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Honor Bixby, J. Bentham, Bin Zhou, M. Di Cesare, C. Paciorek, J. Bennett, C. Taddei, Gretchen A. Stevens, A. Rodriguez-Martinez, R. Carrillo-Larco, Y. Khang, M. Sorić, E. Gregg, J. Miranda, Z. Bhutta, S. Savin, Marisa K. Sophiea, M. L. Iurilli, Bethlehem D Solomon, Melanie J. Cowan, L. Riley, G. Danaei, P. Bovet, A. Chiriță-Emandi, I. Hambleton, A. Hayes, Nayu Ikeda, A. Kengne, A. Laxmaiah, Yanping Li, S. Mcgarvey, A. Mostafa, M. Neovius, G. Starc, A. Zainuddin, Leandra Abarca-Gómez, Z. Abdeen, S. Abdrakhmanova, Suhaila Abdul Ghaffar, Zargar Abdul Hamid, Jamila Abubakar Garba, Niveen M. E. Abu-Rmeileh, Benjamín Acosta-Cázares, R. Adams, W. Aekplakorn, K. Afsana, I. Agdeppa, C. Aguilar-Salinas, C. Agyemang, Mohamad Hasnan Ahmad, Noor Ani Ahmad, N. Ahmadi, A. Ahmadvand, W. Ahrens, K. Ajlouni, F. Albuhairan, Shahla Aldhukair, H. Al-Hazzaa, Mohamed M. Ali, O. Ali, A. Alkerwi, Amani Rashed Al-Othman, Rajaa Al-Raddadi, M. Álvarez-Pedrerol, Eman Aly, D. Amarapurkar, P. Amouyel, A. Amuzu, L. Andersen, S. Anderssen, L. Ängquist, R. Anjana, A. Ansari-Moghaddam, H. Aounallah-Skhiri, J. Araújo, I. Ariansen, T. Aris, Raphael E. Arku, N. Arlappa, K. Aryal, T. Aspelund, F. Assah, M. Assunção, May Soe Aung, J. Auvinen, M. Avdičová, A. Azevedo, F. Azizi, M. Azmin, B. Babu, Azlin Baharudin, S. Bahijri, Jennifer L Baker, N. Balakrishna, M. Bamoshmoosh, M. Banach, P. Bandosz, J. Banegas, C. Barbagallo, A. Barceló, A. Barkat, A. Barros, M. Barros, I. Bata, A. Batieha, R. Batista, Z. Battakova, Assembekov Batyrbek, L. Baur, R. Beaglehole, S. Bel-Serrat, H. Ben Romdhane, Judith Benedics, M. Benet, S. Berkinbayev, A. Bernabé-Ortiz, G. Bernotiene, H. Bettiol, A. Bhagyalaxmi, Sumit Bharadwaj, S. Bhargava, H. Bi, Y. Bi, A. Biehl, Elysée Claude Bika Lele, M. Bikbov, B. Bista, D. Bjelica, P. Bjerregaard, E. Bjertness, M. B. Bjertness, C. Björkelund, A. Blokstra, Simona Bo, M. Bobák, L. Boddy, B. Boehm, H. Boeing, J. Boggia, C. Boissonnet, M. Bonaccio, V. Bongard, M. Bopp, R. Borchini, H. Borghs, Lien Braeckevelt, L. Braeckman, M. Bragt, I. Brajkovich, F. Branca, Juergen Breckenkamp, J. Breda, H. Brenner, L. Brewster, G. Brian, L. Brîndușe, G. Bruno, H. Bueno-de-Mesquita, Anna Bugge, M. Buoncristiano, G. Burazeri, Con Burns, Antonio Cabrera de León, J. Cacciottolo, H. Cai, Tilema Cama, C. Cameron, J. Camolas, G. Çan, G. Can, A. P. Cândido, F. Cañete, M. Capanzana, E. Capuano, V. Capuano, V. Cardoso, A. Carlsson, E. Carmuega, M. J. Carvalho, F. Casanueva, J. Casas, C. Caserta, Ertugrul Celikcan, L. Censi, J. César, S. Chamukuttan, A. Chan, Q. Chan, H. Chaturvedi, N. Chaturvedi, Norsyamlina Che Abdul Rahim, Chien-Jen Chen, Fangfang Chen, Huashuai Chen, Shuohua Chen, Zhengming Chen, Ching-Yu Cheng, Yiling J. Cheng, A. Chetrit, E. Chikova-Iscener, A. Chiolero, S. Chiou, M. Chirlaque, B. Cho, Yumi Cho, K. Christensen, D. Christofaro, J. Chudek, R. Cífková, M. Cilia, E. Cinteză, F. Claessens, Janine Clarke, E. Clays, H. Concin, S. C. Confortin, C. Cooper, T. Coppinger, S. Costanzo, D. Cottel, C. Cowell, C. Craig, A. Crampin, A. Crujeiras, J. Cruz, A. Cucu, L. Cui, J. Dallongeville, A. Damasceno, C. T. Damsgaard, R. Dankner, T. Dantoft, G. D’Arrigo, P. Dasgupta, S. Dastgiri, L. Dauchet, K. Davletov, G. De Backer, D. De Bacquer, A. De Curtis, G. de Gaetano, S. de Henauw, P. D. de Oliveira, K. de Ridder, S. D. de Rooij, D. De Smedt, M. Deepa, A. Deev, A. Dehghan, H. Delisle, F. Delpeuch, E. Dennison, V. Deschamps, K. Dhana, M. Dhimal, A. Di Castelnuovo, J. S. Dias-da-Costa, Alejandro Díaz, Ž. Dika, Shirin Djalalinia, Ha T. P. Do, A. Dobson, M. Donati, C. Donfrancesco, Silvana P. Donoso, A. Döring, M. Dorobanțu, A. Dorosty, E. d’Orsi, K. Doua, W. Drygas, J. Duan, C. Duante, R. Duda, V. Duleva, V. Dulskienė, S. Dumith, V. Dzērve, E. Dziankowska-Zaborszczyk, Ricky Eddie, E. Egbagbe, R. Eggertsen, G. Eiben, U. Ekelund, J. El Ati, D. Eldemire-Shearer, M. Eliasen, P. Elliott, R. Engle-Stone, R. Erasmus, C. Erem, L. Eriksen, J. Eriksson, J. Escobedo-de la Peña, A. Evans, D. Faeh, C. Fall, Victoria Farrugia Sant’Angelo, F. Farzadfar, M. Fattahi, F. Félix-Redondo, T. Ferguson, R. Fernandes, D. Fernández-Bergés, D. Ferrante, M. Ferrari, C. Ferreccio, Eldridge Ferrer, J. Ferrières, A. Fijałkowska, G. Fink, K. Fischer, Eric Monterubio Flores, B. Föger, L. Foo, Ann‐Sofie Forslund, M. Forsner, H. Fouad, Damian K. Francis, M. Franco, O. Franco, G. Frontera, F. Fuchs, S. Fuchs, Y. Fujita, Takuro Furusawa, Z. Gaciong, M. Gafencu, D. Galeone, F. Galvano, Jingli Gao, M. García-de-la-Hera, Dickman Gareta, S. Garnett, J. Gaspoz, Magda Gasull, Louise Gates, A. Gazzinelli, Harald Geiger, J. Geleijnse, A. Ghanbari, E. Ghasemi, Anoosheh Ghasemian, O. Gheorghe-Fronea, S. Giampaoli, F. Gianfagna, T. Gill, J. Giovannelli, G. Gironella, A. Giwercman, J. Godos, S. Gogen, R. Goldsmith, D. Goltzman, H. Gonçalves, Angel R Gonzalez, D. González-Chica, M. González-Gross, Margot González-León, J. González-Rivas, M. González-Villalpando, F. Gottrand, António Pedro Soares Ricardo Graça, S. Graff-Iversen, D. Grafnetter, Aneta Grajda, M. Grammatikopoulou, R. D. Gregor, T. Grodzicki, A. Grøntved, G. Grosso, G. Gruden, D. Gu, E. Gualdi-Russo, E. Gudmundsson, V. Gudnason, Ramiro Guerrero, I. Guessous, A. Guimarães, M. Gulliford, Johanna Gunnlaugsdottir, M. Gunter, Xiuhua Guo, Yin-yan Guo, Prakash C. Gupta, Rajeev Gupta, O. Gureje, Beata Gurzkowska, L. Gutierrez, F. Gutzwiller, F. Hadaegh, C. Hadjigeorgiou, Rosa Haghshenas, J. Halkjær, R. Hardy, Rachakulla Hari Kumar, M. Hassapidou, J. Hata, T. Haugsgjerd, Jiang He, Yu-na He, Regina Heidinger-Felső, M. Heinen, Tatjana Hejgaard, M. Hendriks, A. Henriques, Leticia Hernandez Cadena, S. Herrala, V. Herrera, I. Herter-Aeberli, R. Heshmat, A. Hill, S. Ho, S. Ho, M. Hobbs, A. Hofman, W. Hopman, A. Horimoto, Claudia M. Hormiga, B. Horta, L. Houti, C. Howitt, T. Htay, A. Htet, M. Htike, Yonghua Hu, J. Huerta, I. Huhtaniemi, Constanta Huidumac Petrescu, M. Huisman, A. Husseini, Chinh Nguyen Huu, I. Huybrechts, N. Hwalla, J. Hyska, L. Iacoviello, J. Ibarluzea, M. Ibrahim, Norazizah Ibrahim Wong, M. Ikram, V. Irazola, T. Ishida, Muhammad Islam, A. Ismail, V. Ivković, M. Iwasaki, T. Jääskeläinen, R. Jackson, Jeremy Michael Jacobs, H. Jaddou, T. Jafar, K. James, K. Jamil, K. Jamrozik, I. Janszky, E. Janus, J. Jarani, M. Jarvelin, G. Jasienska, A. Jelaković, B. Jelaković, Garry L R Jennings, Seung-lyeal Jeong, C. Jiang, Ramon O Jimenez, M. Joffres, M. Johansson, J. Jokelainen, J. Jonas, T. Jørgensen, Pradeep Joshi, D. Jović, J. Jozwiak, A. Juolevi, G. Jurak, V. Jureša, R. Kaaks, A. Kafatos, E. Kajantie, O. Kalter‐Leibovici, N. Kamaruddin, Y. Kameli, E. Kapantais, K. Karki, A. Kasaeian, M. Katibeh, J. Katz, P. Katzmarzyk, J. Kauhanen, P. Kaur, M. Kavousi, G. Kazakbaeva, U. Keil, L. Keinan-Boker, S. Keinänen-Kiukaanniemi, R. Kelishadi, C. Kelleher, H. Kemper, A. Kerimkulova, M. Kersting
541 12. 4. 2019.

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities1,2. This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity3–6. Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017—and more than 80% in some low- and middle-income regions—was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing—and in some countries reversal—of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories. Contrary to the view that urbanization is a major driver of the global rise in obesity, the global increase in body-mass index is shown to be mostly due to increases in the body-mass indexes of rural populations.


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