TY - JOUR
T1 - Worldwide trends in underweight and obesity from 1990 to 2022
T2 - a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults
AU - Phelps, Nowell H.
AU - Singleton, Rosie K.
AU - Zhou, Bin
AU - Heap, Rachel A.
AU - Mishra, Anu
AU - Bennett, James E.
AU - Paciorek, Christopher J.
AU - Lhoste, Victor PF
AU - Carrillo-Larco, Rodrigo M.
AU - Stevens, Gretchen A.
AU - Rodriguez-Martinez, Andrea
AU - Bixby, Honor
AU - Bentham, James
AU - Di Cesare, Mariachiara
AU - Danaei, Goodarz
AU - Rayner, Archie W.
AU - Barradas-Pires, Ana
AU - Cowan, Melanie J.
AU - Savin, Stefan
AU - Riley, Leanne M.
AU - Aguilar-Salinas, Carlos A.
AU - Baker, Jennifer L.
AU - Barkat, Amina
AU - Bhutta, Zulfiqar A.
AU - Branca, Francesco
AU - Caixeta, Roberta B.
AU - Cuschieri, Sarah
AU - Farzadfar, Farshad
AU - Ganapathy, Shubash
AU - Ikeda, Nayu
AU - Iotova, Violeta
AU - Kengne, Andre P.
AU - Khang, Young Ho
AU - Laxmaiah, Avula
AU - Lin, Hsien Ho
AU - Ma, Jun
AU - Mbanya, Jean Claude N.
AU - Miranda, J. Jaime
AU - Pradeepa, Rajendra
AU - Rodríguez-Artalejo, Fernando
AU - Sorić, Maroje
AU - Turley, Maria
AU - Wang, Limin
AU - Gehring, Ulrike
AU - Nguyen, Nguyen D.
AU - Onland-Moret, N. Charlotte
AU - Timmermans, Erik J.
AU - van der Schouw, Yvonne T.
AU - Verschuren, WM Monique
AU - Widyahening, Indah S.
N1 - Publisher Copyright:
© 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
PY - 2024/3/16
Y1 - 2024/3/16
N2 - Background: Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods: We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For school-aged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). Findings: From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation: The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity. Funding: UK Medical Research Council, UK Research and Innovation (Research England), UK Research and Innovation (Innovate UK), and European Union.
AB - Background: Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods: We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For school-aged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). Findings: From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation: The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity. Funding: UK Medical Research Council, UK Research and Innovation (Research England), UK Research and Innovation (Innovate UK), and European Union.
UR - http://www.scopus.com/inward/record.url?scp=85186605044&partnerID=8YFLogxK
U2 - 10.1016/S0140-6736(23)02750-2
DO - 10.1016/S0140-6736(23)02750-2
M3 - Article
C2 - 38432237
AN - SCOPUS:85186605044
SN - 0140-6736
VL - 403
SP - 1027
EP - 1050
JO - The Lancet
JF - The Lancet
IS - 10431
M1 - 10.1016/S0140-6736(23)02750-2
ER -