Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.Peer reviewe

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

Intégration européenne et développement économique

European integration and economic development. The principle of enlarging the European Union (EU) to the associated countries of eastern and central Europe is now admitted by all. Before the effort is made to foresee the economic evolution of the countries applying for membership and thus deducing the consequences for the EU' s economy, the achievements already made during the first five years of economic reform in eastern and central Europe are assessed ; and the conclusions, drawn. This enlargement - not to be identified with economic concerns alone - cannot be separated from the question of the continent's security and stability. Enlargement is not just a response adapted to the risks of eventual, economic and political, instability in applicant countries ; it is also, for the EU, a framework for the economic growth, progress and harmonization that shields from economic instability. At present, the key question is : can the EU adapt its institutions to this new situation ?Le principe de l'élargissement de l'Union européenne (UE) aux pays associés d'Europe centrale et orientale est aujourd'hui acquis. Avant de tenter un exercice prospectif sur l'évolution économique des pays candidats à l'adhésion et d'en déduire les conséquences pour l'économie de l'Union, l'auteur mesure le chemin déjà parcouru au cours des cinq premières années de réforme économique dans les PECO et en tire un certain nombre d'enseignements. Il conclut que l'élargissement, qui ne saurait être identifié à ses seuls enjeux économiques - il est indissociable de la question de la sécurité et de la stabilité du continent européen - constitue non seulement une réponse adaptée aux risques de déstabilisation économique et politique que les pays associés pourraient connaître dans le futur, mais qu'il est également, pour l'UE, un gage de croissance économique et un cadre de progrès et d'harmonisation garantissant contre d'éventuelles déstabilisations économiques. La question centrale est désormais celle de la capacité de l'UE à adapter ses institutions à la nouvelle donne.Delpeuch Jean-Luc. Intégration européenne et développement économique. In: Revue d'études comparatives Est-Ouest, vol. 27, 1996, n°4. pp. 159-168

Accueil et mot d’introduction

Avant d’aller plus loin dans le débat, je tiens à vous accueillir très chaleureusement à Cluny et à vous proposer de nous attarder un instant sur l’intitulé même de la question « Pourquoi (ne pas) commémorer ? », posée en ouverture du colloque qui nous réunit. En nous appuyant sur la définition même du mot « commémoration » et en explicitant le sens du « (ne pas) » qui figure entre parenthèses au centre de la question, nous pourrions reformuler l’interrogation sur un mode shakespearien : « Fa..