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Worldwide Trends in Underweight and Obesity
Quick Takes
- The combined burden of underweight and obesity has increased in a majority of countries, with many countries experiencing a rise in obesity, which surpassed the declines in underweight children and adults.
- This transition to obesity dominance was already apparent in adults in much of the world in 1990 and has followed in school-aged children and adolescents.
- There is a need throughout the world for social and agricultural policies and food programs that address the remaining burden of being underweight while curbing and reversing the rise in obesity by enhancing access to healthy and nutritious foods.
Study Questions:
What are the trends in the estimated prevalence of underweight and obesity from 1990 to 2022 among adults and children across 200 countries and territories?
Methods:
MEDLINE (via PubMed) was searched for published references from database inception up to September 25, 2023, with no language restrictions, using search terms such as obesity, overweight, thinness, and malnutrition. References were screened to include measured data on height and weight, collected from probabilistic samples of national, subnational, or community populations in individuals ≥5 years of age. A Bayesian hierarchical model was used to estimate trends in the prevalence of different body mass index (BMI) categories, separately for adults (ages ≥20 years) and school-aged children and adolescents (ages 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, the individual and combined prevalence of underweight (BMI <18.5 kg/m2) and obesity (BMI ≥30 kg/m2) were reported. For school-aged children and adolescents, thinness (BMI <2 standard deviations [SD] below the median of the World Health Organization growth reference) and obesity (BMI >2 SD above the median) were reported.
Results:
Data from 3,663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population were included in the present analysis. 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, while the combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean, Polynesia, and Micronesia and countries in the Middle East and North Africa. Obesity prevalence was higher than underweight 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%), and increased among girls in 140 countries (70%) and boys in 137 countries (69%). The countries with the highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were Polynesia, Micronesia, and the Caribbean for both sexes and Chile and Qatar for boys. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness 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.
Conclusions:
The authors conclude that 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 being underweight while curbing and reversing the increase in obesity.
Perspective:
These data demonstrate a continued increase in the prevalence of overweight and obesity across a majority of countries and in both children and adults. Also observed were rates of underweight, which have declined in many countries but also remain unacceptably prevalent. The results support the need for enhanced nutrition and nutritional education to further reduce rates of underweight children and adults while also preventing increased rates of obesity. It is likely that regional geopolitical instability plays a role in the combined burden of underweight and obesity.
Clinical Topics: Prevention
Keywords: Nutrition Therapy, Obesity, Thinness
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