Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Dec 16;390(10113):2627-2642.
doi: 10.1016/S0140-6736(17)32129-3. Epub 2017 Oct 10.

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

Collaborators
Free PMC article

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). Lancet. .
Free PMC article

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.

Figures

Figure 1
Figure 1
Trends in age-standardised mean BMI by sex and region in females Children and adolescents were aged 5–19 years and adults were aged 20 years and older. The lines show the posterior mean estimates and the shaded areas show the 95% credible intervals. See appendix for trends by country. BMI=body-mass index.
Figure 2
Figure 2
Trends in age-standardised mean BMI by sex and region in males Children and adolescents were aged 5–19 years and adults were aged 20 years and older. The lines show the posterior mean estimates and the shaded areas show the 95% credible intervals. See appendix for trends by country. BMI=body-mass index.
Figure 3
Figure 3
Age-standardised mean BMI, prevalence of obesity, and prevalence of moderate and severe underweight by sex and country in 2016 in children and adolescents Children and adolescents were aged 5–19 years. Obesity was defined as more than 2 SD above the median of the WHO growth reference. Moderate and severe underweight was defined as more than 2 SD below the median. See appendix for results for adults. BMI=body-mass index.
Figure 4
Figure 4
Age-standardised mean BMI in children and adolescents in 1975 and 2016 Each line shows one country. BMI=body-mass index.
Figure 5
Figure 5
Comparison of age-standardised mean BMI in children and adolescents and in adults Children and adolescents were aged 5–19 years and adults were aged 20 years and older. Each point shows one country. The dotted line shows the linear association between the two outcomes. BMI=body-mass index.
Figure 6
Figure 6
Comparison of change in age-standardised mean BMI in children and adolescents and in adults Children and adolescents were aged 5–19 years and adults were aged 20 years and older. Each point shows one country. The dotted line shows the linear association between the two outcomes. BMI=body-mass index.
Figure 7
Figure 7
Comparison of age-standardised mean BMI in 1975 and 2016, and change per decade in age-standardised mean BMI from 1975 to 2016 by sex Each point shows one country. BMI=body-mass index.
Figure 8
Figure 8
Trends in age-standardised prevalence of BMI categories in female children and adolescents by region Children and adolescents were aged 5–19 years. See appendix for results for adults. BMI=body-mass index.
Figure 9
Figure 9
Trends in age-standardised prevalence of BMI categories in male children and adolescents by region Children and adolescents were aged 5–19 years. See appendix for results for adults. BMI=body-mass index.
Figure 10
Figure 10
Trends in the number of children and adolescents with obesity and with moderate and severe underweight by region Children and adolescents were aged 5–19 years. See appendix for results for adults. BMI=body-mass index.

Comment in

Similar articles

See all similar articles

Cited by 586 articles

See all "Cited by" articles

References

    1. Han Z, Mulla S, Beyene J, Liao G, McDonald SD. Maternal underweight and the risk of preterm birth and low birth weight: a systematic review and meta-analyses. Int J Epidemiol. 2011;40:65–101. - PubMed
    1. Black RE, Victora CG, Walker SP. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382:427–451. - PubMed
    1. WHO . Consideration of the evidence on childhood obesity for the Commission on Ending Childhood Obesity: report of the Ad hoc Working Group on Science and Evidence for Ending Childhood Obesity. World Health Organization; Geneva: 2016.
    1. Lobstein T, Baur L, Uauy R. Obesity in children and young people: a crisis in public health. Obes Rev. 2004;5:4–85. - PubMed
    1. MacLean P, Higgins J, Giles E, Sherk V, Jackman M. The role for adipose tissue in weight regain after weight loss. Obes Rev. 2015;16:45–54. - PMC - PubMed
Feedback