The epidemiological burden of obesity in childhood: a worldwide epidemic requiring urgent action

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Abstract

Background

In recent decades, the prevalence of obesity in children has increased dramatically. This worldwide epidemic has important consequences, including psychiatric, psychological and psychosocial disorders in childhood and increased risk of developing non-communicable diseases (NCDs) later in life. Treatment of obesity is difficult and children with excess weight are likely to become adults with obesity. These trends have led member states of the World Health Organization (WHO) to endorse a target of no increase in obesity in childhood by 2025.

Main body

Estimates of overweight in children aged under 5 years are available jointly from the United Nations Children’s Fund (UNICEF), WHO and the World Bank. The Institute for Health Metrics and Evaluation (IHME) has published country-level estimates of obesity in children aged 2–4 years. For children aged 5–19 years, obesity estimates are available from the NCD Risk Factor Collaboration. The global prevalence of overweight in children aged 5 years or under has increased modestly, but with heterogeneous trends in low and middle-income regions, while the prevalence of obesity in children aged 2–4 years has increased moderately. In 1975, obesity in children aged 5–19 years was relatively rare, but was much more common in 2016.

Conclusions

It is recognised that the key drivers of this epidemic form an obesogenic environment, which includes changing food systems and reduced physical activity. Although cost-effective interventions such as WHO ‘best buys’ have been identified, political will and implementation have so far been limited. There is therefore a need to implement effective programmes and policies in multiple sectors to address overnutrition, undernutrition, mobility and physical activity. To be successful, the obesity epidemic must be a political priority, with these issues addressed both locally and globally. Work by governments, civil society, private corporations and other key stakeholders must be coordinated.

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Most cited references 38

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Economic Burden of Obesity: A Systematic Literature Review

Maximilian Tremmel, Ulf-G Gerdtham, Peter M. Nilsson … (2017)

Background: The rising prevalence of obesity represents an important public health issue. An assessment of its costs may be useful in providing recommendations for policy and decision makers. This systematic review aimed to assess the economic burden of obesity and to identify, measure and describe the different obesity-related diseases included in the selected studies. Methods: A systematic literature search of studies in the English language was carried out in Medline (PubMed) and Web of Science databases to select cost-of-illness studies calculating the cost of obesity in a study population aged ≥18 years with obesity, as defined by a body mass index of ≥30 kg/m², for the whole selected country. The time frame for the analysis was January 2011 to September 2016. Results: The included twenty three studies reported a substantial economic burden of obesity in both developed and developing countries. There was considerable heterogeneity in methodological approaches, target populations, study time frames, and perspectives. This prevents an informative comparison between most of the studies. Specifically, there was great variety in the included obesity-related diseases and complications among the studies. Conclusions: There is an urgent need for public health measures to prevent obesity in order to save societal resources. Moreover, international consensus is required on standardized methods to calculate the cost of obesity to improve homogeneity and comparability. This aspect should also be considered when including obesity-related diseases.

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Long-term morbidity and mortality of overweight adolescents. A follow-up of the Harvard Growth Study of 1922 to 1935.

A Must, P Jacques, G Dallal … (1992)

Overweight in adults is associated with increased morbidity and mortality. In contrast, the long-term effect of overweight in adolescence on morbidity and mortality is not known. We studied the relation between overweight and morbidity and mortality in 508 lean or overweight adolescents 13 to 18 years old who participated in the Harvard Growth Study of 1922 to 1935. Overweight adolescents were defined as those with a body-mass index that on two occasions was greater than the 75th percentile in subjects of the same age and sex in a large national survey. Lean adolescents were defined as those with a body-mass index between the 25th and 50th percentiles. Subjects who were still alive were interviewed in 1988 to obtain information about their medical history, weight, functional capacity, and other risk factors. For those who had died, information on the cause of death was obtained from death certificates. Overweight in adolescent subjects was associated with an increased risk of mortality from all causes and disease-specific mortality among men, but not among women. The relative risks among men were 1.8 (95 percent confidence interval, 1.2 to 2.7; P = 0.004) for mortality from all causes and 2.3 (95 percent confidence interval, 1.4 to 4.1; P = 0.002) for mortality from coronary heart disease. The risk of morbidity from coronary heart disease and atherosclerosis was increased among men and women who had been overweight in adolescence. The risk of colorectal cancer and gout was increased among men and the risk of arthritis was increased among women who had been overweight in adolescence. Overweight in adolescence was a more powerful predictor of these risks than overweight in adulthood. Overweight in adolescence predicted a broad range of adverse health effects that were independent of adult weight after 55 years of follow-up.

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What childhood obesity prevention programmes work? A systematic review and meta-analysis.

Y Wang, L Cai, Y. Wu … (2015)

Previous reviews of childhood obesity prevention have focused largely on schools and findings have been inconsistent. Funded by the US Agency for Healthcare Research and Quality (AHRQ) and the National Institutes of Health, we systematically evaluated the effectiveness of childhood obesity prevention programmes conducted in high-income countries and implemented in various settings. We searched MEDLINE®, Embase, PsycINFO, CINAHL®, ClinicalTrials.gov and the Cochrane Library from inception through 22 April 2013 for relevant studies, including randomized controlled trials, quasi-experimental studies and natural experiments, targeting diet, physical activity or both, and conducted in children aged 2-18 in high-income countries. Two reviewers independently abstracted the data. The strength of evidence (SOE) supporting interventions was graded for each study setting (e.g. home, school). Meta-analyses were performed on studies judged sufficiently similar and appropriate to pool using random effect models. This paper reported our findings on various adiposity-related outcomes. We identified 147 articles (139 intervention studies) of which 115 studies were primarily school based, although other settings could have been involved. Most were conducted in the United States and within the past decade. SOE was high for physical activity-only interventions delivered in schools with home involvement or combined diet-physical activity interventions delivered in schools with both home and community components. SOE was moderate for school-based interventions targeting either diet or physical activity, combined interventions delivered in schools with home or community components or combined interventions delivered in the community with a school component. SOE was low for combined interventions in childcare or home settings. Evidence was insufficient for other interventions. In conclusion, at least moderately strong evidence supports the effectiveness of school-based interventions for preventing childhood obesity. More research is needed to evaluate programmes in other settings or of other design types, especially environmental, policy and consumer health informatics-oriented interventions.

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Author and article information

Contributors

Mariachiara Di Cesare: c.dicesare@mdx.ac.uk

James Bentham: j.bentham@kent.ac.uk

Journal

Journal ID (nlm-ta): BMC Med

Journal ID (iso-abbrev): BMC Med

Title: BMC Medicine

Publisher: BioMed Central (London )

ISSN (Electronic): 1741-7015

Publication date (Electronic): 25 November 2019

Publication date PMC-release: 25 November 2019

Publication date Collection: 2019

Volume: 17

Electronic Location Identifier: 212

Affiliations

[1 ]ISNI 0000 0001 0710 330X, GRID grid.15822.3c, Middlesex University, The Burroughs, ; London, NW4 4BT UK

[2 ]ISNI 0000 0001 0657 4636, GRID grid.4808.4, University of Zagreb, ; Trg Republike Hrvatske 14, 10000 Zagreb, Croatia

[3 ]ISNI 0000 0001 0721 6013, GRID grid.8954.0, University of Ljubljana, ; Kongresni trg 12, 1000 Ljubljana, Slovenia

[4 ]Center for Primary Care and Public Health, Secteur Croisettes/Bâtiment SC-B, Route de la Corniche 2, 1066 Epalinges, Lausanne, Switzerland

[5 ]GRID grid.450284.f, Ministry of Health, ; Hospital Road, Victoria, Republic of Seychelles

[6 ]ISNI 0000 0001 0673 9488, GRID grid.11100.31, Universidad Peruana Cayetano Heredia, ; Av. Honorio Delgado 430, San Martín de Porres, 15102 Lima, Peru

[7 ]ISNI 0000 0001 0633 6224, GRID grid.7147.5, Aga Khan University, ; National Stadium Rd, Karachi, 74800 Pakistan

[8 ]Independent consultant, Los Angeles, USA

[9 ]ISNI 0000 0001 2232 2818, GRID grid.9759.2, c/o: School of Mathematics, Statistics and Actuarial Science, University of Kent, ; Giles Lane, Canterbury, CT2 7NZ UK

[10 ]ISNI 0000 0001 1456 3750, GRID grid.412419.b, ICMR-National Institute of Nutrition, Beside Tarnaka Metro Station, , Osmania University PO, ; Hyderabad, Telangana 500007 India

[11 ]ISNI 0000 0000 9155 0024, GRID grid.415021.3, South African Medical Research Council, ; Francie Van Zijl Dr, Parow Valley, Cape Town, 7501 South Africa

[12 ]ISNI 0000 0001 2232 2818, GRID grid.9759.2, University of Kent, ; Giles Lane, Canterbury, CT2 7NZ UK

Article

Publisher ID: 1449

DOI: 10.1186/s12916-019-1449-8

PMC ID: 6876113

PubMed ID: 31760948

SO-VID: 7133811e-74ad-4e46-97d7-450adf31cc59

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 25 April 2019

Date accepted : 23 October 2019

Custom metadata

ScienceOpen disciplines: Medicine

Keywords: obesity,overweight,global health,children,adolescents

Data availability:

ScienceOpen disciplines: Medicine

Keywords: obesity, overweight, global health, children, adolescents

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