India's rural transformation and rising obesity burden.

• We show that the rise in rural obesity in India is closely associated with urbanization of its rural spaces. • These risks have increased disproportionately among lower socio-economic classes. • Those living near towns with a population of 50,000 & those living in more economically developed states are at greater risk. • Greater diet diversity alleviates the urban effect of the rural obesity pandemic. While obesity across rural India has doubled in the last decade, research explaining such an unprecedented change is sparse. This paper shows that the rise in the incidence of rural obesity is associated with the process of structural transformation, especially within rural spaces. As the distance to nearby towns from the villages has reduced, urban proximity not only leads to improved livelihoods but also a change in dietary practices and access to processed food. Combining the rural sample of India's latest National Family Health Survey (2015–16) with the estimates for town distance from the village clusters, we show that an additional kilometer of reduction in rural–urban distance increases the risk of obesity among women by 0.06 percent. Our estimates imply that for every kilometer of reduction in rural–urban proximity 3000 rural women become at-risk for obesity. Heterogeneity analysis shows that this burden is higher in towns with a population of over 50,000. We also find that the risk has increased disproportionately among the lower socio-economic classes. Similarly, states at a more mature stage of structural transformation face higher risk of obesity. Finally, we find that higher dietary diversity reduces the influence of urban growth on rural obesity. Our findings underscore the looming dual burden of malnutrition among developing countries and suggest that nutrition policies that promote diet diversity could be a panacea. [ABSTRACT FROM AUTHOR]