Supplementary Material for: The Global Spread of Severe Obesity in Toddlers, Children and Adolescents – a Systematic Review & Meta Analysis

Introduction: Severe obesity among children and adolescents has emerged as a public health concern in multiple places around the world. Methods: We searched the Medline database for articles on severe obesity rates in children published between January 1960 and January 2020. For studies with available prevalence rates for an early and a more recent time period, the relative increase in prevalence was imputed. Results: In total, 874 publications were identified, of which 38 contained relevant epidemiological data. Rates of severe obesity varied significantly according to age, gender, geographic area, and the definition of severe obesity. The highest rates of class II and III obesity in the US according to the Centers of Disease Control cutoff were 9.5% and 4.5%, respectively. Seventeen studies reported prevalence rates in at least two time periods. Data for 9,190,718 individuals showed a 1.71 (95%CI, 1.53-1.90) greater odds for severe obesity in 2006-2017 (N=5,029,584) vs. 1967-2007 (N=4,161,134). In an analysis limited to studies from 1980s’ with a minimum follow-up of 20 years, a 9.16(95%CI, 7.76-10.80) greater odds for severe obesity in recent vs. earlier time was found. An analysis limited to studies from 2000, with a follow-up of 5-15 years, a 1.09 (95%CI, 0.99-1.20) greater odds was noted when comparing (2011-2017; N=4,991,831) vs. (2000-2011; N=4,134,340). Conclusion: Severe pediatric obesity is escalating with a marked increase from the1980’s and a slower rate from 2000.

引言：儿童与青少年重度肥胖已成为全球多国的公共卫生关切议题。方法：本研究检索Medline数据库中1960年1月至2020年1月发表的儿童重度肥胖患病率相关文献。对于同时提供早期与较晚研究时段患病率数据的文献，我们推算其患病率相对增幅。结果：本研究共检索到874篇文献，其中38篇包含相关流行病学数据。重度肥胖患病率因年龄、性别、地理区域以及重度肥胖定义的不同而存在显著差异。按照美国疾病控制中心（Centers of Disease Control）的cutoff判定标准，美国II级与III级肥胖的最高患病率分别为9.5%与4.5%。共有17项研究报告了至少两个研究时段的患病率数据。针对9190718名个体的数据分析显示，2006-2017年（N=5029584）与1967-2007年（N=4161134）相比，重度肥胖的患病优势比为1.71（95%置信区间：1.53~1.90）。在仅纳入1980年代开展、且最短随访时长为20年的研究的亚组分析中，近期相较于早期时段，重度肥胖的患病优势比为9.16（95%置信区间：7.76~10.80）。在仅纳入2000年及以后开展、随访时长为5~15年的研究的亚组分析中，对比2011-2017年（N=4991831）与2000-2011年（N=4134340），重度肥胖的患病优势比为1.09（95%置信区间：0.99~1.20）。结论：儿童重度肥胖患病率呈持续上升态势，其中1980年代以来增幅显著，2000年以来的增长速率有所放缓。