Rising prevalence of BMI ≥40 kg/m2 : A high-demand epidemic needing better documentation

Abstract

Whilst previously rare, some surveys indicate substantial increases in the population with body mass index (BMI) ≥40 kg/m² since the 1980s. Clinicians report emerging care challenges for this population, often with high resource demands. Accurate prevalence data, gathered using reliable methods, are needed to inform health care practice, planning, and research. We searched digitally for English language sources with measured prevalence data on adult BMI ≥40 collected since 2010. The search strategy included sources identified from recent work by NCD-RisC (2017), grey sources, a literature search to find current sources, and digital snowball searching. Eighteen countries, across five continents, reported BMI ≥40 prevalence data in surveys since 2010: 12% of eligible national surveys examined. Prevalence of BMI ≥40 ranged from 1.3% (Spain) to 7.7% (USA) for all adults, 0.7% (Serbia) to 5.6% (USA) for men, and 1.8% (Poland) to 9.7% (USA) for women. Limited trend data covering recent decades support significant growth of BMI ≥40 population. Methodological limitations include small samples and data collection methods likely to exclude people with very high BMIs. BMI ≥40 data are not routinely reported in international surveys. Lack of data impairs surveillance of population trends, understanding of causation, and societal provision for individuals living with higher weights.

Keywords: BMI ≥40; data quality; prevalence; severe obesity.

Figure 1

Search strategy (A) part 1 and 2: NCD‐RisC sources and grey sources, (B) part 3 & 4: literature search

Figure 2

International body mass index (BMI) ≥40 prevalence rates by country: (A) all adults, (B) men, and (C) women

Figure 3

Changes in the distribution of body mass index (BMI) between 1976‐1980 and 2005‐2006, adults aged 20 to 74 years: United States.63 Data are age adjusted by the direct method to the year US Census 2000 estimates using age groups 20 to 39, 40 to 59, and 60 to 74. Overweight is BMI of 25.0 to 29.9 kg/m²; obesity is BMI at or above 30.0 kg/m²; and severe obesity is BMI at or above 40.0 kg/m². Pregnant women are excluded from the analysis. Sources: NCHS, National Health Examination Survey, and National Health and Nutrition Examination Surveys