The research analyzed the height and weight of more than 112 million adults living in urban and rural areas of 200 countries and territories. The data, taken between 1985 and 2017, was used to calculate body mass index (BMI) -- a measure used to determine whether an individual is overweight or not.
The researchers found that, globally, BMI rose by an average of 2 kilogram per square meter (kg/m²) in women and 2.2 kg/m² in men. They also found that in some low- and middle-income countries, rural areas accounted for over 80 percent of the increase in BMI.
In addition, the researchers reported that, since 1985, the average BMI of men and women in rural areas rose by 2.1 kg/m². Meanwhile in urban areas, the average BMI of men and women only increased by 1.6 kg/m² and 1.3 kg/m², respectively.
"The results of this massive global study overturn commonly held perceptions that more people living in cities is the main cause of the global rise in obesity," said Majid Ezzati, one of the authors of the study. (Related: Taking a closer look at what rural living is really like.)
Rethinking the obesity problem
According to Ezzati, the disparity between urban and rural areas is due to the quality of food. He cites the fact that when it comes to public health, a lot of focus is put on the negative aspects of urban living. However, he counters this by pointing out that cities provide a wealth of opportunities for better nutrition, more physical exercise and recreation, and overall improved health. "These things," Ezzati adds, "are often harder to find in rural areas."
The study itself notes that rural areas in low- or middle-income countries that have shifted toward higher incomes and better infrastructure have gained considerable health benefits. The trade-off of being able to buy food, however, is that rural populations now find it difficult to afford nutritious food.
It is generally believed that cities have easier and greater access to food services, while rural areas are left without any options when it comes to their next meal. However, the present research suggests that the urban food network is now able to reach rural areas, giving their inhabitants access to the same kinds of unhealthy foods city dwellers usually eat. This shift from traditional food staples to an abundance of modern ultra-processed foods is driven by more mechanized farming practices, as well as the pull of modern conveniences.
The study points out that this problem will not be addressed if modern research and policies continue to focus only on the issue of urban obesity. While obesity prevention programs that encourage physical activity and consumption of nutritious foods are great, these plans do not include rural populations.
The findings of the present study thus challenge modern perceptions of obesity. While there are some exceptions, such as in sub-Saharan Africa, the researchers believe that the pattern they have observed globally is likely to spread in that region as well if the focus of modern nutritional programs aren't modified to include improving rural health.
"We deal with undernutrition by sending aid to remote areas," said Ezzati. "We deal with obesity by assuming it just applies to urban areas. It doesn't."
Ezzati also believes that combating the immediate effects of food insecurity is important, but policies need to be able to address the long-term effects of focusing too much on alleviating hunger and not paying enough attention to proper nutrition.
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