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

Thumbnail Image
File version

Version of Record (VoR)

Bixby, H
Bentham, J
Zhou, B
Di Cesare, M
Paciorek, CJ
Bennett, JE
Taddei, C
Stevens, GA
Rodriguez-Martinez, A
Carrillo-Larco, RM
Khang, YH
Sorić, M
Gregg, EW
Ahmadvand, A
et al.
Griffith University Author(s)
Primary Supervisor
Other Supervisors
File type(s)

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.

Journal Title


Conference Title
Book Title




Thesis Type
Degree Program
Publisher link
Patent number
Grant identifier(s)
Rights Statement
Rights Statement

© The authors 2020. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

Item Access Status
Access the data
Related item(s)

Clinical sciences

Health services and systems

Public health

Persistent link to this record

Bixby, H; Bentham, J; Zhou, B; Di Cesare, M; Paciorek, CJ; Bennett, JE; Taddei, C; Stevens, GA; Rodriguez-Martinez, A; Carrillo-Larco, RM; Khang, YH; Sorić, M; Gregg, EW; Miranda, JJ; Bhutta, ZA; Savin, S; Sophiea, MK; Iurilli, MLC; Solomon, BD; Cowan, MJ; Riley, LM; Danaei, G; Bovet, P; Chirita-Emandi, A; Hambleton, IR; Hayes, AJ; Ikeda, N; Kengne, AP; Laxmaiah, A; Li, Y; McGarvey, ST; Mostafa, A; Neovius, M; Starc, G; Zainuddin, AA; Abarca-Gómez, L; Abdeen, ZA; Abdrakhmanova, S; Abdul Ghaffar, S; Abdul Hamid, Z; Abubakar Garba, J; Abu-Rmeileh, NM; Acosta-Cazares, B; Adams, RJ; Aekplakorn, W; Afsana, K; Agdeppa, IA; Aguilar-Salinas, CA; Agyemang, C; Ahmad, MH; Ahmad, NA; Ahmadi, N; Ahmadvand, et al., Rising rural body-mass index is the main driver of the global obesity epidemic in adults, Nature, 2019, 569 (7755), pp. 260-264