Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults

NCD Risk Factor Collaboration (NCD-RisC), James Bentham, Mariachiara Di Cesare, Ver Bilano, Honor Bixby, Bin Zhou, Gretchen A. Stevens, Leanne M. Riley, Cristina Taddei, Kaveh Hajifathalian, Yuan Lu, Stefan Savin, Melanie J. Cowan, Christopher J. Paciorek, Adela Chirita-Emandi, Alison J. Hayes, Joanne Katz, Roya Kelishadi, Andre Pascal Kengne, Young-Ho KhangAvula Laxmaiah, Yanping Li, Jun Ma, J. Jamie Miranda, Aya Mostafa, Martin Neovius, Cristina Padez, Lekhraj Rampal, Aubrianna Zhu, James E. Bennett, Goodarz Danaei, Zulfiqar Bhutta, Majid Ezzati, Leandra Abarca-Gómez, Ziad A. Abdeen, Zargar Abdul Hamid, Niveen M. Abu-Rmeileh, Benjamin Acosta-Cazares, Cecilia Acuin, Robert J. Adams, Wichai Aekplakorn, Kaosar Afsana, Carlos A. Aguilar-Salinas, Charles Agyemang, Alireza Ahmadvand, Wolfgang Ahrens, Kamel Ajlouni, Nazgul Akhtaeva, Hazzaa M. Al-Hazzaa, Amani Rashed Al-Othman, Rajaa Al-Raddadi, Fadia S. AlBuhairan, Shahla AlDhukair, Mohamed M. Ali, Osman Ali, Ala'a Alkerwi, Mar Alvarez-Pedrerol, Eman Aly, Deepak N. Amarapurkar, Philippe Amouyel, Antoinette Amuzu, Lars Bo Andersen, Sigmund A. Anderssen, Dolores S. Andrade, Lars H. Ängquist, Ranjit Mohan Anjana, Hajer Aounallah-Skhiri, Joana Araújo, Inger Ariansen, Tahir Aris, Nimmathota Arlappa, Dominique Arveiler, Krishna K. Aryal, Thor Aspelund, Felix K. Assah, Maria Cecília F. Assunção, May Soe Aung, Mária Avdicová, Ana Azevedo, Fereidoun Azizi, Bontha V. Babu, Suhad Bahijri, Jennifer L. Baker, Nagalla Balakrishna, Mohamed Bamoshmoosh, Maciej Banach, Piotr Bandosz, José R. Banegas, Carlo M. Barbagallo, Alberto Barceló, Amina Barkat, Aluisio J. D. Barros, Mauro V.G. Barros, Iqbal Bata, Anwar M. Batieha, Rosangela L. Batista, Assembekov Batyrbek, Louise A. Baur, Robert Beaglehole, Habiba Ben Romdhane, Judith Benedics, Mikhail Benet, James E. Bennett, Antonio Bernabe-Ortiz, Gailute Bernotiene, Heloisa Bettiol, Aroor Bhagyalaxmi, Sumit Bharadwaj, Santosh K. Bhargava, Zaid Bhatti, Zulfiqar Bhutta, Hongsheng Bi, Yufang Bi, Anna Biehl, Mukharram Bikbov, Bihungum Bista, Dusko J. Bjelica, Peter Bjerregaard, Espen Bjertness, Marius B. Bjertness, Cecilia Björkelund, Anneke Blokstra, Simona Bo, Martin Bobak, Lynne M. Boddy, Bernhard O. Boehm, Heiner Boeing, Jose G. Boggia, Carlos P. Boissonnet, Marialaura Bonaccio, Vanina Bongard, Pascal Bovet, Lien Braeckevelt, Lutgart Braeckman, Marjolijn C.E. Bragt, Imperia Brajkovich, Francesco Branca, Juergen Breckenkamp, Joao Breda, Hermann Brenner, Lizzy M. Brewster, Garry R. Brian, Lacramioara Brinduse, Graziella Bruno, H. Bas Bueno-de-Mesquita, Anna Bugge, Marta Buoncristiano, Genc Burazeri, Con Burns, Antonio Cabrera De León, Joseph Cacciottolo, Hui Cai, Tilema Cama, Christine Cameron, José Camolas, Günay Can, Ana Paula C. Cândido, Mario Capanzana, Vincenzo Capuano, Viviane C. Cardoso, Axel C. Carlsson, Maria J. Carvalho, Felipe F. Casanueva, Juan-Pablo Casas, Carmelo A. Caserta, Snehalatha Chamukuttan, Angelique W. Chan, Queenie Chan, Himanshu K. Chaturvedi, Nishi Chaturvedi, Chien Jen Chen, Fangfang Chen, Huashuai Chen, Shuohua Chen, Zhengming Chen, Ching Yu Cheng, Angela Chetrit, Ekaterina Chikova-Iscener, Arnaud Chiolero, Shu-Ti Chiou, Adela Chirita-Emandi, María-Dolores Chirlaque, Belong Cho, Yumi Cho, Kaare Christensen, Diego G. Christofaro, Jerzy Chudek, Renata Cifkova, Eliza Cinteza, Frank Claessens, Els Clays, Hans Concin, Susana C. Confortin, Cyrus Cooper, Rachel Cooper, Tara C. Coppinger, Simona Costanzo, Dominique Cottel, Chris Cowell, Cora L. Craig, Ana B. Crujeiras, Alexandra Cucu, Graziella D'Arrigo, Eleonora D'Orsi, Jean Dallongeville, Albertino Damasceno, Camilla T. Damsgaard, Rachel Dankner, Thomas M. Dantoft, Saeed Dastgiri, Luc Dauchet, Kairat Davletov, Guy De Backer, Dirk De Bacquer, Amalia De Curtis, Giovanni De Gaetano, Stefaan De Henauw, Paula Duarte de Oliveira, Karin De Ridder, Delphine De Smedt, Mohan Deepa, Alexander D. Deev, Abbas Dehghan, Hélène Delisle, Francis Delpeuch, Valérie Deschamps, Klodian Dhana, Augusto F. Di Castelnuovo, Juvenal Soares Dias-Da-Costa, Alejandro Diaz, Zivka Dika, Shirin Djalalinia, Ha T.P. Do, Annette J. Dobson, Maria Benedetta Donati, Chiara Donfrancesco, Silvana P. Donoso, Angela Döring, Maria Dorobantu, Ahmad Reza Dorosty, Kouamelan Doua, Wojciech Drygas, Jia Li Duan, Charmaine Duante, Vesselka Duleva, Virginija Dulskiene, Vilnis Dzerve, Elzbieta Dziankowska-Zaborszczyk, Eruke E. Egbagbe, Robert Eggertsen, Gabriele Eiben, Ulf Ekelund, Jalila El Ati, Paul Elliott, Reina Engle-Stone, Rajiv T. Erasmus, Cihangir Erem, Louise Eriksen, Johan G. Eriksson

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Abstract

Background Underweight, overweight, and obesity in childhood and adolescence are associated with adverse health consequences throughout the life-course. Our aim was to estimate worldwide trends in mean body-mass index (BMI) and a comprehensive set of BMI categories that cover underweight to obesity in children and adolescents, and to compare trends with those of adults.

Methods We pooled 2416 population-based studies with measurements of height and weight on 128·9 million participants aged 5 years and older, including 31·5 million aged 5–19 years. We used a Bayesian hierarchical model to estimate trends from 1975 to 2016 in 200 countries for mean BMI and for prevalence of BMI in the following categories for children and adolescents aged 5–19 years: more than 2 SD below the median of the WHO growth reference for children and adolescents (referred to as moderate and severe underweight hereafter), 2 SD to more than 1 SD below the median (mild underweight), 1 SD below the median to 1 SD above the median (healthy weight), more than 1 SD to 2 SD above the median (overweight but not obese), and more than 2 SD above the median (obesity).

Findings Regional change in age-standardised mean BMI in girls from 1975 to 2016 ranged from virtually no change (−0·01 kg/m2 per decade; 95% credible interval −0·42 to 0·39, posterior probability [PP] of the observed decrease being a true decrease=0·5098) in eastern Europe to an increase of 1·00 kg/m2 per decade (0·69–1·35, PP>0·9999) in central Latin America and an increase of 0·95 kg/m2 per decade (0·64–1·25, PP>0·9999) in Polynesia and Micronesia. The range for boys was from a non-significant increase of 0·09 kg/m2 per decade (−0·33 to 0·49, PP=0·6926) in eastern Europe to an increase of 0·77 kg/m2 per decade (0·50–1·06, PP>0·9999) in Polynesia and Micronesia. Trends in mean BMI have recently flattened in northwestern Europe and the high-income English-speaking and Asia-Pacific regions for both sexes, southwestern Europe for boys, and central and Andean Latin America for girls. By contrast, the rise in BMI has accelerated in east and south Asia for both sexes, and southeast Asia for boys. Global age-standardised prevalence of obesity increased from 0·7% (0·4–1·2) in 1975 to 5·6% (4·8–6·5) in 2016 in girls, and from 0·9% (0·5–1·3) in 1975 to 7·8% (6·7–9·1) in 2016 in boys; the prevalence of moderate and severe underweight decreased from 9·2% (6·0–12·9) in 1975 to 8·4% (6·8–10·1) in 2016 in girls and from 14·8% (10·4–19·5) in 1975 to 12·4% (10·3–14·5) in 2016 in boys. Prevalence of moderate and severe underweight was highest in India, at 22·7% (16·7–29·6) among girls and 30·7% (23·5–38·0) among boys. Prevalence of obesity was more than 30% in girls in Nauru, the Cook Islands, and Palau; and boys in the Cook Islands, Nauru, Palau, Niue, and American Samoa in 2016. Prevalence of obesity was about 20% or more in several countries in Polynesia and Micronesia, the Middle East and north Africa, the Caribbean, and the USA. In 2016, 75 (44–117) million girls and 117 (70–178) million boys worldwide were moderately or severely underweight. In the same year, 50 (24–89) million girls and 74 (39–125) million boys worldwide were obese.

Interpretation The rising trends in children's and adolescents' BMI have plateaued in many high-income countries, albeit at high levels, but have accelerated in parts of Asia, with trends no longer correlated with those of adults.

Original languageEnglish
Pages (from-to)2627-2642
Number of pages16
JournalLancet
Volume390
Issue number10113
DOIs
Publication statusPublished - 16 Dec 2017
Externally publishedYes

Bibliographical note

'© The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.'

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    NCD Risk Factor Collaboration (NCD-RisC), Bentham, J., Di Cesare, M., Bilano, V., Bixby, H., Zhou, B., Stevens, G. A., Riley, L. M., Taddei, C., Hajifathalian, K., Lu, Y., Savin, S., Cowan, M. J., Paciorek, C. J., Chirita-Emandi, A., Hayes, A. J., Katz, J., Kelishadi, R., Kengne, A. P., ... Eriksson, J. G. (2017). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. Lancet, 390(10113), 2627-2642. https://doi.org/10.1016/S0140-6736(17)32129-3