EXPERT REACTION: We just keep on getting fatter

Embargoed until: Publicly released:

An analysis of the trends of adult body-mass index in 200 countries from 1975 to 2014 predicts that if current trends continue, the probability of meeting the global obesity target is virtually zero, and that by 2025, 17 per cent of men and 21 per cent of women in the world will be obese.

Journal/conference: The Lancet

Organisation/s: The University of Adelaide, The University of Sydney, The University of Queensland, University of Western Australia, UNSW, Imperial College London, UK

Media Release

From: The Lancet

The Lancet: We now live in a world in which more people are obese than underweight, major global analysis reveals

  • By 2025, around a fifth of adults worldwide will be obese
  • Over a third of UK men and women, and over 40% of US men and women will be obese by 2025.

**Interactive maps and country by country data available below**

In the past 40 years, there has been a startling increase in the number of obese people worldwide—rising from 105 million in 1975 to 641 million in 2014, according to the most comprehensive analysis of trends in body mass index (BMI) to date, published in The Lancet.

The age-corrected proportion of obese men has more than tripled (3.2% to 10.8%), and the proportion of obese women has more than doubled (6.4% to 14.9%) since 1975. At the same time, the proportion of underweight people fell more modestly—by around a third in both men (13.8% to 8.8%) and women (14.6% to 9.7%).

Over the past four decades, the average age-corrected BMI increased from 21.7kg/m² to 24.2 kg/m² in men and from 22.1kg/m² to 24.4 kg/m² in women (figure 1), equivalent to the world’s population becoming on average 1.5kg heavier each decade. If the rate of obesity continues at this pace, by 2025 roughly a fifth of men (18%) and women (21%) worldwide will be obese, and more than 6% of men and 9% of women will be severely obese (35 kg/m² or greater).

However, excessively low body weight remains a serious public health issue in the world’s poorest regions, and the authors warn that global trends in rising obesity should not overshadow the continuing underweight problem in these poor nations. For example, in south Asia almost a quarter of the population are still underweight, and in central and east Africa levels of underweight still remain higher than 12% in women and 15% in men.

“Over the past 40 years, we have changed from a world in which underweight prevalence was more than double that of obesity, to one in which more people are obese than underweight,” explains senior author Professor Majid Ezzati from the School of Public Health at Imperial College London, London, UK. “If present trends continue, not only will the world not meet the obesity target of halting the rise in the prevalence of obesity at its 2010 level by 2025, but more women will be severely obese than underweight by 2025.”[1]

He adds, “To avoid an epidemic of severe obesity, new policies that can slow down and stop the worldwide increase in body weight must be implemented quickly and rigorously evaluated, including smart food policies and improved health-care training.”[1]

The findings come from a comprehensive new analysis of the global, regional, and national trends in adult (aged 18 and older) BMI between 1975 and 2014. For the first time, this includes the proportion of individuals classified as underweight (less than 18.5 kg/m²), and severely obese (35 kg/m² or higher) and morbidly obese (40 kg/m² or higher).

The Non-Communicable Disease (NCD) Risk Factor Collaboration pooled data from 1698 population-based studies, surveys, and reports totalling 19.2 million men and women aged 18 years or older from 186 countries (covering 99% of the world’s population). Studies were only included if height and weight had been measured to avoid the bias arising from self-reported data. The research team used these data and statistical modelling to calculate average BMI and the prevalence of BMI categories like underweight, obesity, and severe obesity for all countries and years between 1975 and 2014. They found that rates of obesity surpassed those of underweight in women in 2004 and in men in 2011.

Country by country BMI and rankings available below – highlights include:

  • Women in Singapore, Japan, and a few European countries including Czech Republic, Belgium, France, and Switzerland had virtually no increase in average BMI (less than 0.2 kg/m² per decade) over the 40 years.
  • Island nations in Polynesia and Micronesia have the highest average BMI in the world reaching 34.8 kg/m² for women and 32.2 kg/m² for men in American Samoa. In Polynesia and Micronesia more than 38% of men and over half of women are obese.
  • Timor-Leste, Ethiopia, and Eritrea have the lowest average BMI in the world. Timor-Leste was the lowest at 20.8 kg/m² for women and Ethiopia the lowest at 20.1kg/m² for men.
  • More than a fifth of men in India, Bangladesh, Timor-Leste, Afghanistan, Eritrea, and Ethiopia, and a quarter or more of women in Bangladesh and India are still underweight.
  • Among high-income English-speaking countries, the USA has the highest BMI for both men and women (over 28 kg/m²). More than one in four severely obese men and almost one in five severely obese women in the world live in the USA.
  • Men in Cyprus, Ireland, and Malta (27.8 kg/m²), and women in Moldova (27.3 kg/m²) have the highest average BMI in Europe. Bosnian and Dutch men (both around 25.9 kg/m²) and Swiss women (23.7 kg/m²) have the lowest average BMI in Europe.
  • The UK has the third highest average BMI in Europe for women equal to Ireland and the Russian Federation (all around 27.0 kg/m²) and tenth highest for men along with Greece, Hungary, and Lithuania (all around 27.4 kg/m²).
  • Almost a fifth of the world’s obese adults (118 million) live in just six high-income English-speaking countries—Australia, Canada, Ireland, New Zealand, UK, and USA. Over a quarter (27.1%; 50 million) of the world’s severely obese people also live in these countries (figure 9).
  • By 2025, the UK is projected to have the highest levels of obese women in Europe (38%), followed by Ireland (37%) and Malta (34%). Similar trends are projected in men, with Ireland and the UK again showing the greatest proportion (both around 38%), followed Lithuania (36%). By comparison, 43% of US women and 45% of US men are predicted to be obese in 2025.

Writing in a linked Comment, Professor George Davey Smith from the MRC Integrative Epidemiology Unit, School of Social and Community Medicine, Bristol, UK discusses “a fatter, healthier but more unequal world”. He points out that although in high income countries obesity is a major and growing problem, under-nutrition in low income countries remains a major health issue, including for the offspring of seriously under-weight women. He writes, “A focus on obesity at the expense of recognition of the substantial remaining burden of undernutrition threatens to divert resources away from disorders that affect the poor to those that are more likely to affect the wealthier in low income countries.”

NOTES TO EDITORS:

This study was funded by Wellcome Trust, Grand Challenges Canada

[1] Quotes direct from author and cannot be found in text of Article

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Expert Reaction

These comments have been collated by the Science Media Centre to provide a variety of expert perspectives on this issue. Feel free to use these quotes in your stories. Views expressed are the personal opinions of the experts named. They do not represent the views of the SMC or any other organisation unless specifically stated.

Professor Jennie Brand-Miller is Director of the Glycemic Index Research Service at the University of Sydney and Director of the Glycemic Index Foundation

The most interesting finding in my mind is that there has been virtually no increase in BMI in the women of Belgium, France and Switzerland – the countries associated with good chocolate, cheese and wine.   We need to study them carefully (the women, not the chocolate…) and learn from them. 

 

Last updated: 03 Nov 2016 7:36pm
Dr Rosemary Stanton OAM, Nutritionist, Visiting Fellow, School of Medical Sciences, University of New South Wales

It's time to take the world’s increasing incidence of obesity seriously – not least for its effects on health care costs.

Treating obesity is difficult and rarely successful. So it’s imperative to take action at the earlier stages remembering that all obese people were once 'merely' overweight.

Australia joins five other high-income English speaking countries in being home to 118 million obese adults and 50 million who are severely obese.

Preventing obesity involves changing from our current diet in which over 35% of kilojoules come from junk food and drinks. These are the real problem in obesity. They are also displacing healthy foods like vegetables (only 7% of Australian adults meet the recommendations), fruit (current consumption is half the recommended two pieces a day) and wholegrain products (largely forgotten in favour of refined grains).

The Lancet paper also highlights the problems of underweight in many countries, including our neighbour, East Timor. Pregnant women are especially in need of a healthy diet to achieve a healthy weight since undernutrition at this time is a potent risk factor for children to become obese later in life, especially if junk food invades their lives.

Extremes of weight are a major global problem. The solution lies in a healthy diet with minimal junk food. 

Last updated: 03 Nov 2016 7:16pm
Professor Manny Noakes is an Adjunct Research Professor in the School of Health Sciences at UniSA

The statistics are alarming and impact not only on increasing chronic diseases globally but also on the environment. Heavier populations consume more fuels as well as food which is not sustainable.

The low cost of junk foods and beverages is a contributor. Amplifying this is the transmission of obesity between generations as a result in part of epigenetic changes. 

Appropriate food policies and universal nutrition and healthy weight programs particularly targeting preconception are urgently needed.

Last updated: 03 Nov 2016 6:29pm
Dr Lennert Veerman is Professor of Public Health at Griffith University. He has published on a broad range of topics including obesity and other risk factors for chronic disease.

The new Lancet study once again shows that Australia is one of the countries with a high proportion of people that are overweight or obese, along with other ‘Anglo-Saxon’ countries. The causes are, of course, in the diet and the amount of physical activity we get. This in turn point to our food system and, mainly, the way we transport ourselves.

Diet and exercise programs for people who are already obese are not the solution: both are around aplenty, but people find it difficult to adhere to them in the long run. Within a few years, all of the weight tends to be back, with interest.

To reduce obesity levels we have to clean up our living environment. We need to reduce access to energy dense foods and increase access to healthy food options like fruits, vegetables, foods based on whole grains. First from schools; that is comparatively easy and has been successful.

Other measures that are likely to be effective:

  • Tax energy-dense, nutrient poor (‘junk’) foods, starting with sugared drinks
  • Restrict advertising for junk foods, starting with ads targeting children
  • Stimulate employers to ensure workplace canteens offer healthy foods prominently / as default options

To increase levels of physical activity, our best bet is to facilitate active transport: walking, cycling, and public transport, rather than the use of private motor vehicles. Potential measures include:

  • Invest in bikeway networks that offer safe and convenient routes to reach major destinations by bicycle. Safety is key to getting more people to cycle, so off-road bikeways are best.
  • Make sure walking to local destinations is easy, quick and safe: construct walkways where there aren’t any, avoid long waiting times for traffic lights, etc.
  • Built medium density residential facilities in areas with good public transport access and local shops within walking distance, and preferably with low traffic volumes.
  • Make car parking expensive if good public transport facilities are available.
  • Put a price on greenhouse gas emissions.

The key to cure the obesity epidemic is not in telling overweight people to ‘take personal responsibility’, but in creating health food and built environments

Last updated: 03 Nov 2016 6:16pm
Professor David Crawford is Alfred Deakin Professor and Co-Director of the Institute for Physical Activity and Nutrition at Deakin University

 

This study is important as it highlights just how common and intractable obesity is, with a staggering number of people affected across the globe. It also underscores the need for us to redouble our efforts to prevent obesity, and to better support those who are already overweight and living with the health and social consequences. It is particularly concerning that those who are the most disadvantaged are the most affected. We must work together to address this global crisis, which if left unchecked will bankrupt our already overwhelmed health care systems.
 

Last updated: 03 Nov 2016 6:07pm
Terry Slevin is Chair of Cancer Council Australia's Occupational and Environmental Cancer Risk Committee, and is President of the Public Health Association Australia

This is an extraordinary and frightening report which must prompt action. In 2010 it was estimated that around 4,000 of people (3.4% of the total number of cases) diagnosed with cancers in Australia was as a result obesity. With the success in driving smoking rates down, obesity is the most important cancer risk factor for non smokers. On average the population is getting older, and fatter. 

That inevitably will increase the cancer burden.
 
Programs to promote healthy weight and policies to restrict the capacity to promote unhealthy food – and taxing those products contributing to this problem, like sugary drinks, are essential parts of the solution.  Obesity is long term challenge for the health of people around the world. Every country, including Australia, must act to tackle this slow moving but unquestionable public health disaster.
 
Australia has been an international leader on tobacco control. We now need to decide if we want to take that same leadership in tackling the obesity epidemic

Last updated: 03 Nov 2016 5:54pm
Professor Margaret Allman-Farinelli is a Professor of Dietetics in the Charles Perkins Centre at the University of Sydney

These are sobering statistics for the world that despite concentrated effort in many affluent nations such as Australia, US and UK we have not managed to halt the increase in obesity. We can expect flow on effects to the costs of health care as associated chronic disease takes hold and losses in productivity occur as a result of this global trend. In Australia we anticipate an aging population to be supported by a younger population who have become overweight and obese sooner than their parents and are more likely to experience the unwanted associated chronic diseases of obesity sooner. As an example from 1995 until 2012 the percentage of obese 18 to 24 year old women increased from 6% to 20%.

Clearly we live in a world of inequality where those in less affluent nations suffer from lack of nutrient rich foods and those in affluent countries from an oversupply of energy laden and often nutrient-poor foods. Both are making our world unwell and it is time for better efforts by all government and private sectors to join forces to redress this situation for our global survival

Last updated: 03 Nov 2016 5:40pm
Dr Joanna McMillan is an Accredited Practising Dietitian, Registered Nutritionist and Founder of Dr Joanna and Get Lean

This report highlights the fact the world is facing an epidemic of obesity. This is not a matter of aesthetics but a serious health matter that will drive the rise of the so-called ‘diseases of affluence’ including type 2 diabetes, heart disease and many cancers. It shows us that despite the multi-million dollar weight loss industry and numerous governmental policies around the world, we are failing to halt this epidemic. The report predicts that we have zero chance of meeting the global targets by 2025. In Australia the projection for 2025 is that 37-38% of us will be obese. That figure is frightening and we desperately need our government to make this a priority. 
 
This is not all down to personal responsibility and blame - if we continue to make that our emphasis we will fail. We need policies that make it easier for people to eat well, such as making healthy food more affordable and junk foods more expensive (yet our government is rejecting the tax on sugar-sweetened soft drinks), and be more active. This means better public transport, more cycle paths in cities, fewer work hours to allow for more active leisure time. 
 
There must also be a huge focus on prevention as we know that the diet and lifestyle of the parents affects the offspring from before conception - but especially from conception to year two. Focus right from this age is required to turn the future health statistics around

Last updated: 03 Nov 2016 5:22pm
Jonine Jancey is an Associate Professor in the Department of Health Promotion at Curtin University

It’s easy to ‘victim blame’ or to suggest that individual’s should take responsibility for their own weight and simply eat less and eat more healthy food.  However, the evidence indicates that environmental factors strongly influence health behaviours and that individual responsibility, without due consideration of the environmental influences, is somewhat naive.

The public health model recognises that peoples’ food intake resulting in overweight and obesity is strongly influenced by the ‘obesogenic environment’ that we live in. There is a need for this environment to be modified through policy and environmental change, such as, controls over the location of fast food outlets, controls of junk food advertising, availability of fresh fruit and vegetables, and taxes on junk foods. 

An example of this type of approach has been used successfully in tobacco control - could be used to address the obesogenic environment (see below).

Learning from tobacco control to address obesity

Tobacco strategies

Decreases access to tobacco

Stopped tobacco advertising

Increases tax - tobacco

Comprehensive social marketing campaigns

Potential obesogenic environment strategies

Control location/number fast food outlets

Control junk food advertising

Increase tax - junk food

Social marketing campaigns

 

 

Last updated: 03 Nov 2016 5:00pm
Professor Clare Collins is a Professor in Nutrition & Dietetics and Deputy Director of the Priority Research Centre in Physical Activity & Nutrition at the University of Newcastle

This paper confirms that we can no longer ignore the consequences of over and under nutrition. This paper is a global call to action for all groups, whether government, NGO, professional bodies and industry to establish policies and practices that support people in having access to food of high nutritional quality, in the right amounts and proportions, to optimise their health and well being. This will be good for individuals, communities, and the economy and healthcare system.

Last updated: 03 Nov 2016 4:59pm

The change in BMI globally may only represent a limited picture of what is happening to health, it is perhaps best seen as a symptom rather than the disease. Underlying this are the changes in society including a transition in dietary habits from a traditional food based diet to one that is more processed and ‘westernised’.

It should also be considered that looking at only average BMI and not looking at the detail, including the articles conclusion, could mean that we miss the issue that there are still significant numbers of underweight and undernourished individuals especially in the world’s poorest areas including South Asian, and also in countries such as Australia.

Research of this type is important, as it quantifies what is happening, and should provide political pressure to improve public health systems to help people to be able to choose food that is acceptable, sustainable and healthy. However, caution needs to be taken if headlines about us living ‘in a world in which more people are obese than underweight’ are taken on face value.

As this might lead to stigmatising messages and photographs of headless individual’s abdomens and hips alongside alarmist headlines of an obesity crisis. The underlying message needs to focus on food security for all, which must be the priority, to minimise the health burdens associated both, with being under and overweight, as it is all too easy to focus on just the increase in BMI. Perhaps the bigger picture is that although average BMI is increasing; so are health inequalities and ease of access to healthy and safe food for many.

Last updated: 03 Nov 2016 4:52pm
Bruce Neal is a Senior Director at The George Institute for Global Health, Professor of Medicine at the University of Sydney and Chair of the Australian Division of World Action on Salt and Health.

This is a sophisticated, high quality analyses using a tremendous quantity of data. It highlights the huge problem of obesity around the world and the very concerning prospects for obesity in many developing economies. 
 
Governments around the world are going to need to take completely different types of actions if this issue is to be addressed. 
 
This is a problem of the food environment not individuals, and it is interventions that change the food environment that are required to address it. 
 
The world’s population hasn’t turned into sloths and gluttons – what has happened is that we now live in a swamp of low cost, high calorie junk food that is pushed down our throats by sophisticated advertising programs designed to maximise industry profits.
 
Industry is only partly to blame – after all, it's required to do pretty much whatever it reasonably can to benefit shareholders. Government ultimately controls what is acceptable corporate behaviour and what is not. And it's government that needs to start taking actions on behalf of the people.
 
Strategies based upon education and personal choice and not going to work. Incentives and disincentives that change the behaviour of the food industry are required – this means subsidies and regulations that support healthy food choices, and corresponding taxations and restrictions that control the sale, consumption and advertising of unhealthy products. 

Last updated: 03 Nov 2016 4:51pm

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