Several fiscal and regulatory approaches can reach rural areas globally.
These range from programmes that combine comprehensive marketing controls, school-food controls and labels on ultra-processed foods, such as those instituted in Chile, to the taxation of unhealthy ultra-processed foods and beverages, as in Mexico.
Rural hunger, wasting and stunting are rapidly being replaced by overweight and obesity in most regions of the world except sub-Saharan Africa, South Asia and a small number of countries in other areas.
This finding is fundamental, because the main focus of geographically targeted obesity-prevention programmes and policies around the globe has been to address urban obesity.
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.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).It was thought that the levels of physical activity in rural areas were much higher than those in cities, and hence that the likelihood of weight gain was much smaller in rural than in urban populations.Research has shown that in some low-income countries, such as China, people living in urban areas have diets that are distinctly different from those of their rural counterparts.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.This cookie stores just a session ID; no other information is captured.Accepting the NEJM cookie is necessary to use the website.