Background Obesity is one of the 21st century's greatest public health challenges. Evidence on how inequalities intersect to shape the obesity burden is scarce, particularly since the COVID-19 pandemic. We aimed to investigate trends in the incidence and prevalence of obesity among adults in England, and to examine variation by age, sex, socioeconomic status, ethnicity, and geographical region. Methods In this retrospective, longitudinal cohort study, we analysed whole-population, individual-level, anonymised, electronic health records with life-course data on the entire population of adults aged 18-99 years in England, accessed via the National Health Service England Secure Data Environment. We estimated age-and sex-standardised incidence and prevalence rates of obesity (BMI >= 30 & centerdot;0 kg/m2 or clinician-assigned diagnosis) from 2019 to 2025 and used negative binomial regression to examine trends by age, sex, socioeconomic status, ethnicity, and geographical region (defined using middle layer super output areas: neighbourhood-level units comprised of 5000 to 15 000 individuals). Findings Between Nov 1, 2019, and April 30, 2025, we identified 54 892 390 adults with records in the National Health Service England Secure Data Environment. 4 131 555 people had a first presentation of obesity during the study period, of whom 2 278 485 (55 & centerdot;1%) were women and 1 853 070 (44 & centerdot;9%) were men. 3 106 740 (75 & centerdot;2%) of individuals were White, 482 690 (11 & centerdot;7%) were Asian or Asian British, and 291 920 (7 & centerdot;1%) were Black, Black British, Caribbean, or African. The median age at first presentation of obesity was 43 years (IQR 31-58), and mean BMI was 33 & centerdot;4 kg/m2 (SD 10 & centerdot;7). The overall age-and sex-standardised incidence of first-recorded obesity was 22 per 1000 person-years (95% CI 22-22) and increased by 4% over the study period (incidence rate ratio [IRR] 2024-2025 vs 2019-2020 1 & centerdot;04, 95% CI 1 & centerdot;01-1 & centerdot;07), with marked variation across subgroups. The steepest increases over time occurred in those aged 20-29 years (IRR 1 & centerdot;16, 95% CI 1 & centerdot;08-1 & centerdot;25) and in those aged 30-39 years (1 & centerdot;19, 1 & centerdot;13-1 & centerdot;25). Obesity incidence was 35% greater in the most socioeconomically deprived quintile compared with the least deprived quintile (IRR 1 & centerdot;35, 95% CI 1 & centerdot;28-1 & centerdot;42), with greater disparities in women (1 & centerdot;54, 1 & centerdot;45-1 & centerdot;64), particularly Asian women (1 & centerdot;94, 1 & centerdot;86-2 & centerdot;02). By 2025, overall obesity prevalence reached 30 & centerdot;3%, rising from 26 & centerdot;3% at the start of the study. There was considerable variation in obesity prevalence by age, sex, socioeconomic status, and ethnicity, ranging from 4 & centerdot;3% in the least socioeconomically deprived White men aged 18-19 years to 66 & centerdot;1% in the most deprived Black women aged 60-69 years, which was nearly double that in the least-deprived White women in the same age group (60-69 years; 34 & centerdot;5%). Geographical disparities were striking, with prevalence varying between 8 & centerdot;5% and 48 & centerdot;1% (a nearly 6-fold difference), with the largest increases over time observed in most deprived regions. Interpretation Obesity affects nearly one in three adults in England, with disproportionate burden among disadvantaged groups and widening disparities since the COVID-19 pandemic. Increasing rates among individuals of childbearing age risk perpetuating intergenerational cycles of health inequality. The intersection of sociodemographic determinants underscores the preventable nature of obesity and the need to address dimensions of inequality in prevention efforts.
Background Data on national trends in the prevalence of type 2 diabetes and intermediate hyperglycaemia using the oral glucose tolerance test (OGTT) are scarce. We aimed to identify trends in the prevalence of type 2 diabetes and intermediate hyperglycaemia in Mauritius, a country that has monitored prevalence over 34 years using OGTT. Methods Non-communicable disease risk factor surveys using standardised protocols were conducted in the general population in 1987, 1992, 1998, 2004, 2009, 2015, and 2021 in Mauritius, with 36 744 survey attendances by adults aged 25–74 years examined. The participation rate was more than 85% in each survey. Participants had fasting plasma glucose measured at the survey site by site staff, and those who were not pregnant or taking glucose-lowering medication had an OGTT. Blood samples were immediately centrifuged to isolate plasma for glucose measurement. Glycaemic status was classified according to WHO 2006 criteria. Findings In 1987, the age and sex-standardised prevalence of type 2 diabetes in Mauritius was 14·7% (698 of 5017 people; 95% CI 13·7–15·7), which increased gradually, peaking at 23·3% (1599 of 5833; 22·4–24·3) in 2009, and decreased significantly to 19·9% (899 of 3343; 18·6–21·1) in 2021. This decrease was consistent in direction across sexes, age groups, and ethnicities. The age and sex-standardised prevalence of intermediate hyperglycaemia was 20·8% (1024 of 5017 people; 95% CI 19·6–21·9) in 1987, peaked at 24·9% (1495 of 5833; 23·8–26·1) in 2009, and declined to 15·6% (580 of 3343; 14·3–16·9) in 2021. The proportion of all individuals with type 2 diabetes who were newly diagnosed decreased from 67·0% in 1987 (468 of 698 people) to 32·5% (292 of 899) in 2021. Interpretation Mauritius is the first country to show a decreasing prevalence of type 2 diabetes and intermediate hyperglycaemia over time, using the objective, gold standard OGTT-based diagnostic criteria recommended by the WHO. These results underscore that national efforts to prevent and control type 2 diabetes can reduce its burden; systematic monitoring of diabetes and intermediate hyperglycaemia occurrence using the OGTT is crucial. Funding Mauritian Ministry of Health and Wellness.
