2.5. ADULT MALNUTRITION (UNDERWEIGHT AND OVERWEIGHT)

Poor nutrition intake among adults, leading to either face a double burden of under- and overnutrition occurring underweight or overweight, is closely associated with ill simultaneously among different population groups. health. More than one-third of all deaths worldwide are due The prevalence of overweight is growing rapidly in the to ten main risk factors, and seven of these are related to Asia/Pacific region (Figure 2.5.2). Since 1990, the share of nutrition (WHO, 2002b). overweight people has increased by about 5% for both male In developing countries, underweight is the risk factor and female populations on average in Asian countries. The most closely associated with early death. Undernutrition in speed was much slower but the share has also grown at 3% pregnant women also leads to low birthweight babies (see for men and 4% for women in OECD countries during the Indicator 2.2 “Preterm birth and low birthweight”). Social same period. determinants of health such as poverty, inadequate water However, up to now, obesity is still more prevalent in and sanitation, and inequitable access to education and OECD countries than in countries in Asia, but a sizeable health services underlie malnutrition. A key driver of the share of overweight adults is obese in the several countries increasing obesity epidemic is a changing food environ- of the Pacific (Figure 2.5.3). In developing countries obesity ment, in which nutrient poor and energy dense processed is more common among people with a higher socioeco- foods are readily available and often cheaper than healthier nomic status, those living in urban regions and middle- alternatives. aged women. In developed countries, obesity is increasing Globally, the rise in overweight and obesity is becom- among all age groups, and is associated with lower socio- ing a major public health concern. Obesity is a known risk economic status, especially among women (Sassi, 2010). factor for numerous health problems, including hyperten- sion, high cholesterol, diabetes, cardiovascular diseases, respiratory problems (asthma), musculoskeletal diseases Definition and comparability (arthritis) and some forms of cancer, and mortality also increases progressively once the overweight threshold is The most frequently used measure of underweight, crossed (Sassi, 2010). overweight and obesity is the Body Mass Index (BMI). This is a single number that evaluates an individual’s Across 15 Asian countries, 17% of females and 13% of weight in relation to height, and is defined as weight males were underweight on average, compared to an aver- in kilograms divided by the square of height in metres age of 4% and 2% in OECD countries (Figure 2.5.1, left panel). (kg/m2). A significant proportion of adults in southern Asia are underweight and in India, Pakistan, Bangladesh and Viet Based on the WHO classification, adults with a BMI Nam, more than one-quarter of adults have a BMI of less below 18.5 are considered to be underweight and 25 or than 18.5, while in New Zealand and Australia, less than 5% over are overweight. Adults who have a BMI of 30 or of male and female populations are underweight. It should be over are defined as obese. noted that some Asian populations may have different associ- In many countries, self-reported estimates of height ations between BMI, percentage of body fat and health risks and weight are collected through population-based than other populations (WHO Expert Consultation, 2004). health surveys while in Australia, Japan, the Republic The average rates of overweight are similar between of Korea and New Zealand, health examinations Asian and OECD countries (Figure 2.5.1, right panel). measure actual height and weight. These differences Although the average rate for male in the OECD is much limit data comparability. BMI estimates from health higher than 20 Asian countries, the rate for female in Asian examinations are more reliable, and generally result countries slightly exceeds the OECD average. Countries in higher values than from self-report surveys. such as the Lao PDR, the Philippines, Malaysia and Thailand

50 HEALTH AT A GLANCE: ASIA/PACIFIC 2014 © OECD/WHO 2014 2.5. ADULT MALNUTRITION (UNDERWEIGHT AND OVERWEIGHT)

2.5.1. Adults who are underweight or overweight, latest year available

Underweight (BMI < 18.5) Overweight BMI ≥ 25) Females Males Females Males

India Pakistan Bangladesh Viet Nam Nepal Asia15/20 Sri Lanka Cambodia Singapore Lao PDR Philippines Japan Malaysia Thailand China Korea, Rep. Fiji OECD Mongolia Australia New Zealand Brunei Darussalam Indonesia Korea, DPR Myanmar Papua New Guinea Solomon Islands 40 30 20 10 0 0 20 40 60 80 % %

Source: OECD Health Statistics 2014; WHO Global Database on Body Mass Index; WHO Global Infobase.

2.5.2. Changes in overweight prevalence, 1990-2009 2.5.3. Adults who are obese, latest year available

Females Males Females Males

Fiji Fiji Malaysia Mongolia Viet Nam New Zealand Papua New Guinea Brunei Darussalam Solomon Islands Australia Myanmar OECD Thailand Solomon Islands Indonesia Japan New Zealand Korea, DPR Australia Lao PDR Korea, Rep. Myanmar Lao PDR Thailand Sri Lanka Malaysia Cambodia Asia20 Mongolia Papua New Guinea Philippines Philippines Asia20 Pakistan China Indonesia Japan China Pakistan Singapore Singapore India Brunei Darussalam Korea, Rep. OECD Viet Nam Bangladesh Cambodia India Nepal Nepal Bangladesh Korea, DPR Sri Lanka -5 0 5 10 15 030405010 20 % Age standardised rates (%)

Source: WHO Global Database on Body Mass Index. Source: OECD Health Statistics 2014; WHO Infobase. 1 2 http://dx.doi.org/10.1787/888933152683

HEALTH AT A GLANCE: ASIA/PACIFIC 2014 © OECD/WHO 2014 51 From: Health at a Glance: Asia/Pacific 2014 Measuring Progress towards Universal Health Coverage

Access the complete publication at: https://doi.org/10.1787/health_glance_ap-2014-en

Please cite this chapter as:

OECD/World Health Organization (2014), “Adult malnutrition (underweight and overweight)”, in Health at a Glance: Asia/Pacific 2014: Measuring Progress towards Universal Health Coverage, OECD Publishing, Paris.

DOI: https://doi.org/10.1787/health_glance_ap-2014-22-en

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