• Overview
  • Obesity prevalence
  • Population breakdowns
  • Drivers
  • Comorbidities
  • Health systems
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Obesity prevalence

Women, 2017-2018

Survey type:Measured
Age:15-49
Sample size:3722
Area covered:National
References:DHS Pakistan 2018. https://www.dhsprogram.com/pubs/pdf/FR354/FR354.pdf
Notes:Demographic Health Survey data includes ever married women aged 15-49 years only and may include males aged 15-59.
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 2013-2014

Survey type:Measured
Age:18-69
Sample size:7710
Area covered:Regional
References:STEPS Pakistan 2013/14 Fact Sheet (full report would not download) https://www.who.int/ncds/surveillance/steps/2014_Pakistan_STEPS_FactSheet.pdf (last accessed 05.11.19)
Notes:Punjab & Siindh Province of Pakistan STEPS
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Women, 2012-2013

Survey type:Measured
Age:15-49
Sample size:4170
Area covered:National
References:DHS Pakistann 2012/2013
Notes:Demographic Health Survey data includes ever married women aged 15-49 years only and may include males aged 15-59.
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 1990-1994

Survey type:Measured
Age:15+
Sample size:8972
Area covered:National
References:Jafar TH, Chaturvedi N and Pappas G. (2006). Prevalence of overweight and obesity and their association with hypertension and diabetes mellitus in an Indo-Asian population. CMAJ, 175(9):1071 - 1077.
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Children, 2009-2010

Survey type:Measured
Age:5-12
Sample size:1860
Area covered:Regional
References:Mushtaq MU, Gull S, Mushtaq K, Agdullah HM, Khurshid U, Shahid U, Shad MA, Akram J. Height, weight and BMI percentiles and nutritional status relative to the international growth references among Pakistani school-aged children. BMC Pediatrics 2012, 12:31 doi:10.1186/1471-2431-12-31
Notes:Region: Lahore, IOTF Cut Off (it assumed that the paper oveweight includes obesity)
Cutoffs:IOTF

Overweight/obesity by education

Women, 2011-2012

Survey type:Measured
Age:15-49
Sample size:4,767
Area covered:National
References:Janjua et al 2015. Association of Household and Community Socioeconomic Position and Urbanicity with Underweight and Overweight among Women in Pakistan. PLoS ONE 10(4). doi:10.1371/journal.pone.0122314
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Overweight/obesity by age

Women, 2011-2012

Survey type:Measured
Sample size:4,767
Area covered:National
References:Janjua et al 2015. Association of Household and Community Socioeconomic Position and Urbanicity with Underweight and Overweight among Women in Pakistan. PLoS ONE 10(4). doi:10.1371/journal.pone.0122314
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Overweight/obesity by region

Women, 2011-2012

Survey type:Measured
Age:15-49
Sample size:4,767
References:Janjua et al 2015. Association of Household and Community Socioeconomic Position and Urbanicity with Underweight and Overweight among Women in Pakistan. PLoS ONE 10(4). doi:10.1371/journal.pone.0122314
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Children, 2009

Survey type:Measured
Age:5-12
Sample size:1860
Area covered:Lahore, Pakistan
References:Mushtaq MU, Gull S, Abdullah HM et al. Prevalence and socioeconomic correlates of overweight and obesity among Pakistani primary school children. BMC Public Health, 2011: Volume 11, Number 1, Page 1
Notes:Overweight (> + 1SD) and obesity (> + 2SD) were defined using the World Health Organization child growth reference 2007.
Cutoffs:WHO

Overweight/obesity by socio-economic group

Women, 2011-2012

Survey type:Measured
Age:15-49
Sample size:4,767
Area covered:National
References:Janjua et al 2015. Association of Household and Community Socioeconomic Position and Urbanicity with Underweight and Overweight among Women in Pakistan. PLoS ONE 10(4). doi:10.1371/journal.pone.0122314
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Children, 2009

Survey type:Measured
Age:5-12
Sample size:1860
Area covered:Subnational - Lahore
References:Mushtaq MU, Gull S, Abdullah HM, Shahid U, Shad MA, Akram J. Prevalence and socioeconomic correlates of overweight and obesity among Pakistani primary school children. BMC Public Health. 2011;11:724. doi:10.1186/1471-2458-11-724.
Notes:Overweight (> + 1SD) and obesity (> + 2SD) were defined using the World Health Organization child growth reference 2007.
Cutoffs:WHO

Insufficient physical activity

Adults, 2016

References:Guthold R, Stevens GA, Riley LM, Bull FC. Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1.9 million participants. Lancet 2018 http://dx.doi.org/10.1016/S2214-109X(18)30357-7

Men, 2016

References:Guthold R, Stevens GA, Riley LM, Bull FC. Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1.9 million participants. Lancet 2018 http://dx.doi.org/10.1016/S2214-109X(18)30357-7

Women, 2016

References:Guthold R, Stevens GA, Riley LM, Bull FC. Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1.9 million participants. Lancet 2018 http://dx.doi.org/10.1016/S2214-109X(18)30357-7

Children, 2010

Age:11-17
References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A893?lang=en
Notes:% of school going adolescents not meeting WHO recommendations on Physical Activity for Health, i.e. doing less than 60 minutes of moderate- to vigorous-intensity physical activity daily.
Definitions:% Adolescents insufficiently active (age standardised estimate)

Boys, 2010

Age:11-17
References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A893?lang=en
Notes:% of school going adolescents not meeting WHO recommendations on Physical Activity for Health, i.e. doing less than 60 minutes of moderate- to vigorous-intensity physical activity daily.
Definitions:% Adolescents insufficiently active (age standardised estimate)

Girls, 2010

Age:11-17
References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A893?lang=en
Notes:% of school going adolescents not meeting WHO recommendations on Physical Activity for Health, i.e. doing less than 60 minutes of moderate- to vigorous-intensity physical activity daily.
Definitions:% Adolescents insufficiently active (age standardised estimate)

Average daily frequency of carbonated soft drink consumption

Children, 2009-2015

Survey type:Measured
Age:12-17
References:Beal et al. (2019). Global Patterns of Adolescent Fruit, Vegetable, Carbonated Soft Drink, and Fast-food consumption: A meta-analysis of global school-based student health surveys. Food and Nutrition Bulletin. https://doi.org/10.1177/0379572119848287 sourced from Food Systems Dashboard http://www.foodsystemsdashboard.org/food-system

Estimated per-capita fruit intake

Adults, 2017

Survey type:Measured
Age:25+
References:Global Burden of Disease, the Institute for Health Metrics and Evaluation http://ghdx.healthdata.org/
Definitions:Estimated per-capita fruit intake (g/day)

Prevalence of less-than-daily fruit consumption

Children, 2008-2015

Survey type:Measured
Age:12-17
References:Global School-based Student Health Surveys. Beal et al (2019). Global Patterns of Adolescent Fruit, Vegetable, Carbonated Soft Drink, and Fast-food consumption: A meta-analysis of global school-based student health surveys. Food and Nutrition Bulletin. https://doi.org/10.1177/0379572119848287. Sourced from Food Systems Dashboard http://www.foodsystemsdashboard.org/food-system
Definitions:Prevalence of less-than-daily fruit consumption (% less-than-daily fruit consumption)

Prevalence of less-than-daily vegetable consumption

Children, 2008-2015

Survey type:Measured
Age:12-17
References:Beal et al. (2019). Global Patterns of Adolescent Fruit, Vegetable, Carbonated Soft Drink, and Fast-food consumption: A meta-analysis of global school-based student health surveys. Food and Nutrition Bulletin. https://doi.org/10.1177/0379572119848287 sourced from Food Systems Dashboard http://www.foodsystemsdashboard.org/food-system
Definitions:Prevalence of less-than-daily vegetable consumption (% less-than-daily vegetable consumption)

Average weekly frequency of fast food consumption

Children, 2009-2015

Age:12-17
References:Beal et al. (2019). Global Patterns of Adolescent Fruit, Vegetable, Carbonated Soft Drink, and Fast-food consumption: A meta-analysis of global school-based student health surveys. Food and Nutrition Bulletin. https://doi.org/10.1177/0379572119848287 sourced from Food Systems Dashboard http://www.foodsystemsdashboard.org/food-system

Estimated per-capita processed meat intake

Adults, 2017

Survey type:Measured
Age:25+
References:Global Burden of Disease, the Institute for Health Metrics and Evaluation http://ghdx.healthdata.org/
Definitions:Estimated per-capita processed meat intake (g per day)

Estimated per-capita whole grains intake

Adults, 2017

Survey type:Measured
Age:25+
References:Global Burden of Disease, the Institute for Health Metrics and Evaluation http://ghdx.healthdata.org/
Definitions:Estimated per-capita whole grains intake (g/day)

Mental health - depression disorders

Adults, 2015

References:Prevalence data from Global Burden of Disease study 2015 (http://ghdx.healthdata.org) published in: Depression and Other Common Mental Disorders: Global Health Estimates. Geneva:World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO.
Definitions:% of population with depression disorders

Mental health - anxiety disorders

Adults, 2015

References:Prevalence data from Global Burden of Disease study 2015 (http://ghdx.healthdata.org) published in: Depression and Other Common Mental Disorders: Global Health Estimates. Geneva:World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO.
Definitions:% of population with anxiety disorders

Oesophageal cancer

Men, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, oesophagus, adults ages 20+. ASR (World) per 100,000

Women, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, oesophagus, adults ages 20+. ASR (World) per 100,000

Breast cancer

Women, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, breast, females, ages 20+. ASR (World) per 100,000

Colorectal cancer

Men, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, colorectum, adults, ages 20+. ASR (World) per 100,000

Women, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, colorectum, adults, ages 20+. ASR (World) per 100,000

Pancreatic cancer

Men, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, pancreas, adults, ages 20+. ASR (World) per 100,000

Women, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, pancreas, adults, ages 20+. ASR (World) per 100,000

Gallbladder cancer

Men, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, gallbladder, adults, ages 20+. ASR (World) per 100,000

Women, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, gallbladder, adults, ages 20+. ASR (World) per 100,000

Kidney cancer

Men, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, kidney, adults, ages 20+. ASR (World) per 100,000

Women, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, kidney, adults, ages 20+. ASR (World) per 100,000

Cancer of the uterus

Women, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, cervix uteri, females, ages 20+. ASR (World) per 100,000

Raised blood pressure

Adults, 2015

References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A875?lang=en
Definitions:Age Standardised estimated % Raised blood pressure 2015 (SBP>=140 OR DBP>=90).

Men, 2015

References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A875?lang=en
Definitions:Age Standardised estimated % Raised blood pressure 2015 (SBP>=140 OR DBP>=90).

Women, 2015

References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A875?lang=en
Definitions:Age Standardised estimated % Raised blood pressure 2015 (SBP>=140 OR DBP>=90).

Raised cholesterol

Adults, 2008

References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A885
Definitions:% Raised total cholesterol (>= 5.0 mmol/L) (age-standardized estimate).

Men, 2008

References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A885
Definitions:% Raised total cholesterol (>= 5.0 mmol/L) (age-standardized estimate).

Women, 2008

References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A885
Definitions:% Raised total cholesterol (>= 5.0 mmol/L) (age-standardized estimate).

Raised fasting blood glucose

Men, 2014

References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A869?lang=en
Definitions:Age Standardised % raised fasting blood glucose (>= 7.0 mmol/L or on medication).

Women, 2014

References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A869?lang=en
Definitions:Age Standardised % raised fasting blood glucose (>= 7.0 mmol/L or on medication).

Diabetes prevalence

Adults, 2017

References:Reproduced with kind permission of IDF, International Diabetes Federation. IDF Diabetes Atlas, 8th edition. Brussels, Belgium: International Diabetes Federation, 2017. http://www.diabetesatlas.org
Definitions:Diabetes age-adjusted comparative prevalence (%).

Health systems

Economic classification: Lower Middle Income

Health systems summary

Pakistan’s health system is complex, with many subsystems and competing providers. Healthcare in the public sector is delivered by the federal and/or provincial government (dependent on area) while care in the private sector is delivered by actors ranging from hospitals to individually practising healthcare professionals, traditional healers and philanthropic organisations. The private sector is estimated to serve 70% of the Pakistani population, with Pakistan spending just 3.1% of its GDP on health. In 2015-2016, out of pocket expenditure was close to 60% of total health expenditure.

Pakistan is marked by severe urban-rural disparities. Despite an increase in the number of facilities in recent years, those in rural and remote areas have difficulty accessing services. This is exacerbated by a chronic shortage of healthcare workers.

Indicators

Where is the country’s government in the journey towards defining ‘Obesity as a disease’?No
Where is the country’s healthcare provider in the journey towards defining ‘Obesity as a disease’?No
In practice, how is obesity treatment largely funded?Out of pocket
Is there specialist training available dedicated to the training of health professionals to prevent, diagnose, treat and manage obesity?No
Have any taxes or subsidies been put in place to protect/assist/inform the population around obesity?No
Are there adequate numbers of trained health professionals in specialties relevant to obesity in urban areas?No
Are there adequate numbers of trained health professionals in specialties relevant to obesity in rural areas?No
Are there any obesity-specific recommendations or guidelines published for adults?No
Are there any obesity-specific recommendations or guidelines published for children?No

Perceived barriers to treatment

  • Poor health literacy and/or behaviour
  • Lack of financial investment and funding for coverage
  • High cost of out of pocket payments
  • Food industry influence
  • Obesity not recognised as a disease
  • Fragmented and/or failing health system
  • Lack of training for healthcare professionals
  • Poor adherence or fear of treatment
  • Lack of evidence, monitoring and research

Summary of stakeholder feedback

Obesity is not yet considered a disease in Pakistan by either the government, the healthcare providers or the public. Aside from new nutritional guidelines published in late 2018, stakeholders reported a lack of action around prevention from the government. There were calls for more public awareness campaigns to inform the public around a healthy lifestyle and calls for better obesity-related research.

Stakeholders reported there to be a lack of obesity management and treatment guidelines in Pakistan, and relatedly no routinely used care pathways. It did appear, however, that there was agreement that individuals became eligible for pharmacological treatment at BMI>30 kg/m2. It is unclear whether treatment is covered by the government and insurance providers, but stakeholders reported that treatment was mostly financed out of pocket by individuals.

There is great regional disparity in access to care in Pakistan. Weight management programmes were reported to be concentrated in major cities and even then, stakeholders remarked that they are manned by insufficiently qualified staff. As a result, people living with obesity in rural areas were said to not enter the health system for care (compounded by the fact that those in rural areas are also less likely to consider obesity to be a disease and so think care is necessary).

There is no specialist obesity training available in Pakistan. Stakeholders reported that a lot of treatment is delivered by ‘quacks’, particularly in rural areas. This issue of quacks is not isolated to obesity treatment.

Based on interviews/survey returns from 4 stakeholders

Last updated: June 2020

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