Background: It is generally believed that overweight is less prevalent than undernutrition in the developing world, particularly in rural areas, and that it is concentrated in higher socioeconomic status (SES) groups.
Objective: The purpose of this study was to examine patterns of adult female overweight and underweight in the developing world by using categories of urban or rural status and SES strata.
Design: Body mass index (BMI; in kg/m2) data collected in 36 countries from 1992 to 2000 by nationally representative cross-sectional surveys of women aged 20–49 y (n = 148579) were classified as indicating underweight (BMI < 18.5) and overweight (BMI = 25). Associations between the nutritional status of urban and rural women and each country’s per capita gross national income (GNI) and level of urbanization were explored in the overall sample and among different SES groups.
Results: Overweight exceeded underweight in well over half of the countries: the median ratio of overweight to underweight was 5.8 in urban and 2.1 in rural areas. Countries with high GNIs and high levels of urbanization had not only high absolute prevalences of overweight but also small urban-rural differences in overweight and very high ratios of overweight to underweight. In the more-developed countries, overweight among low-SES women was high in both rural (38%) and urban (51%) settings. Even many poor countries, countries in which underweight persists as a significant problem, had fairly high prevalences of rural overweight.
Conclusions: In most developing economies, prevalences of overweight in young women residing in both urban and rural areas are higher than those in underweight women, especially in countries at higher levels of socioeconomic development. Research is needed to assess male and child overweight to understand the dynamics facing these groups as well.