Research

JAMA Pediatrics | Original Investigation

Global Prevalence of Overweight and Obesity in Children and Adolescents

A Systematic Review and Meta-Analysis
Xinyue Zhang, PhD; Jiaye Liu, PhD; Yinyun Ni, PhD; Cheng Yi, MD; Yiqiao Fang, MD; Qingyang Ning, MD; Bingbing Shen, MD;
Kaixiang Zhang, MD; Yang Liu, MD; Lin Yang, MD; Kewei Li, PhD; Yong Liu, PhD; Rui Huang, PhD; Zhihui Li, PhD

Supplemental content
IMPORTANCE Overweight and obesity in childhood and adolescence is a global health issue
associated with adverse outcomes throughout the life course.

OBJECTIVE To estimate worldwide prevalence of overweight and obesity in children and

adolescents from 2000 to 2023 and to assess potential risk factors for and comorbidities
of obesity.
DATA SOURCES MEDLINE, Web of Science, Embase, and Cochrane.

STUDY SELECTION The inclusion criteria were: (1) studies provided adequate information,
(2) diagnosis based on body mass index cutoffs proposed by accepted references, (3) studies
performed on general population between January 2000 and March 2023, (4) participants
were younger than 18 years.

DATA EXTRACTION AND SYNTHESIS The current study was performed in accordance with the
Meta-analysis of Observational Studies in Epidemiology guidelines. DerSimonian-Laird
random-effects model with Free-Tukey double arcsine transformation was used for data
analysis. Sensitivity analysis, meta-regression, and subgroup analysis of obesity among
children and adolescents were conducted.

MAIN OUTCOMES AND MEASURES Prevalence of overweight and obesity among children and
adolescents assessed by World Health Organization, International Obesity Task Force,
the US Centers for Disease Control and Prevention, or other national references.

RESULTS A total of 2033 studies from 154 different countries or regions involving 45 890 555
individuals were included. The overall prevalence of obesity in children and adolescents was
8.5% (95% CI 8.2-8.8). We found that the prevalence varied across countries, ranging from
0.4% (Vanuatu) to 28.4% (Puerto Rico). Higher prevalence of obesity among children and
adolescents was reported in countries with Human Development Index scores of 0.8 or
greater and high-income countries or regions. Compared to 2000 to 2011, a 1.5-fold increase
in the prevalence of obesity was observed in 2012 to 2023. Substantial differences in rates of
obesity were noted when stratified by 11 risk factors. Children and adolescents with obesity
had a high risk of depression and hypertension. The pooled estimates of overweight and
excess weight in children and adolescents were 14.8% (95% CI 14.5-15.1) and 22.2%
(95% CI 21.6-22.8), respectively.

CONCLUSIONS AND RELEVANCE This study’s findings indicated 1 of 5 children or adolescents

experienced excess weight and that rates of excess weight varied by regional income and
Human Development Index. Excess weight among children and adolescents was associated
with a mix of inherent, behavioral, environmental, and sociocultural influences that
need the attention and committed intervention of primary care professionals, clinicians,
Author Affiliations: Author
health authorities, and the general public. affiliations are listed at the end of this
article.
Corresponding Authors: Kewei Li,
PhD, Department of Pediatrics, West
China Hospital, Sichuan University,
No 37. Guoxue Alley, 610000,
Chengdu, China (vivian5225133@
outlook.com) and Zhihui Li, PhD,
Division of Thyroid Surgery,
Department of General Surgery,
West China Hospital, Sichuan
University, No 37. Guoxue Alley,
JAMA Pediatr. 2024;178(8):800-813. doi:10.1001/jamapediatrics.2024.1576 610000, Chengdu, China
Published online June 10, 2024. (rockoliver@vip.sina.com).

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 Global Prevalence of Overweight and Obesity in Children and Adolescents Original Investigation Research

O
verweight and obesity in children and adolescents is
an emerging worldwide health concern. Estimates of Key Points
the prevalence have shown heterogeneity across coun-
Question What is the global prevalence of overweight and obesity
tries and regions, typically demonstrating a growing trend.1-4 in children and adolescents?
The Global Burden of Disease Obesity Collaborators 5 re-
Findings In this systematic review and meta-analysis, we found
ported an overall prevalence of 5.0% for childhood obesity,
high prevalence of overweight and obesity in children and
with 107.7 million children having obesity globally in 2015,
adolescents. Various possible risk factors were identified,
and data from the World Obesity Federation6 indicate that the including inherent, dietary, and environmental factors.
rising trend has not yet been stopped, as it estimated that 158
Meaning These findings suggest that excess weight commonly
million children and adolescents aged 5 to 19 years would ex-
occurrs in children and adolescents, indicating a need for more
perience obesity in 2020, 206 million in 2025, and 254 mil-
control measures incorporating behavioral, environmental,
lion in 2030. Awareness is growing that the epidemiological and sociocultural factors.
burden of childhood obesity has posed incremental expenses
for both individuals and society.7
Obesity could result from multidimensional biological, as apparently healthy children or adolescents from school,
behavioral, and environmental causes, and unbalanced diet community, or national demographic census); (3) used stan-
and sedentary habits appearing to be the main drivers.8-10 Since dardized instruments, self-reported questionnaires, or clini-
obesity is a disease in and of itself, managing it becomes more cally structured interviews for assessment of overweight and
difficult when it coexists with other pathological illnesses in- obesity; and (4) completed data collection between January
cluding diabetes, cardiovascular disease, and psychological 2000 and March 2023. We excluded studies of hospitalized
disorders.11 Furthermore, childhood overweight and obesity patients or a mix of hospitalized and general populations. Title
have been shown to persist into adulthood,12 and their re- and abstract screening were done by X.Z, J.L, K.L, and C.Y
lated adverse outcomes include not only certain health con- based on the selection criteria. If articles seemed relevant, then
ditions in childhood, but also a greater risk and earlier onset the full text was assessed for inclusion.
of chronic disorders in later life.13-15 Hence, there is a demand
for routine surveillance of weight status in children and ado- Data Extraction and Quality Assessment
lescents. Researchers reviewed and extracted data from included stud-
There has been a dearth of studies into the prevalence of ies by using a data extraction form that included country or
obesity among children and adolescents from global perspec- region, geographic region, publication year, study period, in-
tive since the Non-Communicable Diseases Risk Factor come of country or region, Human Development Index (HDI)
Collaboration16 reported an estimation of 5.6% of girls and 7.8% of the country or region, study design, sample source, diag-
of boys with obesity in 2016. The present study pooled a larger nostic reference, sample size, study quality, risk factors, and
and more recent set of national surveys than previously re- comorbidities. We also included race and ethnicity in sub-
ported to estimate global prevalence as well as risk factors and group analyses for comprehensive assessment, and the cat-
comorbidities associated with overweight and obesity among egories in this study were in accordance with our data sources,
children and adolescents under 18 years old from 2000 to 2023. using a 4-level variable (Asian, Black, Hispanic, and White). Ini-
tial data extraction was done by X.Z, J.L, K.L, and C.Y. For qual-
ity assurance, data collected from all the included studies were
validated by a second team member (Y.F, Q.N, B.S, or Y.N) for
Methods accuracy and completeness against the original source. All dis-
Search Strategy and Selection Criteria crepancies were reviewed and resolved either by consensus
The study followed the Meta-analysis of Observational or by a third team member if consensus was not reached. When
Studies in Epidemiology (MOOSE) reporting guideline. duplicate data were identified, the duplicate with the small-
A comprehensive literature search were performed in est sample size or shortest duration of follow-up was ex-
MEDLINE, Web of Science, Embase, and Cochrane databases cluded. We assessed the quality of included studies using an
between January 1, 2000, and March 31, 2023. The search assessment scale based on the Joanna Briggs Institute Tool in
strategy was structured to include terms pertaining to accordance with previous published studies.15,16 Studies scor-
“overweight,” “obesity,” “excess weight,” “children,” ing 1 to 3 were defined as low quality, 4 to 6 as average qual-
“adolescent,” and “prevalence.” eTable 1 in Supplement 1 ity, and 7 to 9 as high quality. Studies were not excluded re-
contains a full list of the search terms used. The study protocol gardless of their quality score to increase transparency and to
was registered in PROSPERO (CRD42023483885). ensure all available evidence in this area was reported.
Predefined inclusion criteria were cohort studies, case-
control trials, and randomized clinical trials that (1) reported Statistical Analysis
the prevalence of obesity, overweight, and excess weight (over- All data analysis was performed using R version 4.0.0 (R Foun-
weight and obesity) assessed by body mass index (BMI, cal- dation) with the meta and metafor statistical packages.
culated as weight in kilograms divided by height in meters A 95% CI was estimated using the Wilson score method, and
squared) cutoffs in children and adolescents younger than 18 the pooled prevalence was calculated using the DerSimonian-
years; (2) were conducted in the general population (defined Laird random-effects model with Free-Tukey double arcsine

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 Research Original Investigation Global Prevalence of Overweight and Obesity in Children and Adolescents

studies involving 45 890 555 children and adolescents from 154

Figure 1. Flow Diagram of Study Selection Process
countries or regions were included in the final analysis (Figure 1).
65 448 Records identified from databases
22 166 Embase Study Characteristics and Risk of Bias
21 405 MEDLINE The characteristics and quality assessment score of all 2033 in-
20 235 Web of Science
1642 Cochrane Library cluded studies are presented in eTables 2-5 in Supplement 1.
The sample size ranged from 30 to 3 190 300 participants. The
26 205 Duplicates removed before screening cross-sectional design was used in most of the included re-
search. The mean or median age and sex of participants was
reported in 737 and 1090 studies. The median (IQR) age was
39 243 Records screened
10.0 (7.1-12.5) years, and the median (IQR) proportion of par-
ticipants who were female was 49.64% (48.1-51.5).
33 417 Records excluded

Prevalence of Obesity Among Children and Adolescents

5826 Reports assessed for eligibility The prevalence of obesity in children and adolescents was re-
ported by 1668 studies comprising 44 414 245 individuals from
3793 Excluded 152 countries or regions (eTable 3 in Supplement 1). A total of
1824 Irrelevant or duplicate data
1322 Inadequate information 4 519 587 participants were diagnosed as having obesity with
381 Review, meta-analysis, letter, a pooled prevalence of 8.5% (95% CI, 8.2-8.8; I2, 99.9%).
or case report
266 Improper study design To gain a deeper understanding of the heterogeneity, we
conducted a sensitivity analysis by performing a set of leave-
1-out diagnostic tests (eTables 6-7 in Supplement 1). After re-
2033 Studies included in review
moving the outliers, the pooled estimate of obesity for chil-
dren and adolescents was 8.3% (95% CI, 8.0-8.6; I2, 99.9%).
To further explore the source of heterogeneity, meta-
transformation. Heterogeneity among the included studies regression analysis was performed. Our univariate meta-
was evaluated through the Cochran Q and I2 statistics. Given regression model indicated that country or region (R2, 66.6%;
the anticipated heterogeneity in global data, a random- P < .001), geographic region (R2, 46.8%; P < .001), diagnostic
effects model was used to estimate the prevalence of obesity, reference (R2, 0; P < .001), HDI level (R2, 41.9%; P < .001),
overweight, and excess weight. Sensitivity analyses were con- sample size (R2, 0.01%; P < .001), sample source (R2, 2.4%;
ducted by performing a set of leave-1-out diagnostic tests fo- P < .001), and publication year (R 2 , 1.4%; P = .02) were
cusing on the significant heterogeneity associated with obe- associated with heterogeneity, while study design was not
sity where individual studies were systematically removed (R2 = 4.4%; P = .63) (eTable 8 in Supplement 1). By perform-
from the meta-analysis and the pooled-effect estimate recal- ing multivariable meta-regression, it was found that the geo-
culated. The results were then verified by using a build-in func- graphic region, income level of the country or region, sample
tion in metafor. As sensitivity analysis was unable to decrease sources, diagnostic reference, and sample size showed the
the heterogeneity, meta-regression was performed by using a highest predictor importance of 99.99% (eTable 9 in Supple-
mixed-effects model. Univariable and multivariable meta- ment 1).
regression (multimodel inference) were performed by using In subgroup analyses, prevalence of obesity varied sub-
the dmetar package in synthesizing evidence from multiple stantially across different countries and regions, from 0.4%
studies and exploring heterogeneity. The random-effects (Vanuatu, 95% CI, 0.1-0.8) to 28.4% (Puerto Rico, 95% CI,
weighting method was used for assigning weights in meta- 23.6-33.4). Stratified data by geographic regions, the highest
regression. To assess the potential confounding effects of obesity prevalence was found in Polynesia with an estimated
heterogeneity, subgroup analyses were conducted. Charac- rate of 19.5% (95% CI, 16.1-23.1), and the lowest prevalence
teristics of participants were compared with the prevalence of appeared in Middle Africa (2.4%; 95% CI, 1.8-3.0). The
obesity to determine the pooled estimates of risk factors and prevalence of obesity in countries and regions with HDI
comorbidities. IQR was defined as the difference between the scores of 0.8 or greater was 9.5% (95% CI, 9.2-9.8), whereas
first and the third quartile. P < .05 was considered as signifi- countries and regions with HDI scores lower than 0.8
cant difference. showed a significantly lower prevalence of 7.6% (95% CI, 7.3-
7.9; P < .001). Likewise, there was a positive association
between income of countries and regions and prevalence of
children and adolescents’ obesity, with high-income coun-
Results tries showing the highest prevalence (9.3%; 95% CI, 9.0-9.6)
The search identified 65 448 records, 39 243 of which were re- and low-income countries exhibiting the lowest (3.6%;
tained after removing duplicates. Titles and abstracts were 95% CI, 2.5-4.8; P < .001). We also discovered significant dis-
screened, resulting in the exclusion of 33 417 ineligible rec- parity among race and ethnicity, with the highest prevalence
ords. Full texts of the remaining 5826 records were assessed appearing in the Hispanic population (23.55; 95% CI, 20.66-
for eligibility, and 3793 were excluded. Overall, 2033 eligible 26.56) and the lowest appearing in the Asian population

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 Global Prevalence of Overweight and Obesity in Children and Adolescents Original Investigation Research

(10.0%; 95% CI 8.73-11.29; P < .001). Regarding sample Prevalence of Overweight and Excess Weight
sources, participants from medical institutions presented in Children and Adolescents
the highest prevalence of 13.6% (95% CI, 12.2-15.1), although We further performed analyses on the prevalence of over-
sample sources drawn from databases contained most weight and excess weight in children and adolescents. In total,
participants. Considering the diagnostic references for 5 621 782 participants were diagnosed as having overweight
assessing obesity, 466 studies used the World Health Organi- with a pooled prevalence of 14.8% (95% CI, 14.5-15.1; I2, 99.8%),
zation reference 17 (8.6%; 95% CI, 7.9-9.3), 807 used the and 5 621 782 participants were diagnosed as having excess
International Obesity Task Force reference18 (5.4%; 95% CI, weight with a pooled prevalence of 22.2% (95% CI, 21.6-22.8;
5.1-5.7), 453 used the US Centers for Disease Control and I2, 100.0%) (Figure 2). Details on subgroup analyses for over-
Prevention reference19 (14.5%; 95% CI, 13.6-15.3), and 282 weight and excess weight are listed in eTables 13-14 in Supple-
studies used various national references (9.7%; 95% CI, ment 1.
9.0-10.3). A pattern of decreased prevalence was found in
studies having more than 5000 participants (7.7%; 95% CI,
7.1-8.2) than those with fewer than 5000 participants
(8.7%; 95% CI, 8.4-9.1; P < .001). Moreover, studies per-
Discussion
formed from 2000 to 2011 showed significantly lower rates This systematic review and meta-analysis provided a compre-
(7.1%; 95% CI, 6.8-7.3) than those performed from 2012 to hensive analysis of the global epidemiology of overweight and
2023 (11.3%; 95% CI, 10.8-11.8; P < .001) (Table 1; eTable 10 obesity from 2000 to 2023 in children and adolescents younger
in Supplement 1. than 18 years. The overall prevalence of pediatric obesity,
overweight, and excess weight was 8.5%, 14.8%, and 22.2%,
Analysis of Risk Factors Associated With Obesity respectively. According to our findings, there were notable re-
Among Children and Adolescents gional variations, with Polynesia exhibiting the highest preva-
To gain a more comprehensive view of obesity in children lence across all 3 categories and Middle and Western Africa dis-
and adolescents, further analysis regarding potential risk playing the lowest rates. Furthermore, a number of factors
factors were performed (Table 2; eTable 11 in Supplement 1). demonstrated a noteworthy association with the prevalence
Results indicated that a significant difference in the preva- of pediatric obesity, including age, sex, school type, maternal
lence of obesity was found in the pooled estimate by age obesity, having breakfast, number of meals per day, hours of
(0-5, 6-12, or 13-18 years; 8.5% vs 9.4% vs 6.9%, respectively; playing on the computer per day, maternal smoking in preg-
P < .001), sex (male or female; 9.4% vs 7.5%, respectively; nancy, birth weight, regular exercise, and sleep duration.
P < .001), school type (public or private; 6.5% vs 11.6%, Besides, children and adolescents with obesity are more likely
respectively; P < .001), maternal weight status (obesity or to experience mental and physical comorbidities, such as de-
nonobesity; 15.9% vs 8.1%, respectively; P = .001), breakfast pression and hypertension.
(having breakfast daily or usually skipping breakfast; 7.1% vs T h e N o n - C o m m u n i c a b l e D i s e a s e s R i s k Fa c t o r
10.0%, respectively; P = .03), numbers of meals per day (>3 Collaboration16 provided data on global prevalence of obe-
or ≤3; 3.3% vs 11.6%, respectively; P = .008), hours of playing sity in children and adolescents aged 5 to 19 years from 1975
on the computer per day (≥2 or <2 hours; 11.9% vs 5.5%, to 2016 and found the prevalence had grown for both boys and
respectively; P = .01), maternal smoking in pregnancy girls, from 0.9% to 7.8% and 0.7% to 5.6%, respectively. Their
(smoking or never; 7.7% vs 4.7%, respectively; P = .006), key finding was that, although the prevalence of obesity in
birth weight (low, normal, or high; 6.2% vs 9.2% vs 12.8%, high-income nations had plateaued around the year 2000, in
respectively; P = .005), physical activity (regular or irregular; other parts of Asia it was still rising. Our findings reconfirmed
7.7% vs 12.1%, respectively; P = .006), and nightly sleep that obesity was more common in boys than girls. More im-
duration (<10 or ≥10 hours; 13.7% vs 7.2%, respectively; portantly, we found a sharply increased prevalence of obe-
P = .03). Minimal differences were observed among other sity from 2012 to 2023 to 2000 to 2011. Even though obesity
factors. is growing more widespread globally, there are still notable re-
gional differences to be aware of. According to previous stud-
Comorbidities of Obesity Among Children and Adolescents ies, Polynesia, the Caribbean, Northern America, and Central
Eight comorbidities associated with obesity among children America have the highest rates of obesity (above 15%).16,20
and adolescents were investigated (Table 3; eTable 12 in Apart from the fact that many countries in these regions, such
Supplement 1). There were 26 studies reporting on hyperten- as the US, are well developed, which may contribute to the high
sion in children and adolescents with obesity, with a pooled prevalence of childhood obesity, it is noteworthy that most of
rate of 28.0% (95% CI, 20.2-36.6). In addition, 13 studies these regions are adjacent to each other geographically, indi-
documented dental caries (17.9%; 95% CI, 12.6-23.8), 8 cating that the genetic traits and unique diet habits of the ha-
included vitamin D deficiency (11.6% 95% CI, 5.4-19.9), 7 bitants may also be potential drivers. Interestingly, the low-
included asthma (18.8%; 95% CI, 12.5-26.2), 3 reported on est prevalence (under 4%) appeared in Western European,
diabetes (1.2%; 95% CI, 0.2-3.0), 3 included flatfoot (26.1%; Middle Africa, Melanesia, and Western Africa, covering highly
95% CI, 6.7-52.2), 2 reported on anxiety (25.1%; 95% CI, developed countries as well as a large number of the least-
0-94.2), and 2 included depression (35.2%; 95% CI, 0.4- developed countries. While the prevalence in Western Europe
87.0). may be attributed to the quality of the health care system and

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 Research Original Investigation Global Prevalence of Overweight and Obesity in Children and Adolescents

Table 1. Subgroup Analysis for Obesity Prevalence Among Children and Adolescents

Subgroup Studies, No. Events, No. Total, No. Prevalence (95% CI) P value I2, %
Country
Albania 2 671 8069 8.72 (6.67-11.03) <.001 90.1
Algeria 3 119 3837 3.53 (1.82-5.76) <.001 89.0
Argentina 13 2516 25 261 11.53 (9.22-14.07) <.001 95.8
Australia 57 14 105 220 141 5.96 (5.39-6.55) <.001 96.6
Austria 4 315 8940 3.66 (1.78-6.15) <.001 96.4
Bahamas 1 279 1308 21.33 (19.15-23.59) <.001 NA
Bahrain 3 295 3350 9.74 (5.48-15.04) <.001 94.4
Bangladesh 8 966 18 088 7.76 (3.96-12.68) <.001 98.9
Barbados 1 214 1504 14.23 (12.51-16.04) <.001 NA
Belgium 15 870 39 466 2.22 (1.48-3.10) <.001 96.2
Benin 2 33 3398 1.30 (0.11-3.62) <.001 92.8
Bhutan 1 2 392 0.51 (0.01-1.53) <.001 NA
Bolivia 4 446 7020 3.87 (1.45-7.35) <.001 97.0
Bosnia and Herzegovina 2 619 6108 10.52 (4.05-19.54) <.001 99.0
Botswana 1 35 707 4.95 (3.46-6.68) <.001 NA
Brazil 92 31 043 333 397 8.65 (7.59-9.77) <.001 99.1
Brunei Darussalam 1 319 1824 17.49 (15.78-19.27) <.001 NA
Bulgaria 6 1130 14 734 6.29 (2.53-11.57) <.001 99.2
Burkina Faso 3 185 8431 2.20 (0.66-4.57) <.001 94.9
Burundi 1 52 3493 1.49 (1.11-1.92) <.001 NA
Cameroon 7 334 13 385 2.32 (1.74-2.97) <.001 79.2
Canada 47 380 348 3 478 991 10.43 (9.26-11.66) <.001 99.5
Chile 13 4894 173 378 15.94 (10.03-22.91) <.001 99.7
China mainland 148 410 959 5 986 764 7.77 (7.11-8.45) <.001 99.9
Colombia 6 889 25 937 4.70 (3.02-6.73) <.001 96.5
Comoros 1 173 2699 6.41 (5.52-7.37) <.001 NA
Congo 2 286 12 922 1.95 (0.81-3.56) <.001 96.7
Costa Rica 1 49 128 347 366 14.14 (14.03-14.26) <.001 NA
Cote d’Ivoire 2 71 4545 1.76 (0.72-3.22) <.001 88.1
Croatia 8 1486 19 623 5.77 (2.28-10.71) <.001 99.3
Cyprus 8 1522 21 867 6.54 (5.42-7.76) <.001 90.7
Czech 7 1488 48 743 4.35 (1.87-7.78) <.001 99.4
Denmark 12 2047 68 426 3.07 (1.58-5.02) <.001 99.3
Djibouti 2 226 3249 6.93 (3.75-11) <.001 94.2
Dominican Republic 1 117 954 12.26 (10.26-14.42) <.001 NA
East Timor 1 20 1631 1.23 (0.74-1.82) <.001 NA
Ecuador 4 1435 12 962 12.28 (4.03-24.12) <.001 98.9
Egypt 10 1608 15 845 13.33 (10.72-16.17) <.001 95.2
El Salvador 1 10 087 111 991 9.01 (8.84-9.18) <.001 NA
Estonia 4 188 10 275 2.09 (0.97-3.60) <.001 94.4
Ethiopia 11 336 18 012 2.70 (1.61-4.06) <.001 94.7
Fiji 3 684 12 257 6.07 (4.52-7.84) <.001 89.8
Finland 8 838 31 278 2.88 (2.45-3.34) <.001 76.5
France 23 5411 162 311 3.93 (3.17-4.76) <.001 97.9
French Polynesis 1 420 1902 22.08 (20.25-23.97) <.001 NA
Gabon 1 129 3482 3.70 (3.10-4.36) <.001 NA
Gambia 1 114 3360 3.39 (2.81-4.03) <.001 NA
Georgia 2 281 3226 8.60 (7.65-9.61) <.001 0
Germany 39 7349 168 736 4.35 (3.74-5.01) <.001 97.3
Ghana 13 686 20 425 7.16 (4.06-11.04) <.001 98.7

(continued)

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 Global Prevalence of Overweight and Obesity in Children and Adolescents Original Investigation Research

Table 1. Subgroup Analysis for Obesity Prevalence Among Children and Adolescents (continued)

Subgroup Studies, No. Events, No. Total, No. Prevalence (95% CI) P value I2, %
Greece 59 33 519 418 004 8.19 (7.54-8.86) <.001 97.5
Greenland 2 34 1501 2.18 (1.30-3.28) <.001 39.8
Guatemala 1 71 363 19.56 (15.63-23.81) <.001 NA
Guinea 1 80 3216 2.49 (1.98-3.06) <.001 NA
Honduras 1 112 2554 4.39 (3.62-5.22) <.001 NA
Hong Kong 11 13 180 256 924 5.32 (4.59-6.11) <.001 96.0
Hungary 11 3129 43 224 6.30 (4.36-8.58) <.001 98.7
Iceland 4 438 14 284 2.67 (1.66-3.90) <.001 92.4
India 89 14 355 318 874 5.63 (4.92-6.39) <.001 98.7
Indonesia 12 10 682 186 391 10.18 (8.71-11.76) <.001 98.0
Iran 79 169 562 460 7462 8.28 (7.83-8.75) <.001 99.6
Iraq 5 617 21 340 5.09 (2.86-7.91) <.001 98.4
Ireland 15 4289 65 512 5.78 (5.00-6.60) <.001 93.5
Israel 9 24 855 612 186 6.41 (4.82-8.22) <.001 99.8
Italy 55 30 477 282 659 8.49 (6.77-10.38) <.001 99.6
Jamaica 1 107 1061 10.08 (8.34-11.97) <.001 NA
Japan 14 3071 86 053 3.9 0(2.84-5.12) <.001 98.5
Jordan 12 1508 14 367 9.09 (6.49-12.08) <.001 97.1
Kazakhstan 2 241 6388 2.51 (0-9.86) <.001 99.4
Kenya 4 143 2826 5.48 (3.91-7.29) <.001 70.5
Kiribati 1 117 1582 7.40 (6.16-8.74) <.001 NA
Kuwait 11 4506 64 261 20.49 (11.68-31.01) <.001 99.8
Kyrgyzstan 1 161 5958 2.70 (2.31-3.13) <.001 NA
Laos 1 36 1644 2.19 (1.53-2.96) <.001 NA
Latvia 5 537 13 122 2.85 (0.32-7.59) <.001 99.2
Lebanon 7 1440 20 131 6.84 (5.32-8.52) <.001 92.2
Liberia 1 55 3259 1.69 (1.27-2.16) <.001 NA
Libya 4 1146 9251 10.22 (7.54-13.26) <.001 90.3
Lithuania 5 912 19 529 3.82 (0.90-8.66) <.001 99.5
Luxemburg 1 90 3904 2.31 (1.86-2.80) <.001 NA
Macedonia 4 508 11 931 5.86 (1.98-11.60) <.001 99.2
Malawi 2 298 7134 2.74 (0.01-9.72) <.001 99.3
Malaysia 20 14 446 126 080 10.90 (9.84-12.01) <.001 96.1
Mali 1 101 4591 2.20 (1.79-2.65) <.001 NA
Malta 5 970 6904 12.67 (9.28-16.51) <.001 94.7
Mauritania 1 69 2028 3.40 (2.65-4.24) <.001 NA
Mauritius 3 235 2996 6.87 (4.09-10.29) <.001 87.7
Mexico 37 11 205 69 829 16.56 (14.05-19.22) <.001 98.7
Mongolia 1 67 3707 1.81 (1.40-2.26) <.001 NA
Montenegro 3 583 6999 9.26 (4.09-16.22) <.001 98.3
Morocco 5 1241 14 974 7.78 (2.87-14.80) <.001 99.4
Mozambique 1 408 9721 4.20 (3.81-4.60) <.001 NA
Multiple countries 15 12178 210 258 6.36 (4.31-8.78) <.001 99.7
Namibia 2 79 3781 2.09 (1.65-2.57) <.001 0
Nepal 7 212 7945 3.36 (0.80-7.48) <.001 98.0
the Netherlands 25 7303 252 778 3.23 (2.38-4.19) <.001 99.2
New Zealand 10 36 378 226 167 15.33 (10.95-20.28) <.001 99.8
Niger 1 179 5123 3.49 (3.01-4.01) <.001 NA
Nigeria 13 1672 49 525 4.02 (2.67-5.62) <.001 98.0
Norway 18 1187 53 178 2.37 (2.06-2.70) <.001 78.2
Pakistan 12 1515 24 011 10.37 (7.89-13.15) <.001 96.8

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 Research Original Investigation Global Prevalence of Overweight and Obesity in Children and Adolescents

Table 1. Subgroup Analysis for Obesity Prevalence Among Children and Adolescents (continued)

Subgroup Studies, No. Events, No. Total, No. Prevalence (95% CI) P value I2, %
Palestine 8 488 7463 5.68 (3.19-8.82) <.001 96.2
Peru 4 35 815 2 341 760 6.25 (2.06-12.47) <.001 99.4
Philippines 1 173 6162 2.81 (2.41-3.24) <.001 NA
Poland 39 3675 94 598 4.32 (3.55-5.15) <.001 97.1
Portugal 38 9655 121 395 8.39 (7.22-9.64) <.001 98.2
Puerto Rico 4 1339 5211 28.35 (23.57-33.39) <.001 90.6
Qatar 3 700 11 824 9.13 (5.22-13.99) <.001 98.1
Republic of Marshall Islands 1 167 3271 5.11 (4.38-5.89) <.001 NA
Romania 10 6096 55 265 6.46 (3.56-10.15) <.001 99.6
Russia 5 358 19 758 2.28 (0.63-4.88) <.001 98.9
Rwanda 1 95 4116 2.31 (1.87-2.79) <.001 NA
Samoa 1 467 2418 19.31 (17.76-20.91) <.001 NA
San Marino 1 37 303 12.21 (8.75-16.15) <.001 NA
Saudi Arabia 29 9734 72 356 16.93 (13.7-20.42) <.001 99.3
Senegal 1 49 6062 0.81 (0.60-1.05) <.001 NANA
Serbia 10 2035 32 643 8.21 (6.18-10.49) <.001 97.7
Seychelles 4 1759 30 478 6.60 (3.51-10.52) <.001 98.3
Sierra Leone 1 446 4698 9.49 (8.67-10.35) <.001 NA
Singapore 3 649 9870 6.55 (6.07-7.05) <.001 0
Slovakia 2 55 5078 1.23 (0.44-2.39) <.001 87.6
Slovenia 11 2501 46 166 4.97 (3.78-6.32) <.001 97.4
Solomon Islands 1 38 1421 2.67 (1.89-3.58) <.001 NA
South Africa 24 2565 45 509 6.20 (4.49-8.16) <.001 98.3
South Korea 26 633 630 5 644 482 8.39 (7.68-9.14) <.001 99.8
Spain 54 392 129 2 821 506 9.28 (8.27-10.33) <.001 99.5
Sri Lanka 4 667 15 077 3.34 (1.53-5.80) <.001 94.7
Sudan 3 168 2344 7.11 (2.84-13.07) <.001 95.4
Suriname 1 167 1453 11.49 (9.9-13.19) <.001 NA
Sweden 33 12 744 1 131 530 3.18 (2.45-4.01) <.001 99.4
Switzerland 10 965 31 991 3.24 (2.08-4.64) <.001 97.5
Syria 3 1231 7292 10.99 (3.39-22.19) <.001 99.1
Taiwan 21 8752 70 568 12.05 (9.99-14.28) <.001 98.6
Tajikistan 1 42 2822 1.49 (1.07-1.97) <.001 NA
Tanzania 7 505 12 740 4.88 (3.35-6.67) <.001 92.8
Thailand 15 3775 42 954 9.80 (7.75-12.07) <.001 98.1
Togo 2 41 3862 1.26 (0.46-2.44) <.001 76.7
Tonga 3 998 4602 18.33 (12.1-25.52) <.001 96.8
Trinidad and Tobago 2 450 2699 13.05 (5.47-23.22) <.001 95.4
Tunisia 2 123 2138 5.75 (4.80-6.78) <.001 0
Turkey 55 10 879 152 633 6.97 (5.79-8.25) <.001 98.9
Turkmenistan 1 1055 9768 10.80 (10.19-11.42) <.001 NA
Uganda 1 55 4212 1.31 (0.98-1.67) <.001 NA
Ukraine 5 1406 40 633 2.56 (1.11-4.57) <.001 99.0
United Arab Emirates 7 5422 31 845 15.62 (13.86-17.45) <.001 82.1
United Kingdom 53 163 750 1 294 718 7.63 (6.40-8.95) <.001 99.6
US 262 1 849 465 10, 411 152 18.57 (18.03-19.12) <.001 99.8
Vanuatu 1 4 1119 0.36 (0.08-0.81) <.001 NA
Vietnam 13 2617 30 800 6.91 (3.85-10.77) <.001 99.2
Yemen 1 975 10 924 8.93 (8.40-9.47) <.001 NA
Zambia 1 397 11 677 3.40 (3.08-3.74) <.001 NA
Zimbabwe 2 207 5379 5.05 (1.44-10.64) <.001 97.3

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 Global Prevalence of Overweight and Obesity in Children and Adolescents Original Investigation Research

Table 1. Subgroup Analysis for Obesity Prevalence Among Children and Adolescents (continued)

Subgroup Studies, No. Events, No. Total, No. Prevalence (95% CI) P value I2, %
Geographic region
Southern Europe 248 474 682 3 770 379 8.42 (7.84-9.01) <.001 99.6
Northern Africa 27 4405 48 389 9.22 (7.32-11.3) <.001 98.2
South America 133 76 759 2 914 148 9.38 (8.24-10.59) <.001 99.8
Australia and New Zealand 67 50 483 446 308 6.99 (5.74-8.36) <.001 99.6
Western Europe 124 24 042 687 349 3.79 (3.38-4.22) <.001 98.7
Caribbean 10 2506 12 737 19.22 (15.1-23.7) <.001 97.3
Western Asia 152 62 734 1 040 310 9.94 (9.03-10.88) <.001 99.5
Southern Asia 125 18 163 391 407 5.79 (5.17-6.45) <.001 98.6
Western Africa 43 3781 122 523 3.95 (3.13-4.87) <.001 98.2
Southern Africa 27 2679 49 997 5.76 (4.24-7.50) <.001 98.2
South-Eastern Asia 146 202 279 5 014 818 8.71 (8.26-9.17) <.001 99.6
Eastern Europe 85 17 337 322 033 4.58 (3.75-5.50) <.001 99.3
Eastern Africa 34 4384 105 992 4.12 (3.30-5.04) <.001 97.9
Middle Africa 10 749 29 789 2.36 (1.83-2.96) <.001 89.1
Northern America 311 2 229 847 13 891 644 17.17 (16.59-17.75) <.001 99.9
Eastern Asia 221 1 069 659 12 048 498 7.78 (7.24-8.32) <.001 99.9
Central America 41 70 603 532 103 15.85 (14.23-17.55) <.001 99.3
Northern Europe 157 186 930 2 701 852 4.55 (3.57-5.63) <.001 99.9
Melanesia 5 726 14 797 3.79 (1.84-6.40) <.001 97.5
Polynesia 5 1885 8922 19.45 (16.06-23.07) <.001 94.2
Central Asia 12 2004 37 676 4.28 (2.46-6.58) <.001 98.9
Micronesia 10 772 12 316 5.80 (3.95-7.98) <.001 95.4
Not applicable 15 12 178 210 258 6.36 (4.31-8.78) <.001 99.7
HDI
<0.8 1047 871 742 17 166 470 7.56 (7.28-7.85) <.001 99.8
≥0.8 946 3 635 667 27 037 517 9.50 (9.19-9.82) <.001 99.9
Not applicable 15 12 178 210 258 6.36 (4.31-8.78) <.001 99.7
Country or region income
High income 1129 3 692 176 28 815 921 9.29 (8.95-9.64) <.001 99.9
Upper-middle income 495 588 196 9 709 961 8.50 (8.02-8.99) <.001 99.9
Lower-middle income 333 221 821 5 562 640 6.35 (6.09-6.62) <.001 99.2
Low income 36 5216 115 465 3.60 (2.54-4.83) <.001 99.1
Not applicable 15 12 178 210 258 6.36 (4.31-8.78) <.001 99.7
Race and ethnicitya
Asian 23 9414 91 834 9.97 (8.73-11.29) <.001 91.6
Black 53 21 917 129 800 16.64 (14.06-19.39) <.001 99.2
Hispanic 35 250 747 1 141 081 23.55 (20.66-26.56) <.001 99.9
White 66 61 705 505 895 12.28 (11.19-13.42) <.001 98.8
Sample source
Database 681 3 079 529 27 464 011 7.40 (7.01-7.79) <.001 99.9
School 1026 1 073 740 8 985 888 8.66 (8.23-9.10) <.001 99.8
Community 192 233 742 6 721 847 8.90 (8.32-9.50) <.001 99.8
Medical institution 109 132 576 1 242 499 13.59 (12.18-15.05) <.001 99.8
Study design
Cross-sectional 1855 3 797 742 38 296 246 8.38 (8.10-8.67) .004 99.9
Longitudinal 44 492 403 3 216 207 9.70 (8.15-11.36) .004 99.9
Cohort 86 64 556 1 618 514 9.53 (7.82-11.40) .004 99.9
Randomized clinical trial 12 2161 16 279 10.99 (8.06-14.30) .004 97.3
Prospective 10 162 687 1 266 740 9.98 (5.27-15.96) .004 99.9
Case-control 1 38 259 14.67 (10.61-19.26) .004 NA

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 Research Original Investigation Global Prevalence of Overweight and Obesity in Children and Adolescents

Table 1. Subgroup Analysis for Obesity Prevalence Among Children and Adolescents (continued)

Subgroup Studies, No. Events, No. Total, No. Prevalence (95% CI) P value I2, %
Diagnostic reference
WHO 466 730 348 8 703 325 8.59 (7.94-9.26) <.001 99.9
IOTF 807 661 187 8 215 613 5.41 (5.11-5.73) <.001 99.7
CDC 453 1 877 278 14 592 246 14.46 (13.63-15.32) <.001 100.0
National reference 282 1 250 774 12 903 061 9.67 (9.02-10.33) <.001 99.9
Sample size
≤5000 1558 195 777 2 356 611 8.74 (8.41-9.07) <.001 98.8
>5000 450 4 323 810 42 057 634 7.67 (7.12-8.23) <.001 100.0
Study period
2000-2011 1232 1 318 508 21 086 914 7.05 (6.80-7.32) <.001 99.8
2012-2023 681 211 0031 15 956 095 11.31 (10.81-11.81) <.001 99.9
a
Abbreviations: CDC, US Centers for Disease Control and Prevention; Race and ethnicity data were collected via in accordance with the data sources
HDI, Human Development Index; IOTF, International Obesity Task Force; and reported for comprehensive assessment.
NA, not applicable; WHO, World Health Organization.

health-conscious lifestyle choices, the similar prevalence in a risk factor for childhood obesity, our findings revealed
Middle Africa, Melanesia, and Western Africa were mainly otherwise.27,28 Furthermore, our results revealed low birth-
due to their poverty. Furthermore, current findings revealed weight was associated with lowest prevalence of obesity. How-
that pediatric obesity prevalence was closely linked to coun- ever, Yuan et al29 claimed that children weighing less than 1500
try development and national or regional income, which is in g were most likely to be centrally obese. This mismatch may
line with prior research.20 Notably, even among nations in be due to the fact that we used BMI to quantify general obe-
similar economic strata, there are differences in the esti- sity, whereas central obesity is measured by sex-specific waist
mates of prevalence. For example, the prevalence of pediat- to height ratio. Additionally, different infant feeding strate-
ric obesity in the US is 18.6%, while that in Japan, another gies, such as breastfeeding duration and formula addition, ex-
high-income country, is 3.9%. Differences in dietary habits may hibit varying effects on childhood obesity in several
play a role in this disparity. European countries and the meta-analyses.30-32 Nevertheless, our findings showed no
US often embrace a diet preference of processed food, which discernible impact from these parameters.
are typically abundant in unhealthy fats, added sugars, and re- The rise in prevalence of obesity has been profoundly in-
fined carbohydrates. In contrast, diets rich in whole grains and fluenced by environmental and behavioral factors,33 includ-
vegetables, which are generally regarded as healthier op- ing dietary patterns,34,35 physical activity level,36 and use of
tions, have historically been prioritized in Southeast Asian technology.37 The current study revealed that skipping break-
countries. fast was associated with an increased risk of pediatric obe-
Prevalence of obesity in children and adolescents shows sity, which was consistent with previous research.38 Surpris-
disparities across different ages. Our results revealed a lower ingly, having more than 3 meals per day was associated with
prevalence of obesity in adolescents than that of preschool a lower risk of being obese, which might be explained by the
and school-age children, which is largely in accordance with theory that having several small meals throughout a day is
prior studies.20 This decline in obesity prevalence could be healthier than 3 large ones.39,40 As previously noted, chil-
mainly attributed to the hormone shifts as boys and girls dren with obesity tend to participate in less physical activity
approach puberty.21 Besides, teenagers tend to be more con- than their peers without obesity,36 and decreasing levels of ex-
scious about their appearance, thus making more effort ercise as well as increasing sedentary behaviors contribute to
toward weight control. Furthermore, heavier pressure from obesity development. Our findings also showed that children
middle and high school could partly contribute to weight with regular exercise had a much lower chance of obesity. More-
loss in adolescents. over, we observed that playing on the computer for more than
Early life is a pivotal period for childhood obesity 2 hours a day was associated with an increase in risk of excess
development.22 Prior analyses have linked preconception and weight, and time spent watching TV also showed a positive cor-
prenatal environmental exposures to childhood obesity, in- relation, yet not significant. A connection between screen time
cluding high maternal prepregnancy BMI,23 gestational weight and obesity in the pediatric population was initially demon-
gain,24 gestational diabetes,25 and maternal smoking,26 po- strated in studies of TV viewing,41,42 while mobile and gam-
tentially through effects on the environment in uterus. The cur- ing devices are gaining more and more attention.43,44 Screen
rent study determined maternal obesity and smoking in preg- exposure may raise the risk of obesity via increased exposure
nancy as risk factors for childhood and adolescent obesity, to food marketing, increased mindless eating while watching
while maternal diabetes, gastrointestinal diabetes and gesta- screens, displacement of time spent in physical activities,
tional weight gain exhibited positive yet modest impact on it. reinforcement of sedentary behaviors, and reduced sleep
Although prior studies considered paternal obesity to be duration.

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 Global Prevalence of Overweight and Obesity in Children and Adolescents Original Investigation Research

Table 2. Analysis of Risk Factors Associated With Obesity in Children and Adolescents

Risk factor Studies, No. Events, No. Total, No. Prevalence (95% CI) P value I2, %
Age, y
0-5 246 524 593 7 839 060 8.46 (7.64-9.32) 99.9
6-12 816 931 446 8 322 894 9.36 (8.88-9.85) <.001 99.8
13-18 515 10,22 690 10 787 040 6.92 (6.51-7.34) 99.8
Sex
Male 1070 955 224 9 909 202 9.38 (8.95-9.81) 99.8
<.001
Female 1093 616 419 9 365 604 7.50 (7.17-7.83) 99.8
Residential location
Rural 74 39 680 1 388 709 6.25 (5.12-7.48) 99.8
Urban 83 1 146 682 3 005 017 8.12 (6.75-9.60) .14 99.9
Suburban 14 9979 152 193 7.94 (4.72-11.90) 99.8
School type
Public 42 5583 121 865 6.53 (4.94-8.32) 99.0
<.001
Private 40 4622 84 325 11.63 (9.64-13.78) 98.5
Paternal weight status
Obesity 13 1677 8378 12.22 (6.94-18.69) 98.4
.11
Nonobesity 13 3241 32 375 7.06 (3.97-10.93) 99.3
Maternal weight status
Obesity 26 3362 22 637 15.92 (12.24-19.97) 98.2
.001
Nonobesity 26 14 385 146 859 8.06 (5.38-11.23) 99.7
Maternal diabetes
With diabetes 6 233 7351 13.29 (3.80-26.87) 96.1
.32
Without diabetes 6 7503 945 998 7.52 (2.48-14.93) 99.7
Gestational diabetes
With gestational diabetes 5 411 2004 17.83 (9.89-27.44) 95.1
.43
Without gestational diabetes 5 3612 19 981 13.83 (8.32-20.45) 99.1
Paternal diabetes
With diabetes 2 254 13 044 11.43 (0-49.08) 98.8
.73
Without diabetes 2 6800 931 876 6.20 (0-30.41) 99.3
Maternal education
Less than secondary 30 2098 22 838 8.81 (6.12-11.87) 97.4
Secondary 29 6942 49 769 9.83 (7.79-12.06) .63 97.4
Tertiary 33 7916 47 855 11.60 (9.04-14.43) 98.6
Paternal education
Less than secondary 22 941 13 490 6.78 (4.83-9.01) 92.7
Secondary 21 1204 16 386 8.73 (6.71-10.98) .52 93.4
Tertiary 20 1495 28 047 8.27 (5.66-11.32) 97.8
Mother occupation
Employed 20 5601 44 643 9.80 (6.99-13.02) 98.3
.79
Unemployed 20 2537 26 267 8.32 (5.16-12.05) 98.6
Father occupation
Employed 7 882 18 430 6.50 (3.67-10.05) 98.1
.85
Unemployed 7 71 1069 5.42 (1.87-10.42) 85.7
Parental marriage status
Married or cohabiting 4 4050 580 120 2.43 (1.28-3.92) 99.1
Never married, widowed, or 4 3328 391 895 1.35 (0.17-3.22) .92 92.1
divorced
Caregivers
Parents 2 58 662 10.09 (4.79-16.98) 67.1
.79
Grandparents 2 35 217 6.80 (0-35.40) 93.7
No. of children in the family
1 12 2525 14 718 10.32 (5.50-16.39) 98.9
.28
>1 12 3292 38 658 6.88 (3.78-10.78) 99.4

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 Research Original Investigation Global Prevalence of Overweight and Obesity in Children and Adolescents

Table 2. Analysis of Risk Factors Associated With Obesity in Children and Adolescents (continued)

Risk factor Studies, No. Events, No. Total, No. Prevalence (95% CI) P value I2, %
Birth order
First born 7 923 24 389 5.28 (2.63-8.77) 98.9
.63
Not first born 7 924 29 578 4.41 (2.60-6.66) 98.1
Socioeconomic status of family
Low 33 4691 96 335 6.91 (5.15-8.90) 98.4
Middle 30 5498 114 863 7.96 (6.52-9.53) .71 98.0
High 30 5510 109 564 7.56 (6.13-9.12) 96.6
Way of going to school
Walk 12 399 6295 6.40 (3.98-9.31) 93.9
Bike 4 48 832 5.94 (2.92-9.87) .16 74.1
Car 9 335 3014 11.29 (6.66-16.92) 94.5
Breakfast
Daily 24 3902 54 224 7.08 (5.20-9.23) 98.7
.03
Usually skipped 24 1332 14 133 9.96 (7.94-12.16) 92.6
No. of meals per day
>3 4 75 2870 3.26 (1.32-5.97) 88.3
.008
≤3 5 169 1823 11.64 (5.77-19.16) 94.6
Watching TV while eating
Usually 6 364 1640 28.17 (5.37-59.71) 99.3
.56
Never 6 162 1819 18.29 (4.48-38.35) 98.5
Hours of watching TV per d
≥2 h 19 5970 42 021 18.61 (13.58-24.23) 99.3
.06
<2 h 19 10 419 87 570 12.57 (9.16-16.44) 98.9
Hours of playing on the computer
per d
≥2 h 3 593 4466 11.88 (8.20-16.12) 89.9
.01
<2 h 3 1025 13 258 5.48 (2.94-8.73) 96.6
Passive smoking
Exposed 8 3431 30 454 9.68 (6.02-14.09) 98.5
.27
Not exposed 8 3902 70 516 6.50 (3.11-11.01) 99.7
Maternal smoking in pregnancy
Smoking 22 855 11 101 7.66 (5.75-9.80) 92.5
.006
Never 22 3297 66 990 4.70 (3.50-6.07) 98.3
Gestational weight gain
Inadequate 4 807 6561 11.09 (6.49-16.70) 96.3
Adequate 4 2538 17 038 11.19 (6.21-17.37) .63 98.5
Excessive 4 5553 31 198 15.85 (7.75-26.12) 99.6
Maternal age at birth, y
≥25 7 1294 37 181 5.75 (2.90-9.47) 99.0
.37
<25 7 1077 16 680 7.95 (4.73-11.90) 98.3
Term of delivery
Premature 14 4025 25 546 10.92 (8.45-13.66) 95.4
.65
Full term 14 38 255 260 305 10.32 (8.09-12.77) 99.6
Type of delivery
Cesarean 14 1451 17 265 9.94 (7.51-12.67) 96.3
.29
Vaginal 14 1714 21 852 8.35 (6.79-10.05) 94.1
Birth weight
Low (≤2499 g) 17 1958 18 413 6.22 (4.26-8.50) 95.8
Normal (2500-4000 g) 17 37 096 251 645 9.16 (7.14-11.40) .005 99.6
High (≥4001 g) 15 5345 24 954 12.82 (9.56-16.46) 97.6
Duration of breastfeeding
≥3 mo 10 2553 21 255 8.51 (5.00-12.82) 98.9
.68
<3 mo 7 1768 18 803 9.37 (8.26-10.55) 79.5

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 Global Prevalence of Overweight and Obesity in Children and Adolescents Original Investigation Research

Table 2. Analysis of Risk Factors Associated With Obesity in Children and Adolescents (continued)

Risk factor Studies, No. Events, No. Total, No. Prevalence (95% CI) P value I2, %
Breastfeeding amount
None (full formula) 12 5113 38 862 10.45 (7.25-14.13) 99.0
Mixed 8 9030 83 335 10.07 (6.95-13.67) .29 99.5
Full (no formula) 8 2521 31 312 7.88 (6.05-9.93) 96.3
Antibiotic exposure
Exposed 6 29 079 218 911 8.66 (5.15-12.96) 99.1
.84
Not exposed 6 20 079 160 943 7.51 (2.38-14.94) 99.6
Physical activity
Regular exercise 21 3118 32 947 7.65 (5.65-9.92) 97.7
.006
No regular exercise 21 2742 24 289 12.08 (9.88-14.48) 96.3
Nightly sleep duration
<10 h 14 4217 28 615 13.68 (8.99-19.15) 99.2
.03
≥10 h 10 1404 16 849 7.23 (4.42-10.66) 98.2

Table 3. Analysis of Comorbidities for Obesity in Children and Adolescents

Comorbidity Studies, No. Events, No. Total, No. Prevalence (95% CI) I2, %
Hypertension 26 5583 195,22 28.02 (20.16-36.61) 99.2
Dental caries 13 36 472 531 470 17.88 (12.61-23.83) 99.8
Vitamin D deficiency 8 705 4546 11.63 (5.36-19.86) 98.3
Asthma 7 844 7696 18.84 (12.46-26.16) 97.7
Diabetes 3 62 5916 1.23 (0.23-2.98) 95.1
Flatfoot 3 69 354 26.08 (6.69-52.19) 95.8
Anxiety 2 316 1173 25.08 (0-94.18) 99.9
Depression 2 379 1166 35.24 (0.44-86.90) 99.7

Figure 2. Global Prevalence of Excess Weight in Children and Adolescents

Prevalence

2.11% 53.65%

All body systems can be affected by obesity in the short 26.1 times higher likelihood of developing fatty liver disease
or long term, depending upon age and obesity severity. Plenty compared to those who are of a healthy weight.52 Likewise, our
of previous studies have discussed potential comorbidities of research disclosed high prevalence of comorbidities in chil-
multiple system related to childhood obesity.45-51 According dren and adolescents with obesity. The highest pooled preva-
to a systematic analysis, children and adolescents with obe- lence was found in depression, which approximately 1 in 3 chil-
sity have a 1.4 times higher likelihood of developing predia- dren with obesity might experience, followed by hypertension,
betes, 1.7 times higher likelihood of developing asthma, 4.4 with a pooled prevalence of 28.0%. Compared to previously
times higher likelihood of developing high blood pressure, and reported incidence in general population, which is approxi-

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 Research Original Investigation Global Prevalence of Overweight and Obesity in Children and Adolescents

mately 25% for depression53 and 4% for hypertension,54 chil- in less detailed information of the time trajectory of prevalence
dren and adolescents with obesity seemed to be more vulner- for childhood and adolescent obesity.
able to those health condition. The association between obesity
and mentioned comorbidities had been shown to be
bidirectional.55,56 In the management of childhood and ado-
lescent obesity, it is pivotal that comorbidities are assessed
Conclusions
and treated alongside to prevent progression of both. In conclusion, the current study provided new epidemiologi-
cal insights of overweight and obesity among children and ado-
Limitations lescents worldwide. Our findings indicated high prevalence of
There are some limitations in the present research. To our knowl- overweight and obesity in children and adolescent with a
edge, this is the most comprehensive study to date, covering all pooled estimation of 8.5% and 14.8%, meaning approxi-
geographic regions, but some countries and regions had limited mately 1 of every 5 children or adolescents experience excess
data, making it challenging to accurately estimate. Besides, dif- weight. Various risk factors, including inherent, dietary, and
ferent criteria for recognizing overweight and obesity in children environmental factors, were significantly associated with the
may influence the accuracy of the estimation. Moreover, limited prevalence of pediatric obesity. It is noteworthy that children
studies concerning comorbidities were included in our analysis, and adolescents with obesity were at high risk of mental
since we focused on the epidemiology in the literature search pro- and physical comorbidities. Global coordinated action and na-
cess. Additionally, we simply divided the study period into 2 cat- tional control program are paramount to comprehend, pre-
egories, namely 2000 to 2011 and 2012 to 2023, which resulted vent, and manage childr and adolescent obesity.

ARTICLE INFORMATION intellectual content: All authors. 4. Hong Y, Ullah R, Wang JB, Fu JF. Trends of
Statistical analysis: X. Zhang, J. Liu, Ni, Yi, Fang, K. obesity and overweight among children and
Accepted for Publication: April 17, 2024.
Li, Yong Liu. adolescents in China. World J Pediatr. 2023;19(12):
Published Online: June 10, 2024. Obtained funding: J. Liu, K. Li, Yong Liu, Z. Li. 1115-1126. doi:10.1007/s12519-023-00709-7
doi:10.1001/jamapediatrics.2024.1576 Administrative, technical, or material support: X. 5. Afshin A, Forouzanfar MH, Reitsma MB, et al;
Open Access: This is an open access article Zhang, J. Liu, Ni, Yi, Fang, Huang, Z. Li. GBD 2015 Obesity Collaborators. Health effects of
distributed under the terms of the CC-BY License. Supervision: K. Li, Yong Liu, Huang, Z. Li. overweight and obesity in 195 countries over 25
© 2024 Zhang X et al. JAMA Pediatrics. Conflict of Interest Disclosures: None reported. years. N Engl J Med. 2017;377(1):13-27. doi:10.1056/
NEJMoa1614362
Author Affiliations: Division of Thyroid Surgery, Funding/Support: This research is supported by the
Department of General Surgery, Laboratory of 6. World Obesity. Global atlas on childhood obesity.
fellowship of China Postdoctoral Science Foundation
Thyroid and Parathyroid Diseases, Frontiers Science AccessedMay10,2024.https://www.worldobesity.org/
(2021M702340), the Science and Technology
Center for Disease-Related Molecular Network, membersarea/global-atlas-on-childhood-obesity
Department of Sichuan Province (2021ZYCD016 and
West China Hospital, Sichuan University, Chengdu, 2022NSFSC1441), a postdoctoral research grant of 7. Ling J, Chen S, Zahry NR, Kao TA. Economic
China (X. Zhang, J. Liu, Yi, Fang, Ning, Shen, SichuanUniversity(2023SCU12047),the1.3.5projectfor burden of childhood overweight and obesity:
K. Zhang, Z. Li); Department of Nuclear Medicine, a systematic review and meta-analysis. Obes Rev.
disciplines of excellence, West China Hospital, Sichuan
West China Hospital, Sichuan University, Chengdu, 2023;24(2):e13535. doi:10.1111/obr.13535
University (2016105 and ZYGD20006), the National
China (X. Zhang, Huang); Department of Nature Science Foundation of China (NSFC82303674), 8. Janssen I, Katzmarzyk PT, Boyce WF, et al;
Respiratory and Critical Care Medicine, Frontiers “From 0 to 1” Innovative Research Project Health Behaviour in School-Aged Children Obesity
Science Center for Disease-related Molecular (2023SCUH0038), and the Sichuan Science and Working Group. Comparison of overweight and
Network, Center of Precision Medicine, Precision Technology Program (2023YFS0123). obesity prevalence in school-aged youth from 34
Medicine Key Laboratory of Sichuan Province, West countries and their relationships with physical
China Hospital, Sichuan University, Chengdu, China Role of the Funder/Sponsor: The funders had no activity and dietary patterns. Obes Rev. 2005;6(2):
(X. Zhang, J. Liu, Ni, Yi, Fang, Ning, Shen, K. Zhang, role in the design and conduct of the study; 123-132. doi:10.1111/j.1467-789X.2005.00176.x
Z. Li); Frontiers Medical Center, Tianfu Jincheng collection, management, analysis, and
9. Safaei M, Sundararajan EA, Driss M, Boulila W,
Laboratory, Sichuan University, Chengdu, China interpretation of the data; preparation, review, or Shapi’i A. A systematic literature review on obesity:
(J. Liu); Department of Obstetrics and Gynecology, approval of the manuscript; and decision to submit Understanding the causes & consequences of
The Second Affiliated Hospital, Chongqing Medical the manuscript for publication. obesity and reviewing various machine learning
University, Chongqing, China (Yang Liu); Data Sharing Statement: See Supplement 2. approaches used to predict obesity. Comput Biol Med.
Department of Gynecology, The First Affiliated 2021;136:104754. doi:10.1016/j.compbiomed.2021.
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 Global Prevalence of Overweight and Obesity in Children and Adolescents Original Investigation Research

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