Being overweight is no longer just an urban problem, as once thought. A new study published on 8 May in Nature suggests weight gain in rural areas may, in fact, be the biggest driver of the growing global prevalence of obesity (1).
The groundbreaking report, written by members of the NCD Risk Factor Collaboration (NCD-RisC), pulled together the data from almost every country in the world to comprehensively evaluate global body mass index (BMI) trends. Until now, the global rise in BMI in both urban and rural regions has not been comprehensively reviewed. Previous studies were based on limited data or focused on a single country or population.
Rising rural body mass index
The international network of health scientists from around the world examined mean BMI in rural and urban areas of 200 countries and territories from 1985 to 2017. Data were obtained from 2,009 population-based studies of human anthropometry conducted in 190 countries on more than 112 million adults aged 18 years and older.
The findings suggest weight gain in rural areas may be the main factor driving the widespread obesity problem. According to the authors, BMI increased within rural populations in most countries, including developed countries and poor and middle-income nations.
In all high-income countries, the number of overweight and obese people is greater in rural communities compared to urban areas, most notably within the female population. And these levels will soon be the same in less wealthy countries, too — with the exception of sub-Saharan Africa, South Asia, and a small number of other developing countries —as the gap in BMI between urban and rural areas continues to close.
According to the authors, the main causes of the rise in rural BMI are:
- a shift from traditional food products to modern highly processed foods;
- an increase in motorized transport and mechanised farming equipment in rural regions.
Poverty also remains a huge contributor to increasing BMI levels, because it is so often linked to poor food quality. Healthier food options are either unavailable or too expensive – and therefore, substituted with cheap overly-processed foods.
In other words, undernutrition is being replaced with malnutrition in the rural regions of poorer countries leading to excessive consumption of low-quality calories.
How to tackle rural obesity
Being overweight or obese can lead to a multitude of health problems, including cancers, and a higher risk of premature mortality. In fact, obesity is now a leading preventable cause of death worldwide, according to the World Health Organisation (WHO). Almost 40 per cent of adults are overweight and 13 per cent is obese – and as the new report shows, the problem is both an urban one and a rural one.
But at present, most obesity-prevention programmes and policies target urban centres. For example, closing urban streets to cars to promote walking and cycling, constructing cycle paths, and designing buildings to encourage movement. Many cities also create spaces for walking and playing such as parks.
The authors highlight an urgent need for “an integrated approach to rural nutrition that enhances financial and physical access to healthy foods”.
Other policies may be more effective in rural regions. For instance, limiting marketing campaigns, better labelling of processed foods, and taxing unhealthy and highly-processed foods and beverages. Some of these tactics are already being used in low to middle-income countries, such as Chile and Mexico.
(1) Bixby, H. et al. Rising rural body-mass index is the main driver of the global obesity epidemic in adults. Nature (2019). DOI: 10.1038/s41586-019-1171-x