Global Epidemiology Of Obesity

Dr. Sumeet ShahConsultant Laparoscopic and Bariatric Surgeon

Sir Ganga Ram HospitalNew Delhi

The human phenotype is changing rapidly

Increased body size and fatter body composition

Response to environments that make low demands on energy expenditure, together with greater energy-density diets

This change is occurring within one to three generations, around the world

Not entirely an urban phenomenon, but more pronounced in big cities

The Obesity Pandemic• ~1 billion malnourished worldwide• >1 billion overweight worldwide• >350 million obese worldwide• 2.5 million obesity-deaths annually• 2000: 170 million diabetics

worldwide• 2020: Doubled

Source: International obesity task force & WHO

Obesity Trends* Among U.S. AdultsBRFSS, 1990

*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person

No Data <10% 10%–14%

http://www.cdc.gov/nccdphp/dnpa/obesity/

Obesity Trends* Among U.S. AdultsBRFSS, 1998

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% ≥20%

Obesity Trends* Among U.S. AdultsBRFSS, 2006

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity rates: Current and projected

7

0

10

2020

30

40

50

19601970

19801990

20002010

20202030

USA

England

Mauritius

Australia

Brazil

Population percentage with BMI > 30kg/m2

The Demographic Transition

The World’s Population

Was three billion in the 1960s

Now six billion

Will continue to increase for next 50 years

Will level off at 9, 10 or 11 billion by the year 2100

South Atlantic Ocean South Pacific Ocean

North Atlantic Ocean

Indian Ocean

Arctic Ocean Arctic Ocean

Arctic Ocean

North Pacific Ocean

Brazil

South Africa

Tanzania

Kenya

Egypt

Mali

China

India

Ghana

Kyrgyzstan

Bolivia Madagascar Namibia Zimbabwe

Malawi

Cameroon C. A. R. Côte D’Ivoire

Turkey

Vietnam

Kazakhstan Uzbekistan

Uganda

Peru

Colombia

Dominican Republic

Guatemala Haiti

Niger

Nigeria

Senegal

Zambia

Benin

Chad

Guinea

Yemen

Nepal

Bang.

Togo

Patterns of Overweight and Obesity among Women of Child-bearing Age from the DHS (BMI>25, Ages 20-49 , Age-Standardized, Weighted)

10-20% 31-40%21-30% 41-50% >51%<10%

Burkina Faso

Mozambique Comoros

Eritrea

Jordan

Mexico

Prevalence of Obese Preschool Children In Selected Countries and

Territories

Less Active LifestylesLess Active Lifestyles

Childhood Obesity

• 28% of Delhi’s children in the 14-18 age group are overweight or obese.

• 13% of Delhi’s school children – positive for C-reactive protein

• Women & Child Development Ministry• Diabetes Foundation of India

Prevalence of obesity - India

• Overweight – females – 47.5% males - 32%

• Obese – females – 14% males – 3%

• Abdominal adiposity – females – 35% males – 49%

www.nutritionfoundationofindia.in

The “Nutrition Transition”

Changes in age structure of the population, diet and physical activity patterns that result in

– Emergence of obesity as a common problem, with its predictable co-morbidities

– Change in nature and extent of cancer burden– Increases in other chronic diseases depending on the

nature of dietary and lifestyle shifts

with or without solution of existing problems of under- and mal-nutrition

Driving Forces behind the Nutrition Transition

• Increases in life expectancy and declines in mortality: larger proportion of adults and growing number of elderly

• Urbanization• Economic and technical development

• Changes in physical activity and diet– Sedentary occupations and leisure-time activities– Urban environments that restrain physical activity– Dietary change: increases in dietary fat, sugar, animal

products, ?total dietary energy, + declines in dietary quality

Predictable Sequence of the Developing Epidemic of Nutrition-Related Non-Communicable Diseases (NR-NCDs)

Obesity and overweight are the first manifestationWithin a generation, the prevalence of Type 2

diabetes mellitus and/or hypertension and stroke rise

Within two generations, premature CHD emerges as a major cause of premature death, disability and health care costs

Within two generations, the nature of the cancer burden shifts to domination by diet- and physical-activity related cancers

Deaths, by broad cause group and WHO Region, 2000

24

InjuriesNoncommunicableconditions

Communicable diseases, maternal

and perinatal conditions and nutritional deficiencies

AFR EMR EURSEAR WPR AMR

25

50

75

%

So

urc

e:

WH

O,

Wo

rld H

ea

lth R

ep

ort

20

01

Current Situation in the World’s Largest Countries

China (1.26 billion)Fast-growing economy (8.5%/year GDP growth)

% of population in poverty down from 20% in 1980s to <10% % of deaths due to NR-NCDs: 41.6% in 1995, 52.0% by 2020

India (1 billion)Real economic growth 3%/yr GDP

% of population in poverty down from 55% in 1970 to 26%% of deaths due to NR-NCDs: 31.6% in 1995; 43.3% by

2020

Costs of Undernutrition and NR-NCDs in the World’s Largest

Countries

• China: Costs of undernutrition and NR-NCDs currently equal; NR-NCDs will dominate by 2025

• India: Costs of undernutrition still predominate, but NR-NCDs will contribute as much cost by the year 2025

Nature of the Transition in the World’s Largest Countries

• China: dramatic rises in hypertension, stroke• India: major rise in incidence of adult-onset

diabetes

• Reasons for contrasting experience?– ?genetic backgrounds?– Nature of dietary shift (oils and meats in China,

sugars and dairy products in India)

• Increase in prevalence in China over last 20 years was 400% compared to 20% in Australia

Asia Pacific Cohort Studies Collaboration

Health risks overweight

33

Abdominal obesity

Dyslipidemia

Insulin resistance

Hypertension

Proinflammatory state

Prothrombotic state

Cardio-vascular disease

Diabetes Mellitus

Metabolic disorders as a common denominator for the various components

Nutrition may play an important role

in the development

Overweight subjects are at increased risk

of developingmetabolic disorders

Why is obesity an even bigger problem for developing countries?

• More limited resources

• Late recognition of the problem

• Cultural factors favoring overweight, favoring overeating, favoring sedentary lifestyles, and/or stigmatizing thinness in some areas

In Summary…….

• Nearly a million Overweight/ Obese population in the country

• Rising prevalence amongst children and young adults

• Much higher incidence of abdominal adiposity and metabolic syndrome

• Diabetes capital of the world

Number of weight loss operations performed in the

United States

0

10000

20000

30000

40000

50000

60000

70000

80000

1993 1998 2002

JAMA. 2005;294:1909-1917.

Thank You

Thank You