TY - JOUR
T1 - Rising rural body-mass index is the main driver of the global obesity epidemic in adults
AU - Bixby, Honor
AU - Bentham, James
AU - Zhou, Bin
AU - Di Cesare, Mariachiara
AU - Paciorek, Christopher J.
AU - Bennett, James E.
AU - Taddei, Cristina
AU - Stevens, Gretchen A.
AU - Rodriguez-Martinez, Andrea
AU - Carrillo-Larco, Rodrigo M.
AU - Khang, Young Ho
AU - Sorić, Maroje
AU - Gregg, Edward W.
AU - Miranda, J. Jaime
AU - Bhutta, Zulfiqar A.
AU - Savin, Stefan
AU - Sophiea, Marisa K.
AU - Iurilli, Maria L.C.
AU - Solomon, Bethlehem D.
AU - Cowan, Melanie J.
AU - Riley, Leanne M.
AU - Danaei, Goodarz
AU - Bovet, Pascal
AU - Chirita-Emandi, Adela
AU - Hambleton, Ian R.
AU - Hayes, Alison J.
AU - Ikeda, Nayu
AU - Kengne, Andre P.
AU - Laxmaiah, Avula
AU - Li, Yanping
AU - McGarvey, Stephen T.
AU - Mostafa, Aya
AU - Neovius, Martin
AU - Starc, Gregor
AU - Zainuddin, Ahmad A.
AU - Abarca-Gómez, Leandra
AU - Abdeen, Ziad A.
AU - Abdrakhmanova, Shynar
AU - Abdul Ghaffar, Suhaila
AU - Abdul Hamid, Zargar
AU - Abubakar Garba, Jamila
AU - Abu-Rmeileh, Niveen M.
AU - Acosta-Cazares, Benjamin
AU - Adams, Robert J.
AU - Aekplakorn, Wichai
AU - Afsana, Kaosar
AU - Agdeppa, Imelda A.
AU - Aguilar-Salinas, Carlos A.
AU - Agyemang, Charles
AU - Keinan-Boker, Lital
AU - Dankner, Rachel
AU - Kalter-Leibovici, Ofra
N1 - Funding Information: Competing interests M.E. reports a charitable grant from the AstraZeneca Young Health Programme, and personal fees from Prudential, Scor and Third Bridge, outside the submitted work. The other authors declare no competing interests. Funding Information: Acknowledgements This study was funded by the Wellcome Trust. H.B. was supported by a Medical Research Council Doctoral Training Partnership Studentship, J.B. by a Royal Society Research Grant, and M.D.C. by an Academy of Medical Sciences Springboard Award. We thank L. Jaacks, B. Popkin, S. Sundberg and W. Willett for recommendations of relevant citations. The authors are responsible for the views expressed in this Letter and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated. Publisher Copyright: © 2019, The Author(s).
PY - 2019/5/9
Y1 - 2019/5/9
N2 - Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities1,2. This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity3–6. 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.
AB - Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities1,2. This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity3–6. 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.
UR - http://www.scopus.com/inward/record.url?scp=85065577280&partnerID=8YFLogxK
U2 - https://doi.org/10.1038/s41586-019-1171-x
DO - https://doi.org/10.1038/s41586-019-1171-x
M3 - Article
C2 - 31068725
SN - 0028-0836
VL - 569
SP - 260
EP - 264
JO - Nature
JF - Nature
IS - 7755
ER -