It is unknown whether the characteristics of communities in which immigrants settle further influences this risk. Migration studies have demonstrated that Asian and African populations who move to more Westernized countries experience an accelerated risk of obesity-related conditions, including diabetes within the first 10 years of arrival, a period marked by changes in lifestyle caused by acculturation ( 16). Recent immigrants may be particularly susceptible to such effects. The growing literature suggests that residents living in areas that are more walkable are less likely to be obese ( 11– 15). Evidence from industrialized countries suggest that physical activity levels are lower in newly developed areas-characterized by urban sprawl-than older, more traditionally designed neighborhoods, in part because of the reliance suburban design places on mass automobile transit ( 9– 12). Thus, the way we structure and build our cities will play an increasingly greater role in shaping the health of the world’s population. The move from a rural, agrarian existence to urban living is associated with increased exposure to unhealthy foods, fewer opportunities for physical activity, and a heightened risk of becoming obese and developing diabetes ( 3, 6).įor the first time in human history, one-half of the world’s population is living in urban areas, and most of the future population growth is expected to occur in such settings ( 8). In these settings, urbanization has proceeded at a particularly rapid pace, incited by economic development, population growth, and rural-to-urban migration ( 6, 8). In developing countries, the rise in diabetes seems to be intricately linked to shifts in urbanization ( 5, 6). Local residents in many of these regions carry a high genetic predisposition toward developing diabetes, which renders them particularly vulnerable to elements of the environment that contribute to obesity ( 4– 7). In many developing countries, globalization as a phenomenon has led not only to economic growth and development but to an increasingly “Western” way of life characterized by sedentarism and the overconsumption of high-energy foods that are low in nutrients ( 5, 6). The largest increases in diabetes prevalence are projected to occur in low- and middle-income countries, with the greatest relative rises expected in the Middle East, sub-Saharan Africa, and India ( 2, 4). According to the World Health Organization, nearly 350 million people worldwide have diabetes, and these figures will continue to climb, fueled by the ongoing epidemic of obesity and aging of the world’s population ( 1– 3). Recent decades have seen an unprecedented rise in the global burden of diabetes.
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