Energy expenditure and obesity across the economic spectrum
Amanda McGrosky, Amy Luke, Leonore Arab, Kweku Bedu-Addo, A. Bonomi, Pascal Bovet, Søren Brage, Maciej S. Buchowski, Nancy F. Butte, Stefan Gerardus Camps, Regina C. Casper, Daniel K. Cummings, Sai Krupa Das, Sanjoy Deb, Lara R. Dugas, Ulf Ekelund, Terrence Forrester, Barry W. Fudge, Melanie B. Gillingham, Annelies Goris, Michael Gurven, Catherine Hambly, Annemiek Joosen, Peter T. Katzmarzyk, Kitty P. Kempen, William E. Kraus, Wantanee Kriengsinyos, Rebecca Kuriyan, Robert F. Kushner, Estelle V. Lambert, Christel Larsson, William R. Leonard, Nader Lessan, Marie Löf, Corby K. Martin, Anine Christine Medin, Marian L. Neuhouser, Kirsi H. Pietiläinen, Guy Plasqui, Ross L. Prentice, Susan B. Racette, David A. Raichlen, Éric Ravussin, Leanne M. Redman, Rebecca M. Reynolds, Eric B. Rimm, Susan B. Roberts, Asher Y. Rosinger, Mary H. Samuels, Srishti Sinha, J. Josh Snodgrass, Eric Stice, Ricardo Uauy, Samuel S. Urlacher, Jeanine Verbunt, Bruce M. Wolfe, Brian M. Wood, Xueying Zhang, Alexia J. Murphy‐Alford, Cornelia J. Loechl, Jennifer Rood, Hiroyuki Sagayama, Dale A. Schoeller, Klaas R. Westerterp, William W. Wong, Yosuke Yamada, John R. Speakman, Herman Pontzer, Lene Frost Andersen, Linda G. Bandini, Stephan Branth, N C De Bruin, Richard Cooper, Alice E. Dutman, Cara B. Ebbeling, Mikael Fogelholm, Tamara Harris, Rik Heijligenberg, Hans U. Jorgensen, David S. Ludwig, Eric Matsiko, M. McCloskey, Gerwin A. L. Meijer, Daphne Pannemans, Renaat Philippaerts, Jacob Plange‐Rhule, Elisabet Rothenberg, Sabine Schulz, Albert Stunkard, Amy F. Subar, Minna Tanskanen, Ricardo Uauy, Rita J. G. van den Berg-Emons, Ludo M. Van Etten, Wim G. van Gemert, E J Velthuis-te Wierik, Wilhelmine W. Verboeket-van de Venne, Walter C. Willett
Abstract
Global economic development has been associated with an increased prevalence of obesity and related health problems. Increased caloric intake and reduced energy expenditure are both cited as development-related contributors to the obesity crisis, but their relative importance remains unresolved. Here, we examine energy expenditure and two measures of obesity (body fat percentage and body mass index, BMI) for 4,213 adults from 34 populations across six continents and a wide range of lifestyles and economies, including hunter-gatherer, pastoralist, farming, and industrialized populations. Economic development was positively associated with greater body mass, BMI, and body fat, but also with greater total, basal, and activity energy expenditure. Body size-adjusted total and basal energy expenditures both decreased approximately 6 to 11% with increasing economic development, but were highly variable among populations and did not correspond closely with lifestyle. Body size-adjusted total energy expenditure was negatively, but weakly, associated with measures of obesity, accounting for roughly one-tenth of the elevated body fat percentage and BMI associated with economic development. In contrast, estimated energy intake was greater in economically developed populations, and in populations with available data (n = 25), the percentage of ultraprocessed food in the diet was associated with body fat percentage, suggesting that dietary intake plays a far greater role than reduced energy expenditure in obesity related to economic development.