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
Authors: Nowell H Phelps, Rosie K Singleton, Bin Zhou, Rachel A Heap, Anu Mishra, James E Bennett, Christopher J Paciorek, Victor PF Lhoste, Rodrigo M Carrillo-Larco, Gretchen A Stevens, Andrea Rodriguez-Martinez, Honor Bixby, James Bentham, Mariachiara Di Cesare, Goodarz Danaei, Archie W Rayner, Ana Barradas-Pires, Melanie J Cowan, Stefan Savin, Leanne M Riley, Carlos A Aguilar-Salinas, Jennifer L Baker, Amina Barkat, Zulfiqar A Bhutta, Francesco Branca, Roberta B Caixeta, Sarah Cuschieri, Farshad Farzadfar, Shubash Ganapathy, Nayu Ikeda, Violeta Iotova, Andre P Kengne, Young-Ho Khang, Avula Laxmaiah, Hsien-Ho Lin, Jun Ma, Jean Claude N Mbanya, J Jaime Miranda, Rajendra Pradeepa, Fernando Rodríguez-Artalejo, Maroje Sorić, Maria Turley, Limin Wang, Karen Webster-Kerr, Julie Aarestrup, Leandra Abarca-Gómez, Mohsen Abbasi-Kangevari, Ziad A Abdeen, Shynar Abdrakhmanova, Suhaila Abdul Ghaffar, Hanan F Abdul Rahim, Zulfiya Abdurrahmonova, Niveen M Abu-Rmeileh, Jamila Abubakar Garba, Benjamin Acosta-Cazares, Ishag Adam, Marzena Adamczyk, Robert J Adams, Seth Adu-Afarwuah, Wichai Aekplakorn, Kaosar Afsana, Shoaib Afzal, Valirie N Agbor, Imelda A Agdeppa, Javad Aghazadeh-Attari, Åsa Ågren, Hassan Aguenaou, Charles Agyemang, Mohamad Hasnan Ahmad, Noor Ani Ahmad, Ali Ahmadi, Naser Ahmadi, Nastaran Ahmadi, Imran Ahmed, Soheir H Ahmed, Wolfgang Ahrens, Gulmira Aitmurzaeva, Kamel Ajlouni, Hazzaa M Al-Hazzaa, Halima Al-Hinai, Badreya Al-Lahou, Jawad A Al-Lawati, Rajaa Al-Raddadi, Deena Al Asfoor, Huda M Al Hourani, Nawal M Al Qaoud, Monira Alarouj, Fadia AlBuhairan, Shahla AlDhukair, Maryam A Aldwairji, Sylvia Alexius, Mohamed M Ali, Anna V Alieva, Abdullah Alkandari, Ala'a Alkerwi, Buthaina M Alkhatib, Kristine Allin, Shaker A Alomary, Husam F Alomirah, Arwa M Alshangiti, Mar Alvarez-Pedrerol, Eman Aly, Deepak N Amarapurkar, Pilar Amiano Etxezarreta, John Amoah, Norbert Amougou, Philippe Amouyel, Lars Bo Andersen, Sigmund A Anderssen, Odysseas Androutsos, Lars Ängquist, Ranjit Mohan Anjana, Alireza Ansari-Moghaddam, Elena Anufrieva, Hajer Aounallah-Skhiri, Joana Araújo, Inger Ariansen, Tahir Aris, Raphael E Arku, Nimmathota Arlappa, Krishna K Aryal, Nega Assefa, Thor Aspelund, Felix K Assah, Batyrbek Assembekov, Maria Cecília F Assunção, May Soe Aung, Correia Júnior Marco Aurélio de Valois, Juha Auvinen, Mária Avdičová, Shina Avi, Kishwar Azad, Ana Azevedo, Mohsen Azimi-Nezhad, Fereidoun Azizi, Bontha V Babu, Flora Bacopoulou, Maja Bæksgaard Jørgensen, Azli Baharudin, Suhad Bahijri, Izet Bajramovic, Marta Bakacs, Nagalla Balakrishna, Yulia Balanova, Mohamed Bamoshmoosh, Maciej Banach, José R Banegas, Joanna Baran, Rafał Baran, Carlo M Barbagallo, Valter Barbosa Filho, Alberto Barceló, Maja Baretić, Joaquin Barnoya, Lena Barrera, Marta Barreto, Aluisio JD Barros, Mauro Virgílio Gomes Barros, Anna Bartosiewicz, Abdul Basit, Joao Luiz Bastos, Iqbal Bata, Anwar M Batieha, Aline P Batista, Rosangela L Batista, Zhamilya Battakova, Louise A Baur, Pascal M Bayauli, Robert Beaglehole, Silvia Bel-Serrat, Antonisamy Belavendra, Habiba Ben Romdhane, Theodora Benedek, Judith Benedics, Mikhail Benet, Gilda Estela Benitez Rolandi, Michaela Benzeval, Elling Bere, Nicolas Berger, Ingunn Holden Bergh, Yemane Berhane, Salim Berkinbayev, Antonio Bernabe-Ortiz, Gailute Bernotiene, Ximena Berrios Carrasola, Heloísa Bettiol, Manfred E Beutel, Augustin F Beybey, Jorge Bezerra, Aroor Bhagyalaxmi, Sumit Bharadwaj, Santosh K Bhargava, Hongsheng Bi, Yufang Bi, Daniel Bia, Katia Biasch, Elysée Claude Bika Lele, Mukharram M Bikbov, Bihungum Bista, Dusko J Bjelica, Anne A Bjerregaard, Peter Bjerregaard, Espen Bjertness, Marius B Bjertness, Cecilia Björkelund, Katia V Bloch, Anneke Blokstra, Moran Blychfeld Magnazu, Simona Bo, Martin Bobak, Lynne M Boddy, Bernhard O Boehm, Jolanda MA Boer, Jose G Boggia, Elena Bogova, Carlos P Boissonnet, Stig E Bojesen, Marialaura Bonaccio, Vanina Bongard, Alice Bonilla-Vargas, Matthias Bopp, Herman Borghs, Steve Botomba, Rupert RA Bourne, Pascal Bovet, Khadichamo Boymatova, Lien Braeckevelt, Lutgart Braeckman, Marjolijn CE Bragt, Tasanee Braithwaite, Imperia Brajkovich, Juergen Breckenkamp, João Breda, Hermann Brenner, Lizzy M Brewster, Garry R Brian, Yajaira Briceño, Lacramioara Brinduse, Bettina Bringolf-Isler, Miguel Brito, Sinead Brophy, Johannes Brug, Graziella Bruno, Anna Bugge, Marta Buoncristiano, Genc Burazeri, Con Burns, Antonio Cabrera de León, Joseph Cacciottolo, Hui Cai, Tilema Cama, Christine Cameron, José Camolas, Günay Can, Ana Paula c Cândido, Felicia Cañete, Mario V Capanzana, Naděžda Čapková, Eduardo Capuano, Rocco Capuano, Vincenzo Capuano, Marloes Cardol, Viviane C Cardoso, Axel C Carlsson, Esteban Carmuega, Joana Carvalho, José A Casajús, Felipe F Casanueva, Maribel Casas, Ertugrul Celikcan, Laura Censi, Marvin Cervantes-Loaiza, Juraci A Cesar, Parinya Chamnan, Snehalatha Chamukuttan, Angelique Chan, Queenie Chan, Fadi J Charchar, Marie-Aline Charles, Himanshu K Chaturvedi, Nish Chaturvedi, Norsyamlina Che Abdul Rahim, Miao Li Chee, Chien-Jen Chen, Fangfang Chen, Huashuai Chen, Long-Sheng Chen, Shuohua Chen, Zhengming Chen, Ching-Yu Cheng, Yiling J Cheng, Bahman Cheraghian, Angela Chetrit, Ekaterina Chikova-Iscener, Mai JM Chinapaw, Anne Chinnock, Arnaud Chiolero, Shu-Ti Chiou, Adela Chirita-Emandi, María-Dolores Chirlaque, Belong Cho, Kaare Christensen, Diego G Christofaro, Jerzy Chudek, Renata Cifkova, Michelle Cilia, Eliza Cinteza, Massimo Cirillo, Frank Claessens, Philip Clare, Janine Clarke, Els Clays, Emmanuel Cohen, Cosmin R Cojocaru, Sandra Colorado-Yohar, Laura-María Compañ-Gabucio, Hans Concin, Susana C Confortin, Cyrus Cooper, Tara C Coppinger, Eva Corpeleijn, Lilia Yadira Cortés, Simona Costanzo, Dominique Cottel, Chris Cowell, Cora L Craig, Amelia C Crampin, Amanda J Cross, Ana B Crujeiras, Juan J Cruz, Tamás Csányi, Semánová Csilla, Alexandra M Cucu, Liufu Cui, Felipe V Cureau, Ewelina Czenczek-Lewandowska, Graziella D'Arrigo, Eleonora d'Orsi, Alanna G da Silva, Liliana Dacica, Christina C Dahm, Jean Dallongeville, Albertino Damasceno, Camilla T Damsgaard, Rachel Dankner, Thomas M Dantoft, Parasmani Dasgupta, Saeed Dastgiri, Luc Dauchet, Kairat Davletov, Francisco de Assis Guedes de Vasconcelos, Maria Alice Altenburg de Assis, Guy De Backer, Dirk De Bacquer, Jaco De Bacquer, Jeroen de Bont, Amalia De Curtis, Patrícia de Fragas Hinnig, Giovanni de Gaetano, Stefaan De Henauw, Pilar De Miguel-Etayo, Jan-Walter De Neve, Paula Duarte de Oliveira, David De Ridder, Karin De Ridder, Susanne R de Rooij, Ana Carolina MGN de Sá, Delphine De Smedt, Mohan Deepa, Alexander D Deev, Vincent Jr DeGennaro, Hélène Delisle, Francis Delpeuch, Stefaan Demarest, Elaine Dennison, Katarzyna Dereń, Valérie Deschamps, Ruslan D Devrishov, Meghnath Dhimal, Augusto Di Castelnuovo, Juvenal Soares Dias-da-Costa, María Elena Díaz-Sánchez, Alejandro Diaz, Pedro Díaz Fernández, María Pilar Díez Ripollés, Zivka Dika, Shirin Djalalinia, Visnja Djordjic, Ha TP Do, Annette J Dobson, Liria Dominguez, Maria Benedetta Donati, Chiara Donfrancesco, Guanghui Dong, Yanhui Dong, Silvana P Donoso, Angela Döring, Maria Dorobantu, Ahmad Reza Dorosty, Marcus Dörr, Kouamelan Doua, Nico Dragano, Wojciech Drygas, Shufa Du, Jia Li Duan, Charmaine A Duante, Priscilla Duboz, Vesselka L Duleva, Virginija Dulskiene, Samuel C Dumith, Anar Dushpanova, Terence Dwyer, Azhar Dyussupova, Vilnis Dzerve, Elzbieta Dziankowska-Zaborszczyk, Narges Ebrahimi, Guadalupe Echeverría, Ricky Eddie, Ebrahim Eftekhar, Vasiliki Efthymiou, Eruke E Egbagbe, Robert Eggertsen, Sareh Eghtesad, Gabriele Eiben, Ulf Ekelund, Mohammad El-Khateeb, Laila El Ammari, Jalila El Ati, Denise Eldemire-Shearer, Paul Elliott, Ofem Enang, Ronit Endevelt, Reina Engle-Stone, Rajiv T Erasmus, Cihangir Erem, Gul Ergor, Louise Eriksen, Johan G Eriksson, Jorge Escobedo-de la Peña, Saeid Eslami, Ali Esmaeili, Alun Evans, Roger G Evans, David Faeh, Guy Fagherazzi, Ildar Fakhradiyev, Albina A Fakhretdinova, Caroline H Fall, Elnaz Faramarzi, Mojtaba Farjam, Victoria Farrugia Sant'Angelo, Yosef Farzi, Mohammad Reza Fattahi, Asher Fawwad, Wafaie W Fawzi, Francisco J Felix-Redondo, Trevor S Ferguson, Romulo A Fernandes, Daniel Fernández-Bergés, Daniel Ferrante, Thomas Ferrao, Gerson Ferrari, Marika Ferrari, Marco M Ferrario, Catterina Ferreccio, Haroldo S Ferreira, Eldridge Ferrer, Jean Ferrieres, Thamara Hubler Figueiró, Anna Fijalkowska, Günther Fink, Mauro Fisberg, Krista Fischer, Leng Huat Foo, Maria Forsner, Edward F Fottrell, Heba M Fouad, Damian K Francis, Maria do Carmo Franco, Zlatko Fras, Brooklyn Fraser, Guillermo Frontera, Flavio D Fuchs, Sandra C Fuchs, Isti I Fujiati, Yuki Fujita, Matsuda Fumihiko, Viktoriya Furdela, Takuro Furusawa, Stefan Adela Gabriela, Zbigniew Gaciong, Mihai Gafencu, Manuel Galán Cuesta, Andrzej Galbarczyk, Sonya V Galcheva, Henrike Galenkamp, Daniela Galeone, Myriam Galfo, Fabio Galvano, Jingli Gao, Pei Gao, Manoli Garcia-de-la-Hera, María José García Mérida, Marta García Solano, Dickman Gareta, Sarah P Garnett, Jean-Michel Gaspoz, Magda Gasull, Adroaldo Cesar Araujo Gaya, Anelise Reis Gaya, Andrea Gazzinelli, Ulrike Gehring, Harald Geiger, Johanna M Geleijnse, Ronnie George, Eva Gerdts, Ebrahim Ghaderi, Seyyed-Hadi Ghamari, Ali Ghanbari, Erfan Ghasemi, Oana-Florentina Gheorghe-Fronea, Alessandro Gialluisi, Simona Giampaoli, Francesco Gianfagna, Christian Gieger, Tiffany K Gill, Jonathan Giovannelli, Glen Gironella, Aleksander Giwercman, Konstantinos Gkiouras, Natalya Glushkova, Ramesh Godara, Justyna Godos, Sibel Gogen, Marcel Goldberg, David Goltzman, Georgina Gómez, Jesús Humberto Gómez Gómez, Luis F Gomez, Santiago F Gómez, Aleksandra Gomula, Bruna Gonçalves Cordeiro da Silva, Helen Gonçalves, Mauer Gonçalves, Ana D González-Alvarez, David A Gonzalez-Chica, Esther M González-Gil, Marcela Gonzalez-Gross, Margot González-Leon, Juan P González-Rivas, Clicerio González-Villalpando, María-Elena González-Villalpando, Angel R Gonzalez, 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Bhawesh Koirala, Elin Kolle, Sanda M Kolo, Patrick Kolsteren, Jürgen König, Raija Korpelainen, Paul Korrovits, Magdalena Korzycka, Jelena Kos, Seppo Koskinen, Katsuyasu Kouda, Malik Koussoh Simone, Éva Kovács, Viktoria Anna Kovacs, Irina Kovalskys, Sudhir Kowlessur, Slawomir Koziel, Jana Kratenova, Wolfgang Kratzer, Vilma Kriaucioniene, Susi Kriemler, Peter Lund Kristensen, Helena Krizan, Maria F Kroker-Lobos, Steinar Krokstad, Daan Kromhout, Herculina S Kruger, Ruan Kruger, Łukasz Kryst, Ruzena Kubinova, Renata Kuciene, Urho M Kujala, Enisa Kujundzic, Zbigniew Kulaga, Mukhtar Kulimbet, Vaitheeswaran Kulothungan, R Krishna Kumar, Meena Kumari, Marie Kunešová, Pawel Kurjata, Yadlapalli S Kusuma, Vladimir Kutsenko, Kari Kuulasmaa, Catherine Kyobutungi, Quang Ngoc La, Fatima Zahra Laamiri, Tiina Laatikainen, Demetre Labadarios, Carl Lachat, Karl J Lackner, Daphne Lai, Youcef Laid, Lachmie Lall, Tai Hing Lam, Maritza Landaeta Jimenez, Edwige Landais, Tiina Lankila, Vera Lanska, Georg Lappas, Bagher Larijani, Simo Pone Larissa, Mina P Lateva, Tint Swe Latt, Martino Laurenzi, Laura Lauria, Maria Lazo-Porras, Gwenaëlle Le Coroller, Khanh Le Nguyen Bao, Agnès Le Port, Tuyen D Le, Jeannette Lee, Jeonghee Lee, Paul H Lee, Terho Lehtimäki, Daniel Lemogoum, Elvynna Leong, Branimir Leskošek, Justyna Leszczak, Katja B Leth-Møller, Gabriel M Leung, Naomi S Levitt, Yanping Li, Merike Liivak, Christa L Lilly, Charlie Lim, Wei-Yen Lim, M Fernanda Lima-Costa, Xu Lin, Lars Lind, Vijaya Lingam, Birgit Linkohr, Allan Linneberg, Lauren Lissner, Mieczyslaw Litwin, Jing Liu, Lijuan Liu, Liping Liu, Xiaotian Liu, Wei-Cheng Lo, Helle-Mai Loit, Khuong Quynh Long, Guadalupe Longo Abril, Luis Lopes, Marcus SS Lopes, Oscar Lopes, Esther Lopez-Garcia, Tania Lopez, Paulo A Lotufo, José Eugenio Lozano, Janice L Lukrafka, Dalia Luksiene, Annamari Lundqvist, Nuno Lunet, Charles Lunogelo, Michala Lustigová, Edyta Łuszczki, Jean-René M'Buyamba-Kabangu, Guansheng Ma, Xu Ma, George LL Machado-Coelho, 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Alicia Matijasevich, Piotr Matłosz, Tandi E Matsha, Victor Matsudo, Giletta Matteo, Pallab K Maulik, Christina Mavrogianni, Artur Mazur, Shelly R McFarlane, Stephen T McGarvey, Martin McKee, Rachael M McLean, Scott B McLean, Margaret L McNairy, Breige A McNulty, Sounnia Mediene Benchekor, Jurate Medzioniene, Kirsten Mehlig, Amir Houshang Mehrparvar, Aline Meirhaeghe, Jørgen Meisfjord, Christa Meisinger, Jesus D Melgarejo, Marina Melkumova, Júlio Mello, Fabián Méndez, Carlos O Mendivil, Ana Maria B Menezes, Geetha R Menon, Gert BM Mensink, Maria Teresa Menzano, Indrapal I Meshram, Diane T Meto, Haakon E Meyer, Jie Mi, Kim F Michaelsen, Nathalie Michels, Kairit Mikkel, Karolina Miłkowska, Jody C Miller, Olga Milushkina, Cláudia S Minderico, GK Mini, Juan Francisco Miquel, Mohammad Reza Mirjalili, Daphne Mirkopoulou, Erkin Mirrakhimov, Marjeta Mišigoj-Duraković, Antonio Mistretta, Veronica Mocanu, Pietro A Modesti, Sahar Saeedi Moghaddam, Shukri F Mohamed, Kazem Mohammad, Mohammad Reza 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Journal: The Lancet (2024)

<h2>Summary</h2><h3>Background</h3> 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. <h3>Methods</h3> 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/m<sup>2</sup>) and obesity (BMI ≥30 kg/m<sup>2</sup>). For school-aged 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). <h3>Findings</h3> 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. <h3>Interpretation</h3> 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 obesity. <h3>Funding</h3> UK Medical Research Council, UK Research and Innovation (Research England), UK Research and Innovation (Innovate UK), and European Union.