The worldwide epidemic of female obesity




The rapidly rising number of individuals who are overweight and obese has been called a worldwide epidemic of obesity with >35% of adults today considered to be overweight or obese. Women are more likely to be overweight and obese than their male counterparts, which has far-reaching effects on reproductive health and specifically pregnancy, with obese women facing an increased risk of gestational diabetes, preeclampsia, operative delivery, fetal macrosomia, and neonatal morbidity. The etiology of obesity is highly complex encompassing genetic, environmental, physiologic, cultural, political, and socioeconomic factors, making it challenging to develop effective interventions on both a local and global scale. This article describes the extent and the cost of the obesity epidemic, which, although historically seen as a disease of high-income countries, is now clearly a global epidemic that impacts low- and middle-income countries and indigenous groups who bear an ever-increasing burden of this disease.


Definition


Obesity was first recognized as a disease by the World Health Organization (WHO) in 1948 at the time of its formation , and since then multiple measures have been trialed to accurately measure body fat percentage, the most accepted of which is body mass index (BMI) measured in kilograms of weight per meter squared of height . Although, historically, obesity has been considered a disease primarily of industrialized countries, there are now growing data on the rising prevalence of obesity across the world as it becomes a leading cause of morbidity and mortality globally . Much controversy exists over the use of BMI as an indicator of body fat mass because the percentage of body fat differs by sex, age, and ethnicity making it an imperfect tool for categorizing individuals who are overweight and obese . Two individuals with the same BMI may have markedly differing percentages of total body fat. Other guidelines suggest the use of waist circumference as an assessment of visceral fat as this is a better correlate with insulin resistance and metabolic dysfunction . Despite its limitations, BMI is a general reflection of body fat mass and is widely used globally ; it also correlates with the risk of morbidity and mortality associated with obesity as well as all-cause mortality. Adults with a BMI of 25–30 kg/m 2 are considered overweight and those with a BMI of >30 kg/m 2 are defined as obese .




Scope of the epidemic


An estimated 1.1 billion adults were considered overweight in 2005 , and this is predicted to increase to 1.5 billion by 2015, 300 million of whom are classified as obese (see Fig. 1 ). A staggering 35.8 million disability-adjusted life years (DALYs) are lost due to overweight and obesity accounting for 2.3% of global DALYs with 35% of adults globally considered overweight or obese . Global obesity has doubled in the period between 1980 and 2008 with 2.8 million deaths attributable to this disease. Significant challenges present themselves in measuring the scope of obesity globally with additional barriers in low- and middle-income countries (LMICs). BMI is often calculated based on self-reported height and weight with inherent limitations of underestimating weight . In LMICs, the country reporting is skewed by disparate accessing of health-care systems, with those of higher socioeconomic status (SES) having more encounters with medical care and therefore passive surveillance of BMI rates disproportionately representing segments of society of higher SES .




Fig. 1


Global prevalence of overweight and obesity in females aged 15 years and older, 2010. Reproduced, with permission of the publisher from “WHO Global Comparable Estimates”, 2010. ( https://apps.who.int/infobase/Comparisons.aspx , accessed 22 August, 2014).


According to the most recent data published in 2011 from the WHO, there is significant variation across the globe with the estimated overweight and obesity prevalence for women aged ≥15 years globally ranging from a low of 3.7% in Ethiopia to a high of 93% in Nauru (see Table 1 ). The WHO region for the Americas represents the highest prevalence rates with 62% of both men and women overweight and 26% obese compared to the WHO region for Southeast Asia, with only 14% of men and women considered overweight and 3% obese as shown in Fig. 1 . Overall, the Americas, Europe, and the Eastern Mediterranean report the highest rates of overweight and obese individuals. Women are more likely to be obese than their male counterparts matched for ethnicity and age . Of the 193 countries for which data are available, 107 (55.4%) have reported overweight/obesity rates of >50% for women over the age of 15 (see Table 2 ).



Table 1

Prevalence of obesity by country and WHO world region. Reproduced with permission of publisher from “WHO Global Comparable Estimates,” 2010. ( https://apps.who.int/infobase/Comparisons.aspx , accessed 22 August 2014).



















































































































































































































































































































































































































































































































































































































































AFR Ethiopia 3.7 EUR Kazakhstan 38.9 AFR Equatorial Guinea 52.3 WPR Brunei Darussalam 65.2
AFR Eritrea 6.3 SEAR Thailand 39.9 EUR Albania 52.5 EMR Jordan 65.4
SEAR Bangladesh 6.7 EUR Italy 40 AMR Honduras 52.5 EUR Slovenia 65.7
SEAR Sri Lanka 7.9 EUR Romania 40.6 EUR Armenia 52.8 EUR Turkey 65.7
SEAR Nepal 9.9 AFR Comoros 40.7 WPR Solomon Islands 52.9 AMR Bahamas 65.9
WPR Viet Nam 12.2 AFR Senegal 41 AFR Botswana 53.5 EMR Qatar 65.9
WPR Cambodia 13.8 EUR Denmark 41.4 EMR Iraq 53.6 EMR Saudi Arabia 65.9
AFR Democratic Republic of the Congo 15.8 WPR Malaysia 42.2 EUR Georgia 53.8 WPR Australia 66.5
WPR Japan 16.2 EUR Belgium 42.9 EUR Finland 54.5 AMR Cuba 67.2
SEAR India 18.1 AFR Benin 43.8 WPR Marshall Islands 54.7 WPR Vanuatu 67.2
AFR Burkina Faso 19.4 EUR Lithuania 43.9 EUR Austria 55.2 AMR Venezuela (Bolivarian Republic of) 67.3
AFR Central African Republic 20 EUR Kyrgyzstan 43.9 AMR Ecuador 55.5 EUR San Marino 67.4
AFR Zambia 20 EUR Ireland 43.9 AMR Guyana 55.8 EUR Malta 67.6
EMR Afghanistan 20.8 EUR Poland 44.3 AMR Paraguay 56 EUR Monaco 67.6
AFR Burundi 21.1 EUR Latvia 44.7 AMR Suriname 56.1 AFR South Africa 68.5
AFR Rwanda 21.7 AFR Liberia 45.4 EUR Luxembourg 56.2 EUR Andorra 68.7
AFR Chad 22.9 EUR Turkmenistan 45.5 EMR Lebanon 56.7 WPR Fiji 69.5
AFR Kenya 23.3 EUR Bulgaria 45.5 EUR Azerbaijan 56.8 EMR Bahrain 69.5
AFR Uganda 23.9 AFR Cameroon 45.8 AMR El Salvador 56.8 EUR Belarus 69.9
EMR Somalia 24 EUR Norway 45.8 AFR Mauritius 56.8 AMR Peru 70.1
AFR Madagascar 24.1 EUR Netherlands 46.1 EUR Germany 57.1 AFR Lesotho 70.8
AFR Guinea-Bissau 25.1 SEAR Myanmar 47 EUR The former Yugoslav Republic of Macedonia 57.4 AMR Guatemala 70.9
AFR Niger 25.1 EUR Sweden 47.2 EMR Morocco 57.5 AMR Argentina 71.2
AFR Malawi 25.2 EUR Hungary 47.4 AMR Belize 57.6 EMR United Arab Emirates 71.6
WPR Singapore 26.7 EUR Tajikistan 47.4 AMR Haiti 57.7 AMR Dominican Republic 71.7
AFR Congo 26.8 AFR Cape Verde 48 AMR Saint Vincent and the Grenadines 58.3 AMR Mexico 73
AFR Mozambique 26.9 EUR Croatia 48.3 AFR Mauritania 58.6 AMR Nicaragua 73.1
AFR Gambia 27 EUR Ukraine 48.5 EUR Switzerland 58.9 AMR Bolivia 73.2
SEAR Indonesia 27.1 EUR Serbia and Montenegro 48.5 AMR Panama 58.9 AMR Chile 73.3
AFR United Republic of Tanzania 28.7 AFR Sierra Leone 49.1 EUR Israel 59.3 AFR Seychelles 73.8
EMR Pakistan 29.5 WPR Lao People’s Democratic Republic 49.2 AMR Canada 59.5 AMR Saint Lucia 74.1
AFR Sao Tome and Principe 30.5 EUR Czech Republic 49.3 EMR Syrian Arab Republic 59.6 WPR New Zealand 74.2
WPR China 32 AFR Algeria 49.4 EMR Libyan Arab Jamahiriya 59.8 WPR Mongolia 74.4
EMR Yemen 32.2 SEAR Bhutan 49.6 EMR Iran (Islamic Republic of) 60.2 EMR Egypt 76
AFR Ghana 32.5 SEAR Democratic People’s Republic of Korea 49.7 AMR Brazil 60.3 AMR United States 76.7
EMR Sudan 32.5 EUR Spain 49.8 AMR Grenada 60.4 WPR Kiribati 77.1
WPR Philippines 33.6 EUR Uzbekistan 49.9 AMR Colombia 61.1 AMR Jamaica 79
EUR Estonia 33.8 AFR Zimbabwe 50.6 EMR Tunisia 61.4 EMR Kuwait 80.4
WPR Papua New Guinea 34 EUR Republic of Moldova 50.7 AMR Antigua and Barbuda 62.1 AMR Trinidad and Tobago 80.8
AFR Namibia 34.4 EMR Oman 50.8 AMR Saint Kitts and Nevis 62.6 AMR Dominica 80.8
EMR Djibouti 34.5 SEAR Maldives 50.8 WPR Tuvalu 62.9 AMR Barbados 83.3
AFR Guinea 34.9 WPR Republic of Korea 51 EUR Slovakia 62.9 WPR Samoa 84.1
AFR Togo 35.5 EUR Bosnia and Herzegovina 51 EUR Cyprus 63 WPR Palau 84.5
AFR Cote d’Ivoire 36 SEAR Democratic Republic of Timor-Leste 51.1 EUR Greece 63.2 WPR Niue 86.7
AFR Nigeria 36.8 EUR Portugal 51.2 EUR Iceland 63.7 WPR Cook Islands 90.3
EUR France 36.9 EUR Russian Federation 51.7 EUR United Kingdom 63.8 WPR Micronesia, Federated States of 91.1
AFR Angola 37.2 AFR Swaziland 51.9 AMR Costa Rica 63.8 WPR Tonga 92.1
AFR Mali 38.4 AFR Gabon 52.2 AMR Uruguay 64.4 WPR Nauru 93

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Nov 6, 2017 | Posted by in OBSTETRICS | Comments Off on The worldwide epidemic of female obesity

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