Rising rural body-mass index is the main driver of the global obesity epidemic in adults

, Honor Bixby, James Bentham, Bin Zhou, Mariachiara Di Cesare, Christopher J. Paciorek, James E. Bennett, Cristina Taddei, Gretchen A. Stevens, Andrea Rodriguez-Martinez, Rodrigo M. Carrillo-Larco, Young-Ho Khang, Maroje Soric, Edward W. Gregg, J. Jaime Miranda, Zulfiqar A. Bhutta, Stefan Savin, Marisa K. Sophiea, Maria L. C. Iurilli, Bethlehem D. Solomon, Melanie J. Cowan, Leanne M. Riley, Goodarz Danaei, Pascal Bovet, Adela Chirita-Emandi, Ian R. Hambleton, Alison J. Hayes, Nayu Ikeda, Andre P. Kengne, Avula Laxmaiah, Yanping Li, Stephen T. McGarvey, Aya Mostafa, Martin Neovius, Gregor Starc, Ahmad A. Zainuddin, Leandra Abarca-Gomez, Ziad A. Abdeen, Shynar Abdrakhmanova, Judith Benedics, Bernhard O. Boehm, Heiner Boeing, Sandra C. Fuchs, Jurgen Koenig, Jing Liu, Elio Riboli, Petra Rust, Karin Schindler, Peter Stehle, Ming-Dong Wang, Kurt Widhalm

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.

Department of Nutritional Sciences
External organisation(s)
Imperial College London, Kent State University, Middlesex University Dubai, University of California, Berkeley, WHO - World Health Organization, Seoul National University (SNU), University of Zagreb, US Ctr Dis Control & Prevent, Centers for Disease Control & Prevention - USA, Universidad Peruana Cayetano Heredia, Aga Khan University, University of Toronto, Harvard University, Minist Hlth, Université de Lausanne, Victor Babes University of Medicine and Pharmacy, Timisoara, University of the West Indies, Cave Hill, Western Sydney University, Natl Inst Biomed Innovat Hlth & Nutr, South African Med Res Council, South African Medical Research Council, ICMR Natl Inst Nutr, Brown University, Ain Shams University, Karolinska Institute, University of Ljubljana, Minist Hlth Malaysia, Kementerian Kesihatan Malaysia, Caja Costarricense Seguro Social, Al-Quds University, Natl Ctr Publ Healthcare, Fed Minist Labour Social Affairs Hlth & Consumer, Nanyang Technological University (NTU), Deutsches Institut für Ernährungsforschung Potsdam-Rehbrücke (DIfE), Universidade Federal do Rio Grande do Sul, Capital Medical University (CUM), Medizinische Universität Wien, Rheinische Friedrich-Wilhelms-Universität Bonn, Publ Hlth Agcy Canada, Public Health Agency of Canada
No. of pages
Publication date
Peer reviewed
Austrian Fields of Science 2012
303009 Nutritional sciences
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