The ballooning obesity pandemic is again front page news—this time following publication in The New England Journal of Medicine (NEJM) of the most extensive obesity study ever carried out.
A team of 2,300 experts, led by the Institute of Health Metrics and Evaluation (IHME) at the University of Washington in Seattle, analyzed data from 68.5 million people in 195 countries to assess trends in the prevalence of overweight and obesity among children and adults between 1980 and 2015. Using Global Burden of Disease study data and methods, they also quantified the burden of disease related to high body-mass index (BMI), according to age, sex, cause, and BMI between 1990 and 2015.
The results are disturbing—and reinforce the need for politicians to go well beyond exhortations and platitudes, to prioritize and implement actions to turn the tide.
Highlights of the study include:
- In 2015, a total of 107.7 million children and 603.7 million adults were obese worldwide.
- Since 1980, the prevalence of obesity has doubled in more than 70 countries and has continuously increased in most other countries.
- The rate of increase in childhood obesity in many countries has been greater than the rate of increase in adult obesity.
- High BMI accounted for 4.0 million deaths globally in 2015, nearly 40 percent of which occurred in persons who were not obese. One of the study authors, Azeem Majeed of Imperial College, London emphasizes the significance of this finding: “Once you hit a BMI of 25, your risk of diabetes, heart disease and cancer all begin to increase.”
In sum, “Excess body weight is one of the most challenging public health problems of our time, affecting nearly one in three people,” says the paper’s lead author, Ashkan Afshin of IHME.
So what can and should be done?
The NEJM study concludes by emphasizing the need to ramp up surveillance of BMI and the identification, implementation, and evaluation of evidence-based interventions to address this problem.
IFPRI first started to work in this field in the early 2000s, culminating in the 2003 book The Double Burden of Malnutrition in Asia: Causes, Consequences and Solutions. And yet, by and large, the first decade of the century was one of widespread inertia toward this looming crisis—even within the nutrition and public health world.
In 2012, the World Health Assembly (WHA) unanimously agreed to a set of six global targets for nutrition by 2025, including “no increase in child overweight.” This target will not be met, but more and more countries are discussing a range of policy measures now.
The Global Nutrition Reports have for some time been highlighting the need for action to address overweight and obesity—including the development and implementation of “double duty actions” that simultaneously target both parts of the double burden. We don’t know enough about what works, at large scale—because few countries have implemented and evaluated large-scale preventive policies and programs. But there are some interesting experiences—showcased in IFPRI’s Nourishing Millions book— that have emerged in recent years, with high potential for wider adaptation.
In IFPRI’s 2017 Global Food Policy Report chapter on the nutrition transition, we emphasize the need to seek ways of turning “obesogenic environments” (especially in urban areas) into enabling environments for improved nutrition. From our work on undernutrition, we know this will require knowledge, data, evidence and their effective framing and communication; political commitment, effective governance, and sound policy; and leadership, capacity, and financing.
Few national governments collect the data required to inform decision makers about what people actually eat. This must change. We also need better information on drivers of unhealthy dietary consumption. And we need to address both environmental and behavioral drivers of poor diets and inactivity. As with undernutrition, it is likely that “pressing all the buttons at once”—implementing a range of policies and programs at the same time—will generate important synergies such that the whole is greater than the sum of its parts.
Finally, we need more innovation. We are living in a world that has more overweight people than ever before, many of whom are sedentary. Smartphones, rather than live interactions, increasingly mediate relationships with people and places. And yet this is a time when the world is better connected than ever before, when fitness tracking tech and dietary apps are ubiquitous. We need to explore innovative ways to use this connectivity, and the opportunities presented by new technologies, to incentivize change on a mass scale.