More than 10 percent of
the world’s population is now obese, a marked rise over the last 30 years that
is leading to widespread health problems and millions of premature deaths,
according to a new study, the most comprehensive research done on the subject.
Published Monday in
The New England Journal
of Medicine, the study showed that the problem had swept the globe,
including regions that have historically had food shortages, like Africa.
The study, compiled by the
Institute for Health Metrics and Evaluation at the University of Washington and
funded by the Gates Foundation, looked at 195 countries, essentially the
world’s population, finding that rates of obesity at
least doubled in 73 countries — including Turkey, Venezuela and Bhutan — from
1980 to 2015, and “continuously increased in most other countries.”
Analyzing some 1,800 data
sets from around the world, researchers found that excess weight played a role
in four million deaths in 2015, from heart disease, diabetes,
kidney disease and other factors.
The per capita death rate
was up 28 percent since 1990 and, notably, 40 percent of the deaths were among
people who were overweight but not heavy enough to be classified as obese.
The study defined obese as
a body mass index of 30 or higher and overweight as a B.M.I. from 25 to 29.
By those measures, nearly
604 million adults worldwide are obese and 108 million children, the authors
reported. Obesity rates among children are rising faster in many countries than
among adults.
In the United States, 12.5
percent of children were obese, up from 5 percent in 1980. Combining children
and adults, the United States had the dubious distinction of having the largest
increase in percentile points of any country, a jump of 16 percentage points to
26.5 percent of the overall population.
A range of nutrition
scientists, including ones who differ significantly on some issues in the
field, uniformly praised the breadth, depth and quality of the study, and the
significance of its message.
“Its global implications
are huge,” said Barry Popkin, a professor of nutrition at the University of
North Carolina. He echoed others in saying the findings tend to also affirm
smaller, more regional studies.
“This study shows what we
know: No country in the globe has reduced overweight or obesity levels. This is
astounding given the huge health and economic costs linked with overweight and
obesity.”
The study largely did not
go deeply into the causes of obesity, but the authors said the growing
accessibility of inexpensive, nutrient-poor packaged foods was probably a major
factor and the general slowdown in physical
activity was probably not.
“The change in physical
activity preceded the global increase in obesity,” said Dr. Ashkan Afshin,
assistant professor at the Institute for Health Metrics and Evaluation and lead
author of the study.
“We have more processed
food, more energy-dense food, more intense marketing of food products, and
these products are more available and more accessible,” he added. “The food
environment seems to be the main driver of obesity.”
Others agreed on the
availability of poor diet, noting that such food can often be the most
accessible and affordable.
“What people eat is the
key factor in whether they become obese or not,” said Adam Drewnowsk, director
of the Center for Public Health Nutrition at the University of Washington, who
was not affiliated with the study, which he deemed “brilliant work by the best
people in the business.”
He said getting people
healthy food was easier said than done.
“It is all very nice to
talk about the need to eat less unhealthy foods and more healthy foods,” he
said. But “unhealthy foods cost less; healthier foods often cost more. People
eat what they can afford.”
The research characterized
growth of obesity in two ways, one that looked at countries that had the
biggest leap in percentage points.
After the United States,
other countries with particularly significant jumps in percent of the
population who are obese included Saudi Arabia, Algeria and Egypt.
But other countries had
rates that rose much faster, even though they remained lower as an overall
percent of the population. Broadly, the fastest rises were found in Latin
America, Africa and China.
In China, for example,
less than 1 percent of the population was obesein 1980, but now more than
5 percent is, a fivefold increase. The rise in childhood obesity in China
roughly paralleled that overall change.
Three countries in Africa
— Burkina Faso, Mali and Guinea-Bissau — had the fastest growth. Burkina Faso,
the country with the fastest growth in the world in obesity, began in 1980 with
around one-third of a percent of its population as obese. Its rate rose to
nearly 7 percent of the population.
“The future health and
economic burden facing all these countries is immense,” Dr. Popkin said.
Regarding the overall
health implications of the study, one point made by the researchers is that
there is a good news/bad news pattern emerging.
The good news is that the
disease burden caused by obesity is actually falling in some of the wealthiest
nations. In the United States, the death rates associated with obesity fell
from 63 per 100,000 in 1990 (the baseline year for this measure) to 61 per
100,000 people, reflecting medications that deal with the effects of obesity,
like hypertension.
The bad news is those
remedies are not available in developing countries or are available only to the
wealthiest people, leading to growing rates of associated deaths and without a
clear solution.
“Most of the obese people
are dying because of cardiovascular disease and diabetes,” said Dr. Afshin,
lead author of the study. That has been somewhat mitigated in the United States
“and other developed nations” with the use of drugs.
“But we cannot have all
people on drugs,” he said. “Ideally, we want to go to the root causes and
address the problem of overeating.”
To date, he said, no
country “has been able to control the food environment, which seems to be the
main driver of obesity.”
Source NYTimes
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