Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, Georgia 30322; email:
Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322; email:
Annu Rev Public Health. 2017 Mar 20;38:145-164. doi: 10.1146/annurev-publhealth-031816-044604. Epub 2016 Dec 23.
We have reviewed the distinctive features of excess weight, its causes, and related prevention and management efforts, as well as data gaps and recommendations for future research in low- and middle-income countries (LMICs). Obesity is rising in every region of the world, and no country has been successful at reversing the epidemic once it has begun. In LMICs, overweight is higher in women compared with men, in urban compared with rural settings, and in older compared with younger individuals; however, the urban-rural overweight differential is shrinking in many countries. Overweight occurs alongside persistent burdens of underweight in LMICs, especially in young women. Changes in the global diet and physical activity are among the hypothesized leading contributors to obesity. Emerging risk factors include environmental contaminants, chronic psychosocial stress, neuroendocrine dysregulation, and genetic/epigenetic mechanisms. Data on effective strategies to prevent the onset of obesity in LMICs or elsewhere are limited. Expanding the research in this area is a key priority and has important possibilities for reverse innovation that may also inform interventions in high-income countries.
我们已经回顾了超重的显著特征、其成因以及相关的预防和管理工作，同时还审查了低收入和中等收入国家（LMICs）的数据差距和未来研究建议。超重问题在世界各个地区都呈上升趋势，而且一旦肥胖流行起来，就没有哪个国家能够成功扭转这一局面。在 LMICs 中，超重问题在女性中比男性更严重，在城市地区比农村地区更严重，在老年人中比年轻人更严重；然而，在许多国家，城乡超重差异正在缩小。超重问题与 LMICs 中持续存在的体重过轻问题并存，尤其是在年轻女性中。全球饮食和身体活动的变化被认为是导致肥胖的主要因素之一。新出现的风险因素包括环境污染物、慢性心理社会压力、神经内分泌失调和遗传/表观遗传机制。关于在 LMICs 或其他地方预防肥胖发生的有效策略的数据有限。扩大这一领域的研究是一个关键优先事项，具有反向创新的重要可能性，这也可能为高收入国家的干预措施提供信息。
