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. 2013 Jun 27;2013:392747. doi: 10.1155/2013/392747

Prevalence of Overweight and Obesity in Adolescents: A Systematic Review

Maria del Mar Bibiloni 1,2, Antoni Pons 1,2, Josep A Tur 1,2,*
PMCID: PMC3901970  PMID: 24555142

Abstract

Objective. To review the extant literature on the prevalence of overweight and obesity in adolescents (10–19 years old) of both sexes. Design. The search was carried out using Medline and Scopus considering articles published from the establishment of the databanks until June 7, 2012. Data on the prevalence of children being overweight and obese from the International Obesity Task Force (IOTF) website was also reviewed. Only original articles and one National Health Report were considered. Forty studies met the inclusion criteria. Results. Twenty-five of these studies were nationally representative, and ten countries were represented only by regional data. Conclusions. The prevalence of overweight and obesity among adolescents worldwide is high, and obesity is higher among boys. The IOTF criterion is the most frequently used method to classify adolescents as overweighed or obese in public health research.

1. Introduction

The prevalence of overweight and obesity among children and adolescents has widely increased worldwide [1, 2], making it one of the most common chronic disorders in this age group and in adulthood.

The use of body mass index (BMI) for age to define being overweight and obese in children and adolescents is well established for both clinical and public health applications, because of their feasibility under clinical settings and in epidemiological studies [3, 4]. In children and adolescents, the natural increases in BMI that occur with age necessitate the use of age-sex-specific thresholds. The most widely used growth charts are the Centers for Disease Control and Prevention (CDC-2000) [5], the International Task Force (IOTF) [6], and the 2007 growth references for 5 to 19 year olds produced by the World Health Organization (WHO-2007) [7].

The CDC-2000 growth charts were developed to evaluate the nutritional status of US children and were originated from five cross-sectional representative surveys carried out in the US between 1963 and 1994. These growth charts are routinely applied to identify children and adolescents with a BMI greater than the 85th or 95th percentiles following the advice of the US Expert Committee on Childhood Obesity [8]. However, the appropriateness of an American dataset for defining overweight in young people from other countries is questionable [9].

The IOTF reference also uses age-sex-specific BMI percentiles, and overweight and obesity definition corresponds to an adult BMI of 25 and 30 kg/m2, respectively, and reflects values in children tracking to overweight and obesity in adults [6]. This reference is based on six large international cross-sectional representative datasets, identifying the BMI values that extrapolate to childhood.

The WHO-2007 growth references were created to replace the National Center for Health Statistics (NCHS) references [10, 11]. This reference was constructed using data from the 1977 NCHS/WHO growth reference (1 to 24 years old) merged with data from the 2006 WHO Child Growth Standards for preschool children (under 5 years of age) using state-of-the-art statistical methods [7].

Although valuable information has been appearing in the literature or online, such as works from the Health Behaviour of School-aged Children study which is mainly related to social determinants of health and well-being among young people [12], no systematic review has been conducted to understand the worldwide magnitude of the overweight and obesity problem among the adolescent population. Thus, the objective of this study was to systematically review the literature regarding the prevalence of overweight and obesity in adolescents (10–19 years old) of both sexes published in the past 12 academic years (1999–2011).

2. Methods

A systematic literature search was performed which ended on June 7, 2012 (see Figure 1). The literature search was conducted in Medline and Scopus using the following MeSH terms: “overweight”; “obesity”; “prevalence”; “adolescent”. In total, 2537 articles were selected. We also reviewed the data on the prevalence of childhood overweight and obesity on the International Obesity Task Force Website at http://www.iaso.org/iotf/. To find the articles included in this review, the following inclusion criteria were used: (1) cross-sectional studies conducted in the last 12 years (1999–2011)—when the original study did not report the survey year, it was not included; (2) national and regional representative samples, but articles published on the prevalence of overweight in towns, urban, or rural areas in a country were excluded; (3) weight and height objectively measured; (4) results presented by sex; (5) and for both overweight and obesity prevalence; (6) the definition of overweight and obesity using the (i) CDC-2000 [5], (ii) IOTF [6], and (iii) WHO-2007 [7] growth references; and (7) studies written in English, Spanish, Italian, or Portuguese. Moreover, if there were more than one national or regional study in the same country, the most recent one was included in the prevalence tables (except for USA [13] and Canada [14], countries in which the most recent data was not included in the tables due to differences in the representativeness of the samples [13] and the impossibility to calculate a single prevalence of overweight and obesity for adolescents' boys and girls [14]; however, no differences in prevalence were observed between studies as it has been indicated in the discussion). The final number of articles included in this review was 39 articles related to overweight and obesity and also a study on the latest statistics on the prevalence of overweight and obesity in South Africa [15].

Figure 1.

Figure 1

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Flow diagram of study selection.

Potentially relevant papers were selected by (1) screening the titles; (2) screening the abstracts, and (3) if abstracts were not available or did not provide sufficient data, the entire article was retrieved and screened to determine whether it met the inclusion criteria. Full-text articles were assessed by 2 authors (M. M. Bibiloni and J. A. Tur). Any matter of doubt was discussed by at least two of the reviewers (M. M. Bibiloni, A. Pons, and J. A. Tur).

3. Results

3.1. Literature Search

A total of thirty-nine articles and a National Health Report were eligible according to the inclusion criteria established for this review. Table 1 presents a description of the forty studies selected for this review including the continent and the country where it was performed (and region for not national studies), year of publishing, total number of participants in the study, number of adolescents, age range, proportion of girls, and number and definition for overweight and obesity classification used. All the articles were published after the year of 2002. Nationally representative data were obtained in twenty-five countries (including Northern Ireland) [15–39], and ten countries were represented only by regional data [40, 42, 44, 45, 47, 50–54].

Table 1.

Descriptive analysis of the studies reviewed.

Area Continent Country, region Date of survey Total n of study1 Total n of adolescents1 Age (years)/school grade Proportion of girls Number of definition Definition Reference
National Africa Seychelles 2004 4,854 2,177 7th, 10th 51.5% 1 IOTF Bovet et al., 2006 [16]
South Africa 2008 9,862 9,862 13–19 50.9% 1 IOTF Reddy et al., 2010 [15]
Tunisia 2004 2,872 2,872 15–19 54.9% 1 IOTF Aounallah-Skhiri et al., 2008 [17]
America Canada 2004 8,661 4,099 12–17 — 3 IOTF, CDC, WHO Shields and Tremblay, 2010 [18]
Mexico 2006 48,304 13,219 12–18 50.7% 1 IOTF Bonvecchio et al., 2009 [19]
USA 2007 44,101 44,101 10–17 — 1 CDC Singh et al., 2010 [20]
Asia Bahrain 2000 506 506 12–17 50.8% 1 IOTF Al-Sendi et al., 2003 [21]
China 2002 44,880 12,475 13–17 47.7% 1 IOTF Li et al., 2008 [22]
Iran 2003-04 21,111 16,035 10–18 51.3% 2 IOTF, CDC Kelishadi et al., 2008 [23]
Israel 2003-04 5,588 5,588 11–19 55.1% 1 CDC Nitzan Kaluski et al., 2009 [24]
Jordan 2009 5,640 637 13–18 55.7% 1 IOTF Khader et al., 2011 [25]
Qatar 2003-04 3,923 3,923 12–17 49.8% 1 IOTF Bener, 2006 [26]
Saudi Arabia 2005 19,317 7,251 13–18 49.2% 2 CDC, WHO El Mouzan et al., 2010 [27]
Taiwan 2003 72,789 58,424 10–18 49.0% 1 IOTF Liou et al., 2009 [28]
United Arab Emirates 2009-10 1,007 276 11–18 — 1 IOTF Ng et al., 2011 [29]
Europe Cyprus 1999-2000 2,467 1,694 10–17 50.7% 1 IOTF Savva et al., 2002 [30]
Czech Republic 2005 1,417 957 11–17 49.4% 1 IOTF Kunesova et al., 2007 [31]
Germany 2008 40,622 5,623 12–16 46.7% 1 IOTF Blüher et al., 2011 [32]
Greece 2003 14,456 14,456 13–19 53.8% 1 IOTF Tzotzas et al., 2008 [33]
Italy 2002 4,386 4,386 11, 13, 15 51.6% 1 IOTF Vieno et al., 2005 [34]
Republic of Ireland 2003 17,499 7,294 11–16 50.6% 1 IOTF Whelton et al., 2007 [35]
Northern Ireland 2003 2,039 964 11–15 51.5% 1 IOTF Whelton et al., 2007 [35]
Portugal 2008 22,048 22,048 10–18 51.5% 2 IOTF, WHO Sardinha et al., 2011 [36]
Sweden 2001 1,732 1,732 10, 13, 16 48.3% 1 IOTF Ekblom et al., 2004 [37]
Oceania Australia 2004 5,407 1,771 8th, 10th 45.6% 1 IOTF Booth et al., 2007 [38]
New Zealand 2007 8,796 8,796 13–17 45.4% 2 IOTF, WHO Utter et al., 2010 [39]
Regional Africa South Africa, Eastern Cape 2008 926 926 13–19 52.1% 1 IOTF Reddy et al., 2010 [15]
South Africa, Free State 2008 1,236 1,236 13–19 49.1% 1 IOTF Reddy et al., 2010 [15]
South Africa, Gauteng 2008 931 931 13–19 52.1% 1 IOTF Reddy et al., 2010 [15]
South Africa, KwaZulu-Natal 2008 910 910 13–19 52.1% 1 IOTF Reddy et al., 2010 [15]
South Africa, Limpopo 2008 1,140 1,140 13–19 50.5% 1 IOTF Reddy et al., 2010 [15]
South Africa, Mpumalanga 2008 1,238 1,238 13–19 49.8% 1 IOTF Reddy et al., 2010 [15]
South Africa, Northern Cape 2008 1,088 1,088 13–19 48.6% 1 IOTF Reddy et al., 2010 [15]
South Africa, North West 2008 1,234 1,234 13–19 48.6% 1 IOTF Reddy et al., 2010 [15]
South Africa, Western Cape 2008 1,159 1,159 13–19 56.4% 1 IOTF Reddy et al., 2010 [15]
America USA, 52 Sates2 2007 — — 10–17 — 1 CDC Singh et al., 2010 [20]
Brazil, Pernambuco State 2006 4,210 4,210 14–19 59.8% 1 IOTF Tassitano et al., 2009 [40]
Asia China, Hong Kong 2003-04 2,098 2,098 11–18 53.2% 2 IOTF, CDC Ko et al., 2008 [41]
India, Manipur 2005-06 3,356 3,356 12–19 56.2% 1 IOTF Bishwalata et al., 2010 [42]
Jordan, Irbid Governorate 2007 1,355 1,355 13–16 55.6% 1 CDC Abu Baker and Daradkeh, 2010 [43]
Europe Denmark, Greater Copenhagen area and 3 municipalities outside the Capital Region 2007–09 7,541 7,541 14–16 50.1% 1 IOTF Søren and Jo, 2010 [44]
France, Aquitaine Region 2004-05 2,385 2,385 11–18 49.1% 1 IOTF Thibault et al., 2010 [45]
Greece, Crete 2005-06 481 481 10–12 54.0% 1 IOTF Manios et al., 2011 [46]
Hungary, Szeged and Szolnok regions 2005-2006 14,290 14,290 11–16 48.1% 1 IOTF Baráth et al., 2010 [47]
Italy, 5 residence regions3 2002 4,386 4,386 11–15 51.6% 1 IOTF Vieno et al., 2005 [34]
Italy, Sardinia 1999–2001 3,946 3,946 11–15 49.0% 1 IOTF Velluzzi et al., 2007 [48]
Italy, Sicily 1999–2001 48,897 48,897 11–15 50.7% 1 CDC Baratta et al., 2006 [49]
Poland, Kujawsko-Pomorskie 2005 — — 13–15 — 1 IOTF Jodkowska et al., 2010 [50]
Poland, Lubuskie 2005 — — 13–15 — 1 IOTF Jodkowska et al., 2010 [50]
Poland, Malapolskie 2005 — — 13–15 — 1 IOTF Jodkowska et al., 2010 [50]
Poland, Podlaskie 2005 — — 13–15 — 1 IOTF Jodkowska et al., 2010 [50]
Poland, Pomorskie 2005 — — 13–15 — 1 IOTF Jodkowska et al., 2010 [50]
Spain, Balearic Islands 2007-08 1,231 1,231 12–17 53.4% 1 WHO Bibiloni et al., 2010 [51]
Spain, Grand Canary 2004-05 1,002 1,002 12–14 50.0% 1 IOTF Henríquez Sánchez et al., 2008 [52]
Switzerland, Canton of Vaud 2005-06 5,207 5,207 10–14 49.7% 2 IOTF, CDC Lasserre et al., 2007 [53]
Turkey, Edirne Province 2001 989 989 12–17 48.1% 1 IOTF Öner et al., 2004 [54]
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1Only subjects with anthropometric measurements were included in each country.

2There are 52 states in the USA, but no information about total number of subjects was included in each state.

3Vieno et al. [34] assessed the overall overweight and obesity prevalence among Italian adolescents, and also according to the geographic region: North-West, North-East, Center, South, and Islands, but no information about total number of subjects was included in each region.

IOTF: International Obesity Task Force; CDC: Center for Disease Control and Prevention; WHO: World Health Organization.

3.2. Prevalence and Criteria for Classification

Table 2 shows overweight and obesity prevalence from the twenty-five national studies (one of them including data from Northern Ireland) that were included in this review according to the continent and the country where it was performed, year of survey, study population, age range, criteria used for classifying overweight and obesity used, and along with total data by sex. There were thirty-two different prevalence levels described in the included articles, because five countries presented data using at least two different criteria for overweight and obesity classification [18, 23, 27, 36, 39]. The IOTF cut-off was used to classify overweight and obesity in twenty-three of the twenty-five national studies considered in the present review.

Table 2.

Description of overweight and obesity prevalence (%) along with total data by sex from each national study that was included in the review according to year of survey, study population, age range, and classification criteria used.

Continent Country Date of survey Study population Age (years)/school grade Criteria Overweight (%) Obesity (%) Reference
All Boys Girls All Boys Girls
Africa Seychelles 2004 School-based survey 7th, 10th IOTF1 12.0 9.5 14.3 5.1 4.2 6.0 Bovet et al., 2006 [16]
South Africa 2008 2008 SA YRBS 13–19 IOTF1 14.4 7.9 20.6 5.3 3.3 7.2 Reddy et al., 2010 [15]
Tunisia 2004 Household-based survey 15–19 IOTF1 12.4 11.0 14.1 2.6 1.9 3.2 Aounallah-Skhiri et al., 2008 [17]
America Canada 2004 2004 CCHS 12–17 IOTF1 19.8 21.2 18.4 9.4 11.1 7.4 Shields and Tremblay, 2010 [18]
CDC-20002 15.9 17.0 14.7 12.1 14.3 9.6
WHO-20073 20.8 21.9 19.6 12.4 15.1 9.4
Mexico 2006 Household-based survey 12–18 IOTF1 21.2 20.1 22.3 8.9 9.2 8.6 Bonvecchio et al., 2009 [19]
USA 2007 2007 NSCH 10–17 CDC-20002 15.2 15.3 15.2 16.4 19.2 13.5 Singh et al., 2010 [20]
Asia Bahrain 2000 School-based survey 12–17 IOTF1 20.0 15.3 24.5 16.4 14.9 17.9 Al-Sendi et al., 2003 [21]
China 2002 2002 CNNHS 13–17 IOTF1 4.6 4.6 4.6 0.6 0.7 0.5 Li et al., 2008 [22]
Iran 2003-04 CASPIAN Study 10–18 IOTF1 5.9 5.7 6.0 1.3 1.5 1.1 Kelishadi et al., 2008 [23]
CDC-20002 4.5 4.3 4.7 1.9 2.3 1.6
Israel 2003-04 MABAT Youth Survey 11–19 CDC-20002 12.9 12.7 13.0 5.6 7.4 4.1 Nitzan Kaluski et al., 2009 [24]
Jordan 2009 Household-based survey 13–18 IOTF1 13.7 11.3 15.5 10.0 12.4 8.2 Khader et al., 2011 [25]
Qatar 2003-04 School-based survey 12–17 IOTF1 23.8 28.6 18.9 6.3 7.9 4.7 Bener, 2006 [26]
Saudi Arabia 2005 Household-based survey 13–18 CDC-20002 17.9 16.5 19.6 7.0 8.2 5.5 El Mouzan et al., 2010 [27]
WHO-20073 16.0 13.6 18.4 10.6 11.2 10.0
Taiwan 2003 School-based survey 10–18 IOTF1 16.3 18.4 14.2 6.2 8.1 4.2 Liou et al., 2009 [28]
United Arab Emirates 2009-10 Household-based survey 11–18 IOTF1 — 16.2 20.5 — 11.7 19.7 Ng et al., 2011 [29]
Europe Cyprus 1999-00 School-based survey 10–17 IOTF1 18.9 21.3 16.5 5.8 7.1 4.5 Savva et al., 2002 [30]
Czech Republic 2005 Lifestyle and Obesity Study 6–17 IOTF1 12.3 16.6 8.0 1.4 1.7 1.0 Kunesova et al., 2007 [31]
Germany 2008 CrescNet database 12–16 IOTF1 18.2 19.3 17.0 6.2 7.6 4.6 Blüher et al., 2011 [32]
Greece 2003 School-based survey 13–19 IOTF1 18.3 23.3 14.0 4.3 6.1 2.7 Tzotzas et al., 2008 [33]
Italy 2002 HBSC Study 11, 13, 15 IOTF1 15.6 20.9 10.6 2.3 3.5 1.2 Vieno et al., 2005 [34]
Republic of Ireland 2003 School-based survey 11–16 IOTF1 18.5 17.8 19.2 5.8 5.6 6.1 Whelton et al., 2007 [35]
Northern Ireland 2003 School-based survey 11–15 IOTF1 18.2 18.5 17.8 5.9 6.0 5.7 Whelton et al., 2007 [35]
Portugal 2008 School-based survey 10–18 IOTF1 17.4 17.7 17.0 5.2 5.8 4.6 Sardinha et al., 2011 [36]
WHO-2007 21.8 20.4 23.1 9.9 10.3 9.6
Sweden 2001 School-based survey 10, 13, 16 IOTF1 15.8 14.6 16.9 4.4 5.0 3.6 Ekblom et al., 2004 [37]
Oceania Australia 2004 2004 SPANS 8th, 10th IOTF1 17.9 19.4 16.2 5.3 6.7 3.6 Booth et al., 2007 [38]
New Zealand 2007 Youth'07 Survey 13–17 IOTF1 24.0 23.3 24.7 10.2 10.8 9.5 Utter et al., 2010 [39]
WHO-2007 25.9 25.9 26.0 13.5 14.6 12.1
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1Overweight and obesity, all adolescents with BMI-for-age ≥25 kg/m2 and <30 kg/m2 and ≥30 kg/m2, respectively, according to the IOTF [6].

2Overweight and obesity, all adolescents with BMI-for-age ≥P85th and <P95th and ≥P95th, respectively, according to the CDC [5].

3Overweight and obesity, all adolescents with BMI-for-age >+1SD and <+2SD and >+2SD, respectively, according to the WHO [7].

IOTF: International Obesity Task Force; CDC: Center for Disease Control and Prevention; WHO: World Health Organization; 2008 SA YRBS: 2008 South African National Youth Risk Behaviour; 2004 CCHS: 2004 Canadian Community Health Survey; 2007 NSCH: National Survey of Children's Health; 2002 CNNHS: 2002 China National Nutrition and Health Survey; CASPIAN Study: Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable disease; HBSC: Health Behaviour in School-aged Children; 2004 SPANS: 2004 NSW Schools Physical Activity and Nutrition Survey.

There was a broad range of overweight and obesity prevalence noted. In general, the prevalence of overweight plus obesity was higher in America [18–20], Oceania [38, 39] and Europe [30–37] and lower in Africa [15–17] and certain parts of Asia [21–29] (in China [22] and Iran [23] the total prevalence was less than 10% by the IOTF cut-offs). Overall, about 30% of American adolescents and 22%–25% of European adolescents (excepting the Czech Republic and Italian adolescents' which showed a prevalence of 13.7% and 17.9%, resp.) were overweight or obese. Among Oceanian adolescents the prevalence ranged from 23.2% in Australia in 2004 to 34.2% in New Zealand in 2007. In Africa, the overall prevalence of overweight and obesity was lower than 20%. Among Asian adolescents there was a broad range of overweight plus obesity. Using IOTF cut-off, the prevalence of being overweight or obese for Asian boys and girls ranged from 5.2% in China in 2002 to 36.4% in Bahrain in 2000.

Table 3 shows regional data prevalence of overweight and obesity from fifteen countries. Specific prevalence from all the geographic regions was included in this review from three countries: South Africa (nine provinces) [15], USA (fifty two states) [20], and Italy (five regions) [34]. In Europe, data from islands of Greece (Crete) [46] and Italy (Sicily and Sardinia) [48, 49] and Spain (Balearic Islands' archipelago [51]; and the Grand Canary Island [52]) were also included. On the other hand, regional but not national data was found for eleven countries (Italy [34], Brazil [40], India [42], Jordan [43], Denmark [44], France [45], Hungary [47], Poland [48], Spain [51, 52], Switzerland [53], and Turkey [54]). The IOTF cut-off was used to classify overweight and obesity in fourteen of the eighteen selected studies that included regional data. In one study [51], data was presented using only the WHO-2007 growth charts and in two studies using only the CDC-2000 growth reference [20, 43].

Table 3.

Description of overweight and obesity prevalence (%) along with total data by sex from each regional study that was included in the review according to year of survey, study population, age range, and classification criteria used.

Continent Country, region Date of survey Study population Age (years) Criteria Overweight (%) Obesity (%) Reference
All Boys Girls All Boys Girls
Africa South Africa, Eastern Cape 2008 2008 SA YRBS 13–19 IOTF1 13.3 4.3 21.1 4.0 2.0 5.6 Reddy et al., 2010 [15]
South Africa, Free State 2008 2008 SA YRBS 13–19 IOTF1 11.6 8.1 15.1 4.7 3.7 5.7 Reddy et al., 2010 [15]
South Africa, Gauteng 2008 2008 SA YRBS 13–19 IOTF1 12.7 10.0 15.4 9.7 8.4 11.0 Reddy et al., 2010 [15]
South Africa, KwaZulu-Natal 2008 2008 SA YRBS 13–19 IOTF1 20.1 8.6 31.5 5.4 3.4 7.3 Reddy et al., 2010 [15]
South Africa, Limpopo 2008 2008 SA YRBS 13–19 IOTF1 10.7 6.2 15.1 2.8 1.0 4.5 Reddy et al., 2010 [15]
South Africa, Mpumalanga 2008 2008 SA YRBS 13–19 IOTF1 15.5 10.0 21.1 6.1 2.3 9.9 Reddy et al., 2010 [15]
South Africa, Northern Cape 2008 2008 SA YRBS 13–19 IOTF1 12.9 7.3 18.3 5.0 4.4 5.6 Reddy et al., 2010 [15]
South Africa, North West 2008 2008 SA YRBS 13–19 IOTF1 11.8 7.0 16.7 3.9 2.2 5.7 Reddy et al., 2010 [15]
South Africa, Western Cape 2008 2008 SA YRBS 13–19 IOTF1 14.3 9.7 18.5 5.6 2.0 8.9 Reddy et al., 2010 [15]
America USA, Alaska 2007 2007 NSCH 10–17 CDC-20002 19.8 22.7 16.7 14.1 14.6 13.7 Singh et al., 2010 [20]
USA, Alabama 2007 2007 NSCH 10–17 CDC-20002 18.2 17.6 18.9 17.9 24.4 10.9 Singh et al., 2010 [20]
USA, Arkansas 2007 2007 NSCH 10–17 CDC-20002 17.1 15.0 19.2 20.4 27.2 13.2 Singh et al., 2010 [20]
USA, Arizona 2007 2007 NSCH 10–17 CDC-20002 12.8 12.7 12.7 17.8 20.6 15.0 Singh et al., 2010 [20]
USA, California 2007 2007 NSCH 10–17 CDC-20002 15.5 13.4 17.5 15.0 17.4 12.8 Singh et al., 2010 [20]
USA, Colorado 2007 2007 NSCH 10–17 CDC-20002 13.0 17.5 8.5 14.2 17.5 10.7 Singh et al., 2010 [20]
USA, Connecticut 2007 2007 NSCH 10–17 CDC-20002 13.2 14.7 11.7 12.5 14.8 10.2 Singh et al., 2010 [20]
USA, Washington, DC 2007 2007 NSCH 10–17 CDC-20002 15.2 11.6 18.7 20.2 22.2 18.2 Singh et al., 2010 [20]
USA, Delaware 2007 2007 NSCH 10–17 CDC-20002 19.9 22.0 17.8 13.3 12.2 14.4 Singh et al., 2010 [20]
USA, Florida 2007 2007 NSCH 10–17 CDC-20002 14.8 12.7 17.1 18.3 21.5 15.0 Singh et al., 2010 [20]
USA, Georgia 2007 2007 NSCH 10–17 CDC-20002 16.0 14.4 17.7 21.3 24.7 17.7 Singh et al., 2010 [20]
USA, Hawaii 2007 2007 NSCH 10–17 CDC-20002 17.3 17.5 17.1 11.2 15.0 7.1 Singh et al., 2010 [20]
USA, Iowa 2007 2007 NSCH 10–17 CDC-20002 15.3 14.8 15.9 11.2 11.3 11.0 Singh et al., 2010 [20]
USA, Idaho 2007 2007 NSCH 10–17 CDC-20002 15.7 14.4 17.2 11.8 16.4 6.8 Singh et al., 2010 [20]
USA, Illinois 2007 2007 NSCH 10–17 CDC-20002 14.2 12.1 16.4 20.7 25.0 16.3 Singh et al., 2010 [20]
USA, Indiana 2007 2007 NSCH 10–17 CDC-20002 15.2 11.5 19.3 14.7 17.4 11.7 Singh et al., 2010 [20]
USA, Kansas 2007 2007 NSCH 10–17 CDC-20002 14.9 16.0 13.7 16.2 16.2 16.3 Singh et al., 2010 [20]
USA, Kentucky 2007 2007 NSCH 10–17 CDC-20002 16.1 17.7 14.6 21.0 22.5 19.4 Singh et al., 2010 [20]
USA, Louisiana 2007 2007 NSCH 10–17 CDC-20002 15.2 15.5 14.9 20.7 23.1 18.1 Singh et al., 2010 [20]
USA, Massachusetts 2007 2007 NSCH 10–17 CDC-20002 16.7 18.2 15.4 13.3 16.1 10.5 Singh et al., 2010 [20]
USA, Maryland 2007 2007 NSCH 10–17 CDC-20002 15.2 19.1 11.1 13.6 17.0 9.9 Singh et al., 2010 [20]
USA, Maine 2007 2007 NSCH 10–17 CDC-20002 15.3 15.6 14.9 12.9 16.0 9.8 Singh et al., 2010 [20]
USA, Michigan 2007 2007 NSCH 10–17 CDC-20002 18.1 20.4 15.8 12.5 14.3 10.5 Singh et al., 2010 [20]
USA, Minnesota 2007 2007 NSCH 10–17 CDC-20002 12.0 12.1 11.8 11.1 14.3 7.6 Singh et al., 2010 [20]
USA, Missouri 2007 2007 NSCH 10–17 CDC-20002 17.4 16.9 17.8 13.6 15.5 11.6 Singh et al., 2010 [20]
USA, Mississippi 2007 2007 NSCH 10–17 CDC-20002 22.6 21.6 23.5 21.9 25.5 18.5 Singh et al., 2010 [20]
USA, Montana 2007 2007 NSCH 10–17 CDC-20002 13.8 15.0 12.5 11.8 16.6 6.6 Singh et al., 2010 [20]
USA, North Carolina 2007 2007 NSCH 10–17 CDC-20002 14.9 13.9 16.0 18.6 19.3 17.9 Singh et al., 2010 [20]
USA, North Dakota 2007 2007 NSCH 10–17 CDC-20002 14.3 16.9 11.6 11.4 15.7 7.0 Singh et al., 2010 [20]
USA, Nebraska 2007 2007 NSCH 10–17 CDC-20002 15.7 13.9 17.5 15.8 23.0 8.1 Singh et al., 2010 [20]
USA, New Hampshire 2007 2007 NSCH 10–17 CDC-20002 16.6 17.1 16.2 12.8 16.3 8.8 Singh et al., 2010 [20]
USA, New Jersey 2007 2007 NSCH 10–17 CDC-20002 15.6 17.3 13.8 15.4 18.6 11.7 Singh et al., 2010 [20]
USA, New Mexico 2007 2007 NSCH 10–17 CDC-20002 16.7 15.3 18.1 16.0 20.4 11.4 Singh et al., 2010 [20]
USA, Nevada 2007 2007 NSCH 10–17 CDC-20002 19.0 21.9 16.0 15.2 19.4 10.8 Singh et al., 2010 [20]
USA, New York 2007 2007 NSCH 10–17 CDC-20002 15.8 15.1 16.5 17.1 20.3 13.8 Singh et al., 2010 [20]
USA, Ohio 2007 2007 NSCH 10–17 CDC-20002 14.8 18.7 10.9 18.5 22.9 14.2 Singh et al., 2010 [20]
USA, Oklahoma 2007 2007 NSCH 10–17 CDC-20002 13.2 18.1 8.2 16.4 17.4 15.4 Singh et al., 2010 [20]
USA, Oregon 2007 2007 NSCH 10–17 CDC-20002 14.7 16.2 13.3 9.6 11.0 8.2 Singh et al., 2010 [20]
USA, Pennsylvania 2007 2007 NSCH 10–17 CDC-20002 14.7 15.5 13.7 15.0 21.0 8.4 Singh et al., 2010 [20]
USA, Rhode Island 2007 2007 NSCH 10–17 CDC-20002 15.7 15.5 16.0 14.4 18.2 10.5 Singh et al., 2010 [20]
USA, South Carolina 2007 2007 NSCH 10–17 CDC-20002 18.5 20.8 15.9 15.3 18.4 12.0 Singh et al., 2010 [20]
USA, South Dakota 2007 2007 NSCH 10–17 CDC-20002 15.2 17.3 13.0 13.2 16.0 10.2 Singh et al., 2010 [20]
USA, Tennessee 2007 2007 NSCH 10–17 CDC-20002 15.9 14.5 17.3 20.6 23.3 17.9 Singh et al., 2010 [20]
USA, Texas 2007 2007 NSCH 10–17 CDC-20002 11.8 11.0 12.6 20.4 20.6 20.2 Singh et al., 2010 [20]
USA, Utah 2007 2007 NSCH 10–17 CDC-20002 11.7 12.1 11.2 11.4 14.7 7.9 Singh et al., 2010 [20]
USA, Virginia 2007 2007 NSCH 10–17 CDC-20002 15.8 16.1 15.4 15.2 16.6 13.9 Singh et al., 2010 [20]
USA, Vermont 2007 2007 NSCH 10–17 CDC-20002 13.8 16.4 11.1 12.9 17.0 8.4 Singh et al., 2010 [20]
USA, Washington 2007 2007 NSCH 10–17 CDC-20002 18.4 21.9 14.7 11.1 14.7 7.3 Singh et al., 2010 [20]
USA, Wisconsin 2007 2007 NSCH 10–17 CDC-20002 14.8 17.3 12.2 13.1 15.6 10.5 Singh et al., 2010 [20]
USA, West Virginia 2007 2007 NSCH 10–17 CDC-20002 16.6 16.9 16.4 18.9 21.8 15.7 Singh et al., 2010 [20]
USA, Wyoming 2007 2007 NSCH 10–17 CDC-20002 15.5 16.6 14.2 10.2 14.1 5.5 Singh et al., 2010 [20]
Brazil, Pernambuco State 2006 GSHS 14–19 IOTF1 11.5 11.3 11.6 2.4 2.0 2.8 Tassitano et al., 2009 [40]
Asia China, Hong Kong 2003-04 School-based survey 11–18 IOTF1 7.1 9.6 4.9 2.8 3.9 1.8 Ko et al., 2008 [41]
CDC-20002 8.3 11.3 5.8 4.1 6.0 2.4
India, Manipur 2005-06 School-based survey 12–19 IOTF1 4.4 4.1 4.7 0.7 1.0 0.4 Bishwalata et al., 2010 [42]
Jordan, Irbid Governorate 2007 School-based survey 13–16 CDC-20002 15.7 11.8 18.9 8.7 12.3 5.8 Abu Baker and Daradkeh, 2010 [43]
Europe Denmark, Greater Copenhagen area and 3 municipalities outside the Capital Region 2007–09 School-based survey 14–16 IOTF1 14.0 15.2 12.9 11.2 14.1 8.2 Søren and Jo, 2010 [44]
France, Aquitaine Region 2004-05 School-based survey 11–18 IOTF1 11.7 13.3 10.1 1.9 2.4 1.4 Thibault et al., 2010 [45]
Greece, Crete 2005-06 School-based survey 10–12 IOTF1 28.0 30.0 27.0 13.0 15.0 10.0 Manios et al., 2011 [46]
Hungary, Szeged and Szolnok regions 2005-06 School-based survey 11–16 IOTF1 16.8 17.9 15.7 6.6 7.9 5.2 Baráth et al., 2010 [47]
Italy, North-West 2002 HBSC Study 11, 13, 16 IOTF1 — 18.3 7.1 — 2.5 1.1 Vieno et al., 2005 [34]
Italy, North-East 2002 HBSC Study 11, 13, 16 IOTF1 — 16.5 11.7 — 0.8 1.5 Vieno et al., 2005 [34]
Italy, Center 2002 HBSC Study 11, 13, 16 IOTF1 — 20.7 11.2 — 3.9 2.5 Vieno et al., 2005 [34]
Italy, South 2002 HBSC Study 11, 13, 16 IOTF1 — 25.7 15.7 — 4.4 0.9 Vieno et al., 2005 [34]
Italy, Islands 2002 HBSC Study 11, 13, 16 IOTF1 — 31.3 10.4 — 7.6 0.8 Vieno et al., 2005 [34]
Italy, Sardinia 1999–2001 School-based survey 11–15 IOTF1 14.9 15.4 14.6 3.7 5.1 3.2 Velluzzi et al., 2007 [48]
Italy, Sicily 1999–2001 Public school-based survey 11–15 CDC-20002 18.3 18.8 17.8 11.8 15.1 8.5 Baratta et al., 2006 [49]
Poland, Kujawsko-Pomorskie 2005 School based survey 13–15 IOTF1 10.7 12.0 9.5 1.4 1.6 1.3 Jodkowska et al., 2010 [50]
Poland, Lubuskie 2005 School based survey 13–15 IOTF1 11.1 12.2 10.1 3.0 2.5 3.5 Jodkowska et al., 2010 [50]
Poland, Malapolskie 2005 School based survey 13–15 IOTF1 12.7 12.8 12.6 1.6 1.9 1.3 Jodkowska et al., 2010 [50]
Poland, Podlaskie 2005 School based survey 13–15 IOTF1 13.9 14.5 13.3 2.8 3.1 2.6 Jodkowska et al., 2010 [50]
Poland, Pomorskie 2005 School based survey 13–15 IOTF1 13.7 13.4 13.9 2.1 2.0 2.2 Jodkowska et al., 2010 [50]
Spain, Balearic Islands 2007-08 School-based survey 12–17 WHO-20073 17.5 19.9 15.5 10.4 12.7 8.5 Bibiloni et al., 2010 [51]
Spain, Grand Canary 2004-05 School-based survey 12–14 IOTF1 21.6 21.0 22.2 7.5 7.8 7.2 Henríquez Sánchez et al., 2008 [52]
Switzerland, Canton of Vaud 2005-06 Public school-based survey 10–14 IOTF1 12.0 13.2 10.7 1.7 1.8 1.7 Lasserre et al., 2007 [53]
CDC-20002 10.7 11.9 9.4 3.6 4.2 3.0
Turkey, Edirne Province 2001 Two school-based surveys 12–17 IOTF1 10.9 11.3 10.6 1.9 1.6 2.1 Öner et al., 2004 [54]
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1Overweight and obesity, all adolescents with BMI-for-age ≥25 kg/m2 and <30 kg/m2 and ≥30 kg/m2, respectively, according to the IOTF [6].

2Overweight and obesity, all adolescents with BMI-for-age ≥P85th and <P95th and ≥P95th, respectively, according to the CDC [5].

3Overweight and obesity, all adolescents with BMI-for-age ≥P85th and <P95th and ≥P97th, respectively, according to the WHO [7].

IOTF: International Obesity Task Force; CDC: Center for Disease Control and Prevention; WHO: World Health Organization; 2008 SA YRBS: 2008 South African National Youth Risk Behaviour; 2007 NSCH: National Survey of Children's Health; GSHS: Global School Based Student Health Survey; HBSC: Health Behaviour in School-aged Children.

In South Africa and USA, substantial geographic variations in adolescent overweight and obesity existed. In 2008, overweight and obesity prevalence varied in South Africa from 13.5% in Limpopo to 25.5% in KwaZulu-Natal. In 2007, overweight and obesity varied in USA from 23.1% in Utah and Minnesota to 44.5% in Mississippi. In 2002, the prevalence of overweight and obesity in Southern Italy and Italian islands was higher among boys. In Southern Italy, the overweight prevalence among girls also was higher than in the other geographic regions.

Comparison between the islands from Greece (Crete), Italy (Sicily and Sardinia), and Spain (Balearic Islands and Grand Canary Island) which were included in this review showed that Crete had the highest prevalence of overweight and obesity—despite data were presented using different definition. In Spain, using the IOTF cut-off (data not shown for Balearic Islands but given by authors), the prevalence of overweight plus obesity was higher in the Grand Canary Island (29.1%) than in the Balearic Islands (24.7%).

3.3. Gender Differences

According to national data, the prevalence of overweight among boys was ≥10% higher than girls in nine countries (Canada [18], Qatar [26], Taiwan [28], Cyprus [30], Czech Republic [31], Germany [32], Greece [33], Italy [34], Australia [38], Denmark [44], and Hungary [47]) and among girls ≥10% higher than boys in seven of the twenty-five countries (South Africa [15], Seychelles [16], Tunisia [17], Mexico [19], Bahrain [21], Saudi Arabia [27], and Sweden [37]). The obesity prevalence was ≥10% higher among boys in seventeen countries (Canada [18], USA [20], China [22], Iran [23], Israel [24], Qatar [26], Saudi Arabia [27], Taiwan [28], Cyprus [30], Czech Republic [31], Germany [32], Greece [33], Italy [34], Portugal [36], Sweden [37], Australia [38], New Zealand [39], Denmark [44], and Hungary [47]) and ≥10% higher among girls in four of the twenty-five countries (South Africa [14], Seychelles [16], Tunisia [17], and Bahrain [21]).

4. Discussion

The aim of this study was to review systematically the literature on overweight and obesity prevalence among adolescents worldwide. Thirty-nine articles and one National Health Report that met the inclusion criteria were considered. The overweight and obesity prevalence in the included studies ranged widely. In sixteen of the twenty-three countries with national representative data using the IOTF cut-off, overweight and obesity prevalence higher than 20% were found, five countries showed prevalence above 30%, and just in two countries prevalence was lower than 10%.

Regarding national data, when prevalence was analysed according to sex, it was observed that boys showed a higher prevalence of overweight in almost half of the countries and a higher prevalence of obesity in almost all countries. These results are consistent with previous studies that pointed out a high prevalence of abdominal obesity among boys [55]. Differences of prevalence of overweight and obesity between genders have been related to geopolitical and cultural conditions [55].

Eight articles compared data between 1980s and/or 1990s with 2000s [16, 19, 20, 22, 28, 32, 37, 50] and pointed out an increased prevalence of overweight and obesity in both sexes over this period. However, among Australian adolescents [38] the overweight and obesity prevalence increased significantly among boys but not among girls over the period 1997–2004. In the Australian National Children's Nutrition and Physical Activity Survey 2007 (NCNPAS07) [14], 25% of boys and 30% of girls aged 9- to 13-year-olds and 25% of boys and 23% of girls aged 14- to 16-year-olds were overweight or obese using the IOTF criteria. A comparison of the 1985, 1995, and 2007 Australian national surveys of 7- to 15-year-olds indicated that Australian children are changing body shape to a more central fat distribution [14]. In USA, overweight and obesity prevalence among adolescents increased 4% in 2003 and 10% in 2007. Overweight and obesity prevalence increased by 3% and 18% among USA girls over this period. However, a cross-sectional analyses of a representative sample (n = 4111) of the USA child and adolescent population (birth through 19 years of age) with data from the National Health and Nutrition Examination Survey 2009-10 (NHANES) indicated a prevalence of overweight and obesity among adolescents aged 12 through 19 years of 15.2% and 18.4%, respectively. Analyses of trends in obesity prevalence for the last two NHANES surveys (2007-08 and 2009-10) indicated that the prevalence of obesity in children and adolescents has not changed in 2009-10 compared with 2007-08 [13]. On the other hand, since 2004 the overweight and obesity trends were stabilized or decreased among German adolescents [32].

In USA, substantial geographic disparities in adolescent overweight and obesity were found, with an apparent shift toward higher prevalence in 2007 for several states [20]. Generally, overweight and obesity prevalence was also higher in southern USA in 2007. Lobstein et al. [56] reported that children in Northern Europe countries generally tended to have lower overweight and obesity prevalence (10–20%) than in Southern Europe (20–35%). Also within the same country, the prevalence and trends of overweight and obesity may not be homogeneous according to different geographic regions [57]. In Italy, a north-south gradient in overweight and obesity prevalence among boys but also in overweight prevalence among girls was also reported [34]. A higher prevalence of overweight and obesity has been reported in Southern Spain in both children [58] and adults [59].

It is important to note that the choice of a reference and a cut-off point will determine the absolute prevalence of overweight and obesity and its trends, and hence different information will be obtained from the papers [60]. The IOTF classification for adolescent overweight and obesity [6] is the most frequently used. Cole et al. [6] argued that the reference they published, supported by the IOTF, is less arbitrary and more international than others and recommended its use in international comparisons. Lately, Monasta et al. [61] suggested that the IOTF reference and cut-offs could be preferable to identify overweight and obesity both at individual and population levels because they are at least based on a crude association with ill and health later in life, namely, the definition of overweight and obesity at age 18 years. However, the IOTF cut-offs have been not recommended for clinical use when assessing an individual child's growth [9, 62–64]. Furthermore, recent findings suggested that a universal BMI classification system for childhood and adolescent overweight and obesity may not correspond to a comparable level of body fatness in all populations [9]. The prevalence estimates may not accurately characterize the population groups most at risk of health disadvantages because the correlation of BMI with adiposity is highly variable and dependent on ethnic group [9, 60, 65, 66].

5. Limitations of the Study

The comparisons of overweight and obesity prevalence need interpretation with caution due to the difference in survey sampling methods, sample sizes, age range of subjects, quality of data in terms of height and weight measurement, and whether national programmes or strategies to tackle overweight and obesity are in place [57]. Even within the same country, the prevalence and trends of overweight and obesity may not be homogenous in view of different ethnicities, geographic regions, and socioeconomic status [57]. Only articles in English, Spanish, Italian, and Portuguese were included in this review.

6. Conclusions

The results of this review allow the following conclusions: (1) overweight and obesity prevalence is high; (2) obesity is higher among boys, although it is not clear which sex has a higher proportion of adolescents with overweight; (3) despite that there is no consensus about criteria to be used to classify adolescents as overweighed or obese, the most frequently used was the IOTF reference [6]. However, the international reference charts for monitoring the secular trends in childhood obesity need to be continually refined and evaluated [56]. The results of this study would contribute to guiding health planners and administrators to develop proper tools for adolescent obesity management.

Conflict of Interests

The authors state that there is no conflict of interests.

Authors' Contribution

Maria del Mar Bibiloni and Josep A. Tur contributed to the design of the strategy for the literature search and double screened and selected the retrieved documents. Antoni Pons provided previous literature searches and analysis. Maria del Mar Bibiloni and Josep A. Tur prepared the main outline of the paper and all authors contributed to the preparation of the paper.

Acknowledgments

The authors would like to thank the Spanish Ministry of Health and Consumption Affairs (Programme of Promotion of Biomedical Research and Health Sciences, Projects 05/1276 and 08/1259, and Red Predimed-RETIC RD06/0045/1004 and CIBERobn CB12/03/30038), Grant of support to research groups no. 35/2011 (Balearic Islands Government and EU FEDER funds), Spanish Ministry of Education and Science (FPU Programme, PhD fellowship to M.M.B.). The Research Group on Community Nutrition and Oxidative Stress, University of Balearic Islands belongs to the Centre Català de la Nutrició (IEC).

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