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Obesity in the world is increasing faster in rural areas than in cities, according to a study released Wednesday, challenging a long-standing assumption that the global overweight epidemic is primarily an urban problem.
Data covering 200 countries and territories compiled by more than 1,000 researchers showed an average gain of about five to six kilograms per woman and per man living in the countryside from 1985 to 2017.
Women and men living in cities, however, received 38% and 24% less, respectively, than their rural counterparts during the same period, according to findings published in Nature.
"The results of this large global study are reversing the myth that more urban dwellers are the main cause of the global rise in obesity," said lead author Majid Ezzati, a professor at the School of Public Health's Imperial College London.
"It means we need to rethink how we tackle this global health problem."
The main exception to the trend was sub-Saharan Africa, where women gained weight faster in the cities.
Obesity has become a global health epidemic, resulting in increasing rates of heart disease, stroke, diabetes and many cancers.
The annual cost of treating health-related impacts could reach $ 1 trillion by 2025, according to estimates by the World Obesity Federation in 2017.
To date, most national and international policies to reduce overweight have focused on cities, including public messaging, redesigning urban spaces to encourage walking, and subsidized sports facilities.
To take into account the state of health in the comparison between countries, the researchers used a standard measure called "body mass index", or "BMI", based on height and weight.
A person with a BMI of 25 or more is considered overweight, while 30 or more is obese. A healthy BMI ranges from 18.5 to 24.9.
About two billion adults worldwide are overweight, nearly one-third of whom are obese. The number of obese people has tripled since 1975.
The study revealed important differences between countries according to the level of income.
In high-income countries, for example, the study showed that rural BMI was generally already higher in 1985, especially among women.
Low levels of income and education, high cost and limited availability of healthy food, vehicle dependence, the gradual elimination of manual labor – all of these factors have probably contributed to the take of progressive weight.
In contrast, urban areas "offer a wealth of opportunities for better nutrition, more physical exercise and recreation and a general improvement in health," said Ezzati.
According to the United Nations, about 55% of the world's population lives in cities or satellite communities. This figure is expected to reach 68% by mid-century.
The most urbanized regions of the world are North America (82%), Latin America and the Caribbean (81%) and Europe (74%).
More recently, the proportion of overweight and obese adults in rural areas of many low- and middle-income countries is also growing faster than in other countries.
"The rural areas of these countries are starting to look like urban areas," said Barry Popkin, an expert on global public health at the University of North Carolina, in a commentary published by Nature.
"The modern food supply is now available in combination with cheap mechanized devices for agriculture and transport," he added. "Ultra-processed foods are also part of the diet of the poor."
At the country level, several results emerge.
Some of the largest increases in BMI among men from 1985 to 2017 were recorded in China, the United States, Bahrain, Peru and the Dominican Republic, with an average of 8 to 9 kilograms per adult.
Women in Egypt and Honduras added – on average, in urban and rural areas – even more.
Rural women in Bangladesh and men living in rural areas of Ethiopia had the lowest average BMI in 1985 at 17.7 and 18.4, respectively, just below the healthy weight threshold. Both cohorts were well above this threshold in 2017.
The male and female populations of the small island nations of the South Pacific have one of the highest BMIs in the world, often well above 30.
"NDC's collaboration on risk factors challenges us to create programs and policies that focus on rural areas to prevent weight gain," Popkin said.
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