Associated factors, concordance, and trends of obesity: body mass index, abdominal waist, and waist- to-height ratio between 2014 and 2022. Analysis of nine national surveys

Abstract

Introduction: Obesity is a global epidemic affecting millions of people worldwide. Its diagnosis and treatment are crucial for the prevention of associated chronic diseases. Objectives: To assess the prevalence of obesity according to different diagnostic criteria, analyze the concordance between various diagnostic methods, and identify associated factors. Methods: Peru's Demographic and Family Health Survey (ENDES) from 2014 to 2022 was utilized. The cut-off points for defining obesity were ≥ 30 for body mass index (BMI), the ATPIII criteria for waist circumference (WC-ATPIII), and 0.56 for the waist-to-height ratio (WHtR). Concordance analyses were performed to compare diagnostic methods and regression analyses were conducted to identify associated factors. Results: The prevalence of obesity according to BMI, WC-ATPIII, and WHtR was 25.65%, 42.04%, and 46.49%, respectively. The concordance between the three criteria was evaluated through the Kappa index. The concordance between obesity by BMI and WC-ATPIII was 0.5141. The concordance between BMI and WHtR was 0.5099. Finally, the concordance between WC-ATPIII and WHtR was 0.7514. Men showed a lower prevalence of obesity compared to women. The obesity trend increased overall during the study period, with marked differences in prevalence according to the obesity measure used. Conclusions: The findings reveal differences in obesity prevalence according to the diagnostic method employed and underscore the need to consider multiple approaches to assess obesity. The results significantly affect public health and provide a foundation for future interventions and policies to combat obesity in Peru.

Prevalence of Obesity According to Body Mass Index, Waist Circumference, and Waist-to-Height Ratio in Peru: A Systematic Review and Meta-Analysis

“…The studies, ranging in date from Jacoby (2003) (9) to Vásquez-Romero (2024) (6) , presented sample sizes from 217 (10) to 35,255 individuals (6) . Four studies were national in scope, while 13 were subnational.…”

“…In contrast, the ENINBSC study (14) showed the lowest prevalence for BMI at 13.10%, and Jacoby (9) recorded the lowest for WC at 19.4% (9) . Regarding WHtR, Aparco and Cárdenas-Quintana (5) reported the highest prevalence at 85.40%, while Vásquez-Romero (6) reported two prevalences for WHtR depending on the cut-off point: ≥ 0.50 (84.78%) and ≥ 0.59 (48.05%).…”

“…Including 16 studies that met rigorous selection criteria, the analysis provides a crucial perspective on the evolution and distribution of obesity across various demographics and regions in the country. However, it is concerning that only five of these studies were published in the last five years (4)(5)(6)13,20) , and only two studies (5,6) aimed to determine obesity prevalence. This indicates a possible lack of recent data that could affect the responsiveness of public health policies to this escalating epidemic.…”

“…Similarly, for WHtR, if the globally consensual cut-off points of ≥ 0.5 (25) are followed, obesity prevalence would reach up to 80%, a value that, as mentioned earlier, does not reflect reality. Therefore, studies like Vásquez-Romero et al (6) used the cut-off of 0.59, which provided a more realistic prevalence, although it still yielded equally high values. Considering this, there is a need to review and possibly recalibrate these cut-off points to reflect the true prevalence of obesity in the country more accurately.…”

“…Additionally, the Food and Nutrition Surveillance by Life Stage Adult Survey (VIANEV, acronym in Spanish) from 2017-2018 showed higher numbers: 26.8% with BMI, 50.4% with waist circumference (WC), and up to 85.4% with waist-to-height ratio (WHtR) (5) . A more recent study by Vásquez-Romero utilizing data from the National Demographic and Health Survey (ENDES, acronym in Spanish) showed national obesity rates of 25.65%, 42.04%, and 46.49%, based on BMI, WC, and WHtR, respectively (6) .…”