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Global obesity: trends, risk factors and policy implications

Nature Reviews Endocrinology volume 9, pages 13–27 (2013)Cite this article

Subjects

Abstract

The worldwide increase in obesity and related chronic diseases has largely been driven by global trade liberalization, economic growth and rapid urbanization. These factors continue to fuel dramatic changes in living environments, diets and lifestyles in ways that promote positive energy balance. Nutritional transitions in low-income and middle-income countries are typically characterized by increases in the consumption of animal fat and protein, refined grains, and added sugar. This change is coupled with reductions in physical activity owing to more mechanized and technologically driven lifestyles. Given the high costs of obesity and comorbidities in terms of health-care expenditure and quality of life, prevention strategies are paramount, particularly in low-income and middle-income countries that must manage coexisting infectious diseases and undernutrition in addition to the obesity epidemic. As countries become increasingly urbanized, undernutrition and obesity can exist side by side within the same country, community or household, which is a particular challenge for health systems with limited resources. Owing to the scope and complexity of the obesity epidemic, prevention strategies and policies across multiple levels are needed in order to have a measurable effect. Changes should include high-level global policies from the international community and coordinated efforts by governments, organizations, communities and individuals to positively influence behavioural change.

Key Points

  • Although globalization has resulted in substantial improvements in quality of life and food security, as well as reductions in poverty, unintended consequences of globalization are also driving the obesity epidemic

  • Global trade liberalization and increases in income and urbanization have created obesogenic environments that promote nutritional transitions and reductions in physical activity, resulting in positive energy balance

  • Dietary changes leading to positive energy balance are characterized by increases in the consumption of animal products, refined grains and sugar

  • Dietary changes are driven by the increased availability of low-cost food and drinks, which are often low in nutritional value and high in energy and sugar

  • Strategies to address the global obesity epidemic require sustained, population-wide interventions and policy recommendations designed to improve diet and increase physical activity using a multilevel systems approach

  • Combating obesity requires coordinated efforts from the international community, governments, industry, health-care systems, schools, urban planners, agricultural and service sectors, the media, communities and individuals

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Figure 1: Global trends in the prevalence of obesity among women and men in 1980 and 2008 from select regions of the world.
Figure 2: Schematic representation of the relationship between globalization and obesity.

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Authors and Affiliations

  1. Department of Nutrition, Harvard School of Public Health, 665 Huntington Avenue, Boston, 02115, MA, USA

    Vasanti S. Malik, Walter C. Willett & Frank B. Hu

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  1. Vasanti S. Malik
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  2. Walter C. Willett
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V. S. Malik researched the data for the article and wrote the manuscript. W. C. Willett and F. B. Hu both reviewed and edited the manuscript. All authors made substantial contributions to discussion of article content.

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Correspondence to Frank B. Hu.

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Malik, V., Willett, W. & Hu, F. Global obesity: trends, risk factors and policy implications. Nat Rev Endocrinol 9, 13–27 (2013). https://doi.org/10.1038/nrendo.2012.199

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