Thirty-Year Urbanization Trajectories and Obesity in Modernizing China

Abstract

The effects of long-term urbanization changes in obesity are unclear. Data were obtained from the China Health and Nutrition Survey (CHNS) 1989–2018. A multidimensional urbanicity index was used to define the urbanization level for communities. Group-based trajectory modeling was used to identify distinct urbanization change trajectories. Gender-stratified multilevel models were used to investigate the association between urbanization trajectories and weight/BMI, through the PROC MIXED procedure, as well as the risk of being overweight + obesity (OO)/obesity (OB), through the PROC GLIMMIX procedure. A total of three patterns of the trajectory of change in urbanization were identified in 304 communities (with 1862 measurements). A total of 25.8% of communities had a low initial urbanization level and continuous increase (termed “LU”), 22.2% of communities had a low–middle initial urbanization level and constant increase (termed “LMU”), and 52.0% of communities had a middle–high initial urbanization and significant increase before 2009, followed by a stable platform since then (termed “MHU”). During the 30 follow-up years, a total of 69490 visits, contributed by 16768 adult participants, were included in the analysis. In the period, weight and BMI were observed in an increasing trend in all urbanization trajectory groups, among both men and women. Compared with LU, men living in MHU were related to higher weight, BMI, and an increased risk of OO (OR: 1.46, 95%CI: 1.26 to 1.69). No significant associations were found between urbanization trajectories and OB risk in men. Among women, the associations between urbanization and all obesity indicators became insignificant after controlling the covariates. Obesity indicators increased along with urbanization in the past thirty years in China. However, the differences among urbanization trajectories narrowed over time. More urbanized features were only significantly associated with a higher risk of obesity indicators in Chinese men. The effects of urbanization on obesity among women were buffered.

Ethnic differences in eating patterns and their associations with obesity among adults in West China

“…In addition, some other studies have reported high obesity rates among indigenous or minority populations in transition from traditional to modern lifestyles (25) . This transition among minority populations was similar to the nutritional and lifestyle transition and subsequent increasing obesity among the entire Chinese population during urbanisation, as revealed by the China Health and Nutrition Survey (26) . However, urbanisation among minority groups happened later and grew slower than that in Han people, a result of the lower proportion of urban residents in ethnic autonomous regions than other Han-dominated provinces in China (8) .…”

Asia’s Growing Contribution to Obesity Surgery Research: A 40-year Bibliometric Analysis

“…Affluent nations like Singapore and Japan potentially attribute their significant contributions to high-income levels [ 23 ], while the high prevalence of obesity in Middle Eastern countries such as Turkey, Israel, Saudi Arabia, Iran, and Lebanon significantly factors into their research output [ 26 ]. In swiftly urbanizing nations like China, escalating obesity rates are seemingly in sync with the pace of urbanization [ 27 ], with eastern regions outpacing western ones, reflecting economic disparities. Eastern China, home to several developed provinces or cities such as Taiwan, Shanghai, Guangdong, Beijing, and Jiangsu, along with prestigious universities and hospitals, is better equipped for advanced studies and technological exploration [ 28 ].…”

Built environment as a risk factor for adult overweight and obesity: Evidence from a longitudinal geospatial analysis in Indonesia

“…A recent study of Indonesia's Sulawesi Province using built-up data from GHSL finds urbanization unfolding outside areas officially designated with implications not only for the provision of municipal services but also the potential to misclassify relevant aspects of the health and well-being [35]. A recent study in China that evaluated urbanization trajectories found a higher risk of being overweight and obese among men in areas with more urbanized features with no differences observed among women by urbanization trajectories [36]. As urbanization proceeds in Indonesia, it is expected that built-up percentages will increase much more than the 6%-point change we observed in the past which poses an increased risk of overweight and obesity over time.…”