Author First name, Last name, Institution

Honor Bixby, Imperial College London
James Bentham, University of Kent
Bin Zhou, Imperial College London
Mariachiara Di Cesare, Middlesex University
Christopher J. Paciorek, University of California, Berkeley
James E. Bennett, Imperial College London
Cristina Taddei, Imperial College London
Gretchen A. Stevens, Organisation Mondiale de la Santé
Andrea Rodriguez-Martinez, Imperial College London
Rodrigo M. Carrillo-Larco, Imperial College London
Young Ho Khang, Seoul National University
Maroje Sorić, University of Zagreb
Edward W. Gregg, Centers for Disease Control and Prevention
J. Jaime Miranda, Universidad Peruana Cayetano Heredia
Zulfiqar A. Bhutta, The Aga Khan University
Stefan Savin, Organisation Mondiale de la Santé
Marisa K. Sophiea, Imperial College London
Maria L.C. Iurilli, Imperial College London
Bethlehem D. Solomon, Imperial College London
Melanie J. Cowan, Organisation Mondiale de la Santé
Leanne M. Riley, Organisation Mondiale de la Santé
Goodarz Danaei, Harvard T.H. Chan School of Public Health
Pascal Bovet, Ministry of Health Seychelles
Adela Chirita-Emandi, Universitatea de Medicina si Farmacie Victor Babes din Timisoara
Ian R. Hambleton, The University of the West Indies
Alison J. Hayes, The University of Sydney
Nayu Ikeda, National Institute of Biomedical Innovation
Andre P. Kengne, South African Medical Research Council
Avula Laxmaiah, National Institute of Nutrition India
Yanping Li, Harvard T.H. Chan School of Public Health

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© 2019, The Author(s). 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.




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Medicine and Health Sciences

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Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.

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Open Access


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Hybrid: This publication is openly available in a subscription-based journal/series