29 research outputs found
Socioeconomic inequalities in overweight and obesity among 6‐ to 9‐year‐old children in 24 countries from the World Health Organization European region
Childhood overweight and obesity have significant short- and long-term negative impacts on children's health and well-being. These challenges are unequally distributed according to socioeconomic status (SES); however, previous studies have often lacked standardized and objectively measured data across national contexts to assess these differences. This study provides a cross-sectional picture of the association between SES and childhood overweight and obesity, based on data from 123,487 children aged 6–9 years in 24 countries in the World Health Organization (WHO) European region. Overall, associations were found between overweight/obesity and the three SES indicators used (parental education, parental employment status, and family-perceived wealth). Our results showed an inverse relationship between the prevalence of childhood overweight/obesity and parental education in high-income countries, whereas the opposite relationship was observed in most of the middle-income countries. The same applied to family-perceived wealth, although parental employment status appeared to be less associated with overweight and obesity or not associated at all. This paper highlights the need for close attention to context when designing interventions, as the association between SES and childhood overweight and obesity varies by country economic development. Population-based interventions have an important role to play, but policies that target specific SES groups are also needed to address inequalities.The authors gratefully acknowledge support through a grant from the
Russian Government in the context of the WHO European Office for
the Prevention and Control of NCDs. The Ministries of health of Austria, Croatia, Greece, Italy, Malta, Norway, and the Russian Federation
provided financial support for the meetings at which the protocol,
data collection procedures, and analyses were discussed. Data collection in the countries was made possible through funding from: Albania: World Health Organization (WHO) Country Office Albania and
the WHO Regional Office for Europe. Bulgaria: WHO Regional Office
for Europe. Croatia: Ministry of Health, Croatian Institute of Public
Health and WHO Regional Office for Europe. Czechia: Ministry of
Health of the Czech Republic, grant nr. 17-31670A and MZCR—RVO
EU 00023761. Denmark: The Danish Ministry of Health. France: Santé
publique France, the French Agency for Public Health. Georgia: WHO.
Ireland: Health Service Executive. Italy: Italian Ministry of Health; Italian National Institute of Health (Istituto Superiore di Sanità). Kazakhstan: the Ministry of Health of the Republic of Kazakhstan within the
scientific and technical program. Kyrgyzstan: World Health Organization.
Latvia: Centre for Disease Prevention and Control, Ministry of Health,
Latvia. Lithuania: Science Foundation of Lithuanian University of Health
Sciences and Lithuanian Science Council and WHO. Malta: Ministry of
Health; Montenegro: WHO and Institute of Public Health of Montenegro. Poland, National Health Program, Ministry of Health. Portugal: Ministry of Health Institutions, the National Institute of Health, Directorate
General of Health, Regional Health Directorates and the kind technical
support from the Center for Studies and Research on Social Dynamics
and Health (CEIDSS). Romania: Ministry of Health; Russian Federation:
WHO. San Marino: Health Ministry, Educational Ministry, Social Security
Institute and Health Authority. Spain: the Spanish Agency for Food
Safety & Nutrition. Tajikistan: WHO Country Office in Tajikistan and
Ministry of Health and Social Protection. Turkmenistan: WHO Country
Office in Turkmenistan and Ministry of Health. Turkey: Turkish Ministry
of Health and World Bank.info:eu-repo/semantics/publishedVersio
Socioeconomic disparities in physical activity, sedentary behavior and sleep patterns among 6- to 9-year-old children from 24 countries in the WHO European region
Physical activity, sedentary behavior, and sleep are important predictors of children's health. This paper aimed to investigate socioeconomic disparities in physical activity, sedentary behavior, and sleep across the WHO European region. This cross-sectional study used data on 124,700 children aged 6 to 9 years from 24 countries participating in the WHO European Childhood Obesity Surveillance Initiative between 2015 and 2017. Socioeconomic status (SES) was measured through parental education, parental employment status, and family perceived wealth. Overall, results showed different patterns in socioeconomic disparities in children's movement behaviors across countries. In general, high SES children were more likely to use motorized transportation. Low SES children were less likely to participate in sports clubs and more likely to have more than 2 h/day of screen time. Children with low parental education had a 2.24 [95% CI 1.94-2.58] times higher risk of practising sports for less than 2 h/week. In the pooled analysis, SES was not significantly related to active play. The relationship between SES and sleep varied by the SES indicator used. Importantly, results showed that low SES is not always associated with a higher prevalence of "less healthy" behaviors. There is a great diversity in SES patterns across countries which supports the need for country-specific, targeted public health interventions.The authors gratefully acknowledge support from a grant from the
Russian Government in the context of the WHO European Office for
the Prevention and Control of NCDs. Data collection in the countries
was made possible through funding from: Croatia: Ministry of Health,
Croatian Institute of Public Health and WHO Regional Office for
Europe. Albania: World Health Organization (WHO) Country Office
Albania and the WHO Regional Office for Europe. Bulgaria: WHO
Regional Office for Europe. Czech Republic: Ministry of Health of the
Czech Republic, grant nr. AZV MZČR 17-31670 A and MZČR–RVO
EÚ 00023761. Denmark: The Danish Ministry of Health. France:
Santé publique France, the French Agency for Public Health. Georgia:
WHO. Ireland: Health Service Executive. Italy: Italian Ministry of
Health; Italian National Institute of Health (Istituto Superiore di
Sanità). Kazakhstan: the Ministry of Health of the Republic of
Kazakhstan within the scientific and technical program. Kyrgyzstan:
World Health Organization. Latvia: Centre for Disease Prevention and
Control, Ministry of Health, Latvia. Lithuania: Science Foundation of
Lithuanian University of Health Sciences and Lithuanian Science
Council and WHO. Malta: Ministry of Health. Montenegro: WHO and
Institute of Public Health of Montenegro. Poland: National Health
Programme, Ministry of Health. Portugal: Ministry of Health Institutions, the National Institute of Health, Directorate General of Health,
Regional Health Directorates and the kind technical support from the
Center for Studies and Research on Social Dynamics and Health
(CEIDSS). Romania: Ministry of Health. Russian Federation: WHO. San Marino: Health Ministry. Spain: the Spanish Agency for Food
Safety & Nutrition. Tajikistan: WHO Country Office in Tajikistan and
Ministry of Health and Social Protection; Turkmenistan: WHO
Country Office in Turkmenistan and Ministry of Health. Turkey:
Turkish Ministry of Health and World Bank. Austria: Federal Ministry
of Labor, Social Affairs, Health and Consumer Protection of Austria.info:eu-repo/semantics/publishedVersio
Parental Perceptions of Children’s Weight Status in 22 Countries: The WHO European Childhood Obesity Surveillance Initiative: COSI 2015/2017
Introduction: Parents can act as important agents of change
and support for healthy childhood growth and development. Studies have found that parents may not be able to
accurately perceive their child’s weight status. The purpose
of this study was to measure parental perceptions of their
child’s weight status and to identify predictors of potential
parental misperceptions. Methods: We used data from the
World Health Organization (WHO) European Childhood
Obesity Surveillance Initiative and 22 countries. Parents
were asked to identify their perceptions of their children’s
weight status as “underweight,” “normal weight,” “a little
overweight,” or “extremely overweight.” We categorized
children’s (6–9 years; n = 124,296) body mass index (BMI) as
BMI-for-age Z-scores based on the 2007 WHO-recommended growth references. For each country included in the analysis and pooled estimates (country level), we calculated the
distribution of children according to the WHO weight status
classification, distribution by parental perception of child’s
weight status, percentages of accurate, overestimating, or
underestimating perceptions, misclassification levels, and
predictors of parental misperceptions using a multilevel logistic regression analysis that included only children with
overweight (including obesity). Statistical analyses were performed using Stata version 15 1. Results: Overall, 64.1% of
parents categorized their child’s weight status accurately
relative to the WHO growth charts. However, parents were
more likely to underestimate their child’s weight if the child
had overweight (82.3%) or obesity (93.8%). Parents were
more likely to underestimate their child’s weight if the child
was male (adjusted OR [adjOR]: 1.41; 95% confidence intervals [CI]: 1.28–1.55); the parent had a lower educational level
(adjOR: 1.41; 95% CI: 1.26–1.57); the father was asked rather
than the mother (adjOR: 1.14; 95% CI: 0.98–1.33); and the
family lived in a rural area (adjOR: 1.10; 95% CI: 0.99–1.24).
Overall, parents’ BMI was not strongly associated with the
underestimation of children’s weight status, but there was a
stronger association in some countries. Discussion/Conclusion: Our study supplements the current literature on factors
that influence parental perceptions of their child’s weight
status. Public health interventions aimed at promoting
healthy childhood growth and development should consider parents’ knowledge and perceptions, as well as the sociocultural contexts in which children and families live.The authors gratefully acknowledge support from a grant from
the Russian Government in the context of the WHO European Office for the Prevention and Control of NCDs. Data collection in the
countries was made possible through funding by: Albania: World
Health Organization through the Joint Programme on Children,
Food Security and Nutrition “Reducing Malnutrition in Children,” funded by the Millennium Development Goals Achievement Fund, and the Institute of Public Health; Bulgaria: Ministry
of Health, National Center of Public Health and Analyses, World
Health Organization Regional Office for Europe; Croatia: Ministry of Health, Croatian Institute of Public Health and World
Health Organization Regional Office for Europe; Czechia: Grants
AZV MZČR 17-31670 A and MZČR – RVO EÚ 00023761; Denmark: Danish Ministry of Health; France: French Public Health
Agency; Georgia: World Health Organization; Ireland: Health
Service Executive; Italy: Ministry of Health; Istituto Superiore di
sanità (National Institute of Health); Kazakhstan: Ministry of Health of the Republic of Kazakhstan and World Health Organization Country Office; Latvia: n/a; Lithuania: Science Foundation of
Lithuanian University of Health Sciences and Lithuanian Science
Council and World Health Organization; Malta: Ministry of
Health; Montenegro: World Health Organization and Institute of
Public Health of Montenegro; Poland: National Health Programme, Ministry of Health; Portugal: Ministry of Health Institutions, the National Institute of Health, Directorate General of
Health, Regional Health Directorates and the kind technical support of Center for Studies and Research on Social Dynamics and
Health (CEIDSS); Romania: Ministry of Health; Russia (Moscow): n/a; San Marino: Health Ministry; Educational Ministry; Social Security Institute; the Health Authority; Spain: Spanish Agency for Food Safety and Nutrition (AESAN); Tajikistan: World
Health Organization Country Office in Tajikistan and Ministry of
Health and Social Protection; and Turkmenistan: World Health
Organization Country Office in Turkmenistan and Ministry of
Health. The authors alone are responsible for the views expressed
in this article and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated.info:eu-repo/semantics/publishedVersio
Methodology and implementation of the WHO European Childhood Obesity Surveillance Initiative (COSI)
Establishment of the WHO European Childhood Obesity Surveillance Initiative (COSI)has resulted in a surveillance system which provides regular, reliable, timely, andaccurate data on children's weight status—through standardized measurement ofbodyweight and height—in the WHO European Region. Additional data on dietaryintake, physical activity, sedentary behavior, family background, and schoolenvironments are collected in several countries. In total, 45 countries in the EuropeanRegion have participated in COSI. The first five data collection rounds, between 2007and 2021, yielded measured anthropometric data on over 1.3 million children. In COSI,data are collected according to a common protocol, using standardized instrumentsand procedures. The systematic collection and analysis of these data enables inter-country comparisons and reveals differences in the prevalence of childhood thinness,overweight, normal weight, and obesity between and within populations. Furthermore,it facilitates investigation of the relationship between overweight, obesity, and poten-tial risk or protective factors and improves the understanding of the development ofoverweight and obesity in European primary-school children in order to supportappropriate and effective policy responses.The authors gratefully acknowledge support through a grant from
the Russian Government in the context of the WHO European
Office for the Prevention and Control of NCDs. The ministries of
health of Austria, Croatia, Greece, Italy, Malta, Norway, and the
Russian Federation provided financial support for the meetings at
which the protocol, data collection procedures, and analyses were
discussed. Data collection in countries was made possible through
funding from the following: Albania: WHO through the Joint
Programme on Children, Food Security and Nutrition “Reducing
Malnutrition in Children,” funded by the Millennium Development
Goals Achievement Fund, and the Institute of Public Health. Austria:
Federal Ministry of Labor, Social Affairs, Health and Consumer
Protection of Austria. Bulgaria: Ministry of Health, National Center
of Public Health and Analyses, and WHO Regional Office for
Europe. Bosnia and Herzegovina: WHO country office support for
training and data management. Croatia: Ministry of Health, Croatian
Institute of Public Health, and WHO Regional Office for Europe.
Czechia: Ministry of Health of the Czech Republic, grant number
17-31670A and MZCR—RVO EU 00023761. Denmark: Danish
Ministry of Health. Estonia: Ministry of Social Affairs, Ministry of
Education and Research (IUT 42-2), WHO Country Office, and
National Institute for Health Development. Finland: Finnish Institute
for Health and Welfare. France: Santé publique France (the French
Agency for Public Health). Georgia: WHO. Greece: International
Hellenic University and Hellenic Medical Association for Obesity.
Hungary: WHO Country Office for Hungary. Ireland: Health Service
Executive. Italy: Ministry of Health. Kazakhstan: Ministry of Health
of the Republic of Kazakhstan, WHO, and UNICEF. Kyrgyzstan:
World Health Organization. Latvia: Ministry of Health and Centre
for Disease Prevention and Control. Lithuania: Science Foundation
of Lithuanian University of Health Sciences and Lithuanian Science
Council and WHO. Malta: Ministry of Health. Montenegro: WHO
and Institute of Public Health of Montenegro. North Macedonia:
Government of North Macedonia through National Annual Program
of Public Health and implemented by the Institute of Public Health
and Centers of Public Health; WHO country office provides support
for training and data management. Norway: the Norwegian Ministry
of Health and Care Services, the Norwegian Directorate of Health,
and the Norwegian Institute of Public Health. Poland: National
Health Programme, Ministry of Health. Portugal: Ministry of Health Institutions, the National Institute of Health, Directorate General of
Health, Regional Health Directorates, and the kind technical support
from the Center for Studies and Research on Social Dynamics and
Health (CEIDSS). Romania: Ministry of Health. Russian Federation:
WHO. San Marino: Health Ministry, Educational Ministry, and Social
Security Institute and Health Authority. Serbia: WHO and the
WHO Country Office (2015-540940 and 2018/873491-0). Slovakia:
Biennial Collaborative Agreement between WHO Regional Office
for Europe and Ministry of Health SR. Slovenia: Ministry of Education, Science and Sport of the Republic of Slovenia within the SLOfit
surveillance system. Spain: Spanish Agency for Food Safety and
Nutrition. Sweden: Public Health Agency of Sweden. Tajikistan:
WHO Country Office in Tajikistan and Ministry of Health and Social
Protection. Turkmenistan: WHO Country Office in Turkmenistan
and Ministry of Health. Turkey: Turkish Ministry of Health and
World Bank.info:eu-repo/semantics/publishedVersio
Physical activity, screen time, and sleep duration of children aged 6-9 years in 25 countries:An analysis within the WHO european childhood obesity surveillance initiative (COSI) 2015-2017
BACKGROUND: Children are becoming less physically active as opportunities for safe active play, recreational activities, and active transport decrease. At the same time, sedentary screen-based activities both during school and leisure time are increasing. OBJECTIVES: This study aimed to evaluate physical activity (PA), screen time, and sleep duration of girls and boys aged 6-9 years in Europe using data from the WHO European Childhood Obesity Surveillance Initiative (COSI). METHOD: The fourth COSI data collection round was conducted in 2015-2017, using a standardized protocol that included a family form completed by parents with specific questions about their children's PA, screen time, and sleep duration. RESULTS: Nationally representative data from 25 countries was included and information on the PA behaviour, screen time, and sleep duration of 150,651 children was analysed. Pooled analysis showed that: 79.4% were actively playing for >1 h each day, 53.9% were not members of a sport or dancing club, 50.0% walked or cycled to school each day, 60.2% engaged in screen time for 1 h/day, 8.2-85.6% were not members of a sport or dancing club, 17.7-94.0% walked or cycled to school each day, 32.3-80.0% engaged in screen time for <2 h/day, and 50.0-95.8% slept for 9-11 h/night. CONCLUSIONS: The prevalence of engagement in PA and the achievement of healthy screen time and sleep duration are heterogenous across the region. Policymakers and other stakeholders, including school administrators and parents, should increase opportunities for young people to participate in daily PA as well as explore solutions to address excessive screen time and short sleep duration to improve the overall physical and mental health and well-being of children
Thinness, overweight, and obesity in 6‐ to 9‐year‐old children from 36 countries: The World Health Organization European Childhood Obesity Surveillance Initiative - COSI 2015-2017
In 2015-2017, the fourth round of the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative (COSI) was conducted in 36 countries. National representative samples of children aged 6–9 (203,323) were measured by trained staff, with similar equipment and using a standardized protocol. This paper assesses the children's body weight status and compares the burden of childhood overweight, obesity, and thinness in Northern, Eastern, and Southern Europe and Central Asia. The results show great geographic variability in height, weight, and body mass index. On average, the children of Northern Europe were the tallest, those of Southern Europe the heaviest, and the children living in Central Asia the lightest and the shortest. Overall, 28.7% of boys and 26.5% of girls were overweight (including obesity) and 2.5% and 1.9%, respectively, were thin according to the WHO definitions. The prevalence of obesity varied from 1.8% of boys and 1.1% of girls in Tajikistan to 21.5% and 19.2%, respectively, in Cyprus, and tended to be higher for boys than for girls. Levels of thinness, stunting, and underweight were relatively low, except in Eastern Europe (for thinness) and in Central Asia. Despite the efforts to halt it, unhealthy weight status is still an important problem in the WHO European Region.The authors gratefully acknowledge support from a grant from the
Russian Government in the context of the WHO European Office for
the Prevention and Control of NCDs. Data collection in the countries
was made possible through funding from the following: Albania:
WHO through the Joint Programme on Children, Food Security and
Nutrition “Reducing Malnutrition in Children,” funded by the
Millennium Development Goals Achievement Fund, and the Institute
of Public Health; Austria: Federal Ministry of Social Affairs, Health,
Care and Consumer Protection, Republic of Austria; Bulgaria: Ministry
of Health, National Center of Public Health and Analyses, WHO
Regional Office for Europe; Croatia: Ministry of Health, Croatian Institute of Public Health and WHO Regional Office for Europe; Czechia:
Ministry of Health of the Czech Republic, grants AZV MZČR
17-31670 A and MZČR – RVO EÚ 00023761; Cyprus: not available;
Denmark: Danish Ministry of Health; Estonia: Ministry of Social
Affairs, Ministry of Education and Research (IUT 42-2), WHO Country
Office, and National Institute for Health Development; Finland: Finnish Institute for Health and Welfare; France: Santé publique France,
the French Agency for Public Health; Georgia: WHO; Greece: International Hellenic University and Hellenic Medical Association for Obesity; Hungary: WHO Country Office for Hungary; Ireland: Health
Service Executive; Italy: Ministry of Health and Italian National Institute of Health; Kazakhstan: Ministry of Health of the Republic of
Kazakhstan and WHO Country Office; Kyrgyzstan: World Health
Organization; Latvia: Ministry of Health, Centre for Disease Prevention and Control; Lithuania: Science Foundation of Lithuanian University of Health Sciences and Lithuanian Science Council and WHO;
Malta: Ministry of Health; Montenegro: WHO and Institute of Public
Health of Montenegro; North Macedonia: funded by the Government
of North Macedonia through National Annual Program of Public
Health and implemented by the Institute of Public Health and Centers
of Public Health in the country. WHO country office provided support
for training and data management; Norway: Ministry of Health and
Norwegian Institute of Public Health; Poland: National Health Programme, Ministry of Health; Portugal: Ministry of Health Institutions,
the National Institute of Health, Directorate General of Health,
Regional Health Directorates and the kind technical support from the
Center for Studies and Research on Social Dynamics and Health
(CEIDSS); Romania: Ministry of Health; Russian Federation: WHO;
San Marino: Health Ministry, Educational Ministry, Social Security
Institute and Health Authority; Serbia: World Health Organization
(Ref. File 2015-540940); Slovakia: Biennial Collaborative Agreement
between WHO Regional Office for Europe and Ministry of Health SR;
Slovenia: Ministry of Education, Science and Sport of the Republic of
Slovenia within the SLOfit surveillance system; Spain: Spanish Agency
for Food Safety and Nutrition (AESAN); Sweden: Public Health
Agency of Sweden; Tajikistan: WHO Country Office in Tajikistan and
Ministry of Health and Social Protection; Turkmenistan: WHO Country Office in Turkmenistan and Ministry of Health; Turkey: Turkish Ministry of Health and World Bank.info:eu-repo/semantics/publishedVersio
Physical activity, screen time, and sleep duration of children aged 6-9 years in 25 countries:An analysis within the WHO european childhood obesity surveillance initiative (COSI) 2015-2017
Background: Children are becoming less physically active as opportunities for safe active play, recreational activities, and active transport decrease. At the same time, sedentary screen-based activities both during school and leisure time are increasing. Objectives: This study aimed to evaluate physical activity (PA), screen time, and sleep duration of girls and boys aged 6-9 years in Europe using data from the WHO European Childhood Obesity Surveillance Initiative (COSI). Method: The fourth COSI data collection round was conducted in 2015-2017, using a standardized protocol that included a family form completed by parents with specific questions about their children's PA, screen time, and sleep duration. Results: Nationally representative data from 25 countries was included and information on the PA behaviour, screen time, and sleep duration of 150,651 children was analysed. Pooled analysis showed that: 79.4% were actively playing for >1 h each day, 53.9% were not members of a sport or dancing club, 50.0% walked or cycled to school each day, 60.2% engaged in screen time for <2 h/day, and 84.9% slept for 9-11 h/night. Country-specific analyses of these behaviours showed pronounced differences, with national prevalences in the range of 61.7-98.3% actively playing for >1 h/day, 8.2-85.6% were not members of a sport or dancing club, 17.7-94.0% walked or cycled to school each day, 32.3-80.0% engaged in screen time for <2 h/day, and 50.0-95.8% slept for 9-11 h/night. Conclusions: The prevalence of engagement in PA and the achievement of healthy screen time and sleep duration are heterogenous across the region. Policymakers and other stakeholders, including school administrators and parents, should increase opportunities for young people to participate in daily PA as well as explore solutions to address excessive screen time and short sleep duration to improve the overall physical and mental health and well-being of children. </p
Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants
Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks
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
Background Underweight 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.
Methods We 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 <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For schoolaged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference)
and obesity (BMI >2 SD above the median).
Findings From 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.
Interpretation The 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 obesit
Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)
From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions