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The obesity transition: stages of the global epidemic

Published on Mar 1, 2019in The Lancet Diabetes & Endocrinology 19.31
· DOI :10.1016/S2213-8587(19)30026-9
Lindsay M. Jaacks12
Estimated H-index: 12
(Harvard University),
Stefanie Vandevijvere7
Estimated H-index: 7
(University of Auckland)
+ 6 AuthorsMajid Ezzati98
Estimated H-index: 98
(Imperial College London)
Summary The global prevalence of obesity has increased substantially over the past 40 years, from less than 1% in 1975, to 6–8% in 2016, among girls and boys, and from 3% to 11% among men and from 6% to 15% among women over the same time period. Our aim was to consolidate the evidence on the epidemiology of obesity into a conceptual model of the so-called obesity transition. We used illustrative examples from the 30 most populous countries, representing 77·5% of the world's population to propose a four stage model. Stage 1 of the obesity transition is characterised by a higher prevalence of obesity in women than in men, in those with higher socioeconomic status than in those with lower socioeconomic status, and in adults than in children. Many countries in south Asia and sub-Saharan Africa are presently in this stage. In countries in stage 2 of the transition, there has been a large increase in the prevalence among adults, a smaller increase among children, and a narrowing of the gap between sexes and in socioeconomic differences among women. Many Latin American and Middle Eastern countries are presently at this stage. High-income east Asian countries are also at this stage, albeit with a much lower prevalence of obesity. In stage 3 of the transition, the prevalence of obesity among those with lower socioeconomic status surpasses that of those with higher socioeconomic status, and plateaus in prevalence can be observed in women with high socioeconomic status and in children. Most European countries are presently at this stage. There are too few signs of countries entering into the proposed fourth stage of the transition, during which obesity prevalence declines, to establish demographic patterns. This conceptual model is intended to provide guidance to researchers and policy makers in identifying the current stage of the obesity transition in a population, anticipating subpopulations that will develop obesity in the future, and enacting proactive measures to attenuate the transition, taking into consideration local contextual factors.
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Published on Jun 10, 2015in PLOS ONE 2.77
Benn Sartorius30
Estimated H-index: 30
(University of KwaZulu-Natal),
Lennert Veerman15
Estimated H-index: 15
(University of Queensland)
+ 2 AuthorsKaren Hofman21
Estimated H-index: 21
(Johns Hopkins University)
Background: Obesity is a major risk factor for emerging non-communicable diseases (NCDS) in middle income countries including South Africa (SA). Understanding the multiple and complex determinants of obesity and their true population attributable impact is critical for informing and developing effective prevention efforts using scientific based evidence. This study identified contextualised high impact factors associated with obesity in South Africa. Methods: Analysis of three national cross sec...
27 Citations Source Cite
Published on Jan 10, 2004in The Lancet 53.25
Chizuru Nishida9
Estimated H-index: 9
to 25 kg/m 2 in different Asian populations; for high risk it varies from 26 kg/m 2 to 31 kg/m 2 . No attempt was made, therefore, to redefine cut-off points for each population separately. The consultation also agreed that the WHO BMI cut-off points should be retained as international classifications. The consultation identified further potential public health action points (23·0, 27·5, 32·5, and 37·5 kg/m 2 ) along the continuum of BMI, and proposed methods by which countries could make decisi...
4,920 Citations Source Cite
Published on Jan 1, 2004in International Journal of Epidemiology 8.36
C. Ni Mhurchu10
Estimated H-index: 10
(University of Auckland),
Anthony Rodgers45
Estimated H-index: 45
(University of Auckland)
+ 2 AuthorsMark Woodward109
Estimated H-index: 109
(University of Sydney)
Background Few prospective data from the Asia-Pacific region are available relating body mass index (BMI) to the risks of stroke and ischaemic heart disease (IHD). Our objective was to assess the age-, sex-, and region-specific associations of BMI with cardiovascular disease using individual participant data from prospective studies in the Asia-Pacific region. Methods Studies were identified from literature searches, proceedings of meetings, and personal communication. All studies had at least 5...
214 Citations Source Cite
Published on Dec 1, 2015in The Lancet 53.25
Mohammad H. Forouzanfar54
Estimated H-index: 54
(University of Washington),
Lily T Alexander8
Estimated H-index: 8
(University of Washington)
+ 718 AuthorsAaron Cohen41
Estimated H-index: 41
(Health Effects Institute)
The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution. Attributab...
1,544 Citations Source Cite
Published on May 3, 2017in Critical Reviews in Food Science and Nutrition 6.20
Suzanne M. Dyer3
Estimated H-index: 3
(University of Adelaide),
Judith Streak Gomersall5
Estimated H-index: 5
(University of Adelaide)
+ 3 AuthorsJackie Street13
Estimated H-index: 13
(University of Adelaide)
ABSTRACTEvidence-based profiling of obesity and overweight in Indigenous Australian children has been poor. This study systematically reviewed evidence of the prevalence and patterns of obesity/overweight, with respect to gender, age, remoteness, and birth weight, in Indigenous Australian children, 0–18 years (PROSPERO CRD42014007626). Study quality and risk of bias were assessed. Twenty-five publications (21 studies) met inclusion criteria, with large variations in prevalence for obesity or ove...
6 Citations Source Cite
Valerie Burke67
Estimated H-index: 67
Matthew Knuiman12
Estimated H-index: 12
Timothy A. Welborn29
Estimated H-index: 29
R Obesity develops during periods of positive energy balance resulting from inadequately low regular physical activity and inadequately high calorie intake R Treatment of obesity in children can be performed on the basis of a behavioral-based training program aiming at reducing sedentary behaviors, increasing physical activity and improving energy intake R Successful dietary measures are reducing the intake of energy-dense foods, foods with added sugars, and increasing the proportion of foods wi...
867 Citations
Published on Jan 1, 2014in Obesity Reviews 8.48
Penny Gordon-Larsen52
Estimated H-index: 52
(University of North Carolina at Chapel Hill),
Huijun Wang14
Estimated H-index: 14
(Chinese Center for Disease Control and Prevention),
Barry M. Popkin317
Estimated H-index: 317
(University of North Carolina at Chapel Hill)
China has experienced a transition from a history of undernutrition to a rapid increase in obesity. The China Health and Nutrition Survey, an ongoing longitudinal, household-based survey of urban and rural residents of nine provinces, documents these changes using measured height and weight across 53,298 observations from 18,059 participants collected from 1991 to 2011. Adult overweight (body mass index [BMI] ≥ 25 kilograms per square meter [kg/m2]) prevalence nearly tripled from 1991 (11.7%) to...
87 Citations Source Cite
Published on Oct 1, 2015in Social Science & Medicine 3.01
Amy Borovoy6
Estimated H-index: 6
(Princeton University),
Christina A. Roberto27
Estimated H-index: 27
(Harvard University)
Controlling population weight gain is a major concern for industrialized nations because of associated health risks. Although Japan is experiencing rising prevalence of obesity and overweight, historically they have had and continue to maintain a low prevalence relative to other developed countries. Therefore, Japan provides an interesting case study of strategies to curb population weight gain. In this paper we explore Japanese approaches to obesity and diet through observational and ethnograph...
10 Citations Source Cite
Published on Oct 1, 2015in European Journal of Public Health 2.78
Rasmus Hoffmann19
Estimated H-index: 19
(Erasmus University Rotterdam),
Terje Andreas Eikemo20
Estimated H-index: 20
(Erasmus University Rotterdam)
+ 7 AuthorsJohan P. Mackenbach92
Estimated H-index: 92
(Erasmus University Rotterdam)
Background: Obesity contributes considerably to the problem of health inequalities in many countries, but quantitative estimates of this contribution and to what extent it is modifiable are scarce. We identify the potential for reducing educational inequalities in all-cause and obesity-related mortality in 21 European populations, by modifying educational differences in obesity and overweight. Methods: Prevalence data and mortality data come from 21 European populations. Mortality rate ratios co...
13 Citations Source Cite
Published on Jun 1, 2015in The Lancet 53.25
Boydoyd Swinburn65
Estimated H-index: 65
(Deakin University),
Vivica Kraak18
Estimated H-index: 18
(Deakin University)
+ 6 AuthorsRoger Magnusson16
Estimated H-index: 16
(University of Sydney)
Summary To achieve WHO's target to halt the rise in obesity and diabetes, dramatic actions are needed to improve the healthiness of food environments. Substantial debate surrounds who is responsible for delivering effective actions and what, specifically, these actions should entail. Arguments are often reduced to a debate between individual and collective responsibilities, and between hard regulatory or fiscal interventions and soft voluntary, education-based approaches. Genuine progress lies b...
109 Citations Source Cite
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