Obesity rising faster in rural areas than cities

Obesity is increasing more rapidly in the world's rural areas than in cities, according to a new study of global trends in body-mass index (BMI).

The research, led by Imperial College London and published in Nature, analysed the height and weight data of more than 112 million adults across urban and rural areas of 200 countries and territories between 1985 and 2017.

Height and weight can be used to calculate BMI, an internationally recognised scale which tells us whether an individual has a healthy weight for their height.

The study, involving a network of more than 1000 researchers across the world, found that from 1985 to 2017, BMI rose by an average of 2.0 kg/m2 in women and 2.2 kg/m2 in men globally, equivalent to each person becoming 5-6 kg heavier. More than half of the global rise over these 33 years was due to increases in BMI in rural areas. In some low- and middle-income countries, rural areas were responsible for over 80 per cent of the increase.

The team found that since 1985, average BMI in rural areas has increased by 2.1 kg/m2 in both women and men. But in cities, the increase was 1.3 kg/m2 and 1.6 kg/m2 in women and men respectively.

These trends have led to striking changes in the geography of BMI over the three decades. In 1985, urban men and women in over three quarters of the countries had a higher BMI than their rural counterparts. Over time, the gap between urban and rural BMI in many of these countries shrank or even reversed.

"The results of this massive global study overturn commonly held perceptions that more people living in cities is the main cause of the global rise in obesity," explains senior author Professor Majid Ezzati of Imperial's School of Public Health. "This means that we need to rethink how we tackle this global health problem."

The team found important differences between high-, middle-, and low-income countries. In high-income countries, the study showed that BMI has been generally higher in rural areas since 1985, especially for women. The researchers suggest this is due to the disadvantages experienced by those living outside cities: lower income and education, limited availability and higher price of healthy foods, and fewer leisure and sports facilities.

"Discussions around public health tend to focus more on the negative aspects of living in cities," says Professor Ezzati. "In fact, cities provide a wealth of opportunities for better nutrition, more physical exercise and recreation, and overall improved health. These things are often harder to find in rural areas."

Meanwhile, rural areas in low- and middle-income countries have seen shifts towards higher incomes, better infrastructure, more mechanised agriculture and increased car use, all of which bring numerous health benefits, but also lead to lower energy expenditure and to more spending on food, which can be processed and low-quality when sufficient regulations are not in place. All these factors contribute to faster increase in BMI in rural areas.

"As countries increase in wealth, the challenge for rural populations changes from affording enough to eat, to affording good quality food," adds Professor Ezzati.

The main exception to the global trend was sub-Saharan Africa where women gained weight more rapidly in cities, possibly because of more low-energy work (such as office work), less need for physical domestic tasks such as collecting firewood and fetching water, shorter commutes and greater access to processed foods.

Regional and country data on BMI in rural and urban populations

  • Nationally, BMI decreased slightly between 1985 and 2017 among women in twelve countries in Europe (Greece, Spain, Lithuania, Czech Republic, Italy, Portugal, Serbia, France, Malta) and Asia Pacific (Nauru, Singapore and Japan). At the other extreme, it increased by more than 5 kg/m2 in women in Egypt and Honduras.
  • Among men, BMI increased in every country, with the largest increases in Saint Lucia, Bahrain, Peru, China, Dominican Republic and the USA, all by more than 3.1 kg/m2.
  • Rural women in Bangladesh had the lowest BMI recorded in the study in 1985, at 17.7 kg/m2. Men living in rural Ethiopia had the lowest male BMI at 18.4 kg/m2, also in 1985.
  • Urban women from the US South Pacific territory of American Samoa had the highest BMI recorded, at 35.4 kg/m2 in 2017. Rural men from the same country were highest for males, at 34.6 kg/m2 also in 2017.
  • In 2017, urban women and men in sub-Saharan Africa weighed more than their rural counterparts by a bigger margin than anywhere else, especially women in west African countries like Niger, Burkina Faso, Togo and Ghana.
  • Rural women in central and eastern European countries were heavier than their urban counterparts by the biggest margin -- around 1 kg/m2 or more in Belarus, Czech Republic and Latvia. This gap has remained largely unchanged since 1985.
  • For rural men, the biggest margins of rural over urban BMI were in Sweden, Czech Republic, Ireland, Australia, Austria and the USA -- all with rural BMI more than 0.35 kg/m2 higher than urban BMI.

The research was funded by the Wellcome Trust, the Medical Research Council, the Royal Society and the Academy of Medical Sciences.

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Materials provided by Imperial College London. Note: Content may be edited for style and length.


Depression, anxiety may take same toll on health as smoking and obesity

An annual physical typically involves a weight check and questions about unhealthy habits like smoking, but a new study from UC San Francisco suggests health care providers may be overlooking a critical question: Are you depressed or anxious?

Anxiety and depression may be leading predictors of conditions ranging from heart disease and high blood pressure to arthritis, headaches, back pain and stomach upset, having similar effects as long-established risk factors like smoking and obesity, according to the new research.

In the study, first author Andrea Niles, PhD, and senior author Aoife O'Donovan, PhD, of the UCSF Department of Psychiatry and the San Francisco VA Medical Center, looked at the health data of more than 15,000 older adults over a four-year period.

They found that 16 percent (2,225) suffered from high levels of anxiety and depression, 31 percent (4,737) were obese and 14 percent (2,125) were current smokers, according to their study published in the journal Health Psychology on Dec. 17, 2018.

Participants with high levels of anxiety and depression were found to face 65 percent increased odds for a heart condition, 64 percent for stroke, 50 percent for high blood pressure and 87 for arthritis, compared to those without anxiety and depression.

"These increased odds are similar to those of participants who are smokers or are obese," said O'Donovan, who, with Niles, also is affiliated with UCSF Weill Institute for Neurosciences. "However, for arthritis, high anxiety and depression seem to confer higher risks than smoking and obesity."

Cancer an Exception to Conditions Impacted by Depression and Anxiety

Unlike the other conditions investigated, the authors found that high levels of depression and anxiety were not associated with cancer incidence. This confirms results from previous studies, but contradicts a prevailing idea shared by many patients.

"Our findings are in line with a lot of other studies showing that psychological distress is not a strong predictor of many types of cancer," O'Donovan said. "On top of highlighting that mental health matters for a whole host of medical illnesses, it is important that we promote these null findings. We need to stop attributing cancer diagnoses to histories of stress, depression and anxiety."

Niles and O'Donovan discovered that symptoms such as headache, stomach upset, back pain and shortness of breath increased exponentially in association with high stress and depression. Odds for headache, for example, were 161 percent higher in this group, compared with no increase among the participants who were obese and smokers.

Treating Mental Health Can Cut Health Care Costs

"Anxiety and depression symptoms are strongly linked to poor physical health, yet these conditions continue to receive limited attention in primary care settings, compared to smoking and obesity," Niles said. "To our knowledge this is the first study that directly compared anxiety and depression to obesity and smoking as prospective risk factors for disease onset in long-term studies."

The results of the study underscore the "long-term costs of untreated depression and anxiety," said O'Donovan. "They serve as a reminder that treating mental health conditions can save money for health systems."

The two authors evaluated health data from a government study of 15,418 retirees, whose average age was 68. Depression and anxiety symptoms were assessed using data from participant interviews. Participants were questioned about their current smoking status, while weight was self-reported or measured during in-person visits. Medical diagnoses and somatic symptoms were reported by participants.

As More Latin Americans Eat Processed Food, Obesity Rates Surge

Nearly 60 percent of Latin Americans are overweight, according to a UN report

Latin America, once plagued by malnutrition, now faces a different type of public health crisis as processed food increasingly replaces traditionally prepared dishes, leading to a surge in obesity rates, a United Nations report showed on Thursday.

Nearly 58 percent of the region's inhabitants, or close to 360 million people, is either overweight or obese, said the report by the United Nations' Food and Agriculture Organization (FAO) and the Pan American Health Organization (PAHO).

The rapid jump in obesity rates has crisscrossed the region, affecting Latin Americans "regardless of their economic situation, place of residence or ethnic origin," it said.

That has occurred partly as economic growth, increased urbanization, higher average incomes and the region's integration into international markets have reduced the consumption of traditionally prepared food and raised that of ultra-processed products, the report said.

The problem is greatest in countries that are net food importers.

The countries with the highest levels of obesity are the Bahamas, Mexico and Chile, with rates of 69 percent, 64 percent and 63 percent, respectively.

Still, even as obesity rates surge, Latin America is still home to the nation with the highest rate of undernourishment; in Haiti, 53 percent of the population is undernourished.

  • Published in World

Scientists find how obesity gene works, a clue to treatment

Scientists have finally figured out how the key gene tied to obesity makes people fat, a major discovery that could open the door to an entirely new approach to the problem beyond diet and exercise.

The work solves a big mystery: Since 2007, researchers have known that a gene called FTO was related to obesity, but they didn't know how, and could not tie it to appetite or other known factors.

Now experiments reveal that a faulty version of the gene causes energy from food to be stored as fat rather than burned. Genetic tinkering in mice and on human cells in the lab suggests this can be reversed, giving hope that a drug or other treatment might be developed to do the same in people.

The work was led by scientists at MIT and Harvard University and published online yesterday by the New England Journal of Medicine.

The discovery challenges the notion that "when people get obese it was basically their own choice because they choose to eat too much or not exercise," said study leader Melina Claussnitzer, a genetics specialist at Harvard-affiliated Beth Israel Deaconess Medical Center. "For the first time, genetics has revealed a mechanism in obesity that was not really suspected before" and gives a third explanation or factor that's involved.

Independent experts praised the discovery.

"It's a big deal," said Dr. Clifford Rosen, a scientist at Maine Medical Center Research Institute and an associate editor at the medical journal.

"A lot of people think the obesity epidemic is all about eating too much," but our fat cells play a role in how food gets used, he said. With this discovery, "you now have a pathway for drugs that can make those fat cells work differently."

Researchers can't guess how long it might take before a drug based on the new findings becomes available.

Obesity costs global economy $2 trillion: Study

LONDON: The global cost of obesity amounts to a whopping $2 trillion annually - or 2.8 per cent of world GDP - nearly equivalent to the impact of smoking or armed violence, war and terrorism, according to a new report.

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