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

NCD Risk Factor Collaboration (NCD-RisC), 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 Sorić, Edward W. Gregg, J. Jamie Miranda, Zulfiqar Bhutta, Stefan Savin, Marisa K. Sophiea, Maria L.C. Iurilli, Bethlehem D. SolomonMelanie J. Cowan, Leanne M. Riley, Goodarz Danaei, Pascal Bovet, Adela Chirita-Emandi, Ian R. Hambleton, Alison J. Hayes, Nayu Ikeda, Andre Kengne, Avula Laxmaiah, Yanping Li, Stephen T. McGarvey, Aya Mostafa, Martin Neovius, Gregor Starc, Ahmad A. Zainuddin, Leandra Abarca-Gómez, Ziad A. Abdeen, Shynar Abdrakhmanova, Suhaila Abdul Ghaffar, Zargar Abdul Hamid, Jamila Abubakar Ghaffar, Niveen Abu-Rmeileh, Benjamin Acosta-Cazares, Robert J. Adams, Wichai Aekplakorn, Kaosar Afsana, Imelda A. Agdeppa, Carlos A. Aguilar-Salinas, Charles Agyemang, Mohamad Hasnan Ahmad, Noor Ani Ahmad, Naser Ahmadi, Alireza Ahmadvand, Wolfgang Ahrens, Kamel Ajlouni, Fadia S. Al Buhairan, Shahla AlDhukair, Hazzaa M. Al-Hazzaa, Mohamed M. Ali, Osman Ali, Ala'a Alkerwi, Amani Rashed Al-Othman, Rajaa Al-Raddadi, Mar Alvarez-Pedrerol, Eman Aly, Deepak N. Amarapurkar, Philippe Amouyel, Antoinette Amuzu, Lars Bo Andersen, Sigmund A. Anderssen, Lars H. Ängquist, Ranjit Mohan Anjana, Alireza Ansari-Moghaddam, Hajer Aounallah-Skhiri, Joana Araújo, Inger Ariansen, Tahir Aris, Raphael E. Arku, Nimmathota Arlappa, Krishna K. Aryal, Thor Aspelund, Felix K. Assah, Maria Cecília F. Assunção, May Soe Aung, Juha Auvinen, Mária Avdicová, Ana Azevedo, Fereidoun Azizi, Mehrdad Azmin, Bontha V. Babu, Azli Baharudin, Suhad Bahijri, Jennifer L. Baker, Nagalla Balakrishna, Mohamed Bamoshmoosh, Maciej Banach, Piotr Bandosz, José R. Banegas, Carlo M. Barbagallo, Alberto Barceló, Amina Barkat, Aluisio J. D. Barros, Mauro V.G. Barros, Iqbal Bata, Anwar M. Batieha, Rosangela L. Batista, Zhamilya Battakova, Assembekov Batyrbek, Louise A. Baur, Robert Beaglehole, Silvia Bel-Serrat, Habiba Ben Romdhane, Judith Benedics, Mikhail Benet, Salim Berkinbayev, Antonio Bernabe-Ortiz, Gailute Bernotiene, Heloisa Bettiol, Aroor Bhagyalaxmi, Sumit Bharadwaj, Hongsheng Bi, Yufang Bi, Anna Biehl, Elysée Claude Bika Lele, Mukharram Bikbov, Bihungum Bista, Dusko J. Bjelica, Peter Bjerregaard, Espen Bjertness, Marius B. Bjertness, Cecilia Björkelund, Anneke Blokstra, Simona Bo, Martin Bobak, Lynne M. Boddy, Bernhard O. Boehm, Heiner Boeing, Jose G. Boggia, Carlos P. Boissonnet, Marialaura Bonaccio, Vanina Bongard, Matthias Bopp, Rossana Borchini, Herman Borghs, Lien Braeckevelt, Lutgart Braeckman, Marjolijn C.E. Bragt, Imperia Brajkovich, Francesco Branca, Juergen Breckenkamp, Joao Breda, Hermann Brenner, Lizzy M. Brewster, Garry R. Brian, Lacramioara Brinduse, Graziella Bruno, H. Bas Bueno-de-Mesquita, Anna Bugge, Marta Buoncristiano, Genc Burazeri, Con Burns, Antonio Cabrera De León, Joseph Cacciottolo, Hui Cai, Tilema Cama, Christine Cameron, José Camolas, Gamze Can, Günay Can, Ana Paula C. Cândido, Felicia Cañete, Mario V. Capanzana, Eduardo Capuano, Vincenzo Capuano, Viviane C. Cardoso, Axel C. Carlsson, Esteban Carmuega, Maria J. Carvalho, Felipe F. Casanueva, Juan-Pablo Casas, Carmelo A. Caserta, Ertugrul Celikcan, Laura Censi, Juraci A. Cesar, Snehalatha Chamukuttan, Angelique W. Chan, Queenie Chan, Himanshu K. Chaturvedi, Nishi Chaturvedi, Norsyamlina Che Abdul Rahim, Chien Jen Chen, Fangfang Chen, Huashuai Chen, Shuohua Chen, Zhengming Chen, Ching Yu Cheng, Yiling J. Cheng, Angela Chetrit, Ekaterina Chikova-Iscener, Arnaud Chiolero, Shu-Ti Chiou, María-Dolores Chirlaque, Belong Cho, Yumi Cho, Kaare Christensen, Diego G. Christofaro, Jerzy Chudek, Renata Cifkova, Michelle Cilia, Eliza Cinteza, Frank Claessens, Janine Clarke, Els Clays, Hans Concin, Susana C. Confortin, Cyrus Cooper, Tara C. Coppinger, Simona Costanzo, Dominique Cottel, Chris Cowell, Cora L. Craig, Amelia Crampin, Ana B. Crujeiras, Juan J. Cruz, Alexandra Cucu, Liufu Cui, Jean Dallongeville, Albertino Damasceno, Camilla T. Damsgaard, Rachel Dankner, Thomas M. Dantoft, Graziella D'Arrigo, Parasmani Dasgupta, Saeed Dastgiri

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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.

Original languageEnglish
Pages (from-to)260-264
Number of pages5
JournalNature
Volume569
DOIs
Publication statusPublished - 8 May 2019

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Keywords

  • Epidemiology
  • risk factors
  • Obesity
  • Rural areas

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    NCD Risk Factor Collaboration (NCD-RisC), Bixby, H., Bentham, J., Zhou, B., Di Cesare, M., Paciorek, C. J., Bennett, J. E., Taddei, C., Stevens, G. A., Rodriguez-Martinez, A., Carrillo-Larco, R. M., Khang, Y-H., Sorić, M., Gregg, E. W., Miranda, J. J., Bhutta, Z., Savin, S., Sophiea, M. K., Iurilli, M. L. C., ... Dastgiri, S. (2019). Rising rural body-mass index is the main driver of the global obesity epidemic in adults. Nature, 569, 260-264. https://doi.org/10.1038/s41586-019-1171-x