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

Honor Bixby, James Bentham, Bin Zhou, Mariachiara Di Cesare, Christopher J. Paciorek, James E. Bennett, Cristina Taddei, Gretchen A. Stevens, Andrea Rodriguez-Martinez, Rodrigo M. Carrillo-Larco, Young Ho Khang, Maroje Sorić, Edward W. Gregg, J. Jaime Miranda, Zulfiqar A. Bhutta, Stefan Savin, Marisa K. Sophiea, Maria L.C. Iurilli, Bethlehem D. Solomon, Melanie J. CowanLeanne M. Riley, Goodarz Danaei, Pascal Bovet, Adela Chirita-Emandi, Ian R. Hambleton, Alison J. Hayes, Nayu Ikeda, Andre P. Kengne, Avula Laxmaiah, Yanping Li, Stephen T. McGarvey, Aya Mostafa, Martin Neovius, Gregor Starc, Ahmad A. Zainuddin, Leandra Abarca-Gómez, Ziad A. Abdeen, Shynar Abdrakhmanova, Suhaila Abdul Ghaffar, Zargar Abdul Hamid, Jamila Abubakar Garba, Niveen M. Abu-Rmeileh, Benjamin Acosta-Cazares, Robert J. Adams, Wichai Aekplakorn, Kaosar Afsana, Imelda A. Agdeppa, Carlos A. Aguilar-Salinas, Charles Agyemang, Mohamad Hasnan Ahmad, Noor Ani Ahmad, Naser Ahmadi, Alireza Ahmadvand, Wolfgang Ahrens, Kamel Ajlouni, Fadia AlBuhairan, Shahla AlDhukair, Hazzaa M. Al-Hazzaa, Mohamed M. Ali, Osman Ali, Alaa Alkerwi, Amani Rashed Al-Othman, Rajaa Al-Raddadi, Mar Alvarez-Pedrerol, Eman Aly, Deepak N. Amarapurkar, Philippe Amouyel, Antoinette Amuzu, Lars Bo Andersen, Sigmund A. Anderssen, Lars H. Ängquist, Ranjit Mohan Anjana, Alireza Ansari-Moghaddam, Hajer Aounallah-Skhiri, Joana Araújo, Inger Ariansen, Tahir Aris, Raphael E. Arku, Nimmathota Arlappa, Krishna K. Aryal, Thor Aspelund, Felix K. Assah, Maria Cecília F. Assunção, May Soe Aung, Juha Auvinen, Mária Avdicová, Ana Azevedo, Fereidoun Azizi, Mehrdad Azmin, Bontha V. Babu, Azli Baharudin, Suhad Bahijri, Jennifer L. Baker, Nagalla Balakrishna, Mohamed Bamoshmoosh, Maciej Banach, Piotr Bandosz, José R. Banegas, Carlo M. Barbagallo, Alberto Barceló, Amina Barkat, Aluisio J.D. Barros, Mauro V.G. Barros, Iqbal Bata, Anwar M. Batieha, Rosangela L. Batista, Zhamilya Battakova, Assembekov Batyrbek, Louise A. Baur, Robert Beaglehole, Silvia Bel-Serrat, Habiba Ben Romdhane, Judith Benedics, Mikhail Benet, Salim Berkinbayev, Antonio Bernabe-Ortiz, Gailute Bernotiene, Heloisa Bettiol, Aroor Bhagyalaxmi, Sumit Bharadwaj, Santosh K. Bhargava, Hongsheng Bi, Yufang Bi, Anna Biehl, Elysée Claude Bika Lele, Mukharram Bikbov, Bihungum Bista, Dusko J. Bjelica, Peter Bjerregaard, Espen Bjertness, Marius B. Bjertness, Cecilia Björkelund, Anneke Blokstra, Simona Bo, Martin Bobak, Lynne M. Boddy, Bernhard O. Boehm, Heiner Boeing, Jose G. Boggia, Carlos P. Boissonnet, Marialaura Bonaccio, Vanina Bongard, Matthias Bopp, Rossana Borchini, Herman Borghs, Lien Braeckevelt, Lutgart Braeckman, Marjolijn C.E. Bragt, Imperia Brajkovich, Francesco Branca, Juergen Breckenkamp, João Breda, Hermann Brenner, Lizzy M. Brewster, Garry R. Brian, Lacramioara Brinduse, Graziella Bruno, H. Bas Bueno-de-Mesquita, Anna Bugge, Marta Buoncristiano, Genc Burazeri, Con Burns, Antonio Cabrera de León, Joseph Cacciottolo, Hui Cai, Tilema Cama, Christine Cameron, José Camolas, Gamze Can, Günay Can, Ana Paula C. Cândido, Felicia Cañete, Mario V. Capanzana, Eduardo Capuano, Vincenzo Capuano, Viviane C. Cardoso, Axel C. Carlsson, Esteban Carmuega, Maria J. Carvalho, Felipe F. Casanueva, Juan Pablo Casas, Carmelo A. Caserta, Ertugrul Celikcan, Laura Censi, Juraci A. Cesar, Snehalatha Chamukuttan, Angelique W. Chan, Queenie Chan, Himanshu K. Chaturvedi, Nishi Chaturvedi, Norsyamlina Che Abdul Rahim, Chien Jen Chen, Fangfang Chen, Huashuai Chen, Shuohua Chen, Zhengming Chen, Ching Yu Cheng, Yiling J. Cheng, Angela Chetrit, Ekaterina Chikova-Iscener, Arnaud Chiolero, Shu Ti Chiou, María Dolores Chirlaque, Belong Cho, Yumi Cho, Kaare Christensen, Diego G. Christofaro, Jerzy Chudek, Renata Cifkova, Michelle Cilia, Eliza Cinteza, Frank Claessens, Janine Clarke, Els Clays, Hans Concin, Susana C. Confortin, Cyrus Cooper, Tara C. Coppinger, Simona Costanzo, Dominique Cottel, Chris Cowell, Cora L. Craig, Amelia C. Crampin, Ana B. Crujeiras, Juan J. Cruz, Alexandra Cucu, Liufu Cui, Jean Dallongeville, Albertino Damasceno, Camilla T. Damsgaard, Rachel Dankner, Thomas M. Dantoft, Graziella D’Arrigo, Parasmani Dasgupta, Saeed Dastgiri, Luc Dauchet, Kairat Davletov, Guy De Backer, Dirk De Bacquer, Amalia De Curtis, Giovanni de Gaetano, Stefaan De Henauw, Paula Duarte de Oliveira, Karin De Ridder, Susanne R. de Rooij, Delphine De Smedt, Mohan Deepa, Alexander D. Deev, Abbas Dehghan, Hélène Delisle, Francis Delpeuch, Elaine Dennison, Valérie Deschamps, Klodian Dhana, Meghnath Dhimal, Augusto F. Di Castelnuovo, Juvenal Soares Dias-da-Costa, Alejandro Diaz, Zivka Dika, Shirin Djalalinia, Ha T.P. Do, Annette J. Dobson, Maria Benedetta Donati, Chiara Donfrancesco, Silvana P. Donoso, Angela Döring, Maria Dorobantu, Ahmad Reza Dorosty, Eleonora d’Orsi, Kouamelan Doua, Wojciech Drygas, Jia Li Duan, Charmaine A. Duante, Rosemary B. Duda, Vesselka Duleva, Virginija Dulskiene, Samuel C. Dumith, Vilnis Dzerve, Elzbieta Dziankowska-Zaborszczyk, Ricky Eddie, Eruke E. Egbagbe, Robert Eggertsen, Gabriele Eiben, Ulf Ekelund, Jalila El Ati, Denise Eldemire-Shearer, Marie Eliasen, Paul Elliott, Reina Engle-Stone, Rajiv T. Erasmus, Cihangir Erem, Louise Eriksen, Johan G. Eriksson, Jorge Escobedo-de la Peña, Alun Evans, David Faeh, Caroline H. Fall, Victoria Farrugia Sant’Angelo, Farshad Farzadfar, Mohammad R. Fattahi, Francisco J. Felix-Redondo, Trevor S. Ferguson, Romulo A. Fernandes, Daniel Fernández-Bergés, Daniel Ferrante, Marika Ferrari, Catterina Ferreccio, Eldridge Ferrer, Jean Ferrieres, Anna Fijalkowska, Günther Fink, Krista Fischer, Eric Monterubio Flores, Bernhard Föger, Leng Huat Foo, Ann Sofie Forslund, Maria Forsner, Heba M. Fouad, Damian K. Francis, Maria do Carmo Franco, Oscar H. Franco, Guillermo Frontera, Flavio D. Fuchs, Sandra C. Fuchs, Yuki Fujita, Takuro Furusawa, Zbigniew Gaciong, Mihai Gafencu, Daniela Galeone, Fabio Galvano, Jingli Gao, Manoli Garcia-de-la-Hera, Dickman Gareta, Sarah P. Garnett, Jean Michel Gaspoz, Magda Gasull, Louise Gates, Andrea Gazzinelli, Harald Geiger, Johanna M. Geleijnse, Ali Ghanbari, Erfan Ghasemi, Anoosheh Ghasemian, Oana Florentina Gheorghe-Fronea, Simona Giampaoli, Francesco Gianfagna, Tiffany K. Gill, Jonathan Giovannelli, Glen Gironella, Aleksander Giwercman, Justyna Godos, Sibel Gogen, Rebecca A. Goldsmith, David Goltzman, Helen Gonçalves, Angel R. Gonzalez, David A. Gonzalez-Chica, Marcela Gonzalez-Gross, Margot González-Leon, Juan P. González-Rivas, María Elena González-Villalpando, Frederic Gottrand, Antonio Pedro Graça, Sidsel Graff-Iversen, Dušan Grafnetter, Aneta Grajda, Maria G. Grammatikopoulou, Ronald D. Gregor, Tomasz Grodzicki, Anders Grøntved, Giuseppe Grosso, Gabriella Gruden, Dongfeng Gu, Emanuela Gualdi-Russo, Elias F. Gudmundsson, Vilmundur Gudnason, Ramiro Guerrero, Idris Guessous, Andre L. Guimaraes, Martin C. Gulliford, Johanna Gunnlaugsdottir, Marc Gunter, Xiuhua Guo, Yin Guo, Prakash C. Gupta, Rajeev Gupta, Oye Gureje, Beata Gurzkowska, Laura Gutierrez, Felix Gutzwiller, Farzad Hadaegh, Charalambos A. Hadjigeorgiou, Rosa Haghshenas, Jytte Halkjær, Rebecca Hardy, Rachakulla Hari Kumar, Maria Hassapidou, Jun Hata, Teresa Haugsgjerd, Jiang He, Yuna He, Regina Heidinger-Felso, Mirjam Heinen, Tatjana Hejgaard, Marleen Elisabeth Hendriks, Ana Henriques, Leticia Hernandez Cadena, Sauli Herrala, Victor M. Herrera, Isabelle Herter-Aeberli, Ramin Heshmat, Allan G. Hill, Sai Yin Ho, Suzanne C. Ho, Michael Hobbs, Albert Hofman, Wilma M. Hopman, Andrea R.V.R. Horimoto, Claudia M. Hormiga, Bernardo L. Horta, Leila Houti, Christina Howitt, Thein Thein Htay, Aung Soe Htet, Maung Maung Than Htike, Yonghua Hu, José María Huerta, Ilpo Tapani Huhtaniemi, Constanta Huidumac Petrescu, Martijn Huisman, Abdullatif Husseini, Chinh Nguyen Huu, Inge Huybrechts, Nahla Hwalla, Jolanda Hyska, Licia Iacoviello, Jesús M. Ibarluzea, Mohsen M. Ibrahim, Norazizah Ibrahim Wong, M. Arfan Ikram, Vilma E. Irazola, Takafumi Ishida, Muhammad Islam, Aziz al Safi Ismail, Vanja Ivkovic, Masanori Iwasaki, Tuija Jääskeläinen, Rod T. Jackson, Jeremy M. Jacobs, Hashem Jaddou, Tazeen Jafar, Kenneth James, Kazi M. Jamil, Konrad Jamrozik, Imre Janszky, Edward Janus, Juel Jarani, Marjo Riitta Jarvelin, Grazyna Jasienska, Ana Jelakovic, Bojan Jelakovic, Garry Jennings, Seung lyeal Jeong, Chao Qiang Jiang, Ramon O. Jimenez, Michel Joffres, Mattias Johansson, Jari J. Jokelainen, Jost B. Jonas, Torben Jørgensen, Pradeep Joshi, Dragana P. Jovic, Jacek Józwiak, Anne Juolevi, Gregor Jurak, Vesna Juresa, Rudolf Kaaks, Anthony Kafatos, Eero O. Kajantie, Ofra Kalter-Leibovici, Nor Azmi Kamaruddin, Yves Kameli, Efthymios Kapantais, Khem B. Karki, Amir Kasaeian, Marzieh Katibeh, Joanne Katz, Peter T. Katzmarzyk, Jussi Kauhanen, Prabhdeep Kaur, Maryam Kavousi, Gyulli Kazakbaeva, Ulrich Keil, Lital Keinan-Boker, Sirkka Keinänen-Kiukaanniemi, Roya Kelishadi, Cecily Kelleher, Han C.G. Kemper, Alina Kerimkulova, Mathilde Kersting, Timothy Key, Yousef Saleh Khader, Davood Khalili, Mohammad Khateeb, Kay Tee Khaw, Bahareh Kheiri, Alireza Khosravi, Ilse M.S.L. Khouw, Stefan Kiechl, Ursula Kiechl-Kohlendorfer, Japhet Killewo, Jeongseon Kim, Yeon Yong Kim, Jeannette Klimont, Jurate Klumbiene, Michael Knoflach, Bhawesh Koirala, Elin Kolle, Patrick Kolsteren, Jürgen König, Raija Korpelainen, Paul Korrovits, Magdalena Korzycka, Seppo Koskinen, Katsuyasu Kouda, Viktoria A. Kovacs, Sudhir Kowlessur, Slawomir Koziel, Wolfgang Kratzer, Susi Kriemler, Peter Lund Kristensen, Steinar Krokstad, Daan Kromhout, Herculina S. Kruger, Ruzena Kubinova, Renata Kuciene, Diana Kuh, Urho M. Kujala, Enisa Kujundzic, Zbigniew Kulaga, R. Krishna Kumar, Marie Kunešová, Pawel Kurjata, Yadlapalli S. Kusuma, Kari Kuulasmaa, Catherine Kyobutungi, Quang Ngoc N. La, Fatima Zahra Laamiri, Tiina Laatikainen, Carl Lachat, Youcef Laid, Tai Hing Lam, Maja Lang Morovic, Vera Lanska, Georg Lappas, Bagher Larijani, Tint Swe Latt, Lars E. Laugsand, Laura Lauria, Maria Lazo-Porras, Khanh Le Nguyen Bao, Agnès Le Port, Tuyen D. Le, Jeannette Lee, Jeonghee Lee, Paul H. Lee, Terho Lehtimäki, Daniel Lemogoum, Naomi S. Levitt, Christa L. Lilly, Wei Yen Lim, M. Fernanda Lima-Costa, Hsien Ho Lin, Xu Lin, Lars Lind, Allan Linneberg, Lauren Lissner, Mieczyslaw Litwin, Jing Liu, Helle Mai Loit, Luis Lopes, Tania Lopez, Esther López-García, Roberto Lorbeer, Paulo A. Lotufo, José Eugenio Lozano, Dalia Luksiene, Annamari Lundqvist, Robert Lundqvist, Nuno Lunet, Per Lytsy, Guansheng Ma, Jun Ma, George L.L. Machado-Coelho, Aristides M. Machado-Rodrigues, Suka Machi, Stefania Maggi, Dianna J. Magliano, Emmanuella Magriplis, Bernard Maire, Marjeta Majer, Marcia Makdisse, Fatemeh Malekzadeh, Reza Malekzadeh, Rahul Malhotra, Sofia Malyutina, Lynell V. Maniego, Yannis Manios, Jim I. Mann, Enzo Manzato, Paula Margozzini, Anastasia Markaki, Oonagh Markey, Eliza Markidou Ioannidou, Larissa Pruner Marques, Pedro Marques-Vidal, Jaume Marrugat, Rosemarie Martin, Yves Martin-Prevel, Reynaldo Martorell, Eva Martos, Stefano Marventano, Shariq R. Masoodi, Ellisiv B. Mathiesen, Prashant Mathur, Alicia Matijasevich, Tandi E. Matsha, Artur Mazur, Jean Claude N. Mbanya, Shelly R. McFarlane, Martin McKee, Stela McLachlan, Rachael M. McLean, Scott B. McLean, Breige A. McNulty, Safiah Md Yusof, Sounnia Mediene-Benchekor, Jurate Medzioniene, Parinaz Mehdipour, Aline Meirhaeghe, Jørgen Meisfjord, Christa Meisinger, Ana Maria B. Menezes, Geetha R. Menon, Gert B.M. Mensink, Alibek Mereke, Indrapal I. Meshram, Andres Metspalu, Haakon E. Meyer, Jie Mi, Kim F. Michaelsen, Nathalie Michels, Kairit Mikkel, Jody C. Miller, Cláudia S. Minderico, Juan Francisco Miquel, Daphne Mirkopoulou, Erkin Mirrakhimov, Marjeta Misigoj-Durakovic, Antonio Mistretta, Veronica Mocanu, Pietro A. Modesti, Sahar Saeeidi Moghaddam, Bahram Mohajer, Mostafa K. Mohamed, Kazem Mohammad, Noushin Mohammadifard, Viswanathan Mohan, Salim Mohanna, Muhammad Fadhli Mohd Yusoff, Farnam Mohebi, Marie Moitry, Drude Molbo, Line T. Møllehave, Niels C. Møller, Dénes Molnár, Amirabbas Momenan, Charles K. Mondo, Eric A. Monterrubio, Kotsedi Daniel K. Monyeki, Jin Soo Moon, Leila B. Moreira, Alain Morejon, Luis A. Moreno, Karen Morgan, Suzanne Morin, Erik Lykke Mortensen, George Moschonis, Malgorzata Mossakowska, Jorge Mota, Anabela Mota-Pinto, Mohammad Esmaeel Motlagh, Jorge Motta, Kelias P. Msyamboza, Thet Thet Mu, Magdalena Muc, Boban Mugoša, Maria Lorenza Muiesan, Parvina Mukhtorova, Martina Müller-Nurasyid, Neil Murphy, Jaakko Mursu, Elaine M. Murtagh, Sanja Music Milanovic, Vera Musil, Iraj Nabipour, Shohreh Naderimagham, Gabriele Nagel, Balkish M. Naidu, Harunobu Nakamura, Jana Námešná, Ei Ei K. Nang, Vinay B. Nangia, Martin Nankap, Sameer Narake, Paola Nardone, Matthias Nauck, Eva Maria Navarrete-Muñoz, William A. Neal, Keiu Nelis, Liis Nelis, Ilona Nenko, Flavio Nervi, Chung T. Nguyen, Nguyen D. Nguyen, Quang Ngoc Nguyen, Ramfis E. Nieto-Martínez, Guang Ning, Toshiharu Ninomiya, Sania Nishtar, Marianna Noale, Oscar A. Noboa, Teresa Norat, Sawada Norie, Davide Noto, Mohannad Al Nsour, Eha Nurk, Moffat Nyirenda, Galina Obreja, Angélica M. Ochoa-Avilés, Eiji Oda, Kyungwon Oh, Kumiko Ohara, Ryutaro Ohtsuka, Örn Olafsson, Maria Teresa Anselmo Olinto, Isabel O. Oliveira, Maciej Oltarzewski, Mohd Azahadi Omar, Altan Onat, Terence W. O’Neill, Sok King Ong, Lariane M. Ono, Pedro Ordunez, Dermot O’Reilly, Rui Ornelas, Ana P. Ortiz, Pedro J. Ortiz, Merete Osler, Clive Osmond, Sergej M. Ostojic, Afshin Ostovar, Johanna A. Otero, Kim Overvad, Ellis Owusu-Dabo, Fred Michel Paccaud, Cristina Padez, Ioannis Pagkalos, Elena Pahomova, Andrzej Pająk, Domenico Palli, Alberto Palloni, Luigi Palmieri, Wen Harn Pan, Songhomitra Panda-Jonas, Arvind Pandey, Francesco Panza, Dimitrios Papandreou, Soon Woo Park, Winsome R. Parnell, Mahboubeh Parsaeian, Ionela M. Pascanu, Nikhil D. Patel, Ivan Pecin, Mangesh S. Pednekar, Nasheeta Peer, Sergio Viana Peixoto, Markku Peltonen, Alexandre C. Pereira, Cynthia M. Pérez, Napoleon Perez-Farinos, Annette Peters, Astrid Petersmann, Janina Petkeviciene, Ausra Petrauskiene, Niloofar Peykari, Son Thai Pham, Daniela Pierannunzio, Iris Pigeot, Hynek Pikhart, Aida Pilav, Lorenza Pilotto, Francesco Pistelli, Freda Pitakaka, Aleksandra Piwonska, Pedro Plans-Rubió, Bee Koon Poh, Hermann Pohlabeln, Raluca M. Pop, Stevo R. Popovic, Miquel Porta, Marileen L.P. Portegies, Georg Posch, Dimitrios Poulimeneas, Hamed Pouraram, Akram Pourshams, Hossein Poustchi, Rajendra Pradeepa, Alison J. Price, Jacqueline F. Price, Jardena J. Puder, Iveta Pudule, Soile E. Puhakka, Maria Puiu, Margus Punab, Radwan F. Qasrawi, Mostafa Qorbani, Tran Quoc Bao, Madhari S. Radhika, Ivana Radic, Ricardas Radisauskas, Mahfuzar Rahman, Mahmudur Rahman, Olli Raitakari, Manu Raj, Hemalatha Rajkumar, Sherali Rakhmatulloev, Sudha Ramachandra Rao, Ambady Ramachandran, Jacqueline Ramke, Elisabete Ramos, Rafel Ramos, Lekhraj Rampal, Sanjay Rampal, Kodavanti Mallikharjuna Rao, Ramon A. Rascon-Pacheco, Mette Rasmussen, Josep Redon, Paul Ferdinand M. Reganit, Valéria Regecová, Luis Revilla, Lourdes Ribas-Barba, Robespierre Ribeiro, Elio Riboli, Fernando Rigo, Natascia Rinaldo, Tobias F. Rinke de Wit, Ana Rito, Raphael M. Ritti-Dias, Juan A. Rivera, Cynthia Robitaille, Daniela Rodrigues, Fernando Rodríguez-Artalejo, María del Cristo Rodriguez-Perez, Laura A. Rodríguez-Villamizar, Rosalba Rojas-Martinez, Nipa Rojroongwasinkul, Dora Romaguera, Annika Rosengren, Ian Rouse, Joel G.R. Roy, Adolfo Rubinstein, Frank J. Rühli, Jean Bernard Ruidavets, Emma Ruiz Moreno, Blanca Sandra Ruiz-Betancourt, Paola Russo, Petra Rust, Marcin Rutkowski, Charumathi Sabanayagam, Harshpal S. Sachdev, Saeid Safiri, Olfa Saidi, Benoit Salanave, Eduardo Salazar-Martinez, Diego Salmerón, Veikko Salomaa, Jukka T. Salonen, Massimo Salvetti, Jose Sánchez-Abanto, Sandjaja, Susana Sans, Loreto Santa-Marina, Diana A. Santos, Ina S. Santos, Osvaldo Santos, Rute Santos, Sara Santos Sanz, Jouko L. Saramies, Luis B. Sardinha, Nizal Sarrafzadegan, Kai Uwe Saum, Savvas Savva, Mathilde Savy, Marcia Scazufca, Angelika Schaffrath Rosario, Herman Schargrodsky, Anja Schienkiewitz, Karin Schindler, Sabine Schipf, Carsten O. Schmidt, Ida Maria Schmidt, Ben Schöttker, Constance Schultsz, Aletta E. Schutte, Sylvain Sebert, Aye Aye Sein, Rusidah Selamat, Vedrana Sember, Abhijit Sen, Idowu O. Senbanjo, Sadaf G. Sepanlou, Victor Sequera, Luis Serra-Majem, Jennifer Servais, Svetlana A. Shalnova, Sanjib K. Sharma, Jonathan E. Shaw, Lela Shengelia, Kenji Shibuya, Hana Shimizu-Furusawa, Dong Wook Shin, Youchan Shin, Alfonso Siani, Rosalynn Siantar, Abla M. Sibai, Antonio M. Silva, Diego Augusto Santos Silva, Mary Simon, Judith Simons, Leon A. Simons, Khairil Si-Ramlee, Agneta Sjöberg, Michael Sjöström, Jolanta Slowikowska-Hilczer, Przemyslaw Slusarczyk, Liam Smeeth, Marieke B. Snijder, Hung Kwan So, Eugène Sobngwi, Stefan Söderberg, Moesijanti Y.E. Soekatri, Agustinus Soemantri, Vincenzo Solfrizzi, Emily Sonestedt, Yi Song, Thorkild I.A. Sørensen, Charles Sossa Jérome, Aïcha Soumaré, Angela Spinelli, Igor Spiroski, Jan A. Staessen, Hanspeter Stamm, Maria G. Stathopoulou, Kaspar Staub, Bill Stavreski, Jostein Steene-Johannessen, Peter Stehle, Aryeh D. Stein, George S. Stergiou, Jochanan Stessman, Doris Stöckl, Tanja Stocks, Jakub Stokwiszewski, Gareth Stratton, Karien Stronks, Maria Wany Strufaldi, Lela Sturua, Ramón Suárez-Medina, Chien An Sun, Johan Sundström, Yn Tz Sung, Jordi Sunyer, Paibul Suriyawongpaisal, Boyd A. Swinburn, Rody G. Sy, René Charles Sylva, Lucjan Szponar, E. Shyong Tai, Mari Liis Tammesoo, Abdonas Tamosiunas, Eng Joo Tan, Xun Tang, Frank Tanser, Yong Tao, Mohammed Rasoul Tarawneh, Jakob Tarp, Carolina B. Tarqui-Mamani, Radka Taxová Braunerová, Anne Taylor, Félicité Tchibindat, William R. Tebar, Grethe Tell, Tania Tello, Holger Theobald, Xenophon Theodoridis, Lutgarde Thijs, Betina H. Thuesen, Lubica Tichá, Erik J. Timmermans, Anne Tjonneland, Hanna K. Tolonen, Janne S. Tolstrup, Murat Topbas, Roman Topór-Madry, María José Tormo, Michael J. Tornaritis, Maties Torrent, Stefania Toselli, Pierre Traissac, Dimitrios Trichopoulos, Antonia Trichopoulou, Oanh T.H. Trinh, Atul Trivedi, Yu Hsiang Tsao, Lechaba Tshepo, Maria Tsigga, Shoichiro Tsugane, Marshall K. Tulloch-Reid, Fikru Tullu, Tomi Pekka Tuomainen, Jaakko Tuomilehto, Maria L. Turley, Per Tynelius, Themistoklis Tzotzas, Christophe Tzourio, Peter Ueda, Eunice E. Ugel, Flora A.M. Ukoli, Hanno Ulmer, Belgin Unal, Hannu M.T. Uusitalo, Justina Vaitkeviciute, Gonzalo Valdivia, Susana Vale, Damaskini Valvi, Yvonne T. van der Schouw, Koen Van Herck, Hoang Van Minh, Lenie van Rossem, Natasja M. Van Schoor, Irene G.M. van Valkengoed, Dirk Vanderschueren, Diego Vanuzzo, Gregorio Varela-Moreiras, Patricia Varona-Pérez, Lars Vatten, Tomas Vega, Toomas Veidebaum, Gustavo Velasquez-Melendez, Biruta Velika, Giovanni Veronesi, W. M.Monique Verschuren, Cesar G. Victora, Giovanni Viegi, Lucie Viet, Paolo Vineis, Jesus Vioque, Jyrki K. Virtanen, Marjolein Visser, Sophie Visvikis-Siest, Bharathi Viswanathan, Tiina Vlasoff, Peter Vollenweider, Henry Völzke, Ari Voutilainen, Sari Voutilainen, Martine Vrijheid, Tanja G.M. Vrijkotte, Alisha N. Wade, Aline Wagner, Thomas Waldhör, Janette Walton, Wan Mohamad Wan Bebakar, Wan Nazaimoon Wan Mohamud, Rildo S. Wanderley, Ming Dong Wang, Qian Wang, Xiangjun Wang, Ya Xing Wang, Ying Wei Wang, S. Goya Wannamethee, Nicholas Wareham, Adelheid Weber, Deepa Weerasekera, Daniel Weghuber, Wenbin Wei, Peter H. Whincup, Kurt Widhalm, Indah S. Widyahening, Andrzej Wiecek, Alet H. Wijga, Rainford J. Wilks, Johann Willeit, Peter Willeit, Tom Wilsgaard, Bogdan Wojtyniak, Jyh Eiin Wong, Tien Yin Wong, Roy A. Wong-McClure, Jean Woo, Mark Woodward, Frederick C. Wu, Jianfeng Wu, Shouling Wu, Haiquan Xu, Liang Xu, Uruwan Yamborisut, Weili Yan, Ling Yang, Xiaoguang Yang, Yang Yang, Nazan Yardim, Mehdi Yaseri, Xingwang Ye, Panayiotis K. Yiallouros, Agneta Yngve, Moein Yoosefi, Akihiro Yoshihara, Qi Sheng You, San Lin You, Novie O. Younger-Coleman, Ahmad Faudzi Yusoff, Luciana Zaccagni, Vassilis Zafiropulos, Farhad Zamani, Sabina Zambon, Antonis Zampelas, Hana Zamrazilová, Maria Elisa Zapata, Ko Ko Zaw, Tomasz Zdrojewski, Tajana Zeljkovic Vrkic, Yi Zeng, Dong Zhao, Wenhua Zhao, Wei Zheng, Yingfeng Zheng, Bekbolat Zholdin, Maigeng Zhou, Dan Zhu, Baurzhan Zhussupov, Esther Zimmermann, Julio Zuñiga Cisneros, Majid Ezzati*, NCD Risk Factor Collaboration (NCD-RisC)

*Corresponding author for this work

Research output: Contribution to journalLetterAcademicpeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)260-264
Number of pages5
JournalNature
Volume569
Issue number7755
DOIs
Publication statusPublished - 9 May 2019

Cite this

Bixby, H., Bentham, J., Zhou, B., Di Cesare, M., Paciorek, C. J., Bennett, J. E., ... NCD Risk Factor Collaboration (NCD-RisC) (2019). Rising rural body-mass index is the main driver of the global obesity epidemic in adults. Nature, 569(7755), 260-264. https://doi.org/10.1038/s41586-019-1171-x