One of the most alarming risks in the analysis is increased BMI, because its burden is large and increasing, and it is prevalent across all levels of SDI.32, 33 The potential drivers of this global epidemic include changes in food industries and systems, which increase availability, accessibility, and affordability of energy-dense foods, along with intense marketing of such foods, as well as reduced opportunities for physical activity.34 A range of interventions have been proposed to reduce obesity, including restricting the advertisement of unhealthy foods to children, improving school meals, taxation of sugar-sweetened beverages, and taxation to reduce consumption of other unhealthy foods and subsidies to increase intake of healthy foods, and using supply-chain incentives to increase production of healthy foods.35 However, the evidence base that many of these interventions can affect trends in obesity at scale is currently weak.36 What we know without a doubt is that obesity rates continue to increase in almost all locations. Low-SDI and middle-SDI countries generally have little financial resources for nutrition programs and mostly rely on external donors whose programmes often preferentially target undernutrition.37
