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In this context, the paper by the NCD Risk Factor Collaboration is ground-breaking, because it pulls together the latest data from almost all countries to comprehensively examine global BMI trends.
The results show that the levels of overweight and obesity are already greater in rural than in urban areas in 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.
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Despite these observations, most research and policy efforts have been focused on tackling urbanization as a major driver of obesity, because the general thinking is still that people living in rural areas are much more likely to face hunger and undernutrition than to be exposed to factors that lead to excessive weight.
All earlier research on BMI trends was based on limited data, and focused on either LMICs or high-income countries.Many low-income communities in urban areas consume predominantly ultra-processed foods and beverages sold at fast-food and small retail outlets, often because they live in so-called ‘food deserts’—low-income areas where these are the only available foods.Rural areas, on the other hand, have been seen as a different type of food desert, where people mainly consume produce from their own farms and gardens, and have less access to ultra-processed and packaged food.This is likely to be linked to the fact that rural areas in LMICs have begun to resemble urban areas, because the modern food supply is now available in combination with cheap mechanized devices for farming and transport.Ultra-processed foods are becoming part of the diets of poor people in these countries, and there are reports that infants are even being fed with these foods.In the past two decades, a shift towards obesogenic diets has promoted weight gain and increased the risk of health problems related to chronic diseases in urban areas in China.But some research findings have indicated that the levels of overweight and obesity are increasing faster in rural than in urban areas, even in many low- and middle-income countries (LMICs).The global problem of overweight and obesity has been seen chiefly as an urban issue, partly because access to food services is much greater and easier in cities than in rural areas.City dwellers have an array of options for purchasing highly processed foods and beverages, which are high in salt, saturated fat and sugar, and which are often termed ‘ultra-processed obesogenic foods’.The dynamics of BMI change in urban and rural areas have not been investigated separately.Writing in , the members of the NCD Risk Factor Collaboration challenge the idea that general BMI trends are mainly a result of urbanization.