The global burden of disease attributable to high body mass index in 195 countries and territories, 1990-2017: An analysis of the Global Burden of Disease Study

Background Obesity represents an urgent problem that needs to be properly addressed, especially among children. Public and global health policy- and decision-makers need timely, reliable quantitative information to develop effective interventions aimed at counteracting the burden generated by high body mass index (BMI). Few studies have assessed the high-BMI-related burden on a global scale. Methods and findings Following the methodology framework and analytical strategies used in the Global Burden of Disease Study (GBD) 2017, the global deaths and disability-adjusted life years (DALYs) attributable to high BMI were analyzed by age, sex, year, and geographical location and by Socio-demographic Index (SDI). All causes of death and DALYs estimated in GBD 2017 were organized into 4 hierarchical levels: level 1 contained 3 broad cause groupings, level 2 included more specific categories within the level 1 groupings, level 3 comprised more detailed causes within the level 2 categories, and level 4 included sub-causes of some level 3 causes. From 1990 to 2017, the global deaths and DALYs attributable to high BMI have more than doubled for both females and males. However, during the study period, the age-standardized rate of high-BMI-related deaths remained stable for females and only increased by 14.5% for males, and the age-standardized rate of high-BMI-related DALYs only increased by 12.7% for females and 26.8% for males. In 2017, the 6 leading GBD level 3 causes of high-BMI-related DALYs were ischemic heart disease, stroke, diabetes mellitus, chronic kidney disease, hypertensive heart disease, and low back pain. For most GBD level 3 causes of high-BMI-related DALYs, high-income North America had the highest attributable proportions of age-standardized DALYs due to high BMI among the 21 GBD regions in both sexes, whereas the lowest attributable proportions were observed in high-income Asia Pacific for females and in eastern sub-Saharan Africa for males. The association between SDI and high-BMI-related DALYs suggested that the lowest age-standardized DALY rates were found in countries in the low-SDI quintile and high-SDI quintile in 2017, and from 1990 to 2017, the age-standardized DALY rates tended to increase in regions with the lowest SDI, but declined in regions with the highest SDI, with the exception of high-income North America. The study's main limitations included the use of information collected from some self-reported data, the employment of cutoff values that may not be adequate for all populations and groups at risk, and the use of a metric that cannot distinguish between lean and fat mass. Conclusions In this study, we observed that the number of global deaths and DALYs attributable to high BMI has substantially increased between 1990 and 2017. Successful population-wide initiatives targeting high BMI may mitigate the burden of a wide range of diseases. Given the large variations in high-BMI-related burden of disease by SDI, future strategies to prevent and reduce the burden should be developed and implemented based on country-specific development status. Author summaryWhy was this study done? Obesity represents an urgent issue that needs to be properly addressed. A successful response to the challenge of obesity requires an accurate understanding of its current burden. Few studies have assessed the disease burden attributable to high body mass index (BMI) at the global level. To better inform prevention and intervention strategies, we aimed to provide comprehensive and updated information about the global disease burden attributable to high BMI in 195 countries and territories. What did the researchers do and find? We used the modeling framework in the Global Burden of Disease Study 2017 to examine the global deaths and disability-adjusted life years (DALYs) attributable to high BMI. Globally, in 2017, high BMI caused 2.4 million (95% UI 1.6 million, 3.4 million) deaths and 70.7 million (95% UI 49.1 million, 94.9 million) DALYs in females, and 2.3 million (95% UI 1.4 million, 3.4 million) deaths and 77.0 million (95% UI 49.7 million, 108.2 million) DALYs in males. Between 1990 and 2017, despite the fact that the age-standardized rate of high-BMI-related DALYs increased by only 12.7% for females and 26.8% for males, the global number of high-BMI-related DALYs has more than doubled for both sexes. Cardiovascular disease was the leading cause of high-BMI-related DALYs, followed by diabetes and kidney diseases, and neoplasms; they together accounted for 89.3% of all high-BMI-related DALYs. The disease burden attributable to high BMI and its temporal changes varied widely by Socio-demographic Index. What do these findings mean? Our results suggest that high BMI remains a major global health challenge. Successful population-wide initiatives targeting high BMI may mitigate the burden of a wide range of diseases, such as cardiovascular disease, diabetes and kidney diseases, and neoplasms. Policy-makers should take into account country-specific development status when developing and implementing strategies to prevent and reduce the disease burden generated by high BMI.