categorized as NWO, and that these women have suboptimal physical and physiological health. These aims are innovative and sig- nificant because they will yield novel data related to lifestyle behaviors most strongly associated with NWO in premenopausal females living in a rural area. Idaho’s population is representative of similar vast regions across the entire West, so this study’s ramifications for future targeted interventions have implications for many. This work is impactful as it wil...