Journal Article

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

Döring, Angela, Assunção, Maria Cecília F., Kulaga, Zbigniew, Miller, Jody C., Rajkumar, Hemalatha, Duan, Jia Li, Ferrante, Daniel, Key, Timothy, Moreira, Leila B., Padez, Cristina, Topór-Madry, Roman, Wong-McClure, Roy A., Ali, Mohamed M., Gates, Louise, Garcia-de-la-Hera, Manoli, Mursu, Jaakko, Wang, Ming-Dong, Krokstad, Steinar, Sepanlou, Sadaf G., Capuano, Eduardo, Al-Hazzaa, Hazzaa M., Alkerwi, Ala’a, Damsgaard, Camilla T., Tolonen, Hanna K., Bruno, Graziella, Huerta, José María, Francis, Damian K., Peters, Annette, Lin, Xu, Herter-Aeberli, Isabelle, Pecin, Ivan, Gunter, Marc, Clays, Els, Michels, Nathalie, Borchini, Rossana, Föger, Bernhard, Abubakar Garba, Jamila, Dias-da-Costa, Juvenal Soares, Brian, Garry R., Suriyawongpaisal, Paibul, Ferrari, Marika, Wannamethee, S. Goya, Ohara, Kumiko, Malhotra, Rahul, Rinke de Wit, Tobias F., Iwasaki, Masanori, Markey, Oonagh, Can, Gamze, Pan, Wen-Harn, Cheng, Yiling J., Eddie, Ricky, Parnell, Winsome R., Tsao, Yu-Hsiang, Bovet, Pascal, Frontera, Guillermo, Guo, Yin, Nankap, Martin, Nenko, Ilona, Fernandes, Romulo A., Chirlaque, María-Dolores, Tshepo, Lechab

2019

Overview

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. Contrary to the view that urbanization is a major driver of the global rise in obesity, the global increase in body-mass index is shown to be mostly due to increases in the body-mass indexes of rural populations.

• Publisher: Nature Publishing Group UK,Nature Publishing Group,Springer Nature
• Subject: 692/308/174 / 692/499 / Adolescent / Adult / Adults / Afdeling Humane voeding / Age Factors / Aged / Aged, 80 and over / Allmänmedicin / Bias / Body height / Body Mass Index / Calories / Collaboration / Developed Countries - statistics & numerical data / Developing Countries - statistics & numerical data / Diet, Healthy - statistics & numerical data / Epidemics / Female / Folkhälsovetenskap, global hälsa och socialmedicin / Food / food system / General Medicine / Geographic Mapping / health / Health Sciences / Human Nutrition / Human Nutrition & Health / Human Nutrition (HNE) / Humane Voeding / Humane Voeding & Gezondheid / Humanities and Social Sciences / Humans / Hälsovetenskap / Income / Individ och samhälle VIDSOC / Individual and Society VIDSOC / International Health / Internationell hälsa / Leerstoelgroep Toxicologie / Letter / Life Sciences / Low income groups / Male / Malnutrition / Medical and Health Sciences / Medicin och hälsovetenskap / Middle Aged / middle-income countries / multidisciplinary / Nutrition / Nutrition and Dietetics / Nutritional Status / Näringslära och dietkunskap / Obesity / Obesity - epidemiology / physical-activity / pooled analysis / Population / Population studies / Public Health, Global Health and Social Medicine / Rural areas / Rural Health - statistics & numerical data / Rural Population - statistics & numerical data / Santé publique et épidémiologie / Science / Science (multidisciplinary) / Sex Factors / Sub-department of Toxicology / systematic analysis / Systematic review / Toxicologie / Toxicology / Trends / Undernutrition / urban / Urban areas / Urban Health - statistics & numerical data / Urban Population - statistics & numerical data / Urbanization / weight / Women / worldwide trends / Young Adult