National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9·1 million participants

Mariel M Finucane, Gretchen A Stevens, Melanie J Cowan, Goodarz Danaei, John K Lin, Christopher J Paciorek, Gitanjali M Singh, Hialy R Gutierrez, Yuan Lu, Adil N Bahalim, Farshad Farzadfar, Leanne M Riley, Majid Ezzati, Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group (Body Mass Index), Gretchen A Stevens, Mariel M Finucane, Melanie Cowan, Goodarz Danaei, John K Lin, Christopher J Paciorek, Gitanjali Singh, Hialy R Gutierrez, Yuan Lu, Adil N Bahalim, Farshad Farzadfar, Leanne M Riley, Majid Ezzati, Geir Aamodt, Ziad Abdeen, Nabila A Abdella, Hanan F Abdul Rahim, Juliet Addo, Mohamed M Ali, Mohannad Al-Nsour, Ramachandran Ambady, Pertti Aro, Bontha V Babu, Carlo M Barbagallo, Alberto Barceló, Henrique Barros, Leonelo E Bautista, Peter Bjerregaard, Enzo Bonora, Pascal Bovet, Juergen Breckenkamp, Grazyna Broda, Ian J Brown, Michael Bursztyn, Antonio Cabrera de León, Francesco P Cappuccio, Katia Castetbon, Somnath Chatterji, Zhengming Chen, Chien-Jen Chen, Lily Chua, Renata Cífková, Linda J Cobiac, Anna Maria Corsi, Cora L Craig, Saeed Dastgiri, Martha S de Sereday, Gonul Dinc, Eleonora Dorsi, Nico Dragano, Adam Drewnowski, Paul Elliott, Anders Engeland, Alireza Esteghamati, Jian-Gao Fan, Gatterina Ferreccio, Nélida S Fornés, Flávio D Fuchs, Simona Giampaoli, Luis F Gómez, Sidsel Graff-Iversen, Janet F Grant, Ramiro Guerrero Carvajal, Martin C Gulliford, Rajeev Gupta, Prakash C Gupta, Oye Gureje, Noor Heim, Joachim Heinrich, Tomas Hemmingsson, Victor M Herrera, Suzanne C Ho, Michelle Holdsworth, Wilma M Hopman, Abdullatif Husseini, Nayu Ikeda, Bjarne K Jacobsen, Tazeen H Jafar, Mohsen Janghorbani, Grazyna Jasienska, Michel R Joffres, Jost B Jonas, Ofra Kalter-Leibovici, Ioannis Karalis, Joanne Katz, Lital Keinan-Boker, Paul Kelly, Omid Khalilzadeh, Yong-Ho Khang, Stefan Kiechl, Yutaka Kiyohara, Maressa P Krause, Yadlapalli S Kusuma, Arnulf Langhammer, Jeannette Lee, Claire Lévy-Marchal, Yanping Li, Yuqiu Li, Stephen Lim, Cheng-Chieh Lin, Lars Lind, Lauren Lissner, Patricio Lopez-Jaramillo, Roberto Lorbeer, Guansheng Ma, Stefan Ma, Francesc Macià, Dianna J Magliano, Marcia Makdisse, Pedro Marques-Vidal, Roberto Miccoli, Juhani Miettola, J Jaime Miranda, Mostafa K Mohamed, V Mohan, Salim Mohanna, Ali Mokdad, Dante D Morales, Lorenza M Muiesan, Iraj Nabipour, Vinay Nangia, Barbara Nemesure, Martin Neovius, Kjersti A Nerhus, Flavio Nervi, Hannelore Neuhauser, Minh Nguyen, Ayse Emel Onal, Altan Onat, Myriam Oróstegui, Hermann Ouedraogo, Demosthenes B Panagiotakos, Francesco Panza, Yongsoo Park, Mangesh S Pednekar, Marco A Peres, Cynthia Pérez, Rafael Pichardo, Hwee Pin Phua, Francesco Pistelli, Pedro Plans, Dorairaj Prabhakaran, Olli T Raitakari, Sanjay Rampal, Lekhraj Rampal, Finn Rasmussen, Josep Redon, Luis Revilla, Victoria Reyes-García, Ragab B Roaeid, Fernando Rodriguez-Artalejo, Luis Rosero-Bixby, Harshpal S Sachdev, José R Sánchez, Selim Y Sanisoglu, Norberto Schapochnik, Martha S Sereday, Lluís Serra-Majem, Jonathan Shaw, Rahman Shiri, Xiao Ou Shu, Eglé Silva, Leon A Simons, Margaret Smith, Vencenzo Solfrizzi, Emily Sonestedt, Pär Stattin, Aryeh D Stein, George S Stergiou, Jochanan Stessman, Akihiro Sudo, Valter Sundh, Kristina Sundquist, Johan Sundström, Martin Tobias, Liv E Torheim, Josep A Tur, Ana I Uhernik, Flora A Ukoli, Mark P Vanderpump, Jose Javier Varo, Marit B Veierød, Gustavo Velásquez-Meléndez, Monique Verschuren, Salvador Villalpando, Jesus Vioque, Mark Ward, Sarwono Waspadji, Johann Willeit, Mark Woodward, Liang Xu, Fei Xu, Gonghuan Yang, Li-Chia Yeh, Jin-Sang Yoon, Qisheng You, Wei Zheng, Maigeng Zhou, Mariel M Finucane, Gretchen A Stevens, Melanie J Cowan, Goodarz Danaei, John K Lin, Christopher J Paciorek, Gitanjali M Singh, Hialy R Gutierrez, Yuan Lu, Adil N Bahalim, Farshad Farzadfar, Leanne M Riley, Majid Ezzati, Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group (Body Mass Index), Gretchen A Stevens, Mariel M Finucane, Melanie Cowan, Goodarz Danaei, John K Lin, Christopher J Paciorek, Gitanjali Singh, Hialy R Gutierrez, Yuan Lu, Adil N Bahalim, Farshad Farzadfar, Leanne M Riley, Majid Ezzati, Geir Aamodt, Ziad Abdeen, Nabila A Abdella, Hanan F Abdul Rahim, Juliet Addo, Mohamed M Ali, Mohannad Al-Nsour, Ramachandran Ambady, Pertti Aro, Bontha V Babu, Carlo M Barbagallo, Alberto Barceló, Henrique Barros, Leonelo E Bautista, Peter Bjerregaard, Enzo Bonora, Pascal Bovet, Juergen Breckenkamp, Grazyna Broda, Ian J Brown, Michael Bursztyn, Antonio Cabrera de León, Francesco P Cappuccio, Katia Castetbon, Somnath Chatterji, Zhengming Chen, Chien-Jen Chen, Lily Chua, Renata Cífková, Linda J Cobiac, Anna Maria Corsi, Cora L Craig, Saeed Dastgiri, Martha S de Sereday, Gonul Dinc, Eleonora Dorsi, Nico Dragano, Adam Drewnowski, Paul Elliott, Anders Engeland, Alireza Esteghamati, Jian-Gao Fan, Gatterina Ferreccio, Nélida S Fornés, Flávio D Fuchs, Simona Giampaoli, Luis F Gómez, Sidsel Graff-Iversen, Janet F Grant, Ramiro Guerrero Carvajal, Martin C Gulliford, Rajeev Gupta, Prakash C Gupta, Oye Gureje, Noor Heim, Joachim Heinrich, Tomas Hemmingsson, Victor M Herrera, Suzanne C Ho, Michelle Holdsworth, Wilma M Hopman, Abdullatif Husseini, Nayu Ikeda, Bjarne K Jacobsen, Tazeen H Jafar, Mohsen Janghorbani, Grazyna Jasienska, Michel R Joffres, Jost B Jonas, Ofra Kalter-Leibovici, Ioannis Karalis, Joanne Katz, Lital Keinan-Boker, Paul Kelly, Omid Khalilzadeh, Yong-Ho Khang, Stefan Kiechl, Yutaka Kiyohara, Maressa P Krause, Yadlapalli S Kusuma, Arnulf Langhammer, Jeannette Lee, Claire Lévy-Marchal, Yanping Li, Yuqiu Li, Stephen Lim, Cheng-Chieh Lin, Lars Lind, Lauren Lissner, Patricio Lopez-Jaramillo, Roberto Lorbeer, Guansheng Ma, Stefan Ma, Francesc Macià, Dianna J Magliano, Marcia Makdisse, Pedro Marques-Vidal, Roberto Miccoli, Juhani Miettola, J Jaime Miranda, Mostafa K Mohamed, V Mohan, Salim Mohanna, Ali Mokdad, Dante D Morales, Lorenza M Muiesan, Iraj Nabipour, Vinay Nangia, Barbara Nemesure, Martin Neovius, Kjersti A Nerhus, Flavio Nervi, Hannelore Neuhauser, Minh Nguyen, Ayse Emel Onal, Altan Onat, Myriam Oróstegui, Hermann Ouedraogo, Demosthenes B Panagiotakos, Francesco Panza, Yongsoo Park, Mangesh S Pednekar, Marco A Peres, Cynthia Pérez, Rafael Pichardo, Hwee Pin Phua, Francesco Pistelli, Pedro Plans, Dorairaj Prabhakaran, Olli T Raitakari, Sanjay Rampal, Lekhraj Rampal, Finn Rasmussen, Josep Redon, Luis Revilla, Victoria Reyes-García, Ragab B Roaeid, Fernando Rodriguez-Artalejo, Luis Rosero-Bixby, Harshpal S Sachdev, José R Sánchez, Selim Y Sanisoglu, Norberto Schapochnik, Martha S Sereday, Lluís Serra-Majem, Jonathan Shaw, Rahman Shiri, Xiao Ou Shu, Eglé Silva, Leon A Simons, Margaret Smith, Vencenzo Solfrizzi, Emily Sonestedt, Pär Stattin, Aryeh D Stein, George S Stergiou, Jochanan Stessman, Akihiro Sudo, Valter Sundh, Kristina Sundquist, Johan Sundström, Martin Tobias, Liv E Torheim, Josep A Tur, Ana I Uhernik, Flora A Ukoli, Mark P Vanderpump, Jose Javier Varo, Marit B Veierød, Gustavo Velásquez-Meléndez, Monique Verschuren, Salvador Villalpando, Jesus Vioque, Mark Ward, Sarwono Waspadji, Johann Willeit, Mark Woodward, Liang Xu, Fei Xu, Gonghuan Yang, Li-Chia Yeh, Jin-Sang Yoon, Qisheng You, Wei Zheng, Maigeng Zhou

Abstract

Background: Excess bodyweight is a major public health concern. However, few worldwide comparative analyses of long-term trends of body-mass index (BMI) have been done, and none have used recent national health examination surveys. We estimated worldwide trends in population mean BMI.

Methods: We estimated trends and their uncertainties of mean BMI for adults 20 years and older in 199 countries and territories. We obtained data from published and unpublished health examination surveys and epidemiological studies (960 country-years and 9·1 million participants). For each sex, we used a Bayesian hierarchical model to estimate mean BMI by age, country, and year, accounting for whether a study was nationally representative.

Findings: Between 1980 and 2008, mean BMI worldwide increased by 0·4 kg/m(2) per decade (95% uncertainty interval 0·2-0·6, posterior probability of being a true increase >0·999) for men and 0·5 kg/m(2) per decade (0·3-0·7, posterior probability >0·999) for women. National BMI change for women ranged from non-significant decreases in 19 countries to increases of more than 2·0 kg/m(2) per decade (posterior probabilities >0·99) in nine countries in Oceania. Male BMI increased in all but eight countries, by more than 2 kg/m(2) per decade in Nauru and Cook Islands (posterior probabilities >0·999). Male and female BMIs in 2008 were highest in some Oceania countries, reaching 33·9 kg/m(2) (32·8-35·0) for men and 35·0 kg/m(2) (33·6-36·3) for women in Nauru. Female BMI was lowest in Bangladesh (20·5 kg/m(2), 19·8-21·3) and male BMI in Democratic Republic of the Congo 19·9 kg/m(2) (18·2-21·5), with BMI less than 21·5 kg/m(2) for both sexes in a few countries in sub-Saharan Africa, and east, south, and southeast Asia. The USA had the highest BMI of high-income countries. In 2008, an estimated 1·46 billion adults (1·41-1·51 billion) worldwide had BMI of 25 kg/m(2) or greater, of these 205 million men (193-217 million) and 297 million women (280-315 million) were obese.

Interpretation: Globally, mean BMI has increased since 1980. The trends since 1980, and mean population BMI in 2008, varied substantially between nations. Interventions and policies that can curb or reverse the increase, and mitigate the health effects of high BMI by targeting its metabolic mediators, are needed in most countries.

Funding: Bill & Melinda Gates Foundation and WHO.