The fat get fatter, the thin stay thin

When the population of a low- or middle-income country increases its average body mass index, it often means the country has added many newly overweight people but not reduced quite as many underweight people, going by the findings of a study on "weight extremes".

Researchers studied the BMI of 730,000 women living in 37 countries between 1991 and 2008 and found the proportion of the overweight and obese in the population had increased much more than the proportion of the underweight had decreased.

And people of average weight are disappearing, the researchers noted.

Persisting undernutrition alongside a simultaneous rise in obesity is a pattern seen in most of the low-income countries that were studied. In India, 25 per cent of the population were found underweight in 2005, only a 20 per cent drop since 1998. At the same time, the percentage of the obese has doubled. The 25 per cent underweight outnumber the overweight and the obese combined, the reserachers said.

"The study is novel because for the first time we are showing that increases in BMI are not happening equally across the board. These are largely driven by populations that are already overweight or obese, with little to no change among underweight individuals," said S V Subramanian, professor of Population Health and Geography at Harvard School of Public Health. He is senior author of the study, conducted by the University of Toronto and the Harvard school and published this month in PLOS Medicine.

Lead author Fahad Razak, University of Toronto clinical fellow working at St Michael's Hospital, said the growing trend of extremes would pose a major challenge for healthcare and policy leaders.

"One might think that as a country grows economically, the majority of the underweight population would move into the average BMI range, but our study shows the opposite: people of average weight are disappearing," Razak said.

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