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Obesity: global epidemiology and pathogenesis


The prevalence of obesity has increased worldwide in the past ~50 years, reaching pandemic levels. Obesity represents a major health challenge because it substantially increases the risk of diseases such as type 2 diabetes mellitus, fatty liver disease, hypertension, myocardial infarction, stroke, dementia, osteoarthritis, obstructive sleep apnoea and several cancers, thereby contributing to a decline in both quality of life and life expectancy. Obesity is also associated with unemployment, social disadvantages and reduced socio-economic productivity, thus increasingly creating an economic burden. Thus far, obesity prevention and treatment strategies — both at the individual and population level — have not been successful in the long term. Lifestyle and behavioural interventions aimed at reducing calorie intake and increasing energy expenditure have limited effectiveness because complex and persistent hormonal, metabolic and neurochemical adaptations defend against weight loss and promote weight regain. Reducing the obesity burden requires approaches that combine individual interventions with changes in the environment and society. Therefore, a better understanding of the remarkable regional differences in obesity prevalence and trends might help to identify societal causes of obesity and provide guidance on which are the most promising intervention strategies.

Key points

  • Obesity prevalence has increased in pandemic dimensions over the past 50 years.

  • Obesity is a disease that can cause premature disability and death by increasing the risk of cardiometabolic diseases, osteoarthritis, dementia, depression and some types of cancers.

  • Obesity prevention and treatments frequently fail in the long term (for example, behavioural interventions aiming at reducing energy intake and increasing energy expenditure) or are not available or suitable (bariatric surgery) for the majority of people affected.

  • Although obesity prevalence increased in every single country in the world, regional differences exist in both obesity prevalence and trends; understanding the drivers of these regional differences might help to provide guidance for the most promising intervention strategies.

  • Changes in the global food system together with increased sedentary behaviour seem to be the main drivers of the obesity pandemic.

  • The major challenge is to translate our knowledge of the main causes of increased obesity prevalence into effective actions; such actions might include policy changes that facilitate individual choices for foods that have reduced fat, sugar and salt content.

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Nature Reviews Endocrinology thanks G. Bray, A. Sharma and H. Toplak for their contribution to the peer review of this work.

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Correspondence to Matthias Blüher.

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Fig. 1: Factors that can influence the chronic positive energy balance, thus subsequently causing obesity.
Fig. 2: Complex biological, environmental and societal factors contributing to obesity.
Fig. 3: Worldwide prevalence of obesity.
Fig. 4: Increase in prevalence of obesity over time.
Fig. 5: The energy flipping point.