Accumulated exposure to rural areas of residence over the life course is associated with overweight and obesity in adulthood: a 25-year prospective cohort study.
This prospective cohort study investigated whether body mass index (BMI) and weight status in mid-adulthood were predicted by trajectories of urban-rural residence from childhood to adulthood.



Participants aged 7-15 years in 1985 (n = 8498) were followed up in 2004-2006 (n = 3999, aged 26-36 years) and 2009-2011 (n = 3049, aged 31-41 years). Area of residence (AOR) was classified as urban or rural at each time point. BMI and/or weight status was calculated from self-reported weight and height (2009-2011). We tested which of three life-course models ("accumulation," "sensitive period," "mobility") best explained the AOR-BMI and/or weight status association using a novel life-course modeling framework.



Accumulation and sensitive period models best described the effect of AOR on mid-adulthood BMI and weight status. Those with greater accumulated exposure to rural areas had a higher BMI (β = 0.29 kg/m2per time in a rural area, P = .005) and were more likely obese (relative risk = 1.13 per time in a rural area, P = .002). Living in rural areas at ages 26-30 years was also associated with a higher BMI and obesity in mid-adulthood.



Greater cumulative exposure to rurality and exposure during the "sensitive period" of young adulthood is associated with obesity in middle-aged adults. This study highlights the important contribution of context to the development of obesity over the life course.
Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
Kira A E
KA
Patterson
Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
Seana L
SL
Gall
Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
Alison J
AJ
Venn
Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
Petr
P
Otahal
Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
Leigh
L
Blizzard
Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia; The George Institute for Global Health, University of Oxford, Oxford, UK.
Terry
T
Dwyer
Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia. Electronic address: Verity.Cleland@utas.edu.au.
Verity J
VJ
Cleland
D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D009765:Obesity / Q000453:epidemiology*; D011157:Population Dynamics; D011446:Prospective Studies; D012111:Residence Characteristics; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014505:Urban Population / Q000706:statistics & numerical data*
Body mass index; Body weight; Life course; Longitudinal studies; Obesity; Rural health