The worldwide epidemic of obesity

Obesity (Body mass index of 30 kg/m2) or greater) is common in many parts of the world, especially in the established market economies, formerly socialist economies of Europe and Latin America and the Caribbean as well as the Middle Eastern Crescent. Worldwide as many as 250 million people may be obese (7% of the adult population in the world) and 2-3 times as many may be considered overweight. The prevalence of obesity seems to be increasing in most parts of the world even in parts where obesity used to be rare. A waist circumference larger than 102 cm in men and 88 cm in women may be a more sensible classification of subjects at increased health risks but information on this point is still scarce. Increased fatness measured by a high BMI, large waist or high waist/hip circumference ratio is associated with many chronic diseases as well as poor physical functioning. In children the assessment of the prevalence of obesity and time trends are more difficult due to the lack of international criteria for overweight and obesity. The WHO has now recommended to use BMI-for-age percentiles but the reference curves are still under development. France, the Netherlands, the United Kingdom and the United States of America are now among the countries who have reported increases in the prevalence of obesity in children and adolescents. Although accurate estimates of components of energy balance over time are not available the evidence that these trends in obesity rates are determined by reduced energy expenditure is much stronger than that for an increased energy or fat intake. Prevention of obesity through health and life-style promotion is among the important challenges for the new millennium and should start in childhood.