From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions.
Bibliographical noteFunding Information:
Banska Bystrica Regional Authority of Public Health, Banska Bystrica, Slovakia; Shina Avi: Tel-Aviv University, Tel-Aviv, Israel; Hebrew University of Jerusalem, Jerusalem, Israel; Ana Azevedo: University of Porto Medical School, Porto, Portugal; Mohsen Azimi-Nezhad: Neyshabur University of Medical Sciences, Neyshabur, Islamic Republic of Iran; Fereidoun Azizi: Research Institute for Endocrine Sciences, Tehran, Islamic Republic of Iran; Mehrdad Azmin: NonCommunicable Diseases Research Center, Tehran, Islamic Republic of Iran; Bontha V Babu: Indian Council of Medical Research, New Delhi, India; Maja Bæksgaard Jørgensen: National Institute of Public Health, Copenhagen, Denmark; Azli Baharudin: Ministry of Health, Kuala Lumpur, Malaysia; Suhad Bahijri: King Abdulaziz University, Jeddah, Saudi Arabia; Jennifer L Baker: Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Nagalla Balakrishna: ICMR - National Institute of Nutrition, Hyderabad, India; Mohamed Bamoshmoosh: University of Science and Technology, Sana’a, Yemen; Maciej Banach: Medical University of Lodz, Lodz, Poland; Piotr Bandosz: Medical University of Gdansk, Gdansk, Poland; José R Banegas: Universidad Autónoma de Madrid CIBERESP, Madrid, Spain; Joanna Baran: University of Rzeszów, Rzeszów, Poland; Carlo M Barbagallo: University of Palermo, Palermo, Italy; Alberto Barceló: Pan American Health Organization, Washington DC, United States; Amina Barkat: Mohammed V University de Rabat, Rabat, Morocco; Aluisio JD Barros: Federal University of Pelotas, Pelotas, Brazil; Mauro Virgílio Gomes Barros: University of Pernambuco, Recife, Brazil; Abdul Basit: Baqai Institute of Diabetology and Endocrinology, Karachi, Pakistan; Joao Luiz D Bastos: Federal University of Santa Catarina, Florianópolis, Brazil; Iqbal Bata: Dalhousie University, Halifax, Canada; Anwar M Batieha: Jordan University of Science and Technology, Irbid, Jordan; Rosangela L Batista: Federal University of Maranhão, São Luís, Brazil; Zhamilya Battakova: National Center of Public Healthcare, Nur-Sultan, Kazakhstan; Assembekov Batyrbek: Al-Farabi Kazakh National University, Almaty, Kazakhstan; Louise A Baur: University of Sydney, Sydney, Australia; Robert Beaglehole: University of Auckland, Auckland, New Zealand; Silvia Bel-Serrat: University College Dublin, Dublin, Ireland; Antonisamy Belavendra: Christian Medical College, Vellore, India; Habiba Ben Romdhane: University Tunis El Manar, Tunis, Tunisia; Judith Benedics: Federal Ministry of Social Affairs, Health, Care and Consumer Protection, Vienna, Austria; Mikhail Benet: Cafam University Foundation, Bogota, Colombia; Ingunn Holden Bergh: Norwegian Institute of Public Health, Oslo, Norway; Salim Berkinbayev: Kazakh National Medical University, Almaty, Kazakhstan; Antonio Bernabe-Ortiz: Universidad Peruana Cayetano Heredia, Lima, Peru; Gailute Bernotiene: Lithuanian University of Health Sciences, Kaunas, Lithuania; Heloísa Bettiol: University of São Paulo, São Paulo, Brazil; Jorge Bezerra: University of Pernambuco, Recife, Brazil; Aroor Bhagyalaxmi: B J Medical College, Ahmedabad, India; Sumit Bharadwaj: Chirayu Medical College, New Delhi, India; Santosh K Bhargava: Sunder Lal Jain Hospital, Delhi, India; Zulfiqar A Bhutta: The Hospital for Sick Children, Toronto, Canada; Aga Khan University, Karachi, Pakistan; Hongsheng Bi: Shandong University of Traditional Chinese Medicine, Jinan, China; Yufang Bi: Shanghai Jiao-Tong University School of Medicine, Shanghai, China; Daniel Bia: Universidad de la República, Montevideo, Uruguay; Elysée Claude Bika Lele: Institute of Medical Research and Medicinal Plant Studies, Yaoundé, Cameroon; Mukharram M Bikbov: Ufa Eye Research Institute, Ufa, Russian Federation; Bihungum Bista: Nepal Health Research Council, Kathmandu, Nepal; Dusko J Bjelica: University of Montenegro, Niksic, Montenegro; Peter Bjerregaard: University of Southern Denmark, Copenhagen, Denmark; Espen Bjertness: University of Oslo, Oslo, Norway; Marius B Bjertness: University of Oslo, Oslo, Norway; Cecilia Björkelund: University of Gothenburg, Gothenburg, Sweden; Katia V Bloch: Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Anneke Blokstra: National Institute for Public Health and the Environment, Bilthoven, Netherlands; Simona Bo: University of Turin, Turin, Italy; Martin Bobak: University College London, London, United Kingdom; Lynne M Boddy: Liverpool John Moores University, Liverpool, United Kingdom; Bernhard O Boehm: Nanyang Technological University Singapore, Singapore, Singapore; Heiner Boeing: German Institute of Human Nutrition, Potsdam, Germany; Jose G Boggia: Universidad de la República, Montevideo, Uruguay; Elena Bogova: Endocrinology Research Centre, Moscow, Russian Federation; Carlos P Boissonnet: Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires, Argentina; Stig E Bojesen: Copenhagen University Hospital, Copenhagen, Denmark; University of Copenhagen, Copenhagen, Denmark; Marialaura Bonaccio: IRCCS Neuromed, Pozzilli, Italy; Vanina Bongard: Toulouse University School of Medicine, Toulouse, France; Alice
We thank WHO country and regional offices and World Heart Federation for support in data identification and access. The NCD-RisC database was funded by the Wellcome Trust. Maria LC Iurilli was supported by a Medical Research Council studentship. Sylvain Sebert received funding by the European Commission with grant agreements 633595 and 874739, respectively, for the DynaHEALTH and LongITools projects. The following contributors have deceased: Konrad Jamrozik, Altan Onat, Robespierre Ribeiro, Michael Sjöström, Agustinus Soemantri, Jutta Stieber, and Dimitrios Trichopou-los. The list of authors shows their last affiliation.
Alison J Hayes: University of Sydney, Sydney, Australia; Nayu Ikeda: National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan; Rod T Jackson: University of Auckland, Auckland, New Zealand; Young-Ho Khang: Seoul National University, Seoul, Republic of Korea; Avula Laxmaiah: ICMR - National Institute of Nutrition, Hyderabad, India; Jing Liu: Capital Medical University Beijing An Zhen Hospital, Beijing, China; J Jaime Miranda: Universidad Peruana Cayetano Heredia, Lima, Peru; Olfa Saidi: University Tunis El Manar, Tunis, Tunisia; Sylvain Sebert: University of Oulu, Oulu, Finland; Maroje Sorić: University of Zagreb, Zagreb, Croatia; Gregor Starc: University of Ljubljana, Ljubljana, Slovenia; Edward W Gregg: Imperial College London, London, United Kingdom; Leandra Abarca-Gómez: Caja Costarricense de Seguro Social, San José, Costa Rica; Ziad A Abdeen: Al-Quds University, East Jerusalem, State of Palestine; Shynar Abdrakhmanova: National Center of Public Healthcare, Nur-Sultan, Kazakhstan; Suhaila Abdul Ghaffar: Ministry of Health, Kuala Lumpur, Malaysia; Hanan F Abdul Rahim: Qatar University, Doha, Qatar; Niveen M Abu-Rmeileh: Birzeit University, Birzeit, State of Palestine; Jamila Abubakar Garba: Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria; Benjamin Acosta-Cazares: Instituto Mexicano del Seguro Social, Mexico City, Mexico; Robert J Adams: Flinders University, Adelaide, Australia; Wichai Aekplakorn: Mahidol University, Nakhon Pathom, Thailand; Kaosar Afsana: BRAC James P Grant School of Public Health, Dhaka, Bangladesh; Shoaib Afzal: University of Copenhagen, Copenhagen, Denmark; Copenhagen University Hospital, Copenhagen, Denmark; Imelda A Agdeppa: Food and Nutrition Research Institute, Taguig, Philippines; Javad Aghazadeh-Attari: Urmia University of Medical Sciences, Urmia, Islamic Republic of Iran; Carlos A Aguilar-Salinas: Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico; Charles Agyemang: University of Amsterdam, Amsterdam, Netherlands; Mohamad Hasnan Ahmad: Ministry of Health, Kuala Lumpur, Malaysia; Noor Ani Ahmad: Ministry of Health, Kuala Lumpur, Malaysia; Ali Ahmadi: Shahrekord University of Medical Sciences, Shahrekord, Islamic Republic of Iran; Naser Ahmadi: Non-Communicable Diseases Research Center, Tehran, Islamic Republic of Iran; Soheir H Ahmed: University of Oslo, Oslo, Norway; Wolfgang Ahrens: University of Bremen, Bremen, Germany; Gulmira Aitmurzaeva: Republican Center for Health Promotion, Bishkek, Kyrgyzstan; Kamel Ajlouni: National Center for Diabetes, Endocrinology and Genetics, Amman, Jordan; Hazzaa M Al-Hazzaa: Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia; Badreya Al-Lahou: Kuwait Institute for Scientific Research, Kuwait City, Kuwait; Rajaa Al-Raddadi: King Abdulaziz University, Jeddah, Saudi Arabia; Monira Alarouj: Dasman Diabetes Institute, Kuwait City, Kuwait; Fadia AlBuhairan: Aldara Hospital and Medical Center, Riyadh, Saudi Arabia; Shahla AlDhukair: King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Mohamed M Ali: World Health Organization, Geneva, Switzerland; Abdullah Alkandari: Dasman Diabetes Institute, Kuwait City, Kuwait; Ala’a Alkerwi: Luxembourg Institute of Health, Strassen, Luxembourg; Kristine Allin: Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Mar Alvarez-Pedrerol: Barcelona Institute for Global Health CIBERESP, Barcelona, Spain; Eman Aly: World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt; Deepak N Amarapurkar: Bombay Hospital and Medical Research Centre, Mumbai, India; Parisa Amiri: Research Center for Social Determinants of Health, Tehran, Islamic Republic of Iran; Norbert Amougou: UMR CNRS-MNHN 7206 Eco-anthropologie, Paris, France; Philippe Amouyel: University of Lille, France; Lille University Hospital, Lille, France; Lars Bo Andersen: Western Norway University of Applied Sciences, Sogndal, Norway; Sigmund A Anderssen: Norwegian School of Sport Sciences, Oslo, Norway; Lars Ängquist: University of Copenhagen, Copenhagen, Denmark; Ranjit Mohan Anjana: Madras Diabetes Research Foundation, Chennai, India; Alireza Ansari-Moghaddam: Zahedan University of Medical Sciences, Zahedan, Islamic Republic of Iran; Hajer Aounallah-Skhiri: National Institute of Public Health, Tunis, Tunisia; Joana Araújo: Institute of Public Health of the University of Porto, Porto, Portugal; Inger Ariansen: Norwegian Institute of Public Health, Oslo, Norway; Tahir Aris: Ministry of Health, Kuala Lumpur, Malaysia; Raphael E Arku: University of Massachusetts Amherst, Amherst, United States; Nimmathota Arlappa: ICMR -National Institute of Nutrition, Hyderabad, India; Krishna K Aryal: Abt Associates, Kathmandu, Nepal; Thor Aspelund: University of Iceland, Reykjavik, Iceland; Felix K Assah: University of Yaoundé 1, Yaoundé, Cameroon; Maria Cecília F Assunc¸ão: Federal University of Pelotas, Pelotas, Brazil; May Soe Aung: University of Medicine 1, Yangon, Myanmar; Juha Auvinen: University of Oulu, Oulu, Finland; Oulu University Hospital, Oulu, Finland; Mária Avdicová: