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Urbanization has been associated with an increase in the levels of overweight and obesity among the populations. However, evidence for this association was based primarily on calculations of body mass index (BMI) – the tool most frequently used to measure overweight and obesity – at the time of birth. 39; study. The dynamics of BMI change in urban and rural areas has not been studied separately. Write in Nature, members of the NCD Risk Factor Collaboration dispute the idea that general trends in BMI are primarily the result of urbanization.
The global problem of overweight and obesity has been considered primarily as an urban problem, in part because access to food services is much greater and easier in cities than in rural areas. City-dwellers have a range of options for purchasing highly processed foods and beverages high in salt, saturated fat and sugar, often referred to as "ultra-processed obesogenic foods". Many low-income urban communities consume mainly ultra-processed foods and beverages sold in fast food and small retail outlets, often because they live in so-called "food deserts", low-income areas. income where these are the only foods available. . Rural areas, on the other hand, have been seen as a different type of food desert, where people consume mainly products from their own farms and gardens and have less access to ultra-processed and packaged foods.
In addition, city dwellers have better transportation options, greater access to smartphones and cable TV, and more non-physical leisure opportunities than those living in rural areas. They are also more likely to hold physically demanding jobs. All of these factors limit energy expenditure. On the other hand, rural areas have been perceived as places where heavy work on farms, forestry and mining activities result in high energy costs. It was thought that levels of physical activity in rural areas were much higher than those in the cities and that, therefore, the likelihood of gaining weight was much lower in rural than in urban populations.
Research has shown that in some low-income countries, such as China, people living in urban areas have a different regime than their rural counterparts. Over the last two decades, the shift to obesogenic diets has promoted weight gain and increased the risk of chronic disease-related health problems in China's urban areas.
However, some research has shown that levels of overweight and obesity are increasing more rapidly in rural areas than in urban areas, even in many low- and middle-income countries (LMICs). This is probably due to the fact that rural areas of middle-income countries have begun to resemble urban areas, as the modern food supply is now available in combination with low-cost mechanized devices for agriculture and transport. Ultra-processed foods are increasingly becoming part of the diet of the poor in these countries, and it seems that infants are even fed these foods. Despite these observations, most research and policy efforts have focused on the fight against urbanization as the main factor of obesity, because the general opinion is still that people living in rural areas are much more likely to cope with hunger and undernutrition that they lead to overweight.
All previous research on trends in BMI was based on limited data and targeted either LMICs or high-income countries. In this context, the collaboration document on risk factors for noncommunicable diseases is innovative, as it brings together the latest data from almost every country to comprehensively examine global trends in BMI. The results show that overweight and obesity rates are already higher in rural than in urban areas of all high-income countries, and also suggest that the rate of change in many LMICs is such that the levels of overweight and obesity in rural areas will soon match, if not exceed, those in urban areas. Hunger, dieback and stunting in rural areas are rapidly being replaced by overweight and obesity in most parts of the world, with the exception of sub-Saharan Africa, the 39 South Asia and a small number of countries in other regions.
This finding is fundamental, as geographically focused programs and policies for obesity prevention around the world are primarily focused on urban obesity control. Examples of interventions focusing on urban areas include physical activity policies such as ciclovías from Latin America closing urban streets to boost walking and cycling; the construction of cycle lanes in urban areas; the design of urban buildings to improve traffic; and the focus on creating walking and play spaces in cities, including the creation of parks. Initiatives that involve working with retailers and food stores have also occurred primarily in the cities. Apart from a small number of policies, such as the provision of government-sponsored stores selling cheaper and healthier foods in remote rural areas of Mexico, rural populations have been largely ignored.
The study of collaboration on noncommunicable disease risk factors challenges us to create programs and policies that focus on rural areas to prevent increased weight gain – a major global divide. Several tax and regulatory approaches can reach rural areas around the world. These range from programs that combine comprehensive marketing controls, school feeding controls and labels on ultra-processed foods, such as those instituted in Chile, to the taxation of beverages and ultra-high-tech foods. processed unhealthy, as in Mexico. These are national programs that require national legislation and are implemented in a growing number of LMICs. However, countries must coordinate multiple regulatory and tax programs similar to those in Chile to have a real impact on people's behavior.
This article is reproduced with permission and was published on May 8, 2019.
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