Global, regional, and national burden of mortality and DALYs attributable to high body mass index from 1990 to 2021 with projections to 2036

Abstract

Background: The prevalence of high body mass index (BMI) has been increasing over the past three decades, resulting in significant public health challenges. This study aims to comprehensively analyze global, regional, and national trends in death and disability-adjusted life years (DALYs) attributable to high BMI from 1990 to 2021.

Methods: We utilized data from the Global Burden of Disease study to estimate deaths and DALYs linked to high BMI across 204 countries and territories. Temporal trends were analyzed by sex, age group, region, and Socio-demographic index (SDI). Decomposition analyses were conducted to assess the impact of demographic factors on BMI-related disease burden. All estimates are presented with 95% uncertainty interval (UI) to quantify statistical uncertainty. The autoregressive integrated moving average model was employed to project future trends to 2036.

Results: Globally, BMI-related deaths increased from 1.46 million (95% UI 0.72, 2.29) in 1990 to 3.71 million (95% UI 1.85, 5.66) in 2021. DALYs rose from 48 million (95% UI 21.2, 77.3) to 128.5 million (95% UI 56, 202.4) over the same period. Diabetes and kidney diseases have now overtaken cardiovascular diseases as the leading cause of DALYs, despite cardiovascular diseases remain the major contributor to BMI-related deaths. They accounted for 82.01% of deaths and 73.91% of DALYs. Among the four regions with the highest SDI, three showed a decline in BMI-related deaths and DALYs, except for high-income North America. In contrast, low-SDI regions continued to face escalating health burdens. Population aging was a primary driver of the increasing burden, which made up 49.43% of the increase in deaths and 47.03% in DALYs.

Conclusions: The increasing prevalence of high BMI has resulted in significant health burdens over the past three decades, with cardiovascular diseases, diabetes and kidney diseases being primary contributors. Low- and middle-income regions bear a larger share of the burden, while population aging exacerbates these challenges. Developing equitable and effective public health strategies is essential for addressing the growing obesity epidemic.

Keywords: Disability-adjusted life years; Global burden of disease; Health inequality; High body mass index; Trends.

Fig. 1

All-age numbers and age-standardized rates of deaths (A) and DALYs (B) attributable to high BMI by sex, 1990–2021. BMI, body mass index; DALYs, disability-adjusted life years

Fig. 2

Age-specific numbers and crude rates of death (A & B) and DALY (C & D) attributable to high BMI by sex, in 2021. The shaded areas represent 95% uncertainty intervals. BMI, body mass index; DALY, disability-adjusted life year

Fig. 3

Age-standardized rates of deaths (A) and DALYs (B) attributable to high BMI in 2021 in 204 countries and territories. BMI, body mass index; DALYs, disability-adjusted life years

Fig. 4

Fraction of hypertensive heart disease, ischemic heart disease, and diabetes mellitus DALYs attributable to high BMI by region (A) and age group (B) in 2021. BMI, body mass index; DALY, disability-adjusted life year

Fig. 5

Decomposition of all-age number changes in deaths (A) and DALYs (B) attributable to high BMI from 1990 to 2021. BMI, body mass index; DALYs, disability-adjusted life years

Fig. 6

Age-standardized rates of deaths (A) and DALYs (B) attributable to high BMI across 21 GBD regions by Socio-demographic index, 1990–2021. BMI, body mass index; DALYs, disability-adjusted life years; GBD, Global Burden of Disease Study

Fig. 7

Age-standardized rates of deaths (A) and DALYs (B) attributable to high BMI across 204 countries and territories by Socio-demographic index in 2021. BMI, body mass index; DALYs, disability-adjusted life years; GBD, Global Burden of Disease Study

Fig. 8

Slope and concentration indexes for deaths (A & B) and DALYs (B & D) attributable to high BMI from 1990 to 2021. The shaded areas represent 95% confidence intervals. The yellow line represents the line of perfect equality. BMI, body mass index; CI, confidence interval; DALYs, disability-adjusted life years

Fig. 9

Frontier analysis based on SDI and age-standardized rates of deaths (A & B) and DALYs (C & D) attributable to high BMI in 204 countries and territories. BMI, body mass index; DALYs, disability-adjusted life years; SDI, socio-demographic index

Fig. 10

Projections of age-standardized rates of deaths (A & B) and DALYs (C & D) attributable to high BMI, for the year 2036. The shaded areas represent 95% uncertainty intervals. BMI, body mass index; DALYs, disability-adjusted life years