Epidemiology of Obesity [Global and Indian Scenario]]

This presentation provides a comprehensive overview of obesity, exploring its epidemiology, underlying causes, and its far-reaching health consequences. It delves into the genetic, environmental, and behavioral factors contributing to obesity, emphasizing the importance of lifestyle modifications, medical interventions, and policy-level strategies.

1. EPIDEMIOLOGY OF OBESITY DR. IMMANUEL JOSHUA. E Senior Resident Dept. of Community Medicine PGIMER, Chandigarh Email: [email protected]

2. Definition Obesity is a chronic complex disease defined by excessive adiposity that can impair health Epidemiology of Obesity 2 OBESITY Obesity is both a disease in its own right and a risk factor for many other non-communicable diseases (NCDs) Once associated with high-income countries, obesity is now also prevalent in low-and middle-income countries, including among lower socio-economic groups.

3. Problem statement and Key facts about Obesity Epidemiology of Obesity 3 In 2022, 1 in 8 people in the world were living with obesity.   Worldwide adult obesity has doubled since 1990, and adolescent obesity has quadrupled. In 2022, 2.5 billion adults (>18 years) were overweight. Of these, 890 million had obesity. In 2022, 43% of adults aged 18 years and over were overweight and 16% were living with obesity. In 2022, 37 million children under the age of 5 were overweight. Over 390 million children and adolescents aged 5–19 years were overweight in 2022, including 160 million who were living with obesity. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight

4. GLOBAL SCENARIO Epidemiology of Obesity 4 Global estimate (2020) and projected number of adults (2025-2035) with high BMI 2020 2025 2030 2035 Adults with overweight (BMI ≥25 to 30 kg/m2) 1.39 bn 1.52 bn 1.65 bn 1.77 bn Adults with obesity (BMI ≥30 kg/m2) 0.81 bn 1.01 bn 1.25 bn 1.53 bn Adults with overweight or obesity as a proportion of all adults globally 42% 46% 50% 54% (Based on data trends for 2000-2016, and assuming no interventions) Source: World Obesity Atlas 2024

5. Epidemiology of Obesity 5 GLOBAL SCENARIO 2020 2025 2030 2035 Children with overweight 260 m 310 m 350 m 390 m Children with obesity 175 m 240 m 310 m 380 m Children with overweight or obesity as a proportion of all children globally 22% 28% 33% 39% Global estimate (2020) and projected number of young people [5-19years] (2025-2035) with overweight (BMI >1sd – 2sd) and obesity (BMI >2sd) (Based on data trends for 2000-2016, and assuming no interventions) Source: World Obesity Atlas 2024

6. Epidemiology of Obesity 6 IN DI AN SCENARIO National Family Health Survey Nutritional status of Adults (15-49 years) NFHS-5 NFHS-4 Urban Rural Total Total Women whose BMI is below Normal (<18.5 Kg/m2) 13.2 21.2 18.7 22.9 Men whose BMI is below Normal (<18.5 Kg/m2) 13.0 17.8 16.2 20.2 Women who are Over-weight or Obese (BMI >25 Kg/m2) 33.2 19.7 24 20.6 Men who are Over-weight or Obese (BMI >25 Kg/m2) 29.8 19.3 22.9 18.9 Women who have high waist-to-hip ratio (>0.85) 59.9 55.2 56.7 NA Men who have high waist-to-hip ratio (>0.90) 50.1 46.4 47.7 NA

7. Epidemiology of Obesity 7 IN DI AN SCENARIO Projected numbers of adults and children with high Body Mass Index (BMI) ADULTS CHILDREN 4.1% 6.2% Annual growth rate in the projected numbers with high BMI 2020–2035 Source: World Obesity Atlas 2024

8. Epidemiology of Obesity 8 IN DI AN SCENARIO Deaths from NCDs due to high BMI in adults 2019 Source: World Obesity Atlas 2024

9. Epidemiology of Obesity 9 IN DI AN SCENARIO Environmental correlates of obesity Source: World Obesity Atlas 2024

10. Epidemiology of Obesity 10 TYPES OF OBESITY Apple-shaped Pear-shaped Excess amount of fat is accumulated above waist line (i.e. in belly region) Excess amount of fat is accumulated below waist line (i.e. hips and thighs) Associated with excess visceral and subcutaneous fat Associated more commonly with subcutaneous fat Most commonly associated with metabolic syndrome Less commonly associated with metabolic syndrome Android Gynecoid

11. B ody M ass I ndex- Indicator of Obesity Epidemiology of Obesity 11 (Metric system)

12. CLASSIFICATION OF OBESITY (based on BMI) Epidemiology of Obesity 12 Classification of BMI WHO (BMI) Asian (BMI) Underweight <18.5 <18.5 Normal 18.5–24.9 18.5–22.9 Overweight 25–29.9 23–24.9 Obese ≥30 ≥25 Obese Class I ≥30-34.99 ≥25-29.9 Obese Class II 35-39.99 ≥30 Obese Class III ≥40 NA

13. WHO CLASSIFICATION OF OBESITY Epidemiology of Obesity 13

14. Epidemiological determinants of obesity Epidemiology of Obesity 14 Non Modifiable Risk factors Modifiable Risk factors Age Gender Family history Genetic factors Unhealthy diet Physical inactivity Habits/addictions Stress Psycho-social factors

15. Epidemiology of Obesity 15 OBESITY Insulin resistance & Type-2 Diabetes Poly Cystic Ovarian Disease Cardio-Vascular Disease Obstructive Sleep Apnea Psychosocial Problems Socio-Economic Status Built environment Physical inactivity/ Sedentary Dietary trends & habits Genetic/ Antenatal factors CAUSES EFFECTS

16. Epidemiology of Obesity 16 Health Effects and Complications of Obesity

17. Relative Risk of health problems associated with obesity GREATLY INCREASED MODERATELY INCREASED SLIGHTLY INCREASED Type 2 diabetes Coronary Heart Disease Ca. Breast/ endometrium/ colon Gall bladder disease Hypertension Reproductive hormonal abnormalities Dyslipidemia osteoarthritis Polycystic ovary syndrome Insulin Resistance Hyperuricemia Impaired Fertility Breathlessness and sleep apnea Low back ache Fetal defects associated with maternal obesity Epidemiology of Obesity 17

18. Assessment of obesity By weight: Body mass index Ponderal index Brocas Index Corpulance Index Skin Fold Thickness Waist Hip ratio Others Total body water Total body potassium Body density Epidemiology of Obesity 18

19. Prevention of Obesity Epidemiology of Obesity 19 Prevention of obesity should begin in early childhood

20. Primary Prevention: 1. Prevent development of overweight and obesity 2. Promote healthy eating and regular physical activity 3. Health education about the importance of optimal weight Epidemiology of Obesity 20 Prevention of Obesity

21. Secondary Prevention 1. Prevent future weight gain and development of weight-related complications in patients with overweight or obesity 2. Screen using BMI 3. Diagnose using BMI and evaluation for complications 4. Treat with lifestyle/behavioral interventions Epidemiology of Obesity 21 Prevention of Obesity

22. Tertiary Prevention 1. Treat with weight-loss therapy to eliminate or ameliorate weight-related complications and prevent disease progression 2. Treat with lifestyle/behavioral interventions 3. Consider bariatric surgery Epidemiology of Obesity 22 Prevention of Obesity

23. How to tackle the burgeoning obesity menace?   Sweetened beverage taxes Front-of-Pack nutrition labelling (FOPL)   Restrictions on advertising to children Depending on the design, FOPL is likely to be highly cost-effective, moderately favourable for health equity, supported by the public, health professionals and civil society groups, and opposed by commercial interests ( Lobstein et al., 2020) Three food-related policies: ( Lobstein et al., 2020) Epidemiology of Obesity 23

24. Epidemiology of Obesity 24 WHO acceleration plan to stop obesity The WHO acceleration plan to stop obesity comprises five workstreams Source: https://www.who.int/publications/i/item/9789240075634

25. Epidemiology of Obesity 25 Workstream 1: Evidence-based, impactful and cost-effective actions

26. Epidemiology of Obesity 26 Workstream 2: Delivery for impact The delivery for impact approach is centered on an impact Cycle, with a lens for on-the-ground implementation and strong emphasis on long-term sustainability for transformational change. The impact Cycle provides a clear framework accompanied with tested tools to systematically and effectively advance implementation efforts.

27. Epidemiology of Obesity 27 Workstream 3: Global Advocacy The plan calls out to people and families living with obesity to lobby for the right to prevention, treatment and management of obesity free of stigma and to participate in the dialogue for change Workstream 4: Engaging partners The plan will involve sustained engagement with a wide range of partners such as the Global Obesity Coalition and include UN agencies, civil society, the private sector and academic institutions, focused on deepening established partnerships and creating new ones.

28. Epidemiology of Obesity 28 Workstream 5: Accountability of ambitious targets

29. THANK YOU….. Epidemiology of Obesity 29