Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

BackgroundUnderweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories.MethodsWe used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI 2 SD above the median).FindingsFrom 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness.InterpretationThe combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity

Adherence to a Plant-Based Diet and Consumption of Specific Plant Foods—Associations with 3-Year Weight-Loss Maintenance and Cardiometabolic Risk Factors: A Secondary Analysis of the PREVIEW Intervention Study

Plant-based diets are recommended by dietary guidelines. This secondary analysis aimed to assess longitudinal associations of an overall plant-based diet and specific plant foods with weight-loss maintenance and cardiometabolic risk factors. Longitudinal data on 710 participants (aged 26–70 years) with overweight or obesity and pre-diabetes from the 3-year weight-loss maintenance phase of the PREVIEW intervention were analyzed. Adherence to an overall plant-based diet was evaluated using a novel plant-based diet index, where all plant-based foods received positive scores and all animal-based foods received negative scores. After adjustment for potential confounders, linear mixed models with repeated measures showed that the plant-based diet index was inversely associated with weight regain, but not with cardiometabolic risk factors. Nut intake was inversely associated with regain of weight and fat mass and increments in total cholesterol and LDL cholesterol. Fruit intake was inversely associated with increments in diastolic blood pressure, total cholesterol, and LDL cholesterol. Vegetable intake was inversely associated with an increment in diastolic blood pressure and triglycerides and was positively associated with an increase in HDL cholesterol. All reported associations with cardiometabolic risk factors were independent of weight change. Long-term consumption of nuts, fruits, and vegetables may be beneficial for weight management and cardiometabolic health, whereas an overall plant-based diet may improve weight management onl

Top 10 International Priorities for Physical Fitness Research and Surveillance Among Children and Adolescents: A Twin-Panel Delphi Study

Background: The measurement of physical fitness has a history that dates back nearly 200 years. Recently, there has been an increase in international research and surveillance on physical fitness creating a need for setting international priorities that could help guide future efforts.Objective: This study aimed to produce a list of the top 10 international priorities for research and surveillance on physical fitness among children and adolescents.Methods: Using a twin-panel Delphi method, two independent panels consisting of 46 international experts were identified (panel 1=28, panel 2=18). The panel participants were asked to list up to five priorities for research or surveillance (round 1), and then rated the items from their own panel on a 5-point Likert scale of importance (round 2). In round 3, experts were asked to rate the priorities identified by the other panel.Results: There was strong between-panel agreement (panel 1: rs=0.76, p<0.01; panel 2: rs=0.77, p<0.01) in the priorities identified. The list of the final top 10 priorities included (i) “conduct longitudinal studies to assess changes in fitness and associations with health”. This was followed by (ii) “use fitness surveillance to inform decision making”, and (iii) “implement regular and consistent international/national fitness surveys using common measures”.Conclusions: The priorities identified in this study provide guidance for future international collaborations and research efforts on the physical fitness of children and adolescents over the next decade and beyond

What Is the Profile of Overweight Individuals Who Are Unsuccessful Responders to a Low-Energy Diet? A PREVIEW Sub-study

This study was performed to evaluate the profile of overweight individuals with pre-diabetes enrolled in PREVIEW who were unable to achieve a body weight loss of ≥8% of the baseline value in response to a 2-month low-energy diet (LED). Their baseline profile reflected potential stress-related vulnerability that predicted a reduced response of body weight to a LED programme. The mean daily energy deficit maintained by unsuccessful weight responders of both sexes was less than the estimated level in successful female (656 vs. 1,299 kcal, p < 0.01) and male (815 vs. 1,659 kcal, p < 0.01) responders. Despite this smaller energy deficit, unsuccessful responders displayed less favorable changes in susceptibility to hunger and appetite sensations. They also did not benefit from the intervention regarding the ability to improve sleep quality. In summary, these results show that some individuals display a behavioral vulnerability which may reduce the ability to lose weight in response to a diet-based weight loss program. They also suggest that this vulnerability may be accentuated by a prolonged diet restriction

Normalizing calf circumference to identify low skeletal muscle mass in older women: a cross-sectional study

Introduction: functional limitation is a result of sarcopenia and is associated with loss of skeletal muscle mass (SMM). Cost-effective methods are important for the identification of sarcopenia. Objective: to propose cutoff points for normalized calf circumference (CC) in order to identify low SMM in older women based on their functional limitation. Methods: in this descriptive, cross-sectional study the CC values of a young female sample (n = 78) were used to establish cutoff points (-2 SD) for low SMM in older women (n = 67). Functional limitation was identified by the six-minute walk test (≤ 400 m). CC was normalized by body mass, height, and BMI. The diagnostic accuracy of CC was calculated with a ROC curve, using functional limitation as standard. Results: cutoff points and area under the curve (AUC) were: CC (≤ 28.5; 0.62); CC·body mass-1 (≤ 0.40; 0.63); CC·height-2 (≤ 8.52; 0.55) and CC·BMI-1 (≤ 1.10; 0.73). Only CC·BMI-1 achieved a desirable accuracy (AUC > 0.7) to distinguish functional limitation. Conclusion: the accuracy attained supports the use of CC·BMI-1 to identify low SMM in older women. In the clinical context it is possible to predict the risk of sarcopenia when sophisticated methods for determining SMM are not available

Diminishing benefits of urban living for children and adolescents’ growth and development

Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1,2,3,4,5,6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5–19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was <1.1 kg m–2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified

Exploring the complex relationship between legislation, policies and research: Built Environments And Child Health in WalEs and AuStralia (BEACHES)

This Data Insight focuses on the work being carried out by the Built Environments And Child Health in WalEs and AuStralia (BEACHES) team in Swansea University. BEACHES is a joint initiative between Swansea University, the Telethon Kids Institute, and the University of Western Australia, with collaborators from Curtin University, Monash University, Queensland University of Technology, and University of Southern Denmark. It provides a summary of key Welsh legislation and policy areas on the built environment and child health. We describe the data used in the BEACHES project and present the statistical analysis to be conducted, as well as the dissemination process and engagement with stakeholders throughout the project. This Data Insight has been produced by the ADR Wales Health and Well-being research team. It provides a snapshot of informative research currently underway at ADR Wales but is not intended to provide a complete picture of the work undertaken within this field or the ADR Wales programme of work. The information presented in this Data Insight has been reviewed by ADR Wales colleagues with expertise within this thematic area and is accepted to be accurate at the point of publication. Views expressed in this Data Insight are those of the researchers and not necessarily those of ADR Wales partner organisations

Women, wellbeing and the city: A model of participatory health research exploring physical activity in Black, Asian and minority ethnic communities

Objective:The aim of this project was to document a partnership working process from a cross-sectoral and cross-cultural participatory health research study focused on promoting physical activity among women from Black, Asian and minority ethnic (BAME) backgrounds.Design:A participatory health research paradigm was used to support this pilot feasibility study into partnership working for health promotion. Action research and community development principles underpinned the design, delivery and interpretation of findings from a community-based survey, data from four focus groups and bespoke interventions.Setting:Community groups from education, leisure, health and religious community sectors, and charity sectors, in the City of Liverpool, met in different venues representing those sectors.Method:Reflection on the process of community engagement in a research study guided by socio-ecological model, community development and action research principles.Results:Seven emerging collaborative processes based on effective partnership working, capacity-building practice and sustaining health and wellbeing evolved from a partnership between a Community Researchers Advisory Group and a Partners Advisory Group. BAME ‘community connectors’ were key to obtaining feedback from 213 women from 16 ethnic groups, which influenced the development of bespoke interventions and local sport and physical activity long-term policy, as one means of reducing social inequalities for women from BAME backgrounds.Conclusion:This feasibility study demonstrates the effectiveness and limitations of partnership working as a public health tool. The local Sport and Physical Activity Alliance and council department worked together to promote the sustainability of BAME-focused programmes as part of their governance and policy frameworks