Obesity is a major epidemic, but its causes are still unclear. In this article, we investigate the relation between the intake of high-fructose corn syrup (HFCS) and the development of obesity. We analyzed food consumption patterns by using US Department of Agriculture food consumption tables from 1967 to 2000. The consumption of HFCS increased > 1000% between 1970 and 1990, far exceeding the changes in intake of any other food or food group. HFCS now represents > 40% of caloric sweeteners added to foods and beverages and is the sole caloric sweetener in soft drinks in the United States. Our most conservative estimate of the consumption of HFCS indicates a daily average of 132 kcal for all Americans aged > or = 2 y, and the top 20% of consumers of caloric sweeteners ingest 316 kcal from HFCS/d. The increased use of HFCS in the United States mirrors the rapid increase in obesity. The digestion, absorption, and metabolism of fructose differ from those of glucose. Hepatic metabolism of fructose favors de novo lipogenesis. In addition, unlike glucose, fructose does not stimulate insulin secretion or enhance leptin production. Because insulin and leptin act as key afferent signals in the regulation of food intake and body weight, this suggests that dietary fructose may contribute to increased energy intake and weight gain. Furthermore, calorically sweetened beverages may enhance caloric overconsumption. Thus, the increase in consumption of HFCS has a temporal relation to the epidemic of obesity, and the overconsumption of HFCS in calorically sweetened beverages may play a role in the epidemic of obesity.

The double burden of malnutrition (DBM), defined as the simultaneous manifestation of both undernutrition and overweight/obesity, affects most low-and middle-income countries (LMICs). This paper describes the dynamics of DBM in LMICs and how it differs by socioeconomic level. The paper shows that DBM has increased in the poorest LMICs, mainly due to overweight/obesity increases. Indonesia is the largest country experiencing severe levels of the DBM, but many other Asian and sub-Saharan African countries also face this problem. We also discuss that overweight increases are mainly due to rapid changes in the food system, particularly the availability of cheap ultra-processed food and beverages in LMICs while there are major reductions in physical activity at work, transportation, home and even leisure related to introductions of activity-saving technologies. Understanding that the lowest income LMICs face severe levels of DBM and that the major direct cause is rapid increases in overweight allows identifying selected critical drivers and possible options for addressing DBM at all levels.

The burden of nutritional problems is shifting from energy imbalance deficiency to excess among older children and adolescents in Brazil and China. The variations across countries may relate to changes and differences in key environmental factors.

Global energy imbalances and related obesity levels are rapidly increasing. The world is rapidly shifting from a dietary period in which the higher-income countries are dominated by patterns of degenerative diseases (whereas the lower- and middle-income countries are dominated by receding famine) to one in which the world is increasingly being dominated by degenerative diseases. This article documents the high levels of overweight and obesity found across higher- and lower-income countries and the global shift of this burden toward the poor and toward urban and rural populations. Dietary changes appear to be shifting universally toward a diet dominated by higher intakes of animal and partially hydrogenated fats and lower intakes of fiber. Activity patterns at work, at leisure, during travel, and in the home are equally shifting rapidly toward reduced energy expenditure. Large-scale decreases in food prices (eg, beef prices) have increased access to supermarkets, and the urbanization of both urban and rural areas is a key underlying factor. Limited documentation of the extent of the increased effects of the fast food and bottled soft drink industries on this nutrition shift is available, but some examples of the heterogeneity of the underlying changes are presented. The challenge to global health is clear.