Elsevier

World Development

Volume 27, Issue 11, November 1999, Pages 1905-1916
World Development

Urbanization, Lifestyle Changes and the Nutrition Transition

https://doi.org/10.1016/S0305-750X(99)00094-7Get rights and content

Abstract

Broad shifts are occurring at a rapid pace in the structure of diet, physical activity patterns, and obesity patterns in urban areas in lower income countries. Examples from China and selected other countries along with pooled time-series and cross-sectional analysis of shifts in diet and occupation structure associated with urbanization are presented. Patterns of obesity from nationally representative surveys indicate that the problems of obesity and dietary excess represent an important challenge facing many lower income countries, particularly their urban populations.

Introduction

The forces that have created major shifts in fertility and mortality patterns have also been linked with equally important shifts in diet, physical activity, and body composition. The concept of the nutrition transition relates to the sense that the underlying shifts in economic, demographic, and related forces that affect fertility, mortality, and disease patterns also affect the structure of diet, physical activity, and body composition trends. The concept of the nutrition transition focuses on large shifts in the structure of diet. The same underlying socioeconomic and demographic changes associated with these dietary changes are also linked with shifts in physical activity, average stature, and body composition patterns. As we will show below, urban residency is linked with large changes in diet and body composition and also with high levels of obesity in lower and middle-income countries.

The nutrition transition has followed five broad patterns: (a) hunting and gathering food, (b) famine, (c) receding famine, (d) degenerative disease, and (e) behavioral change. The major features of each pattern are summarized in Table 1 (Popkin, 1993). These patterns are not restricted to particular periods of human history. For convenience, the patterns are outlined in past tense as historical developments; however, “earlier” patterns are not restricted to the periods in which they first arose, but continue to characterize certain geographic and socioeconomic subpopulations.

As others have shown (Haddad, Ruel and Garrett, 1999), many urban populations in the world still face food insecurity and related problems. But in the same populations where undernutrition and food insecurity are found, other subpopulations, often even in the same household, suffer dietary excess and obesity. It is this complex intertwining of economic and social conditions that creates this rapid transition among some urban subpopulation groups offers a major challenge for food and nutrition policy in many countries in Asia, Africa, Latin America, and the Caribbean.

This article summarizes some of the information that documents these broad shifts in the structure of diet, physical activity patterns, and obesity patterns in urban areas in lower income countries. The particular focus is on the importance of urban residence in this process. Unfortunately the analysis is static in that we do not have many panels that can allow us to unravel the dynamic changes in urban residence and its effects on diet and activity. We have a few examples from China. Rather, we must use crosscountry comparisons along with the limited longitudinal analysis and our understanding of the urbanization process to infer anything about the dynamic processes faced by the world.

Section snippets

The structure of diet and urbanization

People living in urban areas consume diets distinctly different from those of their rural counterparts and the general shifts in their diets enhance energy and fat density and lead to great potential for chronic disease-related health problems. A large descriptive literature on comparisons of urban and rural diets can be summarized as urban diets show trends toward consumption of superior grains (e.g., rice or wheat, rather than corn or millet); more milled and polished grains (e.g., rice,

Crossnational trends

A major change in economic structure associated with the nutrition transition is the shift from a preindustrial agrarian economy to industrialization. This transformation then accelerates; the service sector grows rapidly, industrial production is dominated by capital-intensive processes, and time-allocation patterns change dramatically. Associated socioeconomic changes especially important in the nutrition transition are changes in women's roles (especially with respect to patterns of time

Crosscountry descriptive work

Body mass index (BMI) is the standard population-based measure of overweight and obesity status. This uses height in meters divided by weight in kilograms squared. For adults, the cutoffs used to delineate obesity are less than 18.5 for thinness (chronic energy deficiency), 18.5 to 24.99 for normal, 25.0 to 29.99 for overweight Grade I, 30.0 to 39.99 for overweight Grade II, and 40.0 and above for overweight Grade III (WHO, 1995). For this article, Grades II and III are combined. Ideally we

Health implications

A range of changes in health accompany the nutrition transition in urban areas. Most immediate seems to be the emerging epidemic of non-insulin-dependent diabetes mellitus (NIDDM). There is a growing literature that documents rapid increases in NIDDM in many lower-income countries (Hodge et al., 1996, Hodge et al., 1997, Levitt et al., 1993, Zimmet, McCarty and de Courten, 1997. Other work indicates that many of the other cardiovascular conditions related to NIDDM, such as hypertension,

Discussion

This article presents a great deal of descriptive data that show that urban areas in lower and middle-income countries are further along on the shift toward more “Western diets” dominated by more refined foods and a higher fat diet and also a more sedentary lifestyle and more obesity. The conditions that are leading to the rapid change in diet, activity, and obesity are linked with many chronic diseases. Together these effects are leading to a rapid shift in the composition of disease in

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