The global burden of disease attributable to high body mass index in 195 countries and territories, 1990-2017: An analysis of the Global Burden of Disease Study

Abstract

Background: Obesity represents an urgent problem that needs to be properly addressed, especially among children. Public and global health policy- and decision-makers need timely, reliable quantitative information to develop effective interventions aimed at counteracting the burden generated by high body mass index (BMI). Few studies have assessed the high-BMI-related burden on a global scale.

Methods and findings: Following the methodology framework and analytical strategies used in the Global Burden of Disease Study (GBD) 2017, the global deaths and disability-adjusted life years (DALYs) attributable to high BMI were analyzed by age, sex, year, and geographical location and by Socio-demographic Index (SDI). All causes of death and DALYs estimated in GBD 2017 were organized into 4 hierarchical levels: level 1 contained 3 broad cause groupings, level 2 included more specific categories within the level 1 groupings, level 3 comprised more detailed causes within the level 2 categories, and level 4 included sub-causes of some level 3 causes. From 1990 to 2017, the global deaths and DALYs attributable to high BMI have more than doubled for both females and males. However, during the study period, the age-standardized rate of high-BMI-related deaths remained stable for females and only increased by 14.5% for males, and the age-standardized rate of high-BMI-related DALYs only increased by 12.7% for females and 26.8% for males. In 2017, the 6 leading GBD level 3 causes of high-BMI-related DALYs were ischemic heart disease, stroke, diabetes mellitus, chronic kidney disease, hypertensive heart disease, and low back pain. For most GBD level 3 causes of high-BMI-related DALYs, high-income North America had the highest attributable proportions of age-standardized DALYs due to high BMI among the 21 GBD regions in both sexes, whereas the lowest attributable proportions were observed in high-income Asia Pacific for females and in eastern sub-Saharan Africa for males. The association between SDI and high-BMI-related DALYs suggested that the lowest age-standardized DALY rates were found in countries in the low-SDI quintile and high-SDI quintile in 2017, and from 1990 to 2017, the age-standardized DALY rates tended to increase in regions with the lowest SDI, but declined in regions with the highest SDI, with the exception of high-income North America. The study's main limitations included the use of information collected from some self-reported data, the employment of cutoff values that may not be adequate for all populations and groups at risk, and the use of a metric that cannot distinguish between lean and fat mass.

Conclusions: In this study, we observed that the number of global deaths and DALYs attributable to high BMI has substantially increased between 1990 and 2017. Successful population-wide initiatives targeting high BMI may mitigate the burden of a wide range of diseases. Given the large variations in high-BMI-related burden of disease by SDI, future strategies to prevent and reduce the burden should be developed and implemented based on country-specific development status.

Fig 1. Age-specific numbers and rates of deaths and DALYs attributable to high body mass index by sex, in 2017.

(A) Deaths. (B) DALYs. DALY, disability-adjusted life year.

Fig 2. Age-standardized death and DALY rates attributable to high body mass index for both sexes combined in 2017.

(A) Deaths. (B) DALYs. The maps were drawn by the R package “maptools” with the shapefiles edited manually in ArcMap. ATG, Antigua and Barbuda; Isl, Islands; FSM, Federated States of Micronesia; LCA, Saint Lucia; TLS, Timor-Leste; TTO, Trinidad and Tobago; VCT, Saint Vincent and the Grenadines; DALY, disability-adjusted life year.

Fig 3. Fraction of ischemic heart disease, stroke, and diabetes mellitus age-standardized DALYs attributable to high BMI by region and by age group for females and males in 2017.

(A) By region. (B) By age group. The 3 leading GBD level 3 causes of high-BMI-related DALYs are shown. BMI, body mass index; DALY, disability-adjusted life year; GBD, Global Burden of Disease Study.

Fig 4. Age-standardized DALY rates attributable to high body mass index across 21 GBD regions by Socio-demographic Index for both sexes combined, 1990–2017.

For each region, points from left to right depict estimates from each year from 1990 to 2017. DALY, disability-adjusted life year; GBD, Global Burden of Disease Study.

Fig 5. Age-standardized DALY rates attributable to high body mass index across 195 countries and territories by Socio-demographic Index for both sexes combined in 2017.

DALY, disability-adjusted life year.