{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T13:10:31Z","timestamp":1794489031551,"version":"4.9.1"},"reference-count":21,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2025,7,24]],"date-time":"2025-07-24T00:00:00Z","timestamp":1753315200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>Obesity is commonly defined using body mass index (BMI), but BMI alone does not capture the metabolic and functional consequences of excess weight. We examined the prevalence of clinical obesity, a new definition that incorporates BMI alongside metabolic and functional impairments. We analyzed nationally representative surveys. Clinical obesity was defined as BMI\u2009\u2265\u200930 kg\/m<jats:sup>2<\/jats:sup> and waist-to-height ratio \u22650.5 or BMI\u2009\u2265\u200940 kg\/m<jats:sup>2<\/jats:sup> with at least: self-reported diabetes, fasting plasma glucose \u2265126 mg\/dl, self-reported hypertension, blood pressure \u2265140\/90 mmHg, or total cholesterol \u2265200 mg\/dl. We estimated the survey-weighted and age-standardized prevalence of clinical obesity and BMI-only obesity by country and sex. Data from 56 countries were included (n\u2009=\u2009142,250). The prevalence of clinical obesity ranged between 0% and 29%. The prevalence of clinical obesity was\u2009&lt;\u200910% in 41 countries for men and 30 for women. In men, the largest shift in prevalence of BMI-only obesity and clinical obesity was observed in Malawi (0.7% vs 0.2%, relative change: -68%); in women, the largest shifts in prevalence were seen in Malawi (5.6% vs. 2.6%, relative change: -53%) and Rwanda (2.7% vs. 1.3%, relative change: -52%). The adoption of clinical obesity criteria revises obesity prevalence estimates and highlights metabolic and functional impairments beyond BMI. Our results emphasize the need to carefully consider how obesity is defined in population surveillance to ensure its relevance to health outcomes.<\/jats:p>","DOI":"10.1371\/journal.pgph.0004838","type":"journal-article","created":{"date-parts":[[2025,7,24]],"date-time":"2025-07-24T17:36:58Z","timestamp":1753378618000},"page":"e0004838","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":7,"title":["Prevalence of pre-clinical and clinical obesity in adults: Pooled analysis of 56 population-based national health surveys"],"prefix":"10.1371","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2090-1856","authenticated-orcid":true,"given":"Rodrigo M.","family":"Carrillo-Larco","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilmer Cristobal","family":"Guzman-Vilca","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0623-6543","authenticated-orcid":true,"given":"Carla","family":"Tarazona-Meza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaolin","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6834-1376","authenticated-orcid":true,"given":"Antonio","family":"Bernabe-Ortiz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,7,24]]},"reference":[{"issue":"1","key":"pgph.0004838.ref001","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1056\/NEJMoa1614362","article-title":"Health Effects of Overweight and Obesity in 195 Countries over 25 Years","volume":"377","author":"A Afshin","year":"2017","journal-title":"N Engl J Med"},{"issue":"12","key":"pgph.0004838.ref002","doi-asserted-by":"crossref","first-page":"944","DOI":"10.1016\/S2213-8587(18)30288-2","article-title":"Association of BMI with overall and cause-specific mortality: a population-based cohort study of 3\u00b76 million adults in the UK","volume":"6","author":"K Bhaskaran","year":"2018","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"10258","key":"pgph.0004838.ref003","doi-asserted-by":"crossref","first-page":"1223","DOI":"10.1016\/S0140-6736(20)30752-2","article-title":"Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019","volume":"396","author":"GBD 2019 Risk Factors Collaborators","year":"2020","journal-title":"Lancet"},{"issue":"10046","key":"pgph.0004838.ref004","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1016\/S0140-6736(16)30175-1","article-title":"Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents","volume":"388","author":"Global BMC","year":"2016","journal-title":"Lancet"},{"issue":"2","key":"pgph.0004838.ref005","doi-asserted-by":"crossref","DOI":"10.3390\/cancers15020485","article-title":"Obesity and Cancer: A Current Overview of Epidemiology, Pathogenesis, Outcomes, and Management","volume":"15","author":"S Pati","year":"2023","journal-title":"Cancers (Basel)"},{"issue":"9669","key":"pgph.0004838.ref006","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1016\/S0140-6736(09)60318-4","article-title":"Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies","volume":"373","author":"G Whitlock","year":"2009","journal-title":"Lancet"},{"issue":"10431","key":"pgph.0004838.ref007","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1016\/S0140-6736(23)02750-2","article-title":"Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults","volume":"403","author":"NCD Risk Factor Collaboration (NCD-RisC)","year":"2024","journal-title":"Lancet"},{"key":"pgph.0004838.ref008","article-title":"Definition and diagnostic criteria of clinical obesity","author":"F Rubino","year":"2025","journal-title":"Lancet Diabetes Endocrinol"},{"key":"pgph.0004838.ref009","unstructured":"World Health Organization. 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