Obesity

A healthy amount of body fat in children and teens varies based on age as well as sex. The Centers for Disease Control and Prevention (CDC) developed growth charts for boys and girls ages 2-19 that show the distribution of BMI values at each age. [3] By the CDC’s definition, a child whose BMI falls between the 85th and 94th percentile for age and sex is considered overweight; a BMI at the 95th percentile or higher for age is considered obese. As the rates of obesity rise in children, there is also a category for severe obesity in which the BMI is 120% of the 95th percentile. The American Academy of Pediatrics provides more specific classifications of severe obesity:

• Class 2 Obesity: BMI ≥120% to <140% of the 95th percentile or BMI ≥35 to <40 kg/m²
• Class 3 Obesity: BMI ≥140% of the 95th percentile or BMI ≥40 kg/m²

Obesity can negatively affect nearly every system in a child’s body – the heart, lungs, muscles, bones, kidneys, digestive tract, and hormones that control blood sugar and puberty – and can also take a heavy social and emotional toll. Children with obesity may be burdened by stigma and discrimination from bullying, teasing and victimization. Youth with obesity have substantially higher odds of remaining overweight or obese into adulthood increasing their risk of disease and disability later in life. [4]

The risk of developing diabetes, heart disease, and other weight-related health risks increases with an increasing body mass index (BMI). But evidence shows that in some ethnic and racial groups, weight gain and higher fat mass even if BMI remains in the normal range can still increase health risks.

The Nurses’ Health Study tracked patterns of weight gain and type 2 diabetes (T2D) development in 78,000 U.S. women to see differences by ethnic group. [5] All women were healthy at the start of the study. After 20 years, researchers found that at the same BMI, Asians had more than twice the risk of developing T2D than Whites; Hispanics and Blacks also had higher risks of diabetes than Whites, but to a lesser degree. Increases in weight over time were more harmful in Asians than in other ethnic groups – for every 11 pounds Asians gained during adulthood, they had an 84% increased risk of T2D; Hispanics, Blacks, and Whites who gained weight also had higher risk, but to a much lesser degree than Asians. Other studies have found that even with a lower BMI than Whites, increasing weight in Asians with a BMI of 25 or higher increased risk of high blood pressure, T2D, and early death from all causes. [6-8]

One reason for this difference could be amount and location of body fat. Even with a lower BMI than other populations, Chinese and South Asians tend to carry higher abdominal fat than Whites, which increases the risk for T2D, cardiovascular disease, and other metabolic disorders. [9-11] In contrast, some studies have found that blacks have lower body fat and higher lean muscle mass than whites at the same BMI, and therefore at the same BMI, may be at lower risk of obesity-related diseases. [12,13]

For this reason, the World Health Organization and other organizations have recommended a lower BMI cutoff to classify obesity in Asian people (BMI of 25-27 or greater) as well as a smaller waist circumference to measure visceral fat. [9,14]

Adults

In 2018, the United States had the highest prevalence of adult obesity among high-income Western countries worldwide. [23] From 1999 through 2018, the age-adjusted prevalence of adults with obesity increased significantly from 31% to 42%. [24]. If trends continue, projections estimate that by 2030 nearly 50% of adults will have obesity, and nearly 1 in 4 adults will have severe obesity (BMI ≥35). [25]

Obesity disproportionately affects U.S. racial/ethnic minority populations. Compared to 42% of non-Hispanic whites, 50% of non-Hispanic Black and 45% of Hispanic adults have obesity. [24] There are considerable differences in obesity among non-Hispanic Black adults by sex, with 57% of non-Hispanic Black women having obesity compared to 41% of men. [24] Trends estimate that severe obesity may become the most common BMI category among non-Hispanic Black and low-income adults by 2030. [25]

Obesity rates in Canada are not as high as they are in the U.S., but Canada has seen dramatic increases over the past three decades. Obesity prevalence among Canadian adults increased from 9% in 1975 to 31% by 2016. [23] Indigenous populations in Canada are also disproportionately affected by the burden of obesity. [26]

Children

The U.S. has among the highest childhood obesity rates in the world, with nearly 1 in 3 children with overweight or obesity. In 2015-2016, nearly 19% of children 2-19 years old had obesity, affecting an estimated 14 million children nationwide. Obesity prevalence was highest among adolescents 12-19 years old (21%) and lowest among preschool-aged children 2-5 years old (14%). [27] Recently, the prevalence of obesity declined among children ages 2-5 years old, held steady for children 6-11 years, and continued to rise among adolescents 12-19 years. [28,29] Current trends suggest that an alarming 57% of children currently between 2 and 19 years old will have obesity at age 35. [30]

Overweight and obesity disproportionally affects racial/ethnic minority populations, and such disparities exist as early as age 2 and persist into adulthood. [27,30] The highest obesity prevalence are among Hispanic (26%) and non-Hispanic Black children (22%), compared with the lowest prevalence among non-Hispanic White (14%) and non-Hispanic Asian (11%) children. [27]

Canada has also seen a rise in childhood obesity since the late 1970s. Obesity rates have more than doubled, and in some age groups, tripled. [31] But childhood obesity rates are lower there than they are in the U.S; in 2013, 10% of children ages 6-11 years old and 17% of children ages 12-17 had obesity. [32] Childhood obesity is significant among Canada’s Aboriginal groups. In a 2006 survey of Aboriginal Peoples in Canada, nearly 33% of children ages 6-8 had obesity, and 13% among children ages 9-14. [33]

Adults

Over the past several decades, obesity has become a significant health challenge in Latin America. While undernourishment persists among vulnerable groups, so do overweight and obesity. Each year, obesity among the population grows by 3.6 million individuals, and now exceeds undernourishment as the greatest nutritional threat. [34] Between 1975 and 2014, among the largest increases in BMI in regions worldwide occurred for men in central Latin America, and for women in Andean Latin America and the Caribbean. [35] In 2016, approximately 104 million adults in Latin America had obesity; 15% of men and 16% of women. [23] Countries with the highest prevalence of obesity included Bermuda (women 43%, men 30%) and Puerto Rico (women 42%, men 29%). [23]

Children

While Latin America has shown significant progress in reducing child stunting due to undernourishment, prevalence of overweight and obesity due to malnutrition has grown to be among the highest in the world. [34] As a result, Latin American children have the dual burden of undernutrition coexisting with overweight and obesity. [36] In 2016, 15% of children ages 5-9 years and 10% of adolescents ages 10-19 years had obesity in Latin America and the Caribbean. [34] Among girls ages 5-19 years old, central Latin America demonstrated the highest increase of BMI per decade worldwide over the past 40 years. [37] Inequality further exacerbates overweight and obesity in populations with lower income, and among women, indigenous peoples, Afro-descendants, and rural families. [34]

Adults

Since 1975, obesity rates have been rising across Europe, though not as rapidly or as high as they are in the U.S. [35] Countries with the highest prevalence include Malta and the United Kingdom, hovering around 30% for both men and women. Countries with the lowest obesity prevalence include Austria, Sweden, Denmark, and Switzerland for women and Moldova and Russia for men (<20% for all). [23] The rise in women’s BMI in central and southwestern Europe has been among the lowest over the past 40 years, one of the few places worldwide that can report such a trend. [23,35]

Children

Over the past several decades, many European countries had among the largest increases in the number of children and adolescents with obesity. [37] More recently, obesity has plateaued in many regions, particularly in eastern, northwestern, and southwestern Europe, but prevalence rates remain high in Mediterranean countries. [37,38] In Greece, Malta, and Cyprus, 16% of boys ages 5-19 have obesity, and 11% of girls in Greece and Malta. [37] 

Regional surveys and analyses demonstrate similar childhood obesity trends in Europe. A 2019 systematic review of 130 studies across 28 European countries assessed prevalence trends in overweight and obesity among 2-13-year-old children between 1999-2016. [39] The prevalence of overweight and obesity tended to decrease in the Iberian region and increase in the Mediterranean regions, with no significant changes in Atlantic or Central Europe. Although the overall prevalence of childhood overweight and obesity remains high, trends have stabilized in most European countries, but continues to rise in some Mediterranean countries. [39]

Adults

Undernutrition has historically received more public health attention in Africa than overnutrition. Yet today, obesity and associated chronic diseases have become a growing problem across the continent. Some have called it a “silent epidemic,” striking countries that are still struggling with the health and economic burdens of malnutrition, stunting, infectious disease, and high childhood mortality rates. [40]

Obesity prevalence is higher among African women compared with men, and can vary widely from country to country. For example in 2016, 41% of women in South Africa had obesity (higher than in U.S. women) compared with 16% of men. In stark contrast, the lowest prevalence of obesity was in Ethiopia for women (7.3%) and in Uganda for men (2%); prevalence of undernutrition exceeds that of overnutrition in these African countries among many others. [35]  Between 1975 and 2016, Botswana experienced the largest increases in obesity prevalence in these African regions, jumping from 5% to 31%. [35]

Children

Hunger, underweight, and stunting have long been the more pressing child nutrition concerns across Africa. Even today, more children and adolescents are moderately or severely underweight than obese, particularly in central, east, and west Africa. [35] Yet here too, child obesity rates are on the rise, particularly in southern Africa. In 1975, less than 0.5% of girls and boys in South Africa had obesity, but by 2016 the prevalence jumped to 13% for girls and 10% for boys. [37]

Adults

Researchers have taken a closer look at obesity trends in the six Persian Gulf states (Oman, Bahrain, United Arab Emirates, Saudi Arabia, Qatar, and Kuwait), since these countries have seen tremendous increases in wealth since the discovery of oil reserves in the 1960s. [41] Even in 1975, obesity prevalence in Kuwait, Qatar, and the United Arab Emirates exceeded 20% among women, raking among the top 20 countries worldwide with the highest prevalence. Among men, Kuwait and Qatar also ranked among the top 20 countries with the highest prevalence in 1975, but only at 12%. [23] In 2016, the prevalence of obesity increased to 47% in Kuwait and 45% in Qatar for women, and to approximately 30% for men in both countries. The most significant increases have been observed in Saudi Arabia and Jordan, from 6% in 1975 to around 30% in 2016. [23]

Children

The Middle East and north Africa have seen sharp increases in obesity since 1975, and this region now has among the highest prevalence of child and adolescent obesity worldwide. [38] Girls in Kuwait and Egypt and boys in Kuwait, Qatar, and Saudi Arabia have the highest obesity prevalence in the region, all hovering around 20% of the child and adolescent population. [37] In 1975, girls in the Middle East and north Africa had higher age-standardized BMI than boys, but by 2016 this gap shrank or reversed as boys gained more weight than girls. [37]

Adults

Some countries in Asia have the lowest obesity prevalence worldwide, yet here too it has become a serious problem across the region over the past four decades, even while underweight concerns persist. Japan and South Korea have among the lowest obesity prevalence in the world (<9%) for both men and women. However, recent trends in China are of special concern. Although obesity rates are still low overall, there has been a substantial increase from <1% in 1978, to 6% for women and 7% for men in 2016. [23] China is one of the most populous nations on the planet with more than 1.4 billion people, so even small percentage increases in obesity prevalence translate into millions more cases of chronic disease. Furthermore, Asians have a higher risk of weight-related diseases like type 2 diabetes at lower BMI levels, further exacerbating the health issues related to overweight and obesity.

Children

South Asian countries like Bangladesh, India, and Pakistan have among the highest prevalence of moderate and severe underweight worldwide; 20% in girls and 29% in boys. Nevertheless, trends in mean BMI have significantly accelerated in east, south, and southeast Asia between 1975 and 2016. Although obesity prevalence remains relatively low in south Asia, their large populations add up to large numbers of children who have obesity.

Compared to south Asia, the prevalence of child and adolescent obesity is greater in high income Asia Pacific and east/southeast Asia, particularly among boys. [37,38] Obesity prevalence in Malaysia, Taiwan, and China for boys was less than 0.5% in 1975 and jumped to 15% in 2016. Girls in Asia have lower obesity prevalence compared to boys, but has still been increasing over time, most notably in Malaysia where obesity increased from 0.2% to 10% during this time period. [37] 

It’s important to note that in Asian adults, the health complications associated with overweight and obesity start at a lower BMI than seen in the U.S. and Europe; therefore these estimates of child obesity prevalence in Asia likely underestimate the true public health burden of obesity in Asia.

Adults

The top 13 countries with the highest obesity prevalence worldwide are located within Oceania. Eight of the countries exceed 45% obesity prevalence among men, and 13 countries exceed 50% among women. American Samoa and Nauru have the highest obesity prevalence among women (68%) worldwide; for men it is Nauru at 60%. Australia and New Zealand have lower prevalence in the region but still hover around 30% for both men and women. [23]

Children

Of the top 13 countries with the highest child and adolescent obesity prevalence in 2016, 11 were located in Oceania. There was more than 30% obesity prevalence for both girls and boys in the Cook Islands, Nauru, Palau, and additionally for boys in Niue and American Samoa. [37]

High-income countries in Oceania, Australia and New Zealand have childhood obesity rates in the double digits, but there’s some evidence that rates have hit a plateau. In Australia, 13% of boys and 11% of girls have obesity; in New Zealand the prevalence is higher at 18% and 15% respectively. [37] Overweight and obesity prevalence is even higher in some of New Zealand’s ethnic groups (Maori, 37%; Pacific Islanders, 57%) but have largely unchanged since early 2000. [42]

There are various risk factors for obesity, but not everyone with these risk factors develops obesity. And not everyone who has obesity develops health problems. In these cases, genes may play a role. Studies of siblings or twins show genetic factors that can determine weight and body size throughout life. [43] Some research suggests differences in genes in people who are of normal weight versus those carrying extra weight that may influence appetite control, metabolic rate, or even ability to change behavior. Gene-nutrient interactions can also promote obesity. For example, genes that increase risk of developing obesity have been reported to be stimulated by saturated fatty acids but not by unsaturated fatty acids. [43] The gut microbiome may also play a role in a person’s risk of developing obesity and chronic health conditions. [44]

However, obesity caused by mutations in a single gene, or monogenic obesity, is rare and is more likely influenced by changes in many different genes, called “common” obesity. Still, the modern obesity epidemic is largely fueled by environmental factors, with excess energy intake and low physical activity pinned as the main culprits. [45] First-degree family members (parents, siblings) who live together typically share similar environments that increase the risk of obesity, and health-related habits of parents are often passed onto their children. Examples include food choices, meal preparation methods (cooking at home vs. reliance on fast food), exercise, screen time, and sleep habits, as well as lack of access to outdoor green space.

These findings suggest that genetic factors make a small contribution to obesity risk, and that our genes are not our destiny. Many people who carry potential “obesity genes” do not become overweight, and healthy lifestyles can counteract these genetic effects.

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