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Figure 2.1 Time-trends of the prevalence of obesity in adults in the Health Survey for England (ages 16 + ), 1987-1997 and in the Netherlands (MORGEN project, ages 20-65 years), 1987-1997

UK-men UK-women NL-men NL-women

Figure 2.1 Time-trends of the prevalence of obesity in adults in the Health Survey for England (ages 16 + ), 1987-1997 and in the Netherlands (MORGEN project, ages 20-65 years), 1987-1997

ized or even slightly decreased but still those prevalences remain among the highest in Europe. The study by Molarius et al. (9) showed that the social class differences in the prevalence of obesity are increasing with time. Obesity is increasingly becoming an almost exclusively lower class problem in Europe.

Figure 2.1 shows the extraordinary increase in the prevalence of obesity in England. In the mid 1980s the prevalence of obesity in men from the Netherlands and England was about the same but in 1997 it was at least twice as high in england. The most recent (1988-1994) estimates of obesity in adults in the USA are about 20% in men and 25% in women (8). In other parts of the world obesity is also frequent. Martorell et al. recently described the prevalence of obesity in young adult women aged 15-49 years (10). The estimated prevalence of obesity was on average 10% in Latin American countries and 17% in countries in North Africa and the Middle East.

Obesity is uncommon in sub-Saharan Africa, China and India, although in all regions the prevalence seems to be increasing, particularly among the affluent parts of the population in the larger cities (11). In these countries we quite often see the para doxical condition of both increasing undernutrition and overnutrition. This is clearly related to growing inequalities in income and access to food in these regions. In addition, it has already been mentioned that classification criteria based on Europid populations (i.e. those of European ancestry) might not be appropriate for Asian populations.

There is some uncertainty around most national estimates of obesity prevalence because of the lack of solid data, and the large differences between countries within the same region and secular trends. The numbers corresponding to the midpoint of the estimates add up to about 250 million obese adults, which is about 7% of the total adult world population. It does not seem unreasonable that the true prevalence of obesity is likely to be in the order of 5-10%. In most countries the prevalence of overweight (BMI between 25 and 30 kg/m2) is about two to three times the prevalence of obesity, which would mean that there may be as many as one billion people who are overweight or obese.

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