New dynamics in global obesity facing low- and middle-income countries

Abstract

Levels of overweight and obesity across low- and middle-income countries (LMIC) have approached levels found in higher-income countries. This is particularly true in the Middle East and North Africa and in Latin America and the Caribbean. Using nationally representative samples of women aged 19-49, n = 815,609, this paper documents the annualized rate of increase of overweight from the first survey in early 1990 to the last survey in the present millennium. Overweight increases ranged from 0.31% per year to 0.92% per year for Latin America and the Caribbean and for the Middle East and North Africa, respectively. For a sample of eight countries, using quantile regression, we further demonstrate that mean body mass index (BMI) at the 95th percentile has increased significantly across all regions, representing predicted weight increases of 5-10 kg. Furthermore we highlight a major new concern in LMICs, documenting waist circumference increases of 2-4 cm at the same BMI (e.g. 25) over an 18-year period. In sum, this paper indicates growing potential for increased cardiometabolic problems linked with a large rightward shift in the BMI distribution and increased waist circumference at each BMI level.

Keywords: Low- and middle-income countries; obesity prevalence; obesity trends; waist circumference.

Figure 1

Shifts in underweight and overweight across the low- and middle-income world, 1990–2010 *Data are weighted by each country’s population and based on nationally representative surveys of women aged 19–49 (n = 815,609). Body mass index (BMI) 18.5< is underweight. BMI ≥ 25 is overweight. Data come from the year closest to 1990 and 2010 for each country.

Figure 2

Shifts in the prevalence of underweight and overweight across the low- and middle-income world, 1990–2010. *Data are weighted by each country’s population and based on nationally representative surveys of women aged 19–49 (n= 815,609). Body mass index (BMI) 18.5< is underweight. BMI ≥ 25 is overweight. Data come from the year closest to 1990 and 2010 for each country.

Figure 3

Annualized change in the prevalence of overweight and underweight in the 1990s–2000s sorted by gross national product (GNP) per capita. Based on nationally representative surveys of women 19–45 (n= 815,609). Body mass index (BMI) 18.5< is underweight. BMI ≥ 25 is overweight. Data come from the year closest to 1990 and 2010 for each country.

Figure 4

Annualized change regional population-weighted percent underweight and overweight – in the 1990s and 2000s, rural/urban. *Data are weighted by each country’s population and based on nationally representative surveys of women aged 19–49 (n= 815,609). Body mass index (BMI) 18.5< is underweight. BMI ≥ 25 is overweight. Data come from the year closest to 1990 and 2010 for each country.

Figure 5

Predicted body mass index (BMI) increases across selected countries at the 95th centile in age 30- and 40-year-old women. *Data are weighted by each country’s population and based on nationally representative surveys of women aged 19–49 (n= 815,609). BMI 18.5< is underweight. BMI ≥ 25 is overweight. Data come from the year closest to 1990 and 2010 for each country.