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Nasir Hamid
Planetary health leadership to drive climate action across pharmaceutical supply chains: insights from qualitative research and a call to action
Introduction Pharmaceutical manufacture, delivery and use produces an estimated 10%–55% of national healthcare greenhouse gas emissions. Addressing pharmaceutical supply chain emissions is essential to mitigating healthcare’s climate impact. Our research aimed to explore the constraints to pharmaceutical supply chain climate action and how planetary health leadership can overcome these challenges. Methods We conducted 21 narrative interviews with representatives from pharmaceutical companies and industry and health system stakeholders. Interviews explored perspectives on climate action across pharmaceutical supply chains. Analysis was informed by argumentative discourse analysis, enabling the identification of key storylines. Results Climate action across pharmaceutical supply chains is sporadic and insufficient to achieve health system climate goals. Critical constraints to climate action include (a) structural constraints, particularly complex, fragmented, global supply chains as well as limited renewable energy infrastructure in some countries where supply chains operate and (b) conceptual constraints, the ‘patient-profit-planet dilemma’, where climate action is perceived to conflict with patient well-being and financial considerations. Planetary health leadership can help overcome these constraints in three key ways. First, planetary health leadership can help reconceptualise healthcare delivery, and the role of pharmaceuticals, to align patient and planetary well-being while meeting financial pressures. Second, planetary health leadership can mobilise collective climate action across pharmaceutical supply chains, reframing climate change as a shared problem and challenging issues of transparency, competition and blame. Third, planetary health leadership can challenge wider systems that constrain climate action, leveraging the economic and political power of pharmaceutical supply chains to drive global decarbonisation efforts. Conclusion Planetary health leadership must confront considerable constraints to embed planetary health considerations across pharmaceutical supply chains. Leaders in this space must be willing to go against the status quo and challenge entrenched norms and systems to enable wider spread and support for sustainable healthcare delivery.
Correction to: Health-Related Quality-of-Life Outcomes of Very Preterm or Very Low Birth Weight Adults: Evidence From an Individual Participant Data Meta-Analysis (PharmacoEconomics, (2023), 41, 1, (93-105), 10.1007/s40273-022-01201-2)
In Table 1 of this article, the column header “NZ-VLBW (New Zealand)” was incorrectly placed above the column titled “SF-6D at 19 years” but should have been placed above the columns titled “SF-6D at 22-23 years” and “SF-6D at 26-30 years”. Consequently, the column header “NTNU (Norway)” should have been placed above the columns titled “SF-6D at 19 years” and “SF-6D at 23 years”. The old incorrect and the correct versions of Table 1 are given below. Background characteristics of cohorts BLS (Germany) VICS (Australia) EPICure (UK and Ireland) NZ-VLBW (New Zealand) NTNU (Norway) HUI3 at 26 years SF-6D at 26 years HUI3 at 18 years SF-6D at 18 years HUI3 at 19 years SF-6D at 22–23 years SF-6D at 26–30 years SF-6D at 19 years SF-6D at 23 years VP/VLBW Controls VP/VLBW Controls EP/ELBW Controls EP/ELBW Controls EP Controls VP/VLBW Controls VP/VLBW Controls VP/VLBW Controls VP/VLBW Controls Number completing MAUI 231 224 231 226 186 137 180 143 110 62 230 68 243 100 52 73 33 35 Age at assessment, mean (SD) 26.3 (0.7) 26.3 (0.7) 26.3 (0.7) 26.3 (0.7) 17.9 (0.8) 18.0 (0.9) 18.0 (0.8) 18.1 (0.9) 19.3 (0.6) 19.2 (0.5) 23.4 (0.5) 23.7 (0.6) 28.5 (1.1) 28.3 (0.9) 19.7 (0.8) 19.7 (0.6) 22.5 (0.0) 22.7 (0.6) GA at birth, mean (SD) 30.6 (2.2) 39.7 (1.3) 30.6 (2.2) 39.7 (1.2) 26.7 (2.1) 39.2 (1.4) 26.7 (2.1) 39.2 (1.4) 24.5 (0.7) N/A 29.19 (2.5) N/A 29.20 (2.5) N/A 29.12 (2.4) 39.74 (1.2) 28.82 (2.7) 39.46 (1.1) Birth weight, mean (SD) 1330.1 (319.5) 3360.0 (447.9) 1329.7 (319.4) 3362.3 (446.8) 886.7 (155.3) 3419.1 (468.0) 885.7 (155.1) 3421.5 (462.5) 745.9 (119.4) N/A 1145.4 (238.4) N/A 1134.5 (235.8) N/A 1243.4 (202.8) 3718.9 (478.0) 1194.9 (254.7) 3610.6 (365.0) Male sex, N (%) 125 (54.1) 105 (46.9) 124 (53.7) 105 (46.5) 84 (45.2) 60 (43.8) 82 (45.6) 60 (42.0) 51 (46.4) 23 (37.1) 104 (45.2) 33 (48.5) 103 (42.4) 37 (37.0) 22 (42.3) 30 (41.1) 13 (39.4) 15 (42.9) Study name Bavarian Longitudinal Study Victorian Infant Collaborative Study EPICure New Zealand Very Low Birth Weight Norwegian University of Science and Technology Birth year 1985–6 1991–2 1995 1986 1986–8 Eligibility criteria VP/VLBW (GA <32 wk or BW <1500 g) EP/ELBW (GA <28 wk or BW <1000 g) EP (GA <26 wk) VLBW <1500 g VLBW <1500g Controls Recruited in the same obstetric hospitals Normal birth weight, contemporaneously recruited Recruited at school age Age matched Born to mothers of a 10% random sample, contemporaneously recruited BW body weight, GA gestational age, ELBW extremely low birth weight (<1000 g), EP extremely preterm (<26 wk GA for EPICure and <28 wk GA for VICS), HUI3 Health Utilities Index Mark 3, MAUI multi-attribute utility instrument, N/A not applicable/measurement not administered, SD standard deviation, SF-6D Short Form 6D, VLBW very low birth weight (<1500 g), VP very preterm (<32 wk GA), wk weeks Additional details for each study can be found in published research as follows: BLS [46], VICS [47], NTNU LBW Life [50], EPICure [48] and NZ-VLBW [49] Background characteristics of cohorts BLS (Germany) VICS (Australia) EPICure (UK and Ireland) NZ-VLBW (New Zealand) NTNU (Norway) HUI3 at 26 years SF-6D at 26 years HUI3 at 18 years SF-6D at 18 years HUI3 at 19 years SF-6D at 22–23 years SF-6D at 26–30 years SF-6D at 19 years SF-6D at 23 years VP/VLBW Controls VP/VLBW Controls EP/ELBW Controls EP/ELBW Controls EP Controls VP/VLBW Controls VP/VLBW Controls VP/VLBW Controls VP/VLBW Controls Number completing MAUI 231 224 231 226 186 137 180 143 110 62 230 68 243 100 52 73 33 35 Age at assessment, mean (SD) 26.3 (0.7) 26.3 (0.7) 26.3 (0.7) 26.3 (0.7) 17.9 (0.8) 18.0 (0.9) 18.0 (0.8) 18.1 (0.9) 19.3 (0.6) 19.2 (0.5) 23.4 (0.5) 23.7 (0.6) 28.5 (1.1) 28.3 (0.9) 19.7 (0.8) 19.7 (0.6) 22.5 (0.0) 22.7 (0.6) GA at birth, mean (SD) 30.6 (2.2) 39.7 (1.3) 30.6 (2.2) 39.7 (1.2) 26.7 (2.1) 39.2 (1.4) 26.7 (2.1) 39.2 (1.4) 24.5 (0.7) N/A 29.19 (2.5) N/A 29.20 (2.5) N/A 29.12 (2.4) 39.74 (1.2) 28.82 (2.7) 39.46 (1.1) Birth weight, mean (SD) 1330.1 (319.5) 3360.0 (447.9) 1329.7 (319.4) 3362.3 (446.8) 886.7 (155.3) 3419.1 (468.0) 885.7 (155.1) 3421.5 (462.5) 745.9 (119.4) N/A 1145.4 (238.4) N/A 1134.5 (235.8) N/A 1243.4 (202.8) 3718.9 (478.0) 1194.9 (254.7) 3610.6 (365.0) Male sex, N (%) 125 (54.1) 105 (46.9) 124 (53.7) 105 (46.5) 84 (45.2) 60 (43.8) 82 (45.6) 60 (42.0) 51 (46.4) 23 (37.1) 104 (45.2) 33 (48.5) 103 (42.4) 37 (37.0) 22 (42.3) 30 (41.1) 13 (39.4) 15 (42.9) Study name Bavarian Longitudinal Study Victorian Infant Collaborative Study EPICure New Zealand Very Low Birth Weight Norwegian University of Science and Technology Birth year 1985–6 1991–2 1995 1986 1986–8 Eligibility criteria VP/VLBW (GA <32 wk or BW <1500 g) EP/ELBW (GA <28 wk or BW <1000 g) EP (GA <26 wk) VLBW <1500 g VLBW <1500g Controls Recruited in the same obstetric hospitals Normal birth weight, contemporaneously recruited Recruited at school age Age matched Born to mothers of a 10% random sample, contemporaneously recruited BW body weight, GA gestational age, ELBW extremely low birth weight (<1000 g), EP extremely preterm (<26 wk GA for EPICure and <28 wk GA for VICS), HUI3 Health Utilities Index Mark 3, MAUI multi-attribute utility instrument, N/A not applicable/measurement not administered, SD standard deviation, SF-6D Short Form 6D, VLBW very low birth weight (<1500 g), VP very preterm (<32 wk GA), wk weeks Additional details for each study can be found in published research as follows: BLS [46], VICS [47], NTNU LBW Life [50], EPICure [48] and NZ-VLBW [49] The original article has been corrected.
The Impact of Point-of-Care Testing for Influenza on Antimicrobial Stewardship in UK Primary Care: Nested Cohort Study.
BACKGROUND: Influenza and respiratory syncytial virus (RSV) predominantly circulate during the winter season and cause acute respiratory illness (ARI). Deploying molecular point-of-care testing (POCT) in primary care can inform whether a patient presenting with an ARI has influenza or RSV. An early virological diagnosis could facilitate appropriate use of antivirals and enable better antimicrobial stewardship. OBJECTIVE: This study aimed to report the impact of POCT for influenza and RSV on antimicrobial prescribing, including antiviral therapy in primary care. METHODS: The impact of POCT for influenza on antimicrobial stewardship (PIAMS) in UK primary care was a nested cohort study undertaken from January 20 to May 31, 2023, after the period of peak virus circulation, within practices that contribute data to the English sentinel network. People presenting with ARI had a nasopharyngeal swab performed and were tested for influenza and RSV with a molecular POCT analyzer located within the practice. Data on antimicrobial prescribing and other study outcomes were collected by linking information from the analyzer to coded data from the patient's computerized medical record. RESULTS: In total, 323 swabs were collected from 10 PIAMS study practices. In total, 59.7% (197/323) of swabbed patients were female, and the mean age was 37.28 (SD 25.05) years. Furthermore, 2.9% (9/323) of all swabs were positive, with 0.3% (1/323) positive for influenza A, 1.6% (5/323) positive for influenza B, and 0.9% (3/323) positive for RSV. In total, 80 patients were prescribed antibiotics 7 days following POCT testing. There were no instances of antiviral prescribing in the 7 days post testing. A statistically significant difference in antibiotic prescribing given a positive POCT result compared with a negative test was not found with an unadjusted odds ratio (OR) of 7 days post testing. A statistically significant difference in antibiotic prescribing given a positive POCT result compared with a negative test was not found with an unadjusted OR of 1.54 (95% CI 0.38-6.30; P=.55) and adjusted OR of 1.21 (95% CI 0.00-1.78). CONCLUSIONS: This study illustrates the risk of having a narrow study window; our observation period was not aligned with when influenza was circulating. The peak of weekly incidence of influenza in the sentinel network was in the last week of 2022, and RSV was circulating before this. Further evidence is needed to assess the impact of POCT on antimicrobial prescribing. The viruses tested for using POCT could be aligned with the circulating viruses identified by the sentinel network.
The impact of COVID-19 lockdowns on primary care contact among vulnerable populations in England: a controlled interrupted time series study.
BACKGROUND: UK COVID-19 lockdowns significantly affected primary care access and delivery. Little is known about whether lockdowns disproportionally impacted vulnerable groups, including people who misuse substances, domestic violence or abuse victims, those with intellectual disability, and children with safeguarding concerns. AIM: To evaluate the impact of UK COVID-19 lockdowns on primary care contact rates among vulnerable groups. DESIGN & SETTING: Natural experimental design using all registered patients in the OpenSAFELY platform. METHOD: With approval from NHS England, we conducted controlled interrupted time-series analyses on 24million patients in England between September2019-September2021. RESULTS: Pre-pandemic, primary care consultation rates were 110.1 per 1000 patients per week. Following the initiation of the first lockdown (23/03/2020), there was a large reduction of 29-61 contacts per 1000 patients per week among vulnerable and general population groups. For patients with alcohol misuse, aged ≥14 years with intellectual disability, and children with safeguarding concerns, this reduction was significantly more extreme than corresponding general populations (relative rate difference -23.8 [95% confidence interval -39.8,-7.7], -24.6 [-38.8,-10.5], and -15.4 [-26.9,-3.8], respectively). Following the final lockdown (29/03/2021), all groups had consulting rates exceeding pre-pandemic rates (with increases more marked in vulnerable populations), except those only including children. CONCLUSION: Analyses suggested a larger short-term impact of the first COVID-19 lockdown on primary care contact for some vulnerable groups, compared to the general population; differential impacts persisted through subsequent lockdowns and beyond for some vulnerable groups. There is a need to examine drivers of these differences to enable more equitable primary care access and provision.
Signals of Adverse Reactions to Herbal Medicines: Evidence and Document Analysis Based on a Scoping Review
Background: To date, signals of adverse reactions to herbal medicines have not been systematically reviewed, limiting pharmacovigilance of herbal medicines because of a lack of data. Objectives: We sought to analyse the available evidence on signals involving herbal medicines and to determine to what extent they had been documented at the European Union (EU) level and in the USA. Methods: We used the results of a published scoping review of interventional and non-interventional studies that reported signals of adverse reactions to drugs. We assigned Anatomical Therapeutic Chemical classification to all drugs, and identified herbal medicines when they fell under the Anatomical Therapeutic Chemical V90. We ascertained the presence of the adverse reaction, or related adverse reactions, for each signal in reference documents for healthcare professionals: the US Botanical Safety Handbook and the EU monographs and US Dietary Supplement Fact Sheets; and in those for consumers: the US Dietary Supplement Label Database. We summarised the data descriptively, treating US documents as one and comparing harms across pairs of US and EU documents by signal. Documents were deemed concordant if they both included the same or related adverse reactions, or if neither did. We also compared adverse reactions across US documents for healthcare professionals with those for consumers. Results: Of the 10,861 signals covered by the scoping review, 53 (0.49%) concerned herbal medicines, all based on case reports. Reference documents from both the US and EU were available for 37 signals. Most of the documents were concordant (73%), and ten (27%) were discordant: six adverse reactions were mentioned only in US documents, three only in EU monographs, and one was warned against in US documents but not in EU documents. Twenty-one signals could be followed up in the Botanical Safety Handbook and Dietary Supplement Fact Sheets. Most (68%) US documents for healthcare professionals were concordant. When the Botanical Safety Handbook and Dietary Supplement Fact Sheets did not include an adverse reaction, neither did the Dietary Supplement Label Database. However, when they did, only 20% of the labels for consumers did too. The proportion of labels mentioning adverse reactions otherwise available in documents intended for healthcare professionals ranged widely, reflecting differences across multiple labels for the same products. Conclusions: Very few signals of adverse reactions from the wider scoping review concerned herbal medicines, and were all based on case reports. Information was mostly concordant across documents in the EU and USA. As manufacturers are solely responsible for the contents of the Dietary Supplement Label Database, regulatory oversight may be required to ensure that consistent and comprehensive information on the harms of herbal medicines is made available to consumers in the USA.
GPs' perspectives on GLP-1RAs for obesity management: a qualitative study in England.
Background Effective treatments are needed for the increasing number of people living with obesity. General practitioners (GPs) are key in managing obesity within the NHS but report low confidence in available treatment options. Glucagon-like Peptide-1 receptor agonists (GLP-1RAs) have shown promise in weight management, but at the time of this study lacked commissioned primary care service pathways for this indication. Aim To explore the perspectives of NHS GPs in England on GLP-1RAs and their integration into primary care for weight management. Design and Setting Participants were GPs practising in England, recruited through purposive sampling to reflect diverse geographical and socioeconomic contexts. Method 25 semi-structured interviews, conducted April-July 2024, were thematically analysed. Results Participants generally held positive views about the implementation of GLP-1RAs for weight management in primary care, however this was joined by hesitations about resource limitations. Navigating consultations with patients asking for prescriptions, or support with private use, often posed difficulties. Concerns included that GLP-1RAs could detract from tackling the broader determinants of obesity. Participants also worried that the medications could be misused, ultimately becoming an overly simplistic solution for patients, practitioners, and the wider health system. Conclusion Our findings suggest that while GPs view GLP-1RA integration as a valuable therapeutic option for primary care obesity management, they have concerns about this being done well. To strengthen GP support for implementation, it is essential to recognise the need for adequate resources and ensure that GLP-1RAs are integrated into a holistic strategy for addressing obesity.
Chronic Obstructive Pulmonary Disease and the Management of Cardiopulmonary Risk in the UK: A Systematic Literature Review and Modified Delphi Study
Chronic obstructive pulmonary disease (COPD) is linked to increased mortality and morbidity, especially in patients with coexisting cardiovascular disease. These patients face heightened cardiopulmonary risk, which escalates further after acute exacerbations of COPD. While there is some guidance on the management of acute exacerbations of COPD, there is a lack of specific strategies for addressing cardiopulmonary risk in COPD. This program of work aimed to establish UK consensus statements and a clinical pathway for managing cardiopulmonary risk in patients with COPD, synthesizing evidence and expert input through a modified Delphi approach. A multidisciplinary Taskforce conducted a systematic review, focusing on the UK and addressing questions relating to the healthcare burden of acute exacerbations of COPD (AECOPDs), the link between AECOPDs and cardiopulmonary events, the management of cardiopulmonary risk in patients with COPD, and the guidelines and interventions implemented to optimize COPD management. The evidence identified was summarized and used to synthesize preliminary consensus statements reflecting the current situation and recommendations for action. Following iterative voting rounds, consensus was reached on 18 statements. Further to this, a clinical pathway framework to support the recognition and management of cardiopulmonary risk in patients with COPD using the consensus statements was formulated. AECOPDs were identified as a substantial healthcare burden in the UK, contributing to high mortality, frequent healthcare interactions, and elevated costs. These exacerbations were associated with cardiopulmonary events such as myocardial infarction and stroke. Most UK guidelines have focused on the respiratory management of COPD exacerbations, but lack strategies to specifically address cardiopulmonary risk, highlighting the need for integration of care. This consensus program has identified gaps in management, as well as a need to optimize care and reduce the cost of COPD management through the development of new UK policies and clinical guidance.
Digitally Enabled Care in Diverse Environments (DECIDE): protocol for a programme of rapid evaluation of technology-enabled remote monitoring in health and social care
Background: There is considerable interest in technology-enabled remote monitoring in the UK. The aim is to respond to system pressures and improve access, experience and quality of care. There is an urgent need for process, outcome and impact evaluations of interventions at various stages of development and implementation to address evidence gaps around adoption, spread, sustainability and inequalities. Aim DECIDE (Digitally Enabled Care in Diverse Environments) is a centre for rapid evaluation of technology-enabled remote monitoring funded by the National Institute for Health and Care Research (2023 to 2026). It aims to support service users, service commissioners and providers of remote monitoring services, to enable high quality care. Example questions include: Is the technology-enabled remote monitoring innovation needed and, if so, for whom? How are technology-enabled care pathways implemented, and what are associated outcomes and impacts? What are the opportunities and challenges for sustainability, scale-up and spread? Methods A range of qualitative, quantitative and economic methods will be used. Exact methods and questions will be dependent on the focus, scope and scale of each evaluation. Evaluations will be informed by relevant theory, including the Non-Adoption, Abandonment and the challenges to Spread, Scale-up and Sustainability of technological innovation in health and care (NASSS) framework. A User Advisory Group and External Steering Committee, both with diverse voices, will help shape evaluation design, implementation and dissemination. Project-led dissemination will ensure timely sharing of insights and support impact. Conclusion Evaluations will advance understanding of when and for whom technology-enabled remote monitoring innovation is needed; how it works and how factors related to the intervention, implementation process and wider context influence adoption; associated outcomes and impacts, whether and how these tackle inequalities; and potential challenges to scale and spread. We aim to inform decision-making by policymakers, commissioners, providers, patients/service users and researchers.
A framework for the development and implementation of open trauma guidelines: A Delphi consensus validation
Introduction: Lower limb open fractures are severe injuries that can lead to long-term sequelae. Clinical guidelines for managing these patients are associated with expedited treatment and better outcomes. However, few countries have implemented guidelines for open lower limb fractures. The aim of this study was to develop and validate a framework for the introduction of clinical guidelines in settings that do not have one at present. Methods: Using the qualitative analysis for the Limitations to the Implementation of Open Trauma Guidelines (LINEAGE) study, a framework proposal was designed. This included 4 clusters of inter-related concepts, including clinician, team, health and cultural factors. To validate this framework a modified Delphi study was devised. The elements of the framework were translated into 12 statements that were compiled in a Delphi questionnaire. A panel of orthopaedic and plastic surgeons was assembled to obtain structured feedback and assess the degree of consensus regarding the framework proposal. Results: Using purposive sampling, 43 clinicians enrolled in an international expert panel, including 20 orthopaedic and 23 plastic surgeons based in countries with no guidelines at present. Following three Delphi rounds, 11 out of the 12 assessed statements achieved the threshold for validation. The single statement that did not reach consensus status was then removed from the framework. Discussion: Frameworks are a well-described aid in implementation science, being able to describe complexity and propose strategies for improvement. We present the first validated framework for the development and implementation of open fracture guidelines.
Global, regional, and national prevalence of child and adolescent overweight and obesity, 1990–2021, with forecasts to 2050: a forecasting study for the Global Burden of Disease Study 2021
Background: Despite the well documented consequences of obesity during childhood and adolescence and future risks of excess body mass on non-communicable diseases in adulthood, coordinated global action on excess body mass in early life is still insufficient. Inconsistent measurement and reporting are a barrier to specific targets, resource allocation, and interventions. In this Article we report current estimates of overweight and obesity across childhood and adolescence, progress over time, and forecasts to inform specific actions. Methods: Using established methodology from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021, we modelled overweight and obesity across childhood and adolescence from 1990 to 2021, and then forecasted to 2050. Primary data for our models included 1321 unique measured and self-reported anthropometric data sources from 180 countries and territories from survey microdata, reports, and published literature. These data were used to estimate age-standardised global, regional, and national overweight prevalence and obesity prevalence (separately) for children and young adolescents (aged 5–14 years, typically in school and cared for by child health services) and older adolescents (aged 15–24 years, increasingly out of school and cared for by adult services) by sex for 204 countries and territories from 1990 to 2021. Prevalence estimates from 1990 to 2021 were generated using spatiotemporal Gaussian process regression models, which leveraged temporal and spatial correlation in epidemiological trends to ensure comparability of results across time and geography. Prevalence forecasts from 2022 to 2050 were generated using a generalised ensemble modelling approach assuming continuation of current trends. For every age-sex-location population across time (1990–2050), we estimated obesity (vs overweight) predominance using the log ratio of obesity percentage to overweight percentage. Findings: Between 1990 and 2021, the combined prevalence of overweight and obesity in children and adolescents doubled, and that of obesity alone tripled. By 2021, 93·1 million (95% uncertainty interval 89·6–96·6) individuals aged 5–14 years and 80·6 million (78·2–83·3) aged 15–24 years had obesity. At the super-region level in 2021, the prevalence of overweight and of obesity was highest in north Africa and the Middle East (eg, United Arab Emirates and Kuwait), and the greatest increase from 1990 to 2021 was seen in southeast Asia, east Asia, and Oceania (eg, Taiwan [province of China], Maldives, and China). By 2021, for females in both age groups, many countries in Australasia (eg, Australia) and in high-income North America (eg, Canada) had already transitioned to obesity predominance, as had males and females in a number of countries in north Africa and the Middle East (eg, United Arab Emirates and Qatar) and Oceania (eg, Cook Islands and American Samoa). From 2022 to 2050, global increases in overweight (not obesity) prevalence are forecasted to stabilise, yet the increase in the absolute proportion of the global population with obesity is forecasted to be greater than between 1990 and 2021, with substantial increases forecast between 2022 and 2030, which continue between 2031 and 2050. By 2050, super-region obesity prevalence is forecasted to remain highest in north Africa and the Middle East (eg, United Arab Emirates and Kuwait), and forecasted increases in obesity are still expected to be largest across southeast Asia, east Asia, and Oceania (eg, Timor-Leste and North Korea), but also in south Asia (eg, Nepal and Bangladesh). Compared with those aged 15–24 years, in most super-regions (except Latin America and the Caribbean and the high-income super-region) a greater proportion of those aged 5–14 years are forecasted to have obesity than overweight by 2050. Globally, 15·6% (12·7–17·2) of those aged 5–14 years are forecasted to have obesity by 2050 (186 million [141–221]), compared with 14·2% (11·4–15·7) of those aged 15–24 years (175 million [136–203]). We forecasted that by 2050, there will be more young males (aged 5–14 years) living with obesity (16·5% [13·3–18·3]) than overweight (12·9% [12·2–13·6]); while for females (aged 5–24 years) and older males (aged 15–24 years), overweight will remain more prevalent than obesity. At a regional level, the following populations are forecast to have transitioned to obesity (vs overweight) predominance before 2041–50: children and adolescents (males and females aged 5–24 years) in north Africa and the Middle East and Tropical Latin America; males aged 5–14 years in east Asia, central and southern sub-Saharan Africa, and central Latin America; females aged 5–14 years in Australasia; females aged 15–24 years in Australasia, high-income North America, and southern sub-Saharan Africa; and males aged 15–24 years in high-income North America. Interpretation: Both overweight and obesity increased substantially in every world region between 1990 and 2021, suggesting that current approaches to curbing increases in overweight and obesity have failed a generation of children and adolescents. Beyond 2021, overweight during childhood and adolescence is forecast to stabilise due to further increases in the population who have obesity. Increases in obesity are expected to continue for all populations in all world regions. Because substantial change is forecasted to occur between 2022 and 2030, immediate actions are needed to address this public health crisis. Funding: Bill & Melinda Gates Foundation and Australian National Health and Medical Research Council.