Elsevier

The Lancet

Volume 384, Issue 9945, 30 August–5 September 2014, Pages 766-781
The Lancet

Articles
Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013

https://doi.org/10.1016/S0140-6736(14)60460-8Get rights and content

Summary

Background

In 2010, overweight and obesity were estimated to cause 3·4 million deaths, 3·9% of years of life lost, and 3·8% of disability-adjusted life-years (DALYs) worldwide. The rise in obesity has led to widespread calls for regular monitoring of changes in overweight and obesity prevalence in all populations. Comparable, up-to-date information about levels and trends is essential to quantify population health effects and to prompt decision makers to prioritise action. We estimate the global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013.

Methods

We systematically identified surveys, reports, and published studies (n=1769) that included data for height and weight, both through physical measurements and self-reports. We used mixed effects linear regression to correct for bias in self-reports. We obtained data for prevalence of obesity and overweight by age, sex, country, and year (n=19 244) with a spatiotemporal Gaussian process regression model to estimate prevalence with 95% uncertainty intervals (UIs).

Findings

Worldwide, the proportion of adults with a body-mass index (BMI) of 25 kg/m2 or greater increased between 1980 and 2013 from 28·8% (95% UI 28·4–29·3) to 36·9% (36·3–37·4) in men, and from 29·8% (29·3–30·2) to 38·0% (37·5–38·5) in women. Prevalence has increased substantially in children and adolescents in developed countries; 23·8% (22·9–24·7) of boys and 22·6% (21·7–23·6) of girls were overweight or obese in 2013. The prevalence of overweight and obesity has also increased in children and adolescents in developing countries, from 8·1% (7·7–8·6) to 12·9% (12·3–13·5) in 2013 for boys and from 8·4% (8·1–8·8) to 13·4% (13·0–13·9) in girls. In adults, estimated prevalence of obesity exceeded 50% in men in Tonga and in women in Kuwait, Kiribati, Federated States of Micronesia, Libya, Qatar, Tonga, and Samoa. Since 2006, the increase in adult obesity in developed countries has slowed down.

Interpretation

Because of the established health risks and substantial increases in prevalence, obesity has become a major global health challenge. Not only is obesity increasing, but no national success stories have been reported in the past 33 years. Urgent global action and leadership is needed to help countries to more effectively intervene.

Funding

Bill & Melinda Gates Foundation.

Introduction

The rising prevalence of overweight and obesity in several countries1, 2, 3, 4, 5 has been described as a global pandemic.6, 7, 8 In 2010, overweight and obesity were estimated to cause 3·4 million deaths, 4% of years of life lost, and 4% of disability-adjusted life-years (DALYs) worldwide.9 Data from studies in the USA have suggested that, unabated, the rise in obesity could lead to future falls in life expectancy.10 Concern about the health risks associated with rising obesity has become nearly universal; member states of WHO introduced a voluntary target to stop the rise in obesity by 2025,11 and widespread calls have been made for regular monitoring of changes in the prevalence of overweight and obesity in all populations.12, 13, 14, 15

Monitoring of trends in the prevalence of overweight and obesity depends on household surveys. Many health interview surveys include questions on self-reported weight and height, which have been used to monitor trends over time;16, 17, 18 however, estimates of body-mass index (BMI) from self-reported data are biased downwards.19, 20, 21 Examination surveys provide direct measurements of weight and height, but few countries do repeated national examination surveys, and estimates from these surveys might be biased because of low participation rates.19 Despite the paucity of complete and unbiased information about overweight and obesity, various systematic analyses have tried to assess levels and trends. Finucane and colleagues2 used data from 369 national surveys and 591 subnational surveys to estimate country trends in mean BMI between 1980 and 2008. De Onis and colleagues3 examined 450 national surveys to estimate trends in childhood obesity and overweight from 1990 to 2020. Investigators have used mean BMI estimates to predict levels of overweight and obesity during 1980–2008.1 Data from these analyses suggest widespread increases in overweight and obesity in the past few decades, although data from recent country-specific analyses suggest that trends might have stabilised in some populations.22, 23, 24

Up-to-date information about levels and trends in overweight and obesity is essential both to quantify the health effects and to prompt decision makers to prioritise action and assess where progress is, or is not, being made. We aimed to analyse trends in overweight and obesity by country during 1980–2013 with data from surveys, reports, and scientific literature.

Section snippets

Definitions and data extraction

Following convention, we defined prevalence of overweight and obesity (in adults [aged >18 years] overweight categorised as BMI ≥25 to <30 kg/m2 and obesity as BMI ≥30 kg/m2; in children, classification is based on the International Obesity Task Force [IOTF] definition; appendix). We reported estimates for 188 countries, 21 regions, and development status (developed or developing) as defined in the GBD study.25 We report estimates of the prevalence of overweight and obesity for men and women

Results

Worldwide, prevalence of overweight and obesity combined rose by 27·5% for adults and 47·1% for children between 1980 and 2013. The number of overweight and obese individuals increased from 857 million in 1980, to 2·1 billion in 2013 (data not shown). Figure 1 shows age-standardised global prevalence of overweight and obesity combined and obesity alone in adults, for developing and developed countries between 1980 and 2013. Worldwide, the proportion of men who were overweight increased from

Discussion

Prevalence of obesity and overweight has risen substantially in the past three decades, with marked variations across countries in the levels and trends in overweight and obesity with distinct regional patterns. In developed countries, increases in obesity that began in the 1980s have attenuated in the past 8 years or so. Conversely, our data suggest that there are likely to be continued increases in the developing world, where almost two in three of the world's obese people live. Island

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