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Furthermore, the inhabitants of cities have better options for transport, greater access to smartphones and cable television, and more non-physical leisure opportunities than those living in rural areas.
They are also more likely to have occupations that are not very physically demanding. By contrast, rural areas have been seen as places where heavy work on farms, forestry and mining-related activities leads to high levels of energy expenditure.
In this context, the paper by the NCD Risk Factor Collaboration is ground-breaking, because it pulls together the latest data from almost all countries to comprehensively examine global BMI trends.
The results show that the levels of overweight and obesity are already greater in rural than in urban areas in all high-income countries, and also suggest that the rate of change in many LMICs is such that the levels of overweight and obesity in rural areas will soon match, if not exceed, those in urban areas.
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However, evidence for this association has been based mainly on calculations of the body mass index (BMI)—the most frequently used tool for measuring overweight and obesity—at the time of study.
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.