Rural Obesity Epidemic on the Rise

Obesity is an ongoing global epidemic, focused mainly on middle- to upper-class countries as well as cities around the globe. Historically, cities in non-European countries have had a higher mean body mass index (BMI) than their rural peers, mainly due to better infrastructure, easier access to food, and less hard labor. A recent study published in Nature found that rising obesity rates in these areas could be the main contributors to increasing obesity rates worldwide.

“Data on how BMI in rural and urban populations is changing are needed to plan interventions that address underweight and overweight,” the researchers wrote. “Here, we report on mean BMI in rural and urban areas of 200 countries and territories from 1985 to 2017.”

The researchers reviewed 2,009 population-based studies with height and weight data for more than 112 million adults (age ≥ 18 years) from 190 countries. The reported estimated trends in population mean BMI—a combination of the change in health due to a person’s economic status and environment and the change in the individuals that consist of the population, including their economic status and environment.

Between 1985 and 2017, the population living in urban areas increased from 41% to 55%; during the same time period, the global age-standardized mean BMI went from 22.6 kg/m2 to 24.7 kg/m2 in women and 22.2 kg/m2 to 24.4 kg/m2 in men. However, the increase varied by location: mean BMI increased by 2.09 kg/m2 in rural women and 2.10 kg/m2 in rural men, compared to 1.35 kg/m2 and 1.59 kg/m2 in urban men and women, respectively.

Specifically, the researchers shared: “In 1985, urban men and women in every country in east, south and southeast Asia, Oceania, Latin America and the Caribbean and a region that comprises central Asia, the Middle East and north Africa had a higher mean BMI than their rural peers. The urban–rural gap was as large as 3.25 kg m−2 (2.57–3.96) in women and 3.05 kg m−2 (2.44–3.68) in men in India. Over time, the BMI gap between rural and urban women shrank in all of these regions by at least 40%, as BMI rose faster in rural areas than in cities. In 14 countries in these regions, including Armenia, Chile, Jamaica, Jordan, Malaysia, Taiwan and Turkey, the ordering of rural and urban female BMI reversed over time and rural women had higher BMI than their urban peers in 2017.” Men exhibited a similar pattern.

This changing of the tides explained in Nature shows that obesity is rising faster in rural populations than in Urban cities. Historically, in low-income countries, it was expected that rural living conditions would lead to a lower BMI of the surrounding population compared to those living in nearby or far away urban centers.  Much of this had to do with the increased activity of those living in the rural areas, as well as the lack of access to large amounts of food.

According to the data, this notion has been flipped on its head, as rural BMI outpaces urban BMI. The authors attribute this to several factors pertaining to increasing economic and social disadvantages in rural areas, including:

  • Lower education
  • Lower income
  • Limited availability and higher prices of healthy and fresh foods
  • Less walking than in cities
  • Limited access to public transportation
  • Fewer opportunities to participate in sports or recreational activity

The authors conclude by recommending that, along with rural undernutrition aid, global organizations begin incorporating healthy eating education as well as increased access to healthy food options. It is no longer good enough to just provide mass amounts of processed food, as these rural areas could significantly benefit from healthy food options and health education.

“As economic growth and rural nutrition programmes reduce rural caloric deficiency, the rural undernutrition disadvantage may be replaced with a more general and complex malnutrition that entails excessive consumption of low-quality calories,” the study authors noted. “To avoid such an unhealthy transition, the fragmented national and international responses to undernutrition and obesity should be integrated, and the narrow focus of international aid on undernutrition should be broadened, to enhance access to healthier foods in poor rural and urban communities.”