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Wo ldwide ends in body-mass index, unde weigh ,
o e weigh , and obesi y om 1975 o 2016: a pooled
analysis o 2416 popula ion-based measu emen s udies in
128·9 million child en, adolescen s, and adul s
NCD Risk Fac o Collabo a ion (NCD-RisC)*
Summa y
Backg ound Unde weigh , o e weigh , and obesi y in childhood and adolescence a e associa ed wi h ad e se heal h
consequences h oughou he li e-cou se. Ou aim was o es ima e wo ldwide ends in mean body-mass index (BMI)
and a comp ehensi e se o BMI ca ego ies ha co e unde weigh o obesi y in child en and adolescen s, and o
compa e ends wi h hose o adul s.
Me hods We pooled 2416 popula ion-based s udies wi h measu emen s o heigh and weigh on 128·9 million
pa icipan s aged 5 yea s and olde , including 31·5 million aged 5–19 yea s. We used a Bayesian hie a chical model o
es ima e ends om 1975 o 2016 in 200 coun ies o mean BMI and o p e alence o BMI in he ollowing ca ego ies
o child en and adolescen s aged 5–19 yea s: mo e han 2 SD below he median o he WHO g ow h e e ence o
child en and adolescen s ( e e ed o as mode a e and se e e unde weigh he ea e ), 2 SD o mo e han 1 SD below
he median (mild unde weigh ), 1 SD below he median o 1 SD abo e he median (heal hy weigh ), mo e han 1 SD o
2 SD abo e he median (o e weigh bu no obese), and mo e han 2 SD abo e he median (obesi y).
Findings Regional change in age-s anda dised mean BMI in gi ls om 1975 o 2016 anged om i ually no change
(–0·01 kg/m² pe decade; 95% c edible in e al –0·42 o 0·39, pos e io p obabili y [PP] o he obse ed dec ease being
a ue dec ease=0·5098) in eas e n Eu ope o an inc ease o 1·00 kg/m² pe decade (0·69–1·35, PP>0·9999) in cen al
La in Ame ica and an inc ease o 0·95 kg/m² pe decade (0·64–1·25, PP>0·9999) in Polynesia and Mic onesia. The
ange o boys was om a non-signi ican inc ease o 0·09 kg/m² pe decade (–0·33 o 0·49, PP=0·6926) in eas e n
Eu ope o an inc ease o 0·77 kg/m² pe decade (0·50–1·06, PP>0·9999) in Polynesia and Mic onesia. T ends in mean
BMI ha e ecen ly la ened in no hwes e n Eu ope and he high-income English-speaking and Asia-Paci ic egions
o bo h sexes, sou hwes e n Eu ope o boys, and cen al and Andean La in Ame ica o gi ls. By con as , he ise in
BMI has accele a ed in eas and sou h Asia o bo h sexes, and sou heas Asia o boys. Global age-s anda dised
p e alence o obesi y inc eased om 0·7% (0·4–1·2) in 1975 o 5·6% (4·8–6·5) in 2016 in gi ls, and om 0·9%
(0·5–1·3) in 1975 o 7·8% (6·7–9·1) in 2016 in boys; he p e alence o mode a e and se e e unde weigh dec eased
om 9·2% (6·0–12·9) in 1975 o 8·4% (6·8–10·1) in 2016 in gi ls and om 14·8% (10·4–19·5) in 1975 o 12·4%
(10·3–14·5) in 2016 in boys. P e alence o mode a e and se e e unde weigh was highes in India, a 22·7% (16·7–29·6)
among gi ls and 30·7% (23·5–38·0) among boys. P e alence o obesi y was mo e han 30% in gi ls in Nau u, he Cook
Islands, and Palau; and boys in he Cook Islands, Nau u, Palau, Niue, and Ame ican Samoa in 2016. P e alence o
obesi y was abou 20% o mo e in se e al coun ies in Polynesia and Mic onesia, he Middle Eas and no h A ica, he
Ca ibbean, and he USA. In 2016, 75 (44–117) million gi ls and 117 (70–178) million boys wo ldwide we e mode a ely
o se e ely unde weigh . In he same yea , 50 (24–89) million gi ls and 74 (39–125) million boys wo ldwide we e obese.
In e p e a ion The ising ends in child en’s and adolescen s’ BMI ha e pla eaued in many high-income coun ies,
albei a high le els, bu ha e accele a ed in pa s o Asia, wi h ends no longe co ela ed wi h hose o adul s.
Funding Wellcome T us , As aZeneca Young Heal h P og amme.
Copy igh © The Au ho (s). Published by Else ie L d. This is an Open Access a icle unde he CC BY 4.0 license.
In oduc ion
Being unde weigh , o e weigh , o obese du ing
childhood and adolescence is associa ed wi h ad e se
heal h consequences h oughou he li e-cou se. Unde -
weigh among child en and adolescen s is associa ed wi h
highe isk o in ec ious diseases, and o gi ls o
childbea ing age, is associa ed wi h ad e se p egnancy
ou comes including ma e nal mo ali y, deli e y
complica ions, p e e m bi h, and in au e ine g ow h
e a da ion.1,2 P e en ing and e e sing excess weigh in
child en and adolescen s is also impo an o many
easons;3,4 i s , weigh loss and main enance a e weigh
loss a e ha d o achie e,5 he e o e gaining excess weigh
in childhood and adolescence is likely o lead o li elong
Lance 2017; 390: 2627–42
Published Online
Oc obe 10, 2017
h p://dx.doi.o g/10.1016/
S0140-6736(17)32129-3
See Commen page 2607
*Membe s lis ed in he appendix
Co espondence o:
P o Majid Ezza i, School o
Public Heal h, Impe ial College
London, London W2 1PG, UK
[email p o ec ed]
See Online o appendix
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o e weigh and obesi y.6 Second, being o e weigh in
childhood and adolescence is associa ed wi h g ea e isk
and ea lie onse o ch onic diso de s such as ype 2
diabe es.3,4,7–9 Thi d, childhood and adolescen obesi y
has ad e se psychosocial consequences and lowe s
educa ional a ainmen .3,4,10,11 Finally, child en and
adolescen s a e mo e suscep ible o ood ma ke ing han
adul s, which makes educing child en’s exposu e o
obesogenic oods necessa y o p o ec hem om ha m.3,12
Al hough ends in child en’s and adolescen s’ weigh
s a us ha e been documen ed in indi idual coun ies,
li le compa able in o ma ion exis s on wo ldwide ends,
and none o mean body-mass index (BMI) and
unde weigh . We pooled popula ion-based da a o
es ima e ends om 1975 o 2016 in mean BMI and in
he p e alence o a comp ehensi e se o BMI ca ego ies
ha co e he unde weigh o obese ange among
child en and adolescen s o all coun ies in he wo ld. To
compa e he ajec o y o obesi y and unde weigh in
child en and adolescen s wi h ha o adul s, we also
gene a ed upda ed es ima es o adul s.13
Me hods
S udy design
We pooled and analysed popula ion-based s udies ha
had measu ed heigh and weigh in people aged 5 yea s
and olde o es ima e ends om 1975 o 2016 in mean
BMI and BMI ca ego ies in 200 coun ies and e i o ies
(appendix). We s a ed ou analysis om 5 yea s o age
because he de ini ions o unde weigh , o e weigh , and
obesi y change a 5 yea s o age.14 Fu he , child en en e
school a o a ound his age, which is associa ed wi h a
change in hei nu i ion and physical ac i i y.15
We p esen da a on school-aged child en and
adolescen s aged 5–19 yea s and on adul s aged 20 yea s
and olde . We did sepa a e analyses o child en and
adolescen s and o adul s o wo easons: i s , cu o s
used o de ine unde weigh , o e weigh , and obesi y o
child en and adolescen s a e di e en om hose o
adul s and a y by age and sex because o he na u al
g ow h in childhood and adolescence.16 Second, he
ajec o y o he obesi y epidemic in child en and
adolescen s migh be di e en om ha o adul s,17
mo i a ing sepa a e analyses o ends. Simila ly,
unde weigh in child en and adolescen s is ypically
a ge ed h ough school and communi y-based nu i ion
p og ammes, decoupling i s ajec o y om ha o adul s.
Fo child en and adolescen s, we analysed ends in
mean BMI and p e alence o BMI in he ollowing
ca ego ies: mo e han 2 SD below he median o he WHO
g ow h e e ence o child en and adolescen s16 (he ea e
e e ed o as mode a e and se e e unde weigh ), 2 SD o
mo e han 1 SD below he median (mild unde weigh ),
1 SD below he median o 1 SD abo e he median (heal hy
Resea ch in con ex
E idence be o e his s udy
We sea ched MEDLINE ( ia PubMed) o a icles published in
any language be ween Jan 1, 1950, and July 12, 2017, using he
sea ch e ms (“body size”[mh:noexp] OR “body
heigh ”[mh:noexp] OR “body weigh ”[mh:noexp] OR “bi h
weigh ”[mh:noexp] OR “o e weigh ”[mh:noexp] OR
“obesi y”[mh] OR “ hinness”[mh:noexp] OR “Wais -Hip
Ra io”[mh:noexp] OR “Wais Ci cum e ence”[mh:noexp] OR
“body mass index”[mh:noexp]) AND (“Humans”[mh]) AND
(“Heal h Su eys”[mh] OR “Epidemiological Moni o ing”[mh]
OR “P e alence”[mh]) NOT Commen [p yp] NOT Case
Repo s[p yp]. A icles we e sc eened acco ding o he inclusion
and exclusion c i e ia desc ibed in he Appendix.
We iden i ied h ee p io global analyses o mean body-mass
index (BMI) o p e alence o o e weigh and obesi y among
adul s. One o hese s udies also es ima ed he p e alence o
unde weigh in adul s. Ano he s udy also included da a on
o e weigh and obesi y in child en and adolescen s, using a
combina ion o measu ed and sel - epo ed heigh and weigh ,
and analysed in he same model as adul s. A ew mul icoun y
s udies and sys ema ic e iews ha e epo ed, quan i a i ely o
quali a i ely, ends in o e weigh and obesi y in child en and
adolescen s, some also epo ing unde weigh . To ou
knowledge, he e is no global analysis o mean BMI, which is a
summa y measu e o popula ion dis ibu ion, o p e alence o
unde weigh among child en and adolescen s aged 5–19 yea s.
Added alue o his s udy
This s udy p o ides a comple e pic u e o ends in mean BMI
and p e alence o BMI ca ego ies ha co e he unde weigh o
obese ange among child en and adolescen s aged 5–19 yea s,
o all coun ies in he wo ld wi h he longes obse a ion
pe iod, and compa es ends wi h hose o adul s. I includes
he i s global es ima es o mean BMI and unde weigh
p e alence o child en and adolescen s. We also p esen ends
in he numbe o child en, adolescen s, and adul s who a e
mode a ely o se e ely unde weigh and obese, and hus a isk
o ad e se heal h ou comes.
Implica ions o all he a ailable e idence
O e he pas ou decades, mean BMI and obesi y in child en
and adolescen s aged 5–19 yea s ha e inc eased in mos
egions and coun ies. Despi e his ise, mo e child en and
adolescen s a e mode a ely o se e ely unde weigh han
obese, wi h he bu den o unde weigh inc easingly
concen a ed in sou h Asia and cen al, eas and wes A ica.
The ise in child en’s and adolescen s’ BMI has pla eaued,
albei a high le els, in many high-income coun ies bu has
accele a ed in pa s o Asia. The e is a need o b idging he
disconnec be ween policies ha add ess unde weigh and
o e weigh in child en and adolescen s o cohe en ly add ess
he la ge emaining unde weigh bu den while cu bing and
e e sing he ise in o e weigh and obesi y.
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Age-s anda dised mean BMI (kg/m²) Age-s anda dised mean BMI (kg/m²)Age-s anda dised mean BMI (kg/m²)Age-s anda dised mean BMI (kg/m²)
Age-s anda dised mean BMI (kg/m²)
Cen al Asia
15
20
25
30
Sou h Asia Sou heas Asia Eas Asia High-income Asia-Paci ic
High-income
English-speaking coun ies
15
20
25
30
No hwes e n Eu ope Sou hwes e n Eu ope Cen al Eu ope Eas e n Eu ope
Middle Eas and no h A ica
15
20
25
30
Wes A ica Cen al A ica Eas A ica Sou he n A ica
Cen al La in Ame ica
15
20
25
30
Andean La in Ame ica Sou he n La in Ame ica
Ca ibbean
15
20
25
30
Melanesia Polynesia and Mic onesia
Wo ld
15
20
25
30
Adul s
Child en and adolescen s
1980 1990 2000
Yea Yea Yea Yea
2010 1980 1990 2000 2010 1980 1990 2000 2010 1980 1990 2000 2010
Figu e 1: T ends in age-s anda dised mean BMI by sex and egion in emales
Child en and adolescen s we e aged 5–19 yea s and adul s we e aged 20 yea s and olde . The lines show he pos e io mean es ima es and he shaded a eas show he 95% c edible in e als.
See appendix o ends by coun y. BMI=body-mass index.
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Age-s anda dised mean BMI (kg/m²)Age-s anda dised mean BMI (kg/m²)Age-s anda dised mean BMI (kg/m²)Age-s anda dised mean BMI (kg/m²)Age-s anda dised mean BMI (kg/m²)
Cen al Asia
15
20
25
30
Sou h Asia Sou heas Asia Eas Asia High-income Asia-Paci ic
High-income
English-speaking coun ies
15
20
25
30
No hwes e n Eu ope Sou hwes e n Eu ope Cen al Eu ope Eas e n Eu ope
Middle Eas and no h A ica
15
20
25
30
Wes A ica Cen al A ica Eas A ica Sou he n A ica
Cen al La in Ame ica
15
20
25
30
Andean La in Ame ica Sou he n La in Ame ica
Ca ibbean
15
20
25
30
Melanesia Polynesia and Mic onesia
Wo ld
15
20
25
30
Adul s
Child en and adolescen s
1980 1990 2000
Yea Yea Yea Yea
2010 1980 1990 2000 2010 1980 1990 2000 2010 1980 1990 2000 2010
Figu e 2: T ends in age-s anda dised mean BMI by sex and egion in males
Child en and adolescen s we e aged 5–19 yea s and adul s we e aged 20 yea s and olde . The lines show he pos e io mean es ima es and he shaded a eas show he 95% c edible in e als.
See appendix o ends by coun y. BMI=body-mass index.
A icles
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weigh ), mo e han 1 SD o 2 SD abo e he median
(o e weigh bu no obese), and mo e han 2 SD abo e he
median (obesi y). The cu o s o calcula ing p e alence in
hese BMI ca ego ies we e all age-speci ic and sex-speci ic
and we e applied o da a in 1-yea age bands. We used he
WHO de ini ions because hey include a comp ehensi e
se o BMI ca ego ies anging om mode a e and se e e
unde weigh o obesi y, de ined based on symme ic
h esholds o SDs om he e e ence popula ion median.
Fo adul s, we analysed ends in mean BMI and p e alence
o a comp ehensi e se o BMI ca ego ies as desc ibed in
de ail elsewhe e and in he appendix.13 Resul s o child en
and adolescen s a e p esen ed he e; upda ed esul s
o adul s a e p esen ed in he appendix excep when
compa ed wi h child en and adolescen s.
Da a sou ces
Ou me hods o iden i ying and accessing da a sou ces,
and ou inclusion and exclusion c i e ia, a e desc ibed in
he appendix. In summa y, we used a da abase o
popula ion-based da a on ca diome abolic isk ac o s
colla ed by he Non-communicable Disease Risk Fac o
Collabo a ion (NCD-RisC), a wo ldwide ne wo k o
heal h esea che s and p ac i ione s whose aim is o
documen sys ema ically he wo ldwide ends and
a ia ions in non-communicable disease isk ac o s. The
da abase was colla ed h ough mul iple ou es o
iden i ying and accessing da a. We accessed publicly
a ailable popula ion-based mul i-coun y and na ional
measu emen su eys, as well as he WHO STEPwise
app oach o Su eillance (STEPS) su eys. We eques ed,
ia WHO and i s egional and coun y o ices, help wi h
iden i ica ion and access o popula ion-based su eys
om minis ies o heal h and o he na ional heal h and
s a is ical agencies. We also sen eques s ia he Wo ld
Hea Fede a ion o i s na ional pa ne s. We made a
simila eques o he au ho s o an ea lie pooled
analysis o ca diome abolic isk ac o s,18–21 and in i ed
hem o eanalyse da a om hei s udies and join NCD-
RisC. To iden i y majo sou ces no accessed h ough he
abo e ou es, we sea ched and e iewed published
s udies as de ailed p e iously,13 and in i ed all eligible
s udies o join NCD-RisC. Finally, NCD-RisC membe s
we e pe iodically asked o e iew he lis o sou ces om
hei coun y, o sugges addi ional sou ces no in he
da abase, and o e i y ha he included da a om hei
coun y me he inclusion c i e ia as lis ed in he
appendix and ha he e we e no duplica es.
The lis o da a sou ces and hei cha ac e is ics is
p o ided in he appendix. In summa y, we included
da a collec ed on samples o a na ional, subna ional
(ie, co e ing one o mo e subna ional egions, o
mo e han h ee communi ies), o communi y (one o a
ew communi ies) popula ion, which had measu ed
heigh and weigh . We did no use sel - epo ed heigh
and weigh because hey a e subjec o biases ha
a y by geog aphy, ime, age, sex, and socioeconomic
cha ac e is ics.22–24 Because o hese a ia ions, app oaches
o co ec ing sel - epo ed da a lea e esidual bias.
S a is ical analysis
The s a is ical models used o es ima e mean and
p e alence by coun y, yea , sex, and age a e desc ibed in
de ail in a s a is ical pape and ela ed subs an i e
pape s;13,25–28 he compu e code is a ailable om he
NCD-RisC websi e. In summa y, we o ganised coun ies
in o 21 egions, mos ly based on geog aphy and na ional
income (appendix). The excep ion was high-income
English-speaking coun ies (Aus alia, Canada, I eland,
New Zealand, he UK, and he USA), g ouped oge he in
one egion because BMI and o he ca diome abolic isk
ac o s ha e simila ends in hese coun ies, which can
be dis inc om o he coun ies in hei geog aphical
egions.13,26–28
The model had a hie a chical s uc u e in which
es ima es o each coun y and yea we e in o med by i s
own da a, i a ailable, and by da a om o he yea s in he
same coun y and om o he coun ies, especially hose
in he same egion wi h da a o simila ime pe iods. The
ex en o which es ima es o each coun y-yea we e
in luenced by da a om o he yea s and o he coun ies
depended on whe he he coun y had da a, he sample
size o da a, whe he o no hey we e na ional, and
he wi hin-coun y and wi hin- egion a iabili y o he
a ailable da a. The model inco po a ed non-linea ime
ends comp ising linea e ms and a second-o de
andom walk, all modelled hie a chically. The age
associa ion o BMI was modelled using a cubic spline o
allow non-linea age pa e ns, which migh a y ac oss
coun ies. The model accoun ed o he possibili y ha
BMI in subna ional and communi y samples migh
sys ema ically di e om na ionally ep esen a i e ones,
and ha e la ge a ia ion han in na ional s udies. These
ea u es we e implemen ed by including da a-d i en
ixed-e ec and andom-e ec e ms o subna ional and
communi y da a. The ixed e ec s adjus ed o sys ema ic
di e ences be ween subna ional o communi y s udies
and na ional s udies. The andom e ec s allowed na ional
da a o ha e la ge in luence on he es ima es han
subna ional o communi y da a wi h simila sample sizes.
The model also accoun ed o u al–u ban di e ences in
BMI, h ough he use o da a-d i en ixed e ec s o u al-
only and u ban-only s udies. These u al and u ban e ec s
we e weigh ed by he di e ence be ween s udy-le el and
coun y-le el u banisa ion in he yea when he s udy
was done. The s a is ical model included a co a ia e
(p opo ion o na ional popula ion li ing in u ban a eas;
da a om he Wo ld U baniza ion P ospec s, 2014
e ision) ha is associa ed wi h, and helps p edic , BMI.29
Resul s o model alida ion a e epo ed elsewhe e.13
We pe o med all analyses by sex, because he e a e
di e ences in BMI le els and ends in ela ion o sex.13
We analysed he da a on mean BMI and on each o he
abo e p e alence ca ego ies sepa a ely. We e-scaled he
Fo he NCD-RisC websi e see
www.ncd isc.o g

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Figu e 3: Age-s anda dised
mean BMI, p e alence o
obesi y, and p e alence o
mode a e and se e e
unde weigh by sex and
coun y in 2016 in child en
and adolescen s
Child en and adolescen s we e
aged 5–19 yea s. Obesi y was
de ined as mo e han 2 SD
abo e he median o he WHO
g ow h e e ence. Mode a e
and se e e unde weigh was
de ined as mo e han 2 SD
below he median.
See appendix o esul s o
adul s. BMI=body-mass index.
AMean 8MI in gi ls
Ca ibbean
BMean 8MI in boys
Ca ibbean
Ame icanSamoa Ki iba i Samoa
Age-s anda dised
Ame ican Samoa Ki iba i Samoa
Age-s anda dised
Bah ain Maldi es Sao Tome and P incipe
mean
BMI
(kg/m')
Bah ain Maldi es Sao Tome and P ncipe mean 8MI
(kg/m')
Be muda Ma shall Islands Seychelles -24 Be muda Ma shall Islands Seychelles 24
B unei Da ussalam Mau i ius Solomon Islands B unei Da ussalam Mau i ius Solomon Islands
CaboVe de Mic onesia FS Tokelau CaboVe de Mic onesia FS Tokelau
Como os Mon eneg o Tonga -20 Como os Mon eneg o Tonga 20
CookIslands Nau u Tu alu Cook Islands Nau u Tu alu
Fiji Niue Vanua u Fiji Niue
Vanua u
F enchPolynesia Palau -16 F enchPolynesia Palau 16
CObesi yp e alence in gi ls DObesi yp e alence in boys
ICa ibbean Ca ibbean
Ame ican Samoa Ki iba i Samoa P e alence o Ame ican Samoa Ki iba i Samoa P e alence o
Bah ain Maldi es SaoTome and P incipe obesi y (%) Bah ain Maldi es SaoTome and P ncipe
obesi y
(%)
Be muda Ma shall Islands Seychelles 30 Be muda Ma shall Islands Seychelles 30
B unei Da ussalam Mau i ius Solomon Islands B unei Da ussalam Mau i ius Solomon Islands
CaboVe de Mic onesia FS Tokelau 20 CaboVe de Mic onesia FS Tokelau 20
Como os Mon eneg o Tonga Como os Mon eneg o Tonga
Cook Islands Nau u Tu alu 10 Cook Islands Nau u Tu alu 10
Fiji Niue Vanua u Fiji Niue Vanua u
F enchPolynesia Palau F enchPolynesia Palau
E
Mode a e
and
se e e
unde weigh
p e alence
in
gi ls
F
Mode a e
and
se e e
unde weigh
p e alence
in
boys
ICa ibbean Ca ibbean
Ame ican Samoa Ki iba i Samoa P e alence Ame ican Samoa Ki iba i Samoa P e alence
Bah ain Maldi es SaoTome and P incipe o mode a e Bah ain Maldi es SaoTome and P ncipe o
mode a e
and se e e and se e e
Be muda Ma shall Islands Seychelles
unde weigh
(%) Be muda Ma shall Islands Seychelles
unde weigh
(%)
B unei Da ussalam Mau i ius Solomon Islands 30 B unei Da ussalam Mau i ius Solomon Islands 30
CaboVe de Mic onesia FS Tokelau CaboVe de Mic onesia FS Tokelau
20 20
Como os Mon eneg o Tonga Como os Mon eneg o Tonga
Cook Islands Nau u Tu alu 10 Cook Islands Nau u Tu alu 10
Fiji Niue Vanua u Fiji Niue Vanua u
F enchPolynesia Palau F enchPolynesia Palau
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es ima ed p e alence ca ego ies so ha he sum o
di e en ca ego ies was 1·0 in each age, sex, coun y, and
yea . The a e age scaling ac o s ac oss d aws anged
om 1·03 o 1·07, ie, he sum o he sepa a ely es ima ed
p e alence ca ego ies was close o 1·0.
We i ed he s a is ical model wi h he Ma ko chain
Mon e Ca lo (MCMC) algo i hm, and ob ained
5000 pos -bu n-in samples om he pos e io
dis ibu ion o model pa ame e s, which we e in u n
used o ob ain he pos e io dis ibu ions o he abo e
p ima y ou comes, ie, mean BMI and each o he
p e alence ca ego ies. Fo model i ing, da a on
pa icipan s aged 5–19 yea s we e included in he
analysis o ends in child en and adolescen s, and on
pa icipan s aged 18 yea s and olde in he analysis o
ends in adul s. Da a on pa icipan s aged 18 and
19 yea s we e included in bo h se s o models because
hese g oups o m a ansi ional age om adolescence
o adul hood, and hence help in o m he es ima es in
bo h g oups. Pos e io es ima es we e made in 1-yea
age g oups o ages 5–19 yea s and in 5-yea age g oups
o hose aged 20 yea s and olde . Fo p esen a ion, we
used he pos e io es ima es o ages 5–19 yea s o
child en and adolescen s, and o ages 20 yea s
and olde o adul s. Age-s anda dised es ima es
we e gene a ed by aking weigh ed a e ages o age-
sex-speci ic es ima es, sepa a ely o child en and
adolescen s and o adul s, wi h use o age weigh s
om he WHO s anda d popula ion.30 Es ima es o
egions and he wo ld we e calcula ed as popula ion-
weigh ed a e ages o he cons i uen coun y es ima es
by age g oup and sex. The numbe o child en,
adolescen s, and adul s who we e unde weigh ,
o e weigh , o obese was calcula ed by mul iplying he
co esponding age-speci ic p e alence by he popula ion
by coun y, yea , and sex.
The epo ed c edible in e als (C I) ep esen he
2·5 h o 97·5 h pe cen iles o he pos e io dis ibu ions.
The unce ain ies o ou es ima es, ep esen ed by he
wid hs o he c edible in e als, a ise om unce ain y
due o sampling in each da a sou ce; unce ain y
associa ed wi h he a iabili y o na ional da a beyond
wha is accoun ed o by sampling; addi ional unce ain y
associa ed wi h subna ional and communi y da a, and
da a ha a e om u al-only o u ban-only samples; and
unce ain y due o making es ima es by coun y, yea ,
and age when da a we e missing o sca ce, in he
coun y-yea -age g oup uni o which es ima es a e
made, in p oxima e ime pe iods and ages in ha
coun y and in o he coun ies in he same egion. We
also epo he pos e io p obabili y (PP) ha an
es ima ed inc ease o dec ease ep esen s a uly
inc easing o dec easing end.
Role o he unding sou ce
The unde o he s udy had no ole in s udy design, da a
collec ion, analysis, in e p e a ion, o w i ing o he
epo . Coun y and Regional Da a G oup membe s, JB,
MDC, VB, HB, and BZ had ull access o he da a in he
s udy. The co esponding au ho had inal esponsibili y
o he decision o submi o publica ion.
Resul s
The esul s can be explo ed using dynamic
isualisa ions and downloaded om he NCD-RisC
websi e. We pooled 2416 popula ion-based da a sou ces
wi h measu emen o heigh and weigh on
128·9 million people aged 5 yea s and olde om
1975 o 2016 (appendix). 1099 sou ces included da a on
24·1 million pa icipan s aged 5–17 yea s, 848 sou ces
included da a on 7·4 million pa icipan s aged
18–19 yea s, and 1820 sou ces included da a on
Figu e 4: Age-s anda dised mean BMI in child en and adolescen s in 1975 and 2016
Each line shows one coun y. BMI=body-mass index.
Gi ls, 1975
14 16 18 20 22 24
Wo ld mean: 17·2
Gi ls, 2016 Wo ld mean: 18·6
Boys, 1975 Wo ld mean: 16·8
Boys, 2016 Wo ld mean: 18·5
Mean BMI (kg/m²)
Sub-Saha an A ica
Cen al Asia, Middle Eas , and no h A ica
Sou h Asia
Eas and sou heas Asia
High-income Asia-Paci ic
Oceania
La in Ame ica and Ca ibbean
High-income wes e n
Cen al and eas e n Eu ope
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97·4 million pa icipan s aged 20 yea s and olde
(appendix). Addi ional in o ma ion on he age dis-
ibu ion o da a sou ces and pa icipan s is shown in
he appendix. 1187 (49%) o 2416 da a sou ces we e
om na ional samples, 390 (16%) co e ed one o mo e
subna ional egions, and he emaining 839 (35%) we e
om one o a ew communi ies (appendix). 583 (24%)
o 2416 da a sou ces we e om be o e 1995 and ano he
1833 (76%) we e om 1995 and la e (appendix). The
numbe o da a sou ces pe coun y in di e en egions
anged om 3·4 in he Ca ibbean o 54·0 in he high-
income Asia-Paci ic egion (appendix).
In 1975, he global age-s anda dised mean BMI o
child en and adolescen s aged 5–19 yea s was 17·2 kg/m²
(95% C I 16·8–17·6) o gi ls ( igu e 1) and 16·8 kg/m²
(16·3–17·2) o boys ( igu e 2). Mean BMI was lowes in
sou h Asia, wi h an age-s anda dised mean o 15·8 kg/m²
(15·2–16·3) o gi ls and 15·0 kg/m² (14·5–15·6) o
boys, ollowed by eas A ica (16·5 kg/m² [14·8–18·2] o
gi ls and 15·5 kg/m² [13·6–17·4] o boys). Gi ls in
Melanesia, Polynesia and Mic onesia, and he high-
income English-speaking egion had he highes age-
s anda dised mean BMI in 1975, all abo e 19·0 kg/m².
The highes mean BMIs o boys we e hose in Polynesia
and Mic onesia (19·1 kg/m², 18·0–20·2), ollowed by he
high-income English-speaking egion.
F om 1975 o 2016, child en’s and adolescen s’ age-
s anda dised mean BMI inc eased globally and in mos
egions ( igu es 1 and 2). The global inc ease was
0·32 kg/m² pe decade (95% C I 0·23–0·41, PP o he
obse ed inc ease being a ue inc ease>0·9999) o gi ls
and 0·40 kg/m² pe decade (0·30–0·50, PP>0·9999) o
boys, leading o i ually iden ical age-s anda dised mean
BMIs o 18·6 kg/m² (18·4–18·7) o gi ls and 18·5 kg/m²
(18·3–18·7) o boys in 2016. The co esponding igu es
o adul s we e 24·8 kg/m² (24·6–25·0) in women and
24·5 kg/m² (24·3–24·6) in men.
Regional change in gi ls anged om i ually no
change (–0·01 kg/m² pe decade [95% C I –0·42 o 0·39;
PP o he obse ed dec ease being a ue
dec ease=0·5098]) in eas e n Eu ope o 1·00 kg/m²
inc ease pe decade (0·69–1·35, PP>0·9999) in cen al
La in Ame ica and 0·95 kg/m² pe decade (0·64–1·25,
PP>0·9999) in Polynesia and Mic onesia. The ange o
boys was om 0·09 kg/m² pe decade (–0·33 o 0·49;
PP=0·6926) in eas e n Eu ope o 0·77 kg/m² pe decade
(0·50–1·06, PP>0·9999) in Polynesia and Mic onesia.
In some egions, child en’s and adolescen s’ BMI
inc eased g adually o e he ou decades o analysis
( igu es 1 and 2). Howe e , he e has been a ecen
la ening o ends in no hwes e n Eu ope and he
high-income English-speaking and Asia-Paci ic egions
o bo h sexes, sou hwes e n Eu ope o boys, and cen al
and Andean La in Ame ica o gi ls. Wi h he excep ion
o women in he high-income Asia-Paci ic egion, adul
mean BMI con inues o inc ease in all o hese egions
and sexes ( igu es 1 and 2). By con as wi h his
pla eauing, he ise in mean BMI has accele a ed since
a ound 2000 in eas and sou h Asia o bo h sexes, and in
sou heas Asia o boys.
The lowes mean child and adolescen BMIs in 2016
we e s ill hose in sou h Asia and eas A ica, wi h age-
s anda dised mean BMIs be ween 16·9 and 17·9 kg/m²
o gi ls and boys; he highes we e hose in Polynesia
and Mic onesia o bo h sexes, ollowed by Melanesia
and he high-income English-speaking egion. Age-
s anda dised mean BMIs o gi ls and boys in Polynesia
and Mic onesia, which we e 23·1 kg/m² (95% C I
22·4–23·8) and 22·4 kg/m² (21·6–23·1), espec i ely,
we e highe han hose o adul s in some egions.
Child en’s and adolescen s’ age-s anda dised mean BMI
was also mo e han 20 kg/m² in Melanesia and many
pa s o La in Ame ica and he Ca ibbean.
The egional ankings in 2016 di e ed sligh ly be ween
child en aged 5–9 yea s and adolescen s aged 10–19 yea s
(appendix). Fo example, he lowes mean BMI in
child en aged 5–9 yea s was seen in eas A ica in bo h
sexes, whe eas in hose aged 10–19 yea s, sou h Asian
gi ls and boys had lowe mean BMI han hei A ican
pee s. Polynesians and Mic onesians had he highes
mean BMI in hose aged 5–9 and 10–19 yea s, wi h he
14
16
18
20
22
24
14
16
18
20
22
24
Age-s anda dised mean BMI in
child en and adolescen s (kg/m²)
Females, 1975 Females, 2016
20 25 30 35
Age-s anda dised mean BMI in
child en and adolescen s (kg/m²)
Males, 1975
20 25 30 35
Males, 2016
Age-s anda dised mean BMI in adul s
(kg/m²)
Age-s anda dised mean BMI in adul s
(kg/m²)
Sub-Saha an A ica
Cen al Asia, Middle Eas , and no h A ica
Sou h Asia
Eas and sou heas Asia
High-income Asia-Paci ic
Oceania
La in Ame ica and Ca ibbean
High-income wes e n
Cen al and eas e n Eu ope
Figu e 5: Compa ison o age-s anda dised mean BMI in child en and adolescen s and in adul s
Child en and adolescen s we e aged 5–19 yea s and adul s we e aged 20 yea s and olde . Each poin shows
one coun y. The do ed line shows he linea associa ion be ween he wo ou comes. BMI=body-mass index.
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2635
subsequen spo s held by he high-income English-
speaking egion, egions in La in Ame ica and he
Ca ibbean, and Melanesia. Among hese egions, cen al
La in Ame ica had a poo e anking (ie, highe BMI
ela i e o o he egions) a age 10–19 yea s han a age
5–9 yea s, as did boys in he high-income English-
speaking egion. By con as , eas Asia pe o med wo se
in anking in 5–9 yea s o age han i did in 10–19 yea s.
The lowes age-s anda dised mean BMI o e he
42 yea s o analysis among gi ls was in Bangladesh in
1975 (15·6 kg/m², 95% C I 13·2–17·9), and among boys
was in E hiopia in 1975 (14·4 kg/m², 11·9–17·0; igu es 3
and 4). Age-s anda dised mean BMI in 1975 was less
han 21 kg/m² in e e y coun y, excep o gi ls in
Ame ican Samoa, who had an age-s anda dised mean
BMI o 21·2 kg/m² (20·6–21·9). F om 1975 o 2016,
age-s anda dised mean BMI inc eased by mo e han
0·25 kg/m² pe decade in 155 coun ies in gi ls, wi h he
ise mo e han 1·0 kg/m² pe decade in some coun ies
in Polynesia and in Mexico (PP o being a ue
ise>0·9999); in boys, he ise was mo e han 0·25 kg/m²
pe decade in 189 coun ies and mo e han 1·0 kg/m² pe
decade in he Cook Islands. When subse s o he analysis
pe iod a e conside ed, be o e he yea 2000, age-
s anda dised mean BMI inc eased in almos e e y
coun y. A e 2000, he e we e non-signi ican declines
in mean BMI in 29 coun ies o gi ls and 12 (mos ly
high-income) coun ies o boys.
In 2016, E hiopia had he lowes age-s anda dised
mean BMI o bo h sexes, 16·8 kg/m² (95% C I
15·6–17·9) o gi ls and 15·5 kg/m² (14·4–16·6) o boys
( igu es 3 and 4). O he coun ies wi h low BMI in bo h
sexes in 2016 we e Nige , Senegal, India, Bangladesh,
Myanma , and Cambodia. A he o he ex eme, age-
s anda dised mean BMI was mo e han 24 kg/m² in gi ls
and boys in he Cook Islands and Niue and gi ls in
Samoa, which was g ea e han ha o adul s o he
same sex in 36 coun ies o gi ls and 59 coun ies
o boys. Age-s anda dised mean BMI was be ween
22 and 24 kg/m² in ano he 11 coun ies o gi ls and
10 coun ies o boys including in Polynesian and
Mic onesian islands, gi ls in he Bahamas and Chile,
and boys in Qa a and Kuwai .
The age-s anda dised mean BMI o child en and
adolescen s and o adul s we e co ela ed in 1975 and
2016 (co ela ion coe icien s 0·80 and 0·85 o emales
and 0·92 and 0·89 o males; igu e 5). Changes in age-
s anda dised mean BMI we e mode a ely co ela ed
be ween he wo age g oups be o e 2000 (co ela ion
coe icien 0·52 o emales and 0·51 o males) bu only
weakly a e 2000 (co ela ion coe icien 0·14 o emales
and 0·21 o males; igu e 6). The decoupling o BMI
ends in child en and adolescen s and hose o adul s is
due o a se o dis inc egional phenomena: adul s
con inued o gain weigh in mos wes e n coun ies,
whe e child en’s and adolescen s’ mean BMI s opped
ising. By con as , he ise in adul BMI seems o ha e
pla eaued in Oceania, albei a high le els, whe eas
child en’s and adolescen s’ BMI con inues o ise. In
La in Ame ica and he Ca ibbean, he e is mo e a ia ion
in he a e o BMI inc ease in child en and adolescen s
han in adul s.
In 1975, gi ls had highe age-s anda dised mean BMI
han boys in mos coun ies in sub-Saha an A ica, sou h
Asia, and he Middle Eas and no h A ica, and lowe
age-s anda dised mean BMI han boys in many coun ies
in Eu ope and La in Ame ica and he Ca ibbean
( igu e 7). Highe BMI in gi ls han boys was s ill seen in
2016 in many sub-Saha an A ican and sou h Asian
coun ies. By con as , he gap be ween sexes in BMI in
he Middle Eas and no h A ica sh ank o e e sed as
boys gained mo e weigh han gi ls. In Eu ope and La in
Ame ica, gi ls gained mo e weigh han boys, closing he
gap be ween sexes in BMI.
O e he 42 yea s o analysis, he global age-
s anda dised p e alence o obesi y in child en and
adolescen s inc eased om 0·7% (95% C I 0·4–1·2) in
1975 o 5·6% (4·8–6·5) in 2016 in gi ls ( igu e 8), and
om 0·9% (0·5–1·3) in 1975 o 7·8% (6·7–9·1) in 2016
in boys ( igu e 9). Obesi y inc eased in e e y egion, wi h
p opo ional ise being smalles in high-income egions
Sub-Saha an A ica
Cen al Asia, Middle Eas , and no h A ica
Sou h Asia
Eas and sou heas Asia
High-income Asia-Paci ic
Oceania
La in Ame ica and Ca ibbean
High-income wes e n
Cen al and eas e n Eu ope
1·5
2·0
−0·5
Females, 1975−2000 Females, 2000−2016
−0·5 0 0·5 1·0 1·5 2·0
Change in age-s anda dised mean BMI
in adul s (kg/m²/decade)
−0·500·5 1·0 1·5 2·0
Change in age-s anda dised mean BMI
in adul s (kg/m²/decade)
−0·5
0
0·5
1·0
0
0·5
1·0
1·5
2·0
Change in age-s anda dised mean BMI in
child en and adolescen s (kg/m²/decade)
Change in age-s anda dised mean BMI in
child en and adolescen s (kg/m²/decade)
−0·5 0 0·5 1·0 1·5 2·0 −0·5 0·0 0·5 1·0 1·5 2·0
Males, 2000−2016Males, 1975−2000
Figu e 6: Compa ison o change in age-s anda dised mean BMI in child en and adolescen s and in adul s
Child en and adolescen s we e aged 5–19 yea s and adul s we e aged 20 yea s and olde . Each poin shows
one coun y. The do ed line shows he linea associa ion be ween he wo ou comes. BMI=body-mass index.
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