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Overweight and Obesity

Overweight and obesity is a leading risk factor for global mortality, with the World Health Organization (WHO) estimating that at least 2.8 million people die each year as a result of being overweight (defined by WHO as a Body Mass Index [BMI] greater than or equal to 25) or obese (defined by WHO as a BMI greater than or equal to 30). Previously thought of as a problem of high-income countries, overweight and obesity is now rising dramatically in low- and middle-income countries, particularly in urban areas.

Largely preventable, overweight and obesity increase the risk of a range of noncommunicable diseases (NCDs), including a number of cancers (including endometrial, breast, ovarian, prostate, liver, gallbladder, kidney and colon), diabetes, musculoskeletal disorders and cardiovascular diseases. In 2016, it was estimated that, worldwide, more than 1.9 billion adults (39% of adults) were overweight, and of these over 650 million (13% of adults) were obese. Overweight and obesity are linked to more deaths worldwide than underweight.

Worldwide, obesity has nearly tripled since 1975. According to WHO the major cause of overweight and obesity is an imbalance between energy intake and energy expenditure. Globally, there has been an increase in intake of energy-dense food. At the same time, changes in modes of work, transport and increasing urbanization have contributed to decreasing physical activity levels which are linked to increasing overweight and obesity. WHO defines physical activity as any bodily movement produced by skeletal muscles that requires energy expenditure. Physical inactivity is one of the leading risk factors for death with WHO estimating that physical inactivity causes 3.2 million deaths globally. Worldwide, one in four adults and more than 80% of adolescents are not active enough. Physical inactivity adds to the burden of NCDs and general health worldwide with people who are insufficiently active estimated to have a 20% to 30% increased risk of death compared to those who are sufficiently active.

In 2004, the World Health Assembly – the decision-making body of WHO – endorsed the WHO Global Strategy on Diet, Physical Activity and Health (2004 Global Strategy). The 2004 Global Strategy called for action at global, regional and local levels to improve diets and increase physical activity. In 2010, WHO published the Global Recommendations on Physical Activity for Health (2010 Global Recommendations) focusing on primary prevention of NCDs through physical activity. In 2013, the WHO Global Action Plan for the Prevention and Control of NCDs (Global Action Plan) was endorsed by the World Health Assembly and included calls for Member States to promote healthy diets and physical activity. In January 2017, work on a draft global action plan to promote physical activity commenced. The draft global action plan was considered at the January 2018 session of the Executive Board of WHO. A final draft will now be considered by the World Health Assembly in May 2018.

To address rising rates of childhood overweight and obesity, in 2014, the WHO Director-General established a High-Level Commission on Ending Childhood Obesity to provide a comprehensive response to childhood obesity. The Commission published their report in 2016 and an implementation plan for the report was welcomed by the 2017 session of the World Health Assembly.

Overweight and obesity and physical activity has been incorporated within the broader United Nations General Assembly agenda. In 2011, the Political Declaration on the Prevention and Control of NCDs (2011 Political Declaration) adopted at the first High-Level Meeting of the General Assembly on NCDs called on Member States to advance the implementation of the 2004 Global Strategy. In the 2011 Political Declaration, Member States committed to a range of actions to reduce the impact of unhealthy diet and physical inactivity through education, legislative, regulatory and fiscal measures. In September 2015, the United Nations General Assembly adopted the 2030 Agenda for Sustainable Development. The 2030 Agenda for Sustainable Development came into force on 1 January 2016 and includes 17 Sustainable Development Goals. The Sustainable Development Goals include a number of goals relevant to NCDs and more specifically diet and physical activity. The Addis Ababa Action Agenda of the Third International Conference on Financing for Development (Addis Ababa Action Agenda) defines the means of implementation of the 2030 Agenda for Sustainable Development. In 2016, the United Nations General Assembly proclaimed the United Nations Decade of Action on Nutrition from 2016-2025. The declaration followed a recommendation in the Rome Declaration on Nutrition adopted at the Second International Conference on Nutrition (ICN2) in 2014 for a decade of action and noted the need to reverse ‘rising trends in overweight and obesity’.

The global framework for diet, physical activity and health comprises the following strategies, documents and reports:

 
  • The 2004 Global Strategy endorsed by the May 2004 session of the World Health Assembly. The 2004 Global Strategy has four main objectives including: reducing risk factors for chronic diseases; increasing awareness and understanding; developing, strengthening and implementing global, regional, national policies and action plans and monitoring science and promoting research.
 
  • The 2010 Global Recommendations aim to provide policymakers with guidance on the relationship between physical activity including the frequency, duration, intensity, type and total amount of physical activity needed, and the prevention of NCDs. The Recommendations are broken down into three age groups: 5-17 years old; 18-64 years old; and 65 years old and above.
 
  • The Comprehensive Implementation Plan on Maternal, Infant and Young Child Nutrition (Comprehensive Implementation Plan) endorsed by the 65th World Health Assembly in 2012. The Comprehensive Implementation Plan specifies a set of six global nutrition targets to be achieved by 2025 including: achieve a 40% reduction in the number of children under five who are stunted; achieve a 50% reduction of anaemia in women of reproductive age; achieve a 30% reduction in low birth weight; ensure that there is no increase in childhood overweight; increase the rate of exclusive breastfeeding in the first six months up to at least 50%; reduce and maintain childhood wasting to less than 5%.
 
  • The Global Action Plan endorsed by the 66th World Health Assembly in May 2013. The 2013 World Health Assembly also adopted the comprehensive global monitoring framework for the prevention and control of NCDs including 25 indicators and nine voluntary global targets. The Global Action Plan includes the nine voluntary global targets, including: a 25% relative reduction in risk of premature mortality from cardiovascular diseases, cancer, diabetes, or chronic respiratory diseases; a 10% relative reduction in prevalence of insufficient physical activity; a 30% relative reduction in mean population intake of salt/sodium; a 25% relative reduction in the prevalence of raised blood pressure or contain the prevalence of raised blood pressure, according to national circumstances and a halt in the rise of diabetes and obesity. Appendix 3 of the Global Action Plan ‘Best Buys' and other recommended interventions for the prevention and control of NCDs comprises of a menu of policy options and cost-effective and recommended interventions for Member States. An updated Appendix 3 was endorsed by the 70th World Health Assembly in May 2017.

For unhealthy diets, Appendix 3 best buys include:

  • Reducing salt intake through the reformulation of food and the setting of target levels for the amount of salt in foods and meals;
  • Reducing salt intake through the establishment of a supportive environment in public institutions to enable lower sodium options to be provided;
  • Reducing salt intake through a behaviour change communication and mass media campaign; and
  • Reducing salt intake through the implementation of front-of-pack labelling.

Other effective interventions in Appendix 3 include:

    • Eliminating industrial trans-fats through the development of legislation to ban their use in the food chain; and
    • Reducing sugar consumption through effective taxation on sugar-sweetened beverages.

The best buys for physical inactivity include:

    • Implementing community wide public education and awareness campaigns including mass media combined with other community based programs.

Other effective interventions in Appendix 3 include:

    • Providing physical activity counselling as part of routine primary health care services through the use of a brief intervention.
 
  • The Rome Declaration on Nutrition and the Framework for Action from the ICN2 held in November 2014. The Rome Declaration on Nutrition and the Framework for Action recommend a set of policy options and strategies to promote diversified, safe and healthy diets at all stages of life.
 

The framework for addressing childhood diet, physical activity and health specifically includes the following strategies, documents and reports:

  • The Global Strategy for Infant and Young Child Feeding jointly developed by WHO and UNICEF was endorsed by the 55th World Health Assembly in May 2002 and the UNICEF Executive Board in September 2002. The Global Strategy for Infant and Young Child Feeding is intended as a guide for action with the aim of revitalizing ‘world attention to the impact that feeding practices have on the nutritional status, growth and development, health, and thus the very survival of infants and young children’.
 

 

  • The Report of the Commission on Ending Childhood Obesity published in 2016. The Report includes a set of recommendations to successfully tackle childhood and adolescent obesity including:
    • Promote intake of healthy foods and reduce the intake of unhealthy foods;
    • Promote physical activity and reduce sedentary behaviours;
    • Integrate and strengthen guidance for NCD prevention with current guidance for preconception and antenatal care;
    • Provide guidance on and support for healthy diet, sleep and physical activity in early childhood;
    • Promote healthy school environments, health and nutrition literacy and physical activity among school-age children and adolescents; and
    • Provide family-based, multicomponent lifestyle weight management services for children and young people who are obese.

These recommendations provided the background for the Report of the Commission on Ending Childhood Obesity Implementation Plan welcomed by the World Health Assembly in 2017. The Implementation Plan guides Member States and other partners on the actions needed to implement the recommendations of the Commission.

 The following resource has been established in relation to overweight and obesity regulatory measures:

 
  • The World Cancer Research Fund, NOURISHING Framework is a regularly updated tool providing an extensive overview of implemented government policy actions in relation to overweight and obesity from around the world. The NOURISHING Framework is divided into ten policy areas including: nutrition label standards and regulations on the use of claims and implied claims on food; offer healthy food and set standards in public institutions and other specific settings; use economic tools to address food affordability and purchase incentives; restrict food advertising and other forms of commercial promotion; improve nutritional quality of the whole food supply; set incentives and rules to create a healthy retail and food service environment; harness supply chain and actions across sectors to ensure coherence with health; inform people about food and nutrition through public awareness; nutrition advice and counselling in healthcare settings and give nutrition education and skills.

Overweight and obesity and physical activity also fall within the broader Sustainable Development framework:

  • The 2030 Agenda for Sustainable Development adopted by the United Nations General Assembly in September 2015. The 2030 Agenda for Sustainable Development includes 17 Sustainable Development Goals and 169 targets including the following specifically relevant to overweight and obesity and physical activity:
    • Goal 2 end hunger, achieve food security and improved nutrition and promote sustainable agriculture;
    • Target 2.1 by 2030, end hunger and ensure access by all people, in particular the poor and people in vulnerable situations, including infants, to safe, nutritious and sufficient food all year round;
    • Target 2.2 by 2030, end all forms of malnutrition, including achieving, by 2025, the internationally agreed targets on stunting and wasting in children under 5 years of age, and address the nutritional needs of adolescent girls, pregnant and lactating women and older persons;
    • Goal 3 ensure healthy lives and promote well-being for all at all ages; and
    • Target 3.4 by 2030, reduce by one third premature mortality from NCDs through prevention and treatment and promote mental health and well-being.
  • The Addis Ababa Action Agenda endorsed by the United Nations General Assembly in July 2015. The Addis Ababa Action Agenda defines the means of implementation of the 2030 Agenda for Sustainable Development.

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