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      Health Effects of Overweight and Obesity in 195 Countries over 25 Years.

      research-article
      GBD 2015 Obesity Collaborators
      The New England Journal of Medicine
      Massachusetts Medical Society

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          Abstract

          Background

          While the rising pandemic of obesity has received significant attention in many countries, the effect of this attention on trends and the disease burden of obesity remains uncertain.

          Methods

          We analyzed data from 67.8 million individuals to assess the trends in obesity and overweight prevalence among children and adults between 1980 and 2015. Using the Global Burden of Disease study data and methods, we also quantified the burden of disease related to high body mass index (BMI), by age, sex, cause, and BMI level in 195 countries between 1990 and 2015.

          Results

          In 2015, obesity affected 107.7 million (98.7-118.4) children and 603.7 million (588.2- 619.8) adults worldwide. Obesity prevalence has doubled since 1980 in more than 70 countries and continuously increased in most other countries. Although the prevalence of obesity among children has been lower than adults, the rate of increase in childhood obesity in many countries was greater than the rate of increase in adult obesity. High BMI accounted for 4.0 million (2.7- 5.3) deaths globally, nearly 40% of which occurred among non-obese. More than two-thirds of deaths related to high BMI were due to cardiovascular disease. The disease burden of high BMI has increased since 1990; however, the rate of this increase has been attenuated due to decreases in underlying cardiovascular disease death rates.

          Conclusions

          The rapid increase in prevalence and disease burden of elevated BMI highlights the need for continued focus on surveillance of BMI and identification, implementation, and evaluation of evidence-based interventions to address this problem.

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          Most cited references22

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          Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013.

          In 2010, overweight and obesity were estimated to cause 3·4 million deaths, 3·9% of years of life lost, and 3·8% of disability-adjusted life-years (DALYs) worldwide. The rise in obesity has led to widespread calls for regular monitoring of changes in overweight and obesity prevalence in all populations. Comparable, up-to-date information about levels and trends is essential to quantify population health effects and to prompt decision makers to prioritise action. We estimate the global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013. We systematically identified surveys, reports, and published studies (n=1769) that included data for height and weight, both through physical measurements and self-reports. We used mixed effects linear regression to correct for bias in self-reports. We obtained data for prevalence of obesity and overweight by age, sex, country, and year (n=19,244) with a spatiotemporal Gaussian process regression model to estimate prevalence with 95% uncertainty intervals (UIs). Worldwide, the proportion of adults with a body-mass index (BMI) of 25 kg/m(2) or greater increased between 1980 and 2013 from 28·8% (95% UI 28·4-29·3) to 36·9% (36·3-37·4) in men, and from 29·8% (29·3-30·2) to 38·0% (37·5-38·5) in women. Prevalence has increased substantially in children and adolescents in developed countries; 23·8% (22·9-24·7) of boys and 22·6% (21·7-23·6) of girls were overweight or obese in 2013. The prevalence of overweight and obesity has also increased in children and adolescents in developing countries, from 8·1% (7·7-8·6) to 12·9% (12·3-13·5) in 2013 for boys and from 8·4% (8·1-8·8) to 13·4% (13·0-13·9) in girls. In adults, estimated prevalence of obesity exceeded 50% in men in Tonga and in women in Kuwait, Kiribati, Federated States of Micronesia, Libya, Qatar, Tonga, and Samoa. Since 2006, the increase in adult obesity in developed countries has slowed down. Because of the established health risks and substantial increases in prevalence, obesity has become a major global health challenge. Not only is obesity increasing, but no national success stories have been reported in the past 33 years. Urgent global action and leadership is needed to help countries to more effectively intervene. Bill & Melinda Gates Foundation. Copyright © 2014 Elsevier Ltd. All rights reserved.
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            Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015

            Summary Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors—the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). Findings Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57·8% (95% CI 56·6–58·8) of global deaths and 41·2% (39·8–42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million [192·7 million to 231·1 million] global DALYs), smoking (148·6 million [134·2 million to 163·1 million]), high fasting plasma glucose (143·1 million [125·1 million to 163·5 million]), high BMI (120·1 million [83·8 million to 158·4 million]), childhood undernutrition (113·3 million [103·9 million to 123·4 million]), ambient particulate matter (103·1 million [90·8 million to 115·1 million]), high total cholesterol (88·7 million [74·6 million to 105·7 million]), household air pollution (85·6 million [66·7 million to 106·1 million]), alcohol use (85·0 million [77·2 million to 93·0 million]), and diets high in sodium (83·0 million [49·3 million to 127·5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. Interpretation Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. Funding Bill & Melinda Gates Foundation.
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              Body Fatness and Cancer--Viewpoint of the IARC Working Group.

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                Author and article information

                Journal
                N Engl J Med
                N. Engl. J. Med
                N. Engl. J. Med
                The New England Journal of Medicine
                Massachusetts Medical Society
                0028-4793
                1533-4406
                12 June 2017
                : 10.1056/NEJMoa1614362
                Affiliations
                University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, 98121, United States
                University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, 98121, United States
                University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, 98121, United States
                University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, 98121, United States
                University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, 98121, United States
                University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, 98121, United States
                University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, 98121, United States
                University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, 98121, United States
                University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, 98121, United States
                Iran University of Medical Sciences, Department of Community Medicine, Gastrointestinal and Liver Disease Research Center (GILDRC), Preventative Medicine and Public Health Research Center, Tehran, Iran
                University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, 98121, United States
                University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, 98121, United States
                University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, 98121, United States
                Jimma University, Jimma, Ethiopia
                Sapienza University of Rome, Rome, 185, Italy
                Jimma University, Jimma, Ethiopia
                Washington University School of Medicine, Saint Louis, Missouri, 63110-1093, United States
                Luxembourg Institute of Health, Department of Population Health, Strassen, Luxembourg
                Joint Program of Family and Community Medicine, Jeddah, 21454, Saudi Arabia
                The University of Adelaide, School of Medicine, Adelaide, South Australia, 5005, Australia
                Bahir Dar University, College of Medicine and Health Sciences, Bahir Dar, Ethiopia
                University of Cape Coast, Cape Coast, Ghana
                Uro-Oncology Research Center, Department of Urology, Tehran, 1419733141, Iran
                Dignitas International, Zomba, Malawi
                Oregon Health & Science University, Portland, Oregon, 97239, United States
                Madras Diabetes Research Foundation, Chennai, 600086, India
                Uppsala University, Department of Medical Sciences, Uppsala, 751 85, Sweden
                Dalarna University, School of Health and Social Sciences, Falun, 79188, Sweden
                Qom University of Medical Sciences, Department of Medical Emergency, Qom, 3713649373, Iran
                University College London, Farr Institute of Health Informatics Research, London, NW1 2DA , United Kingdom
                University of Belgrade, Faculty of Medicine, Belgrade, 11000, Serbia
                Monash University School of Public Health and Preventive Medicine, Kanooka, Victoria, 3168 VIC, Australia
                Wollo University, Department of Public Health, Dessie, 1145, Ethiopia
                University of Oxford, Nuffield Department of Population Health, Oxford, OX3 7LF, United Kingdom
                Nevada Division of Public and Behavioral Health, Bureau of Child, Family & Community Wellness, Carson City, Nevada, 89706, United States
                Haramaya University, College of Health and Medical Sciences, Harar, 235, Ethiopia
                Independent Public Health Consultants, Addis Ababa, Ethiopia
                University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, 98121, United States
                University of Oslo, Department of Community Medicine and Global Health, Oslo, 318, Norway
                National Institute of Public Health, Cuernavaca, 62100, Mexico
                Karolinska Institutet, Department of Clinical Science, Intervention and Technology, Stockholm, 14186, Sweden
                Universidade do Porto, i3S - Instituto de Investigação e Inovação em Saúde, Porto, 4200-135, Portugal
                Universidade do Porto, Departamento de Ciências Biológicas, Faculdade de Farmácia, Porto, 4050-313, Portugal
                University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, 98121, United States
                The University of Adelaide, School of Medicine, Adelaide, South Australia, 5005, Australia
                University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, 98121, United States
                Wolayta Sodo University, College of Health Sciences and Medicine, Wolaita, Ethiopia
                Public Health Foundation of India, Gurgaon, 1222002, India
                University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, 98121, United States
                Public Health Foundation of India, Gurgaon, 1222002, India
                University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, 98121, United States
                University of Peradeniya, Department of Community Medicine, Peradeniya, 20400, Sri Lanka
                Universidade Federal do Rio Grande do Sul, Porto Alegre, 90035-003, Brazil
                Arak University of Medical Sciences, Arak, 3819693345, Iran
                Tehran University of Medical Sciences, Endrocrinology and Metabolism Population Sciences Institute, Tehran, Iran
                National Institute for Stroke & Applied Neurosciences, Faculty of Health and Environmental Sciences, Auckland, 627, New Zealand
                University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, 98121, United States
                Catholic University of Portugal, Center for Biotechnology and Fine Chemistry, Porto, P-4202-401, Portugal
                Imperial College London, Department of Primary Care & Public Health, London, W6 8RP, United Kingdom
                Swiss Tropical and Public Health Institute, Department of Epidemiology and Public Health, Basel, Switzerland
                Jimma University, Jimma, Ethiopia
                University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, 98121, United States
                University of Massachusetts Boston, Boston, Massachusetts, 02125, United States
                Center for Public Health Sciences, National Cancer Center, Division of Epidemiology, Tokyo, 104-0045, Japan
                University of Groningen, Groningen, 9700 RB, The Netherlands
                Ambo University, Ambo, 11, Ethiopia
                Tehran University of Medical Sciences, Endrocrinology and Metabolism Population Sciences Institute, Tehran, Iran
                University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, 98121, United States
                University of Oxford, Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Oxford, OX3 7BN, United Kingdom
                Universidade Federal do Rio Grande do Sul, Porto Alegre, 90035-003, Brazil
                American Cancer Society, Surveillance and Health Services Research, Atlanta, Georgia, 30303, United States
                Debre Markos University, Department of Public Health, Debre Markos, 251269, Ethiopia
                CSIR-Indian Institute of Toxicology Research, Epidemiology Division, Lucknow, 226001, India
                Tehran University of Medical Sciences, Tehran, 14117-13135, Iran
                University of Glasgow, MRC/CSO Social & Public Health Sciences Unit, Glasgow G2 3QB, United Kingdom
                South African Medical Research Council, Cape Town, 7505, South Africa
                CSIR-Indian Institute of Toxicology Research, Epidemiology Division, Lucknow, 226001, India
                Jordan University of Science & Technology, Department of Community Medicine, Public Health and Family Medicine, Irbid, 22110, Jordan
                Seoul National University College of Medicine, Seoul, 03080, South Korea
                Ball State University, Department of Nutrition and Health Science, Muncie, Indiana, 47306, United States
                Northeastern University, Department of Health Sciences, Boston, Massachusetts, 02115, United States
                Southern University College, Faculty of Chinese Medicine, Johor, 81300, Malaysia
                University of Canberra, Bruce, Canberra, Australian Capital Territory, 2617, Australia
                National Institute of Health Research & Development, Jakarta, 10560, Indonesia
                University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, 98121, United States
                University of Montreal, Department of Social and Preventive Medicine & Department of Demography & Public Health Research Institute, School of Public Health, Montreal, Quebec, H3C 3J7, Canada
                Public Health Foundation of India, Gurgaon, 1222002, India
                Södertörn University, Stockholm Centre for Health and Social Change, Huddinge, 14189, Sweden
                National Institute for Health Development, Tallinn, 11619, Estonia
                University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, 98121, United States
                University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, 98121, United States
                University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, 98121, United States
                University of Melbourne, Melbourne, Victoria, 3051, Australia
                National Institute of Public Health, Cuernavaca, 62100, Mexico
                University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, 98121, United States
                Imperial College London, Department of Primary Care & Public Health, London, W6 8RP, United Kingdom
                Shiraz University of Medical Sciences, Non-Communicable Diseases Research Center, Shiraz, 71345, Iran
                Tehran University of Medical Sciences, Tehran, 14117-13135, Iran
                Universidade Federal de Minas Gerais, Gerais, 30130-100, Brazil,
                Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Key State Laboratory of Molecular Developmental Biology, Beijing, 100101, China
                Brown University School of Public Health, Providence, Rhode Island, 02912, United States
                Mekelle University, Mekelle, 1871, Ethiopia
                Robert Koch Institute, Department of Epidemiology and Health Monitoring, Berlin, 650261, Germany
                Mekelle University, Mekelle, 1871, Ethiopia
                National Center of Cardiology and Internal Disease, Bishkek, Kyrgyzstan
                Federal Institute for Population Research Friedrich-Ebert-Allee 5, Wiesbaden, D-65186, Germany
                Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
                American University of Beirut, Center for Research on Population and Health, Faculty of Health Sciences, Beirut, Lebanon
                Western Sydney University, Centre for Health Research - School of Medicine, Penrith, New South Wales, 2751, Australia
                University of Ibadan, Department of Medicine, Ibadan, 200001, Nigeria
                University of Melbourne, Melbourne, Victoria, 3051, Australia
                University of British Columbia, Vancouver, British Columbia, V5Z 1M9, Canada
                Alborz University of Medical Sciences, Department of Community Medicine, Karaj, 3187148455, Iran
                Contech School of Public Health, Lahore, 55141, Pakistan
                Society for Health and Demographic Surveillance, West Bengal, 731101, India
                Yonsei University, Department of Preventative Medicine, Wonju, 220-701, South Korea
                Health Science Foundation and Study Center, Kathmandu, Nepal
                University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, 98121, United States
                Maragheh University of Medical Sciences, Department of Public Health, School of Nursing and Midwifery, Maragheh, 5513855731, Iran
                Marshall University, University J Edwards School of Medicine, Huntington, West Virginia, 25701, United States
                Case Western Reserve University School of Medicine, Comprehensive Cancer Center, Cleveland, Ohio, 44106, United States
                University of São Paulo, São Paulo, 05508-000, Brazil
                University of KwaZulu-Natal, Durban, South Africa
                Marshall University, Department of Public Health, Huntington, West Virginia, 25755, United States
                Food and Agriculture Organization, Global Perspective Studies Unit, Rome, Italy
                North-West University, South African Medical Research Council; Hypertension in Africa Research Team, Potchefstroom, 2520, South Africa
                Tehran University of Medical Sciences, Tehran, 14117-13135, Iran
                Shahroud University of Medical Sciences, School of Nursing and Midwifery, Shahroud, 67187187655, Iran
                Tehran University of Medical Sciences, Endrocrinology and Metabolism Population Sciences Institute, Tehran, Iran
                Korea University, Department of Public Health Sciences, Seoul, 2841, South Korea
                Finnish Institute of Occupational Health, Helsinki, FL-00251, Finland
                Northumbria University, Faculty of Health and Life Sciences, Newcastle upon Tyne, United Kingdom
                Haramaya University, College of Health and Medical Sciences, Harar, 235, Ethiopia
                Federal University of Santa Catarina, Florianopolis, 880400-900, Brazil
                Northwestern University, Feinberg School of Medicine, Chicago, Illinois, 60611, United States
                University of Alabama at Birmingham, Birmingham, Alabama, 35294, United States
                Schulich School of Medicine & Dentistry Western University, Department of Epidemiology & Biostatistics, London, Ontario, N6A 5C1, Canada
                Public Health Foundation of India, Gurgaon, 1222002, India
                University of Valencia, Department of Medicine, Valencia, 46010, Spain
                Wollo University, Department of Public Health, Dessie, 1145, Ethiopia
                James Cook University, Cairns, Queensland, 4878, Australia
                University of Groningen, Groningen, 9700 RB, The Netherlands
                Department of Anesthesiology, University of Virginia, Charlottesville, Virginia, 22903, United States
                King Fahad Medical City, Department of Anesthesiology, Riyadh, Saudi Arabia
                Cleveland Clinic, Outcomes Research Consortium, Cleveland, OH, 44195, United States
                Post Graduate Institute of Medical Education and Research, School of Public Health, Chandigarh, 160012, India
                University of Calgary, Calgary, Alberta, T2N 1N4, Canada
                Fundació Sant Joan de Déu, Univeristat de Barcelona, Barcelona, 8830, Spain
                Federal Teaching Hospital, Abakaliki, 23433, Nigeria
                University of Warwick, Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Coventry, CV4 7AL, United Kingdom
                Umeå University, Dept Public Health and Clinical Medicine, Umea, SE-901 87, Sweden
                The UKK Institute for Health Promotion Research, Tampere, 33500, Finland
                National Research University Higher School of Economics, Moscow, 109451, Russia
                Norwegian Institute of Public Health and University of Bergen, Bergen, 31-5020, Norway
                Institute of Population-Based Cancer Research, Department of Research, Cancer Registry of Norway, Oslo, 304, Norway
                Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Sweden, 171 77, Stockholm
                University of Tromsø, Department of Community Medicine, Tromsø, 9037, Norway
                Folkhälsan Research Center, Genetic Epidemiology Group, Helsinki, 250, Finland
                Federal Institute for Population Research Friedrich-Ebert-Allee 5, Wiesbaden, D-65186, Germany
                Ghent University, Faculty of Bioscience Engineering, Ghent, 9000, Belgium
                Federal Institute for Population Research Friedrich-Ebert-Allee 5, Wiesbaden, D-65186, Germany
                Northwestern University, Department of Preventive Medicine, Chicago, Illinois, 60611, United States
                Kyoto University School of Public Health, Department of Biostatistics, Kyoto, 606-8501, Japan
                Aga Khan University, NCD Research to Policy Unit, Nairobi, 623, Kenya
                University Hospital, Setif, 19000, Algeria
                University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, 98121, United States
                University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, 98121, United States
                Article
                10.1056/NEJMoa1614362
                5479627
                28604169
                2feb7e49-1f45-493c-9b66-aeb698944e4b
                Copyright © 2017 Massachusetts Medical Society.

                This Author Final Manuscript is licensed for use under the CC BY license.

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