The Urban-Rural Race to Obesity

“There’s a heck of a lot of bias among a lot of researchers,” Professor Barry Popkin tells us. On the subject of what’s driving global obesity prevalence, he’s certainly right. Is it the urbanization? To be sure, many authoritative voices promote that view.  But it’s just not that simple. A new paper, published yesterday in Nature, advances precisely the opposite view. In the urban-rural race to obesity, rural populations are winning.

In fact, members of the NCD Risk Factor Collaboration write in this paper, “Rising rural body-mass index is the main driver of the global obesity epidemic in adults.”

A Bold Claim

For a phenomenon as complex as pandemic obesity, claiming to have pegged the “main driver” is bold and probably misleading. The truth is that the interaction of complex systems is driving the rise in obesity that is spreading around the world.

But in some places, it’s growing more rapidly in urban, not rural, settings. Dr. Andre Pascal Kengne is director of the South African Medical Research Council’s Non-Communicable Diseases Research Unit in Cape Town, South Africa. He explains:

Life in rural Africa has remained largely physical — mostly agricultural, mostly manual labor. Domestic activities like fetching water are demanding. People tend to walk.

New Narrative, Same Solutions

Popkin responds to this new narrative with a commentary also published yesterday in Nature. This new insight means that we need more of what we’re already doing in Chile and Mexico to overcome obesity, he says. Tax soda and junk food. Regulate food marketing. Educate people with food labels. His conclusion is that “countries must coordinate multiple regulatory and fiscal programmes similar to those in Chile to truly have an impact on people’s behaviour.”

But we wonder. How can we be so sure that obesity is a pandemic of bad behavior? Decades of banging away on behavior haven’t yielded much in the way of results.

Popkin is certainly right about one thing. There really is “a heck of a lot of bias” about obesity. This includes the bias of people who are certain they have the answer.

Click here for the study and here for the commentary. Click here, here, and here for further reporting.

The Town Mouse and the Country Mouse, illustration by Milo Winter from The Aesop for Children / Project Gutenberg

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May 9, 2019