The Nutrition Transition

The nutrition transition: worldwide obesity dynamics
and their determinants

BM Popkin1* and P Gordon-Larsen1
1Department of Nutrition, Schools of Public Health and Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
OBJECTIVE: This paper explores the major changes in diet and physical activity patterns around the world and focuses on shifts in obesity.
DESIGN:Review of results focusing on large-scale surveys and nationally representative studies of diet, activity, and obesity among adults and children.
SUBJECTS: Youth and adults from a range of countries around the world.
MEASUREMENTS: The International Obesity Task Force guidelines for defining overweight and obesity are used for youth and the body mass index Z25 kg/m2 and 30 cutoffs are used,respectively, for adults. RESULTS: The nutrition transition patterns are examined from the time period termed the receding famine pattern to one dominated by nutrition-related noncommunicable diseases (NR-NCDs). The speed of dietary and activity pattern shifts is great, particularly in the developing world, resulting in major shifts in obesity on a worldwide basis. Data limitations force us to examine dataon obesity trends in adults to provide a broader sense of changes in obesity over time, and then to examine the relatively fewer studies on youth. Specifically, this work provides a sense of change both in the United States, Europe, and the lower- and middle-income countries of Asia, Africa, the Middle East, and Latin America.
CONCLUSION: The paper shows that changes are occurring at great speedand at earlier stages of the economic and social development of each country. The burden of obesity is shifting towards the poor. International Journal of Obesity (2004) 28, S2–S9. doi:10.1038/sj.ijo.0802804

INTRODUCTION
Over the past 15 y, there has been increasing evidence that the structure of dietary intakes and the prevalence of obesity around the developing world have been changing atan increasingly rapid pace.1 In many ways, these shifts are a continuation of large-scale changes that have occurred repeatedly over time; however, we will assert and show that the changes facing low- and moderate-income countries appear to be very rapid. While initially these shifts were felt to be limited to higher-income urban populations, it is increasingly clear that these are much broadertrends affecting all segments of society. Two historic processes of change occur simultaneously with, or precede, the ‘nutrition transition’. One is the demographic transitionFthe shift from a pattern of high fertility and mortality to one of low fertility and mortality (typical of modern industrialized countries). The second is the epidemiological transition, first described by Omran:2 the shiftfrom a pattern of high prevalence of infectious diseaseFassociated with malnutrition, periodic famine, and poor environmental sanitationFto one of high prevalence of chronic and degenerative diseaseFassociated with urban– industrial lifestyles.3 The nutrition transition is closely related to the demographic and epidemiologic transitions. Large shifts have occurred in diet and in physical activitypatterns, particularly in the last one or two decades of the 20th century. Modern societies seem to be converging on a diet high in saturated fats, sugar, and refined foods but low in fiberFoften termed the ‘Western diet’Fand on lifestyles characterized by lower levels of activity. These changes are reflected in nutritional outcomes, such as changes in average stature, body composition, andmorbidity.

The last three stages of the nutrition transition are described in more detail in Figure 1. In Stage 3, famine begins to recede as income rises. In Stage 4, changes in diet and activity pattern lead to the emergence of new disease problems and increased disability. In Stage 5, behavioral change begins to reverse the negative tendencies and make possible a process of ‘successful aging’.4,5...