Obesity has become the most common form of malnutrition in the majority of countries

There’s an epidemic that’s crossing the globe from end to end… and it’s more devastating than Covid. According to the World Health Organization (WHO), about 774 million people in the world were afflicted by the coronavirus. However, obesity already affects more than one billion people. A study published this past Thursday in The Lancet reveals that excess weight, a risk factor for dozens of diseases, is already the most common form of malnutrition in most countries. Cases in children have quadrupled in three decades, while the number of obese adults has almost tripled in the same time period.

In one way or another, food-related problems have become entrenched. And, while the number of underweight people on the planet has decreased (due to the drop in starvation, for example), the rise of overweight and obese individuals has, once again, led to an unhealthy food balance in the world.

Insufficient nutrition is as bad as excess weight. They’re both different forms of malnutrition, which is associated with health problems throughout life. Malnutrition poses a risk of premature death, while obesity is also a risk factor for diseases such as cancer, diabetes, or hypertension. It’s also a precursor of cardiovascular diseases. Furthermore, in childhood, excess fat increases the risk of being obese in adulthood, accelerating the appearance of mechanical problems (due to the weight on the joints) and metabolic problems.

The research published in The Lancet, which compiles data from more than 3,600 studies and analyzes the evolution of obesity and of being underweight in the world between 1990 and 2022, reveals a consolidation of two parallel phenomena: while the number of underweight individuals has fallen, obesity is gaining ground, both in rich and low-income countries.

“What the study shows us is that malnutrition is being controlled very well in the world, except in some African countries. Better living conditions and economic development accompany this reduction. But no country in the world has managed to reduce obesity. This article shows that the problem is going in the wrong direction,” warns Fernando Rodríguez Artalejo, a professor of public health at the Autonomous University of Madrid and one of the authors of the newly-published research.

The study offers an X-ray of the prevalence of this form of malnutrition, which is skyrocketing. “The combined prevalence of underweight and obesity has increased in most countries since 1990, due to the rise in obesity surpassing the decline in underweight. Exceptions were most countries in South Asia, and some in Southeast Asia and sub-Saharan Africa,” the paper notes.

“This transition to obesity dominance was already apparent in adults in 1990 in much of the world, and has followed in school-aged children and adolescents. There is a need throughout the world for social and agricultural policies and food programmes that address the remaining burden of underweight while curbing and reversing the rise in obesity by enhancing access to healthy and nutritious foods,” it continues.

On a world map, a growing prevalence of obesity dominates almost all territories. The study — led by Imperial College London, in which more than a thousand scientists from around the world have participated — brings the number of people in the world suffering from this ailment to 878 million adults and 160 million children. This means that, between 1990 and 2022, the prevalence in minors went from 1.7% to 6.9% in girls and from 2.1% to 9.3% in boys. In adults, rates jumped from 8.8% to 18.5% in women and from 4.8% to 14% in men.

“It’s not surprising. You go out into the street and see it. It was expected,” Rodríguez Artalejo sighs. “What are the reasons for this? Well, the study doesn’t analyze the data, it only speculates… but it points to the increase in cheap ultra-processed food in a context that makes it easier to eat at all hours of the day. And the same thing happens in poor countries. This is what globalization has done,” he explains.

According to the study, the prevalence of obesity in the last three decades has grown in the vast majority of territories, especially in the United States, Brunei, some countries in the Caribbean, the Middle East and North Africa. Polynesian countries such as Tonga, Samoa and Niue have the highest obesity rates among both children and adults, with prevalence above 60% in adults. In minors, Chile is also one of the countries where obesity has grown the most: the country reports that up to 33% of adult men are obese. The United States — a paradigm of the expansion of obesity in high-income areas — is also near the top of the rankings, with four out of every 10 American adults either being overweight or obese.

The striking case of French and Spanish women

Spain dances in the middle of the table: the prevalence in adults is 13% in women and 19% in men; in children, it ranges between 9% in girls and 12% in boys. But the researchers highlight a particular phenomenon in this environment: both in Spain and in France, there’s a slight decrease in obesity figures in women… “although the reasons are unknown,” they admit.

When it comes to countries such as Spain and France — where the results are decent — the experts consulted are careful not to celebrate too soon. “We must be cautious when interpreting the result and not think that the battle against obesity has been won. This may suggest that there’s a greater degree of awareness [of the problem in these countries],” agrees Manuel Tena, group leader of the Biomedical Research Networking Centers (CIBER) for Obesity and Nutrition.

Rodríguez Artalejo admits that the bright spots are “eye-catching,” but points out that “it’s probably not representative of Spain as a whole throughout the period of study, because it’s based on small and regional studies. We’re seeing a huge obesity epidemic that we’re beginning to control… but we’re no better off than we were 30 years ago,” he emphasizes.

On the other hand, over the past 30 years, the prevalence of low weight in adults fell in 150 countries (globally, in women, it went from 14.5% to 7% and in men, from 13.7% to 6.2%). That is, 347 million people were underweight in 2022, which represents a decrease of about 45 million compared to 1990. “And this is despite the growth of the world population,” the researchers point out.

Women in India, China, Indonesia, Ethiopia, Bangladesh and Japan made up the highest proportion of underweight adults in 2022. Meanwhile, the prevalence of underweight children fell from 10.3% to 8.2% in girls and from 16.7% to 10.8% in boys. In 2022, 185 million children were underweight.

The authors admit some limitations to the study, such as the lack of data in some countries, or the use of the body mass index (BMI) as an indicator, since it’s “imperfect” to measure excess body fat (obesity is considered to be a BMI over 30, while one is classified as underweight if they’re below 18). However, they defend their findings and propose, for example, that the phenomenon that crystallizes their research — this being the appearance of obesity at increasingly younger ages — “could be due to consumption [of fast food] outside the home and access to commercial foods and processed foods [among] school-age children and adolescents.” They also raise the hypothesis that “some leisure games and sports have been replaced by sedentary activities,” although they admit that the available data regarding these trends is scarce.

The researchers underline the need to combat malnutrition in Africa and South Asia, where “food insecurity persists” and warn of the “urgent need to prevent obesity.” In this sense, they note that efforts focused on individual behaviors in the food environment haven’t had much of an effect. The authors criticize the lack of access to healthy products, especially for low-income populations.

Regarding the explosion of promising anti-obesity drugs, the authors predict that the impact will be “low worldwide in the short-term, due to the high cost” of these therapies. However, Jaume Marrugat, an epidemiologist at the Hospital del Mar Research Institute in Barcelona and one of the authors of the study, sees potential in these therapies to reduce obesity (at least in high-income countries).

“These are terribly effective drugs. Contrary to what we thought in 2015, the forecast is that we’ll see an inflection and we may see a decline in obesity. I hope I’m not wrong because, [if I am], we’re going to be hit by a disaster.”

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