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Ten-fold increase in the number of children and adolescents with obesity since 1975

Worldwide, there has been a more than ten-fold increase in the number of children and adolescents with obesity in the past four decades, increasing from 5 million girls in 1975 to 50 million in 2016, and from 6 million to 74 million boys, according to research.

Despite rise, more children and adolescents remain underweight than obese globally, highlighting the need to improve food security to tackle, at the same time, under-nutrition and excessive weight gain.

Rates of child and adolescent obesity were highest (above 30%) in some islands in Polynesia, and were around 20% or higher in the USA and some countries in the Middle East and North Africa (eg Egypt, Kuwait, Qatar and Saudi Arabia) and the Caribbean (eg Bermuda and Puerto Rico).

Overall, the global prevalence of child and adolescent obesity increased from 0.7% to 5.6% for girls, and from 0.9% to 7.8% for boys.

The study, published in The Lancet, and led by Imperial College London and the World Health Organisation, brought together data from 2416 studies involving 128.9 million participants worldwide including 31.5 million children and adolescents aged 5-19 years, to estimate trends in body mass index (BMI) in 200 countries.

Excessive weight gain in childhood and adolescence is associated with a higher risk and earlier onset of chronic diseases such as type 2 diabetes, worse psychosocial and educational outcomes, and lifelong harms since weight loss is hard to achieve.

Average child and adolescent BMI remains high in many high-income countries in North America and Europe but trends have plateaued in recent years, even while average BMI among adults continues to rise. By contrast, the rise in average BMI has accelerated in many parts of Asia.

In addition to the 124 million children and adolescents classified as obese in 2016, 213 million children and adolescents were in the overweight range.

Professor Majid Ezzati, study author from Imperial College London, said: “While there have been some initiatives led by governments, communities or schools to increase awareness about childhood and adolescent obesity, most high income countries have been reluctant to use taxes and industry regulations to change eating and drinking behaviours to tackle child obesity.

“Most importantly, very few policies and programmes attempt to make healthy foods such as whole grains and fresh fruits and vegetables affordable to poor families. Unaffordability of healthy food options to the poor can lead to social inequalities in obesity, and limit how much we can reduce its burden.”

The authors also note that policies to prevent child obesity in entire countries and communities need to be matched by improved treatments, such as behavioural therapy to change diet and exercise, screening and management of hypertension and liver problems, and in extreme cases, bariatric surgery.

At the other extreme, in 2016 average BMI was lowest for both girls and boys in Ethiopia (16.8 kg/m2 for girls, 15.5 kg/m2 for boys), and was also low in Niger, Senegal, India, Bangladesh, Myanmar, and Cambodia.

Underweight among children and adolescents is associated with higher risk of infectious disease, and for girls of childbearing age, is associated with adverse pregnancy outcomes including maternal mortality, delivery complications, preterm birth and slow intrauterine growth. In south Asia, 20.3% of girls and 28.6% of boys were moderately or severely underweight in 2016 (compared to 23.0% and 37.8% in 1975).

“There is a continued need for policies that enhance food security in low-income countries and households, especially in South Asia. But, our data also show that the transition from underweight to overweight and obesity can happen quickly in an unhealthy nutritional transition, with an increase in nutrient-poor, energy-dense foods. Our findings highlight the disconnect between the global dialogue on overweight and obesity, which has largely overlooked the remaining under-nutrition burden, and the initiatives and donors focusing on under-nutrition that have paid little attention to the looming burden of overweight and obesity,” Professor Ezzati added.

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