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

‘Unschooling’ In The Context Of Growing Mental Health Concerns Among Indian Students: The Journey Of 3 Middle-Class Unschooling Families

India’s education system has often been critiqued for aspects of rigidness, competition, work overload, hierarchic power, and lack of creativity, resulting in feelings of stress and anxiety in students. Interestingly, alternative education approaches have come up in the past few decades in response to formal education, including the rise of unschooling. In this article the self-reported journeys of three unschooling parents are analyzed to bring insights into 1) what role stress and anxiety might play in the decisions of Indian parents to choose unschooling, 2) how key advantages and disadvantages of unschooling are shaped and recognised by unschooling parents, 3) how personal experiences of ‘stress’ are appreciated and experienced in Indian unschooling family contexts, and 4) what distinctively different processes are evident in the upbringing process of unschooled children, compared with those existing in formal education systems. Results reveal that a sense of tedium in formal classrooms, as well as a problematisation of stress, motivates parents’decision for unschooling. Social pressures and challenges are experienced, yet also welcomed by parents as part of the unschooling journey. ‘Stress’ is differently framed and experienced in the stories of unschooling parents, emphasizing the stress which is evoked through unrestricted self-governed learning processes, as opposed to ‘distress’ experienced in systems of directive and sometimes coercive learning. Finally, this article reflects on aspects of ‘trust’ and ‘self-agency’ which were found meaningful in unschooling and how to potentially encourage such notions in formal education settings to prevent mental health issues in children and youth

EMDR in the Time of the COVID-19 Pandemic in India: A Short Report

During the period of the COVID-19 pandemic from the start of 2020 till late 2021, mental health services—seeking and providing—have gone through various changes and adaptations. In this article, we report on eye movement desensitization and reprocessing (EMDR) psychotherapy service providers in India, and how they adapted to the changing circumstances during this time, using a narrative enquiry approach

Rohingyas and Sri Lankan Tamil refugees in Tamil Nadu: a replicable model of semi-permanent resettlement in low-resource settings

Purpose: After being forced to flee their respective home countries, Sri Lankan Tamils and Rohingya refugees resettled in the Indian state of Tamil Nadu. This study attempts to explore the extent to which the state has provided means for integration in the absence of refugee protection laws and citizenship. Design/methodology/approach: A qualitative research approach was used, including in-depth interviews (IDIs) and focus group discussions (FGDs) with participants from both refugee groups between 2019 and early 2020. A representative sample of male and female Sri Lankan Tamils, living in or outside government camps, in urban and rural areas, was included (total number = 75). Similarly, a representative sample of the Rohingya refugee community was included for this study (n = 44). Findings: Despite constraints imposed by inadequate infrastructure, the study finds that Sri Lankan Tamils and Rohingyas both show to be progressively integrated in local society and have been capable of fulfilling some important basic livelihood needs, especially with regards to education. Some areas for improvement are identified as well, most urgently in terms of health and accommodation. Practical implications: Other states in India, as well as in similar low-income countries (LICs), could learn from the current case study with regards to administering workable policies for small groups of refugees. Originality/value: With minimal state facilitation and within the context of limited legal backing, refugee groups have somewhat managed to re-built their lives. This study identifies the threshold of requirements that make this achievement possible and suggests what more could be done to further advance the current state

Mitigating the COVID-19 pandemic in India:an in-depth exploration of challenges and opportunities for three vulnerable population groups

Purpose: The COVID-19 pandemic is certain to have an unprecedented impact on the global population, but marginalized and vulnerable groups in low-income countries (LICs) are predicted to carry the largest burden. This study focuses on the implications of COVID-19-related measures on three population groups in India, including (1) migrant laborers (of which a majority come from Scheduled Castes (SCs) and Scheduled Tribes (STs), as well as Other Backward Classes (OBCs)), (2) children from low-income families and, (3) refugees and internally displaced persons (IDPs). Design/methodology/approach: This study adopts a sequential mixed-method research design. A desk-based study of a selection of government reports was undertaken on the COVID-19-related mitigation measures. The desk study was followed by in-depth interviews with purposively recruited high-ranking experts in specific sectors of policy implementation and service delivery across the country. Findings: The outcomes of this study shed light on (1) the most urgent needs that need to be addressed per population group, (2) the variety of state-level responses as well as best practices observed to deal with mitigation issues and (3) opportunities for quick relief as well as more long-term solutions. Practical implications: The COVID-19 pandemic has not only reduced people's means of maintaining a livelihood but has simultaneously revealed some of India's long-standing problems with infrastructure and resource distribution in a range of sectors, including nutrition and health, education, etc. There is an urgent need to construct effective pathways to trace and respond to those people who are desolate, and to learn from – and support – good practices at the grassroot level. Originality/value: The current study contributes to the discussion on how inclusive public health might be reached

Supported Housing as a recovery option for long-stay patients with severe mental illness in a psychiatric hospital in South India:Learning from an innovative dehospitalization process

Individuals with severe mental illness have long been segregated from living in communities and participating in socio- cultural life. In recent years, owing to progressive legislations and declarations (in India and globally), there has been a growing movement towards promoting social inclusion and community participation, with emphasis on the need to develop alternative and inclusive care paradigms for persons with severe mental illness. However, transitions from inpatient care to community settings is a complex process involving implications at multiple levels involving diverse stakeholders such as mental health service users, care providers, local communities and policy makers. This article studies how the transition from a hospital setting to a community-based recovery model for personals with severe mental illness can be facilitated. It reflects on the innovative process of creating a Supported Housing model in South India, where 11 MH Service users transitioned from a psychiatric ECRC to independent living facilities. Experiences in various phases of the project development, including care provider- and community level responses and feedback were scrutinised to understand the strategies that were employed in enabling the transition. Qualitative methods (including in-depth interviews and naturalistic observations) were used with residents and staff members to explore the challenges they encountered in stabilizing the model, as well as the psychosocial benefits experienced by residents in the last phase. These were complemented with a Brief Psychiatric Rating Scale (BPRS) and WHO Quality of Life scale to compare baseline and post-assessment results and an increase of quality of life. Results display a significant reduction of psychiatric symptoms in patients (p< 0.5). It also describes the challenges encountered in the current context, and strategies that were used to respond and adapt the model to address these concerns effectively. Positive behavioural and psychoemotional changes were observed amongst the residents, significant amongst those being enhanced in their mobility and participation. The article concludes by discussing the implications of this study for the development of innovative community-based models in wider contexts