There is an epidemic that is sweeping the globe from one end to the other and is more devastating than the Covid-19 crisis: if the coronavirus crisis has left 774 million cases worldwide, according to the World Health Organization (WHO), more people are already obese affected more than a billion people. A study published this Thursday in The Lancet shows that obesity, 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 and almost tripled in adults. One way or another, nutritional problems are becoming entrenched, and although the number of underweight people on the planet has decreased (for example, due to the decline in malnutrition), the increase in overweight and obesity is once again unbalancing the nutritional balance. healthy into the world.
Malnutrition is just as bad as being overweight. They are two sides of the same coin: malnutrition, which is associated with lifelong health problems. Malnutrition carries the risk of premature death and obesity is also a risk factor for diseases such as cancer or diabetes and high blood pressure, a precursor to cardiovascular disease. In addition, excess fat in childhood increases the risk of maintaining obesity in adulthood and accelerates the onset of mechanical problems (due to stress on the joints) and metabolic problems.
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The study published in The Lancet, which compiles data from more than 3,600 studies and analyzes the evolution of obesity and underweight in the world between 1990 and 2022, shows a consolidation of two parallel phenomena: while underweight rates are falling, there is a low point due to age-related weight loss inadequate nutrition – Obesity is increasing in both rich and low-income countries. “The study shows us that malnutrition is very well controlled worldwide, with the exception of some African countries. With this decline comes better living conditions and better economic development, as was the case in Spain in the 1950s. But no country in the world has managed to reduce obesity. This article shows that the problem is going wrong,” says Fernando Rodríguez Artalejo, professor of public health at the Autonomous University of Madrid and one of the signatories of this study.
In practice, this x-ray taken by the study shows that overall the prevalence of these malnutrition conditions is skyrocketing, the authors warn: “The combined prevalence of these forms of malnutrition has increased in most countries.” The notable exception is countries in southern and Southeast Asia, as well as for some age and gender groups in sub-Saharan Africa. The decrease in double burden was largely due to a decrease in the prevalence of underweight, while an increase was due to an increase in obesity, leading to a transition from the prevalence of underweight to obesity in many countries,” the authors summarize in the article .
On the world map, a growing prevalence of obesity can be observed in almost all areas. The study, led by Imperial College London and involving more than a thousand scientists from around the world, estimates 878 million adults and 160 million children suffer from the disease worldwide. This means that between 1990 and 2022, the prevalence among minors increased from 1.7% to 6.9% for girls and from 2.1% to 9.3% for boys; In adults, rates increased from 8.8% to 18.5% in women and from 4.8 to 14% in men. “It's not surprising. You go out on the street and you see it. It was what we expected,” says Rodríguez Artalejo. And he continues: “The reasons? The study doesn't analyze data, it just speculates, it points “The rise of cheap, highly processed foods in a context that makes it easier to eat around the clock. And the same thing is happening in poor countries. That's what globalization brings,” he explains.
According to the study, the prevalence of obesity has increased over the past three decades in the vast majority of areas (particularly 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 rates of obesity across all age groups, with the prevalence in adults exceeding 60%. Chile is also one of the countries where obesity has increased the most among minors, reporting a rate of 33% among men, for example. The United States, a prime example of the spread of obesity in high-income areas, also ranks high, with four in 10 American adults suffering from the disease.
The “striking” case of Spanish women
Spain dances in the middle of the table: the prevalence in adults is 13% in women and 19% in men; for children it is between 9% for girls and 12% for boys. But the researchers highlight a particular phenomenon in this environment: both here and in France there has been a slight decrease in obesity rates among women, “although the reasons are unknown,” they admit.
The experts interviewed demand that the bells not be raised in the air. “We need to be careful when interpreting the result and not think that the fight against obesity has been won. This could indicate that there is a higher level of awareness,” agrees Manuel Tena, group leader of the Networked Biomedical Research Center (CIBER) on Obesity and Nutrition. Rodríguez Artalejo admits that it is “striking” but points out that “it is probably not representative of Spain as a whole throughout the study period, since it is based on small and regional studies.” “We are experiencing a huge obesity epidemic that “We're slowly getting it under control, but we're no better than we were 30 years ago,” he says.
The prevalence of underweight in adults decreased in 150 countries during these 30 years (globally, it fell from 14.5% to 7% in women and from 13.7% to 6.2% in men). That is, in 2022, 347 million people were underweight, a decrease of about 45 million compared to 1990 and “despite the growth of the world population,” the researchers emphasize. Women from India, China, Indonesia, Ethiopia, Bangladesh and Japan have the most underweight adults in 2022. In children, the prevalence of underweight fell from 10.3% to 8.2% in girls and from 16.7% to 10.8% in children: in 2022, 185 million children were underweight.
The authors acknowledge some limitations of the study, such as the lack of data in some countries or the use of body mass index (BMI) as an indicator because it is “imperfect” to measure excess body fat (obesity is taken into account , a BMI over 30 and underweight under 18). However, they defend their findings, suggesting, for example, that the phenomenon that leads their research to the emergence of obesity at younger and younger ages “may be due to consumption outside the home and access to commercial and processed foods in school-age children.” and adolescents followed those of adults during this period.” They also hypothesize that “some recreational games and sports have been replaced by sedentary activities,” although they admit that there is little data on these trends.
Researchers are calling for action to combat malnutrition in Africa and South Asia, where “food insecurity continues,” and particularly warning of the “urgent need to prevent obesity.” In this sense, they criticize that efforts focusing on individual behaviors in the food environment have not had much impact. The authors criticize the lack of access to healthy products, especially for the low-income population.
Regarding the explosion of promising anti-obesity drugs, they predict that the impact “will be small globally in the short term due to the high cost” of these therapies. However, Jaume Marrugat, epidemiologist at the Hospital del Mar Research Institute and also a signatory to this study, defends the potential of these therapies to reverse the obesity curve, at least in high-income countries. “These terribly effective drugs. Contrary to what we assumed in 2015, the prediction is that we are experiencing a tipping point and may see a decline in obesity. I hope I'm not mistaken, because if not, what lies ahead will be a drama.
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