The body-mass index (BMI) has increased in many in most countries, parallel to a shift in the proportion of the population who live in cities. This has led to the view that the urban lifestyle is a major driver of the global rise in obesity. Majid Ezzati and colleagues analyse data trends in BMI for over 100 million adults worldwide, separated by rural and urban place of residence from 1985 to 2017. Contrary to the dominant paradigm, the majority of the global rise in mean BMI, especially in some low- and middle-income regions, was due to increases in the BMI of rural populations, which is rising at the same rate or faster in rural populations compared to those living in cities. The authors call for more attention to be paid to inequalities in rural nutrition and infrastructure to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage.
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