Editorial
Obesity and related non-communicable diseases have rapidly become Latin America’s most important public health concern, even while undernutrition remains a problem in some areas. It was estimated that, between 1980 and 2008, the average BMI in Latin American people increased by about 1 kg/m² per decade—twice as fast as the average global increase. Mexico and Chile are now among the world’s fattest nations. The prevalence of childhood obesity and overweight—up to 25% of children in Latin America, as quantified by Juan Ángel Rivera and colleagues in a systematic review recently published in this journal—is similarly high. In parallel with increasing obesity is an upwards trajectory in the prevalence of diabetes and cardiovascular disease: by 2035, the number of people with diabetes in Central and South America is predicted to jump from 24·1 million to 38·5 million, an increase of 60% (compared with a projected increase of 37% in North America and the Caribbean). Cardiovascular disease is already the most common cause of death in Latin America. Worryingly, by contrast with some other regions, where the trend of increasing obesity prevalence is levelling off, the rise in obesity in most of Latin America seems set to continue. Latin America’s increasing obesity prevalence has occurred in parallel with rapid economic growth and a demographic and nutritional transition, a similar scenario to other global regions where obesity is on the rise. A much higher proportion of the population lives in urban areas than did three decades ago, and rates of physical activity in some countries, such as Argentina, are now among the lowest in the world. Diets have shifted to contain more processed, calorie-dense, and high-sugar foods and beverages. Most of the diverse indigenous populations in the region have adopted diets and more sedentary lifestyles typical of an industrialised country. Notable exceptions exist—such as the Aymara people, who have largely retained a traditional lifestyle and diet— but, in general, indigenous people in Latin America are now especially vulnerable to obesity and its complications. Until recently, data on obesity and its causes in Latin America have been scarce, particularly at the national level, and still little or no information is available about some countries. Thus, there is a paltry foundation of knowledge on which to base and assess public health interventions for obesity prevention, and a call for www.thelancet.com/diabetes-endocrinology Vol 2 April 2014
further research is frequently cited. Nevertheless, several initiatives are underway: for example, Bolivia put an Obesity Prevention Strategy into action in 2010; Mexico launched a National Strategy for the Prevention and Control of Overweight, Obesity, and Diabetes in October 2013 (including an 8–10% tax on sugar-sweetened beverages and junk food); and Venezuela has recently appointed ministers to a new dietary production programme that will design food policies for the nation in an effort to combat rising obesity. Latin America is in a strong position to implement such prevention strategies. Relative to some other regions in transition and struggling to cope with an obesity epidemic, most Latin American countries have strong and well established infrastructures, health systems, education, and communications, and an active and engaged civil society. The region benefits from an abundant variety of healthy foods. The climate in most parts of Latin America is amenable to outdoor physical activity. An increasing number of cities are adopting programmes, such as Cyclovias, that enable safe physical activity in urban areas. Thus, there is every reason to believe that, with appropriate planning and implementation, Latin America can reduce obesity prevalence. Should interventions take into account that the nature of the epidemic varies across the region? For example, the age-standardised prevalence of obesity (BMI>30 kg/m²) in 2008 ranged from 16·5% in Peru to 32·8% in Mexico. Additionally, the sex disparity in obesity prevalence is substantial in only some countries, such as Cuba, where, in 2008, obesity affected 27·5% of women but only 13·3% of men. Investigation of the reasons underlying the obesity epidemic in different countries would help to fill knowledge gaps and plan interventions but, in view of limited global resources, it is difficult to argue against the opinion that putting obesity prevention programmes into place (along with effective methods with which to measure their success) is a more urgent priority. The main causes of obesity—a high-calorie diet and physical inactivity—are undoubtedly common to all countries, and interventions that have been effective in other regions will probably also make a difference in Latin America. Thus, although further research is important, now is the time to prioritise investment in obesity prevention programmes. ■ The Lancet Diabetes & Endocrinology
Eric L Wheater/Getty Images
Obesity prevention in Latin America: now is the time
For more on global trends in BMI since 1980 see Articles Lancet 2011; 377: 557–67 For more on obesity in Mexico see In Focus Lancet Diabetes Endocrinol 2014; 2: 15–16 For the Rivera systematic review see Review Lancet Diabetes Endocrinol 2013; published online Dec 13. http:// dx.doi.org/10.1016/S22138587(13)70173-6 For more on regional diabetes incidence see http://www.idf. org/sites/default/files/EN_6E_ Atlas_Full_0.pdf For more on causes of death in Latin America see http://www. paho.org/hq/index. php?option=com_content&view =article&id=2470&Itemid=2003 &lang=en For more on physical activity see http://www.who.int/gho/ ncd/risk_factors/physical_ activity/en/ For more on obesity and diabetes in Latin American indigenous people see http:// jn.nutrition.org/ content/131/3/893S.full For more on metabolic health of Aymara people see http:// www.ncbi.nlm.nih.gov/ pubmed/11369169 For more on the Ciclovias programme see http://www. cicloviasrecreativas.org/en/ For more on global obesity statistics in 2008 see http:// www.who.int/gho/ncd/risk_ factors/overweight/en/
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Obesity and related non-communicable diseases have rapidly become Latin America’s most important public health concern, even while undernutrition remains a problem in some areas. It was estimated that, between 1980 and 2008, the average BMI in Latin American people increased by about 1 kg/m² per decade—twice as fast as the average global increase. Mexico and Chile are now among the world’s fattest nations. The prevalence of childhood obesity and overweight—up to 25% of children in Latin America, as quantified by Juan Ángel Rivera and colleagues in a systematic review recently published in this journal—is similarly high. In parallel with increasing obesity is an upwards trajectory in the prevalence of diabetes and cardiovascular disease: by 2035, the number of people with diabetes in Central and South America is predicted to jump from 24·1 million to 38·5 million, an increase of 60% (compared with a projected increase of 37% in North America and the Caribbean). Cardiovascular disease is already the most common cause of death in Latin America. Worryingly, by contrast with some other regions, where the trend of increasing obesity prevalence is levelling off, the rise in obesity in most of Latin America seems set to continue. Latin America’s increasing obesity prevalence has occurred in parallel with rapid economic growth and a demographic and nutritional transition, a similar scenario to other global regions where obesity is on the rise. A much higher proportion of the population lives in urban areas than did three decades ago, and rates of physical activity in some countries, such as Argentina, are now among the lowest in the world. Diets have shifted to contain more processed, calorie-dense, and high-sugar foods and beverages. Most of the diverse indigenous populations in the region have adopted diets and more sedentary lifestyles typical of an industrialised country. Notable exceptions exist—such as the Aymara people, who have largely retained a traditional lifestyle and diet— but, in general, indigenous people in Latin America are now especially vulnerable to obesity and its complications. Until recently, data on obesity and its causes in Latin America have been scarce, particularly at the national level, and still little or no information is available about some countries. Thus, there is a paltry foundation of knowledge on which to base and assess public health interventions for obesity prevention, and a call for www.thelancet.com/diabetes-endocrinology Vol 2 April 2014
further research is frequently cited. Nevertheless, several initiatives are underway: for example, Bolivia put an Obesity Prevention Strategy into action in 2010; Mexico launched a National Strategy for the Prevention and Control of Overweight, Obesity, and Diabetes in October 2013 (including an 8–10% tax on sugar-sweetened beverages and junk food); and Venezuela has recently appointed ministers to a new dietary production programme that will design food policies for the nation in an effort to combat rising obesity. Latin America is in a strong position to implement such prevention strategies. Relative to some other regions in transition and struggling to cope with an obesity epidemic, most Latin American countries have strong and well established infrastructures, health systems, education, and communications, and an active and engaged civil society. The region benefits from an abundant variety of healthy foods. The climate in most parts of Latin America is amenable to outdoor physical activity. An increasing number of cities are adopting programmes, such as Cyclovias, that enable safe physical activity in urban areas. Thus, there is every reason to believe that, with appropriate planning and implementation, Latin America can reduce obesity prevalence. Should interventions take into account that the nature of the epidemic varies across the region? For example, the age-standardised prevalence of obesity (BMI>30 kg/m²) in 2008 ranged from 16·5% in Peru to 32·8% in Mexico. Additionally, the sex disparity in obesity prevalence is substantial in only some countries, such as Cuba, where, in 2008, obesity affected 27·5% of women but only 13·3% of men. Investigation of the reasons underlying the obesity epidemic in different countries would help to fill knowledge gaps and plan interventions but, in view of limited global resources, it is difficult to argue against the opinion that putting obesity prevention programmes into place (along with effective methods with which to measure their success) is a more urgent priority. The main causes of obesity—a high-calorie diet and physical inactivity—are undoubtedly common to all countries, and interventions that have been effective in other regions will probably also make a difference in Latin America. Thus, although further research is important, now is the time to prioritise investment in obesity prevention programmes. ■ The Lancet Diabetes & Endocrinology
Eric L Wheater/Getty Images
Obesity prevention in Latin America: now is the time
For more on global trends in BMI since 1980 see Articles Lancet 2011; 377: 557–67 For more on obesity in Mexico see In Focus Lancet Diabetes Endocrinol 2014; 2: 15–16 For the Rivera systematic review see Review Lancet Diabetes Endocrinol 2013; published online Dec 13. http:// dx.doi.org/10.1016/S22138587(13)70173-6 For more on regional diabetes incidence see http://www.idf. org/sites/default/files/EN_6E_ Atlas_Full_0.pdf For more on causes of death in Latin America see http://www. paho.org/hq/index. php?option=com_content&view =article&id=2470&Itemid=2003 &lang=en For more on physical activity see http://www.who.int/gho/ ncd/risk_factors/physical_ activity/en/ For more on obesity and diabetes in Latin American indigenous people see http:// jn.nutrition.org/ content/131/3/893S.full For more on metabolic health of Aymara people see http:// www.ncbi.nlm.nih.gov/ pubmed/11369169 For more on the Ciclovias programme see http://www. cicloviasrecreativas.org/en/ For more on global obesity statistics in 2008 see http:// www.who.int/gho/ncd/risk_ factors/overweight/en/
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