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), Simona Giampaoli, Paola Nardone

Research output: Contribution to journalArticle

837 Citations (Scopus)

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. Funding Wellcome Trust, AstraZeneca Young Health Programme. © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
Original languageEnglish
Pages (from-to)2627-2642
Number of pages16
JournalThe Lancet
Volume390
Issue number10113
DOIs
Publication statusPublished - 2017

Fingerprint

Thinness
Polynesia
Micronesia
Body Mass Index
Obesity
Pediatric Obesity
Population
Palau
Eastern Europe
Latin America
American Samoa
Weights and Measures
Central America
Northern Africa
Eastern Africa
Southeastern Asia
Middle East
Far East
Health
Licensure

Keywords

  • adolescent
  • adolescent obesity
  • adult
  • age distribution
  • American Samoa
  • Article
  • Bayes theorem
  • body height
  • body mass
  • body weight
  • Caribbean
  • child
  • childhood obesity
  • controlled study
  • Cook Islands
  • Eastern Europe
  • Federated States of Micronesia
  • female
  • geographic distribution
  • human
  • major clinical study
  • male
  • Nauru
  • Niue
  • North Africa
  • obesity
  • Palau
  • Polynesia
  • prevalence
  • priority journal
  • sex difference
  • South and Central America
  • trend study
  • underweight
  • United States

Cite this

@article{d47a5c5c8d9043958850ecbd7a7e9f75,
title = "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",
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. Funding Wellcome Trust, AstraZeneca Young Health Programme. {\circledC} 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license",
keywords = "adolescent, adolescent obesity, adult, age distribution, American Samoa, Article, Bayes theorem, body height, body mass, body weight, Caribbean, child, childhood obesity, controlled study, Cook Islands, Eastern Europe, Federated States of Micronesia, female, geographic distribution, human, major clinical study, male, Nauru, Niue, North Africa, obesity, Palau, Polynesia, prevalence, priority journal, sex difference, South and Central America, trend study, underweight, United States",
author = "{NCD Risk Factor Collaboration (NCD-RisC)} and L. Abarca-G{\'o}mez and Z.A. Abdeen and Z.A. Hamid and N.M. Abu-Rmeileh and B. Acosta-Cazares and C. Acuin and R.J. Adams and W. Aekplakorn and K. Afsana and C.A. Aguilar-Salinas and C. Agyemang and A. Ahmadvand and W. Ahrens and K. Ajlouni and N. Akhtaeva and H.M. Al-Hazzaa and A.R. Al-Othman and R. Al-Raddadi and {Al Buhairan}, F. and {Al Dhukair}, S. and M.M. Ali and O. Ali and A. Alkerwi and M. Alvarez-Pedrerol and E. Aly and D.N. Amarapurkar and P. Amouyel and A. Amuzu and L.B. Andersen and S.A. Anderssen and D.S. Andrade and L.H. {\"A}ngquist and R.M. Anjana and H. Aounallah-Skhiri and M. Bonaccio and S. Costanzo and {De Curtis}, A. and {de Gaetano}, G. and {Di Castelnuovo}, A.F. and M.B. Donati and C. Donfrancesco and M.D.C. Franco and Simona Giampaoli and F. Gianfagna and L. Lauria and Paola Nardone and L. Palmieri and D. Pierannunzio and M. Porta and M. Salvetti and A. Spinelli and G. Veronesi",
note = "Cited By :26 Export Date: 12 April 2018 CODEN: LANCA References: Han, Z., Mulla, S., Beyene, J., Liao, G., McDonald, S.D., Maternal underweight and the risk of preterm birth and low birth weight: a systematic review and meta-analyses (2011) Int J Epidemiol, 40, pp. 65-101; Black, R.E., Victora, C.G., Walker, S.P., Maternal and child undernutrition and overweight in low-income and middle-income countries (2013) Lancet, 382, pp. 427-451; Lobstein, T., Baur, L., Uauy, R., Obesity in children and young people: a crisis in public health (2004) Obes Rev, 5, pp. 4-85; MacLean, P., Higgins, J., Giles, E., Sherk, V., Jackman, M., The role for adipose tissue in weight regain after weight loss (2015) Obes Rev, 16, pp. 45-54; Singh, A.S., Mulder, C., Twisk, J.W., van Mechelen, W., Chinapaw, M.J., Tracking of childhood overweight into adulthood: a systematic review of the literature (2008) Obes Rev, 9, pp. 474-488; Must, A., Jacques, P.F., Dallal, G.E., Bajema, C.J., Dietz, W.H., Long-term morbidity and mortality of overweight adolescents. A follow-up of the Harvard Growth Study of 1922 to 1935 (1992) N Engl J Med, 327, pp. 1350-1355; Abdullah, A., Wolfe, R., Stoelwinder, J.U., The number of years lived with obesity and the risk of all-cause and cause-specific mortality (2011) Int J Epidemiol, 40, pp. 985-996; Park, M., Falconer, C., Viner, R., Kinra, S., The impact of childhood obesity on morbidity and mortality in adulthood: a systematic review (2012) Obes Rev, 13, pp. 985-1000; Caird, J., Kavanagh, J., O'Mara-Eves, A., Does being overweight impede academic attainment? A systematic review (2014) Health Educ J, 73, pp. 497-521; Quek, Y.H., Tam, W.W., Zhang, M.W., Ho, R., Exploring the association between childhood and adolescent obesity and depression: a meta-analysis (2017) Obes Rev, 18, pp. 742-754; Kraak, V.I., Vandevijvere, S., Sacks, G., Progress achieved in restricting the marketing of high-fat, sugary and salty food and beverage products to children (2016) Bull World Health Organ, 94, pp. 540-548; Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19·2 million participants (2016) Lancet, 387, pp. 1377-1396; de Onis, M., Lobstein, T., Defining obesity risk status in the general childhood population: which cut-offs should we use? (2010) Int J Pediatr Obes, 5, pp. 458-460; P{\'e}rez-Rodrigo, C., Aranceta, J., School-based nutrition education: lessons learned and new perspectives (2001) Public Health Nutr, 4, pp. 131-139; de Onis, M., Onyango, A.W., Borghi, E., Siyam, A., Nishida, C., Siekmann, J., Development of a WHO growth reference for school-aged children and adolescents (2007) Bull World Health Organ, 85, pp. 660-667; Popkin, B.M., Conde, W., Hou, N., Monteiro, C., Is there a lag globally in overweight trends for children compared with adults? (2006) Obesity (Silver Spring), 14, pp. 1846-1853; Finucane, M.M., Stevens, G.A., Cowan, M.J., National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9·1 million participants (2011) Lancet, 377, pp. 557-567; Danaei, G., Finucane, M.M., Lin, J.K., National, regional, and global trends in systolic blood pressure since 1980: systematic analysis of health examination surveys and epidemiological studies with 786 country-years and 5·4 million participants (2011) Lancet, 377, pp. 568-577; Danaei, G., Finucane, M.M., Lu, Y., National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2·7 million participants (2011) Lancet, 378, pp. 31-40; Farzadfar, F., Finucane, M.M., Danaei, G., National, regional, and global trends in serum total cholesterol since 1980: systematic analysis of health examination surveys and epidemiological studies with 321 country-years and 3·0 million participants (2011) Lancet, 377, pp. 578-586; Gorber, S.C., Tremblay, M., Moher, D., Gorber, B., A comparison of direct vs. self–report measures for assessing height, weight and body mass index: a systematic review (2007) Obes Rev, 8, pp. 307-326; Ezzati, M., Martin, H., Skjold, S., Vander Hoorn, S., Murray, C.J., Trends in national and state-level obesity in the USA after correction for self-report bias: analysis of health surveys (2006) J R Soc Med, 99, pp. 250-257; Hayes, A.J., Clarke, P.M., Lung, T.W., Change in bias in self-reported body mass index in Australia between 1995 and 2008 and the evaluation of correction equations (2011) Popul Health Metr, 9, p. 53; Finucane, M.M., Paciorek, C.J., Danaei, G., Ezzati, M., Bayesian estimation of population-level trends in measures of health status (2014) Stat Sci, 29, pp. 18-25; Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4·4 million participants (2016) Lancet, 387, pp. 1513-1530; A century of trends in adult human height (2016) eLife, 5, p. e13410; Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19·1 million participants (2017) Lancet, 389, pp. 37-55; Danaei, G., Singh, G.M., Paciorek, C.J., The global cardiovascular risk transition: associations of four metabolic risk factors with macroeconomic variables in 1980 and 2008 (2013) Circulation, 127, pp. 1493-1502; Ahmad, O.B., Boschi-Pinto, C., Lopez, A.D., Murray, C.J., Lozano, R., Inoue, M., (2001) Age standardization of rates: a new WHO standard, pp. 1-14. , World Health Organization Geneva; Ng, M., Fleming, T., Robinson, M., 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 (2014) Lancet, 384, pp. 766-781; Wabitsch, M., Moss, A., Kromeyer-Hauschild, K., Unexpected plateauing of childhood obesity rates in developed countries (2014) BMC Medicine, 12, p. 17; Olds, T., Maher, C., Zumin, S., Evidence that the prevalence of childhood overweight is plateauing: data from nine countries (2011) Int J Pediatr Obes, 6, pp. 342-360; Rokholm, B., Baker, J.L., S{\o}rensen, T.I.A., The levelling off of the obesity epidemic since the year 1999–a review of evidence and perspectives (2010) Obes Rev, 11, pp. 835-846; Muthuri, S.K., Francis, C.E., Wachira, L.-J.M., Evidence of an overweight/obesity transition among school-aged children and youth in Sub-Saharan Africa: a systematic review (2014) PLoS One, 9, p. e92846; Rivera, J.{\'A}., de Coss{\'i}o, T.G., Pedraza, L.S., Aburto, T.C., S{\'a}nchez, T.G., Martorell, R., Childhood and adolescent overweight and obesity in Latin America: a systematic review (2014) Lancet Diabetes Endocrinol, 2, pp. 321-332; Cole, T.J., Bellizzi, M.C., Flegal, K.M., Dietz, W.H., Establishing a standard definition for child overweight and obesity worldwide: international survey (2000) BMJ, 320, pp. 1240-1243; Cole, T.J., Lobstein, T., Extended international (IOTF) body mass index cut-offs for thinness, overweight and obesity (2012) Pediatr Obes, 7, pp. 284-294; Rito, A., Wijnhoven, T.M., Rutter, H., Prevalence of obesity among Portuguese children (6-8 years old) using three definition criteria: COSI Portugal, 2008 (2012) Pediatr Obes, 7, pp. 413-422; Song, Y., Wang, H.-J., Dong, B., Ma, J., Wang, Z., Agardh, A., 25-year trends in gender disparity for obesity and overweight by using WHO and IOTF definitions among Chinese school-aged children: a multiple cross-sectional study (2016) BMJ Open, 6, p. e011904; Bahk, J., Khang, Y.-H., Trends in measures of childhood obesity in Korea from 1998 to 2012 (2016) J Epidemiol, 26, pp. 199-207; Ahrens, W., Pigeot, I., Pohlabeln, H., Prevalence of overweight and obesity in European children below the age of 10 (2014) Int J Obes, 38, pp. S99-107; Waters, E., de Silva-Sanigorski, A., Hall, B.J., Interventions for preventing obesity in children (2011) Cochrane Database Syst Rev, 12. , CD001871; Wang, Y., Cai, L., Wu, Y., What childhood obesity prevention programmes work? A systematic review and meta-analysis (2015) Obes Rev, 16, pp. 547-565; Sobol-Goldberg, S., Rabinowitz, J., Gross, R., School-based obesity prevention programs: a meta-analysis of randomized controlled trials (2013) Obesity, 21, pp. 2422-2428; Lobstein, T., Jackson-Leach, R., Moodie, M.L., Child and adolescent obesity: part of a bigger picture (2015) Lancet, 385, pp. 2510-2520; Gortmaker, S.L., Wang, Y.C., Long, M.W., Three interventions that reduce childhood obesity are projected to save more than they cost to implement (2015) Health Aff (Millwood), 34, pp. 1932-1939; Popkin, B.M., Relationship between shifts in food system dynamics and acceleration of the global nutrition transition (2017) Nutr Rev, 75, pp. 73-82; Hawkes, C., Harris, J.L., An analysis of the content of food industry pledges on marketing to children (2011) Public Health Nutr, 14, pp. 1403-1414; Bleich, S.N., Rimm, E.B., Brownell, K.D., US nutrition assistance, 2018—modifying SNAP to promote population health (2017) N Engl J Med, 376, pp. 1205-1207; Darmon, N., Drewnowski, A., Contribution of food prices and diet cost to socioeconomic disparities in diet quality and health: a systematic review and analysis (2015) Nutr Rev, 73, pp. 643-660; Powell, L.M., Chriqui, J.F., Khan, T., Wada, R., Chaloupka, F.J., Assessing the potential effectiveness of food and beverage taxes and subsidies for improving public health: a systematic review of prices, demand and body weight outcomes (2013) Obes Rev, 14, pp. 110-128; Dietz, W.H., Baur, L.A., Hall, K., Management of obesity: improvement of health-care training and systems for prevention and care (2015) Lancet, 385, pp. 2521-2533; Screening for obesity in children and adolescents: US Preventive Services Task Force recommendation statement (2017) JAMA, 317, pp. 2417-2426",
year = "2017",
doi = "10.1016/S0140-6736(17)32129-3",
language = "English",
volume = "390",
pages = "2627--2642",
journal = "The Lancet",
issn = "0140-6736",
publisher = "Lancet Publishing Group",
number = "10113",

}

TY - JOUR

T1 - 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

AU - NCD Risk Factor Collaboration (NCD-RisC)

AU - Abarca-Gómez, L.

AU - Abdeen, Z.A.

AU - Hamid, Z.A.

AU - Abu-Rmeileh, N.M.

AU - Acosta-Cazares, B.

AU - Acuin, C.

AU - Adams, R.J.

AU - Aekplakorn, W.

AU - Afsana, K.

AU - Aguilar-Salinas, C.A.

AU - Agyemang, C.

AU - Ahmadvand, A.

AU - Ahrens, W.

AU - Ajlouni, K.

AU - Akhtaeva, N.

AU - Al-Hazzaa, H.M.

AU - Al-Othman, A.R.

AU - Al-Raddadi, R.

AU - Al Buhairan, F.

AU - Al Dhukair, S.

AU - Ali, M.M.

AU - Ali, O.

AU - Alkerwi, A.

AU - Alvarez-Pedrerol, M.

AU - Aly, E.

AU - Amarapurkar, D.N.

AU - Amouyel, P.

AU - Amuzu, A.

AU - Andersen, L.B.

AU - Anderssen, S.A.

AU - Andrade, D.S.

AU - Ängquist, L.H.

AU - Anjana, R.M.

AU - Aounallah-Skhiri, H.

AU - Bonaccio, M.

AU - Costanzo, S.

AU - De Curtis, A.

AU - de Gaetano, G.

AU - Di Castelnuovo, A.F.

AU - Donati, M.B.

AU - Donfrancesco, C.

AU - Franco, M.D.C.

AU - Giampaoli, Simona

AU - Gianfagna, F.

AU - Lauria, L.

AU - Nardone, Paola

AU - Palmieri, L.

AU - Pierannunzio, D.

AU - Porta, M.

AU - Salvetti, M.

AU - Spinelli, A.

AU - Veronesi, G.

N1 - Cited By :26 Export Date: 12 April 2018 CODEN: LANCA References: Han, Z., Mulla, S., Beyene, J., Liao, G., McDonald, S.D., Maternal underweight and the risk of preterm birth and low birth weight: a systematic review and meta-analyses (2011) Int J Epidemiol, 40, pp. 65-101; Black, R.E., Victora, C.G., Walker, S.P., Maternal and child undernutrition and overweight in low-income and middle-income countries (2013) Lancet, 382, pp. 427-451; Lobstein, T., Baur, L., Uauy, R., Obesity in children and young people: a crisis in public health (2004) Obes Rev, 5, pp. 4-85; MacLean, P., Higgins, J., Giles, E., Sherk, V., Jackman, M., The role for adipose tissue in weight regain after weight loss (2015) Obes Rev, 16, pp. 45-54; Singh, A.S., Mulder, C., Twisk, J.W., van Mechelen, W., Chinapaw, M.J., Tracking of childhood overweight into adulthood: a systematic review of the literature (2008) Obes Rev, 9, pp. 474-488; Must, A., Jacques, P.F., Dallal, G.E., Bajema, C.J., Dietz, W.H., Long-term morbidity and mortality of overweight adolescents. A follow-up of the Harvard Growth Study of 1922 to 1935 (1992) N Engl J Med, 327, pp. 1350-1355; Abdullah, A., Wolfe, R., Stoelwinder, J.U., The number of years lived with obesity and the risk of all-cause and cause-specific mortality (2011) Int J Epidemiol, 40, pp. 985-996; Park, M., Falconer, C., Viner, R., Kinra, S., The impact of childhood obesity on morbidity and mortality in adulthood: a systematic review (2012) Obes Rev, 13, pp. 985-1000; Caird, J., Kavanagh, J., O'Mara-Eves, A., Does being overweight impede academic attainment? A systematic review (2014) Health Educ J, 73, pp. 497-521; Quek, Y.H., Tam, W.W., Zhang, M.W., Ho, R., Exploring the association between childhood and adolescent obesity and depression: a meta-analysis (2017) Obes Rev, 18, pp. 742-754; Kraak, V.I., Vandevijvere, S., Sacks, G., Progress achieved in restricting the marketing of high-fat, sugary and salty food and beverage products to children (2016) Bull World Health Organ, 94, pp. 540-548; Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19·2 million participants (2016) Lancet, 387, pp. 1377-1396; de Onis, M., Lobstein, T., Defining obesity risk status in the general childhood population: which cut-offs should we use? (2010) Int J Pediatr Obes, 5, pp. 458-460; Pérez-Rodrigo, C., Aranceta, J., School-based nutrition education: lessons learned and new perspectives (2001) Public Health Nutr, 4, pp. 131-139; de Onis, M., Onyango, A.W., Borghi, E., Siyam, A., Nishida, C., Siekmann, J., Development of a WHO growth reference for school-aged children and adolescents (2007) Bull World Health Organ, 85, pp. 660-667; Popkin, B.M., Conde, W., Hou, N., Monteiro, C., Is there a lag globally in overweight trends for children compared with adults? (2006) Obesity (Silver Spring), 14, pp. 1846-1853; Finucane, M.M., Stevens, G.A., Cowan, M.J., National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9·1 million participants (2011) Lancet, 377, pp. 557-567; Danaei, G., Finucane, M.M., Lin, J.K., National, regional, and global trends in systolic blood pressure since 1980: systematic analysis of health examination surveys and epidemiological studies with 786 country-years and 5·4 million participants (2011) Lancet, 377, pp. 568-577; Danaei, G., Finucane, M.M., Lu, Y., National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2·7 million participants (2011) Lancet, 378, pp. 31-40; Farzadfar, F., Finucane, M.M., Danaei, G., National, regional, and global trends in serum total cholesterol since 1980: systematic analysis of health examination surveys and epidemiological studies with 321 country-years and 3·0 million participants (2011) Lancet, 377, pp. 578-586; Gorber, S.C., Tremblay, M., Moher, D., Gorber, B., A comparison of direct vs. self–report measures for assessing height, weight and body mass index: a systematic review (2007) Obes Rev, 8, pp. 307-326; Ezzati, M., Martin, H., Skjold, S., Vander Hoorn, S., Murray, C.J., Trends in national and state-level obesity in the USA after correction for self-report bias: analysis of health surveys (2006) J R Soc Med, 99, pp. 250-257; Hayes, A.J., Clarke, P.M., Lung, T.W., Change in bias in self-reported body mass index in Australia between 1995 and 2008 and the evaluation of correction equations (2011) Popul Health Metr, 9, p. 53; Finucane, M.M., Paciorek, C.J., Danaei, G., Ezzati, M., Bayesian estimation of population-level trends in measures of health status (2014) Stat Sci, 29, pp. 18-25; Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4·4 million participants (2016) Lancet, 387, pp. 1513-1530; A century of trends in adult human height (2016) eLife, 5, p. e13410; 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PY - 2017

Y1 - 2017

N2 - 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. Funding Wellcome Trust, AstraZeneca Young Health Programme. © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

AB - 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. Funding Wellcome Trust, AstraZeneca Young Health Programme. © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

KW - adolescent

KW - adolescent obesity

KW - adult

KW - age distribution

KW - American Samoa

KW - Article

KW - Bayes theorem

KW - body height

KW - body mass

KW - body weight

KW - Caribbean

KW - child

KW - childhood obesity

KW - controlled study

KW - Cook Islands

KW - Eastern Europe

KW - Federated States of Micronesia

KW - female

KW - geographic distribution

KW - human

KW - major clinical study

KW - male

KW - Nauru

KW - Niue

KW - North Africa

KW - obesity

KW - Palau

KW - Polynesia

KW - prevalence

KW - priority journal

KW - sex difference

KW - South and Central America

KW - trend study

KW - underweight

KW - United States

U2 - 10.1016/S0140-6736(17)32129-3

DO - 10.1016/S0140-6736(17)32129-3

M3 - Article

VL - 390

SP - 2627

EP - 2642

JO - The Lancet

JF - The Lancet

SN - 0140-6736

IS - 10113

ER -