PREVALENCE OF OBESITY

doi:10.1016/S0889-8529(05)70360-1

Endocrinology and Metabolism Clinics of North America

Volume 25, Issue 4, 1 December 1996, Pages 887-905

https://doi.org/10.1016/S0889-8529(05)70360-1 Get rights and content

Any given numerical value for the prevalence of obesity must be interpreted from its frame of reference. As used herein, the frame of reference embodies (1) the criterion (or criteria) used to define obesity (or overweight) and (2) an appropriate description of the make-up of the study population as well as the nature of the survey conducted on that population.

Both the composition of study populations and the criteria for defining obesity can vary widely; therefore, it is important to be aware of the problems caused by such variability when an attempt is made to compare the prevalences of overweight reported for different populations.

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CRITERIA FOR OVERWEIGHT AND OBESITY

There is as yet no consensus concerning the terminology that should be used to describe the condition known variously as adiposity, corpulence, obesity, or overweight; the descriptors that should be employed to describe the different grades of severity of the condition; or the body mass index (BMI) cutoff points that should be used to demarcate the BMI categories that correspond to the descriptors.

DETERMINATION OF PREVALENCE

The prevalence of overweight in a population is determined by measuring the proportion of individuals in that population who are overweight over a specified time period (usually a year). The incidence of overweight in a population is determined by measuring the number of individuals who become overweight during a given time interval. Cumulative incidence refers to the proportion of individuals in the studied population who become overweight during a specified time interval (for example, 10

CROSS-SECTIONAL, PROSPECTIVE, AND RETROSPECTIVE APPROACHES

Studies of the prevalence of overweight in various populations have been cross-sectional, prospective, or retrospective. The differences among the three approaches arise from the particular way a study has been designed and carried out. As Hennekens and Buring⁷ point out, “cross-sectional surveys provide information about the frequency and characteristics of a disease (such as overweight) by furnishing a `snapshot' of the health experience of the population at a specified time.”

A study is

STUDY POPULATIONS

In this review, various populations are examined in terms of the prevalence of overweight and, when possible, BMI distribution. They include samples of the populations of different countries which may or may not be representative of the nation's total population; subsets of such national samples characterized by age, sex, race, national origin, and socioeconomic status; and prospective cohort studies in which particular groups (e.g., registered nurses, Seventh-Day Adventist men) are enrolled in

Sample Design

In 1994 Kuczmarski and co-workers⁹ reported on findings of the NHANES III (phase 1) study conducted from 1988 through 1991. NHANES III is the fourth in a series of cross-sectional national health surveys as shown in Tables 1 and 2.

As was true for the earlier national health surveys, NHANES III was designed to examine a nationally representative sample of the US civilian noninstitutionalized population. In phase 1, conducted from 1988 through 1991, the estimates of prevalence of overweight were

PREVALENCE OF OVERWEIGHT AMONG PARTICULAR GROUPS IN THE UNITED STATES

Earlier studies have shown an increased prevalence of overweight among certain groups. For example, the prevalence of overweight increases with advancing age in women until the sixth decade (in men until the seventh decade), after which it steadily declines (Fig. 1). The prevalence of overweight in the United States also varies with sex and race/ethnicity. In 1988 to 1991,⁹ the age-adjusted prevalence of overweight was higher in women than in men (34.7 versus 31.3%). As shown in Table 1, black

Seventh-Day Adventist Study, 1991

The Seventh-Day Adventist (SDA) study involved 8828 nonsmoking, nondrinking men who in 1960 had satisfactorily completed a four-page questionnaire on demographic, medical, and life-style characteristics.¹³ In 1960 the subjects' mean age was 53 years. The participants were followed up for an average of 15 years; 93% were married; 94% were white; and about 32% were high-school graduates.

At entry, the subjects' age distribution was as follows: less than 40 years, 22.8%; 40 to 49 years, 23.9%; 50

England

As Ashwell² has pointed out, the prevalence of overweight in England has increased steadily during the last 50 years. The data in Table 5 (compiled by the Nutrition and Physical Activity Task Forces¹⁸) are based on the reports of four successive national surveys conducted in England from 1980 through 1993.

In the 1987 population in the United Kingdom, the proportion of men with a BMI of 25 or greater reached its highest level (62%) among those 50 to 64 years of age. The proportion of men with a

DISCUSSION

In the United States, the toll of illness and death attributable to overweight is alarmingly high; hence, it is essential that those concerned with the public health be kept up-to-date about the prevalence of this condition both in the overall US population and in the subgroups that are especially obesity-prone.

It is also important to be able to compare the prevalence of overweight in the US population with prevalences in other countries. Any substantial difference that emerges from such an

References (30)

J.S. Garrow
Treatment of obesity
Lancet
(1992)
S. Abraham et al.
Obese and Overweight Adults in the US
(1983)
M. Ashwell
Obesity in men and women
Int J Obes
(1994)
Committee to Develop Criteria for Evaluating the Outcomes of Approaches to Prevent and Treat Obesity
The nature and problem of obesity
P.B. Goldblatt et al.
Social factors in obesity
JAMA
(1965)
Haut comite´ de la santé publique: la santé en France. Rapport général, Nov 1994, p 307 (Source INSEE: decennial...
C.H. Hennekens et al.
Epidemiology in Medicine (Mayrent SL [ed])
(1987)
Joint FAO/WHO/UNU Expert Consultation. Energy and Protein Requirements. Geneva, World Health Organization, 1985....
R.J. Kuczmarski et al.
Increasing prevalence of overweight among US adults: The National Health and Nutrition Examination Surveys, 1960 to 1991
JAMA
(1994)
A. Kuskowska-Wolk et al.
The predictive validity of body mass index based on self-reported weight and height
Int J Obes
(1989)

D. Laurier et al.