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

Bixby, H. and Bentham, J. and Zhou, B. and Di Cesare, M. and Paciorek, C.J. and Bennett, J.E. and Taddei, C. and Stevens, G.A. and Rodriguez-Martinez, A. and Carrillo-Larco, R.M. and Khang, Y.-H. and SoriÄ�, M. and Gregg, E.W. and Miranda, J.J. and Bhutta, Z.A. and Savin, S. and Sophiea, M.K. and Iurilli, M.L.C. and Solomon, B.D. and Cowan, M.J. and Riley, L.M. and Danaei, G. and Bovet, P. and Chirita-Emandi, A. and Hambleton, I.R. and Hayes, A.J. and Ikeda, N. and Kengne, A.P. and Laxmaiah, A. and Li, Y. and McGarvey, S.T. and Mostafa, A. and Neovius, M. and Starc, G. and Zainuddin, A.A. and Abarca-Gómez, L. and Abdeen, Z.A. and Abdrakhmanova, S. and Abdul Ghaffar, S. and Abdul Hamid, Z. and Abubakar Garba, J. and Abu-Rmeileh, N.M. and Acosta-Cazares, B. and Adams, R.J. and Aekplakorn, W. and Afsana, K. and Agdeppa, I.A. and Aguilar-Salinas, C.A. and Agyemang, C. and Ahmad, M.H. and Ahmad, N.A. and Ahmadi, N. and Ahmadvand, A. and Ahrens, W. and Ajlouni, K. and AlBuhairan, F. and 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Rising rural body-mass index is the main driver of the global obesity epidemic in adults. nature.

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Abstract

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. © 2019, The Author(s).

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