National Prevalence of Obesity Obesity in Mediterranean region (1997–2007): a systematic review C. Papandreou 1 , T. Abu Mourad 1 , C. Jildeh 1,2 , Z. Abdeen 3 , A. Philalithis 1 and N. Tzanakis 4 1 Department of Social Medicine, School of Medicine, University of Crete, Greece; 2 Faculty of Public Health, Al-Quds University, Palestine; 3 Faculty of Medicine, Al-Quds University, Palestine; 4 Department of Thoracic Medicine, Medical School, University of Crete, Greece Received 11 September 2007; revised 17 December 2007; accepted 18 December 2007 Address for correspondence: T Abu Mourad, Department of Social Medicine, School of Medicine, University of Crete, Crete, Greece. E-mail: tayserm@hotmail.com Summary The objective of this review is to determine the distribution of obesity by geo- graphical location, income, age and sex in the Mediterranean region during the last decade. A meta-analysis was conducted for 102 articles cited during the period (1997–2007) in Medline database (for 17 Mediterranean countries) searched during the summer of 2007 using the word ‘obesity’ and its related keywords. The study showed that adults were more obese than children in all Mediterranean continents and in different levels of income. The prevalence of obesity among European children was higher than among Asians. Also, European adults were more obese than European children. The total female adults were found to be more obese (median: 25.3%) than male adults (median: 20.0%). The regression model analysis indicated that male adults were more likely to be obese in the Euro-Med region. Taking different factors into consideration, it was noticed that Mediterranean adults, especially those in the European region, are at higher risk of obesity. Awareness programmes addressing the importance of adopting healthy dietary habits combined with physical activity should target the whole community in general and adults in particular. The findings could guide health planners for better management of obesity. Keywords: Age, economic level, geographic location, obesity, sex. obesity reviews (2008) Introduction The Mediterranean region constitutes an area formed by sea and land that covers about 2.5 million km 2 . This area includes three continents (Europe, Africa, Asia), which in turn contain several countries that possess a seashore of the Mediterranean Sea (1). According to the level of economic development, Mediterranean countries vary from low- to high-income countries (2–9). Other differences existing among these countries are racial and cultural ones (religion, language, habits . . .) (10). Although continents around the world embody many differences, they still have a few things in common. Over the last decade, the prevalence of obesity has risen in both developed and developing countries affect- ing both children and adults (11–13). Obesity, which is an abnormal or excessive fat accumulation to the extent that health is impaired (14), has been found to be associated with various diseases such as hypertension (15), myocardial infarction (16), stroke (17), diabetes mellitus (18), different types of cancer (19) and sleep apnoea syndrome (20). It is clear that obesity does not discriminate between geographi- cal location, economic level, sex and age. To the best of our knowledge, no previous studies have focused on the obesity problem among the Mediterranean region as a whole and its continents in part. This review aims to point out the prevalence and distribution of obesity in the Mediterranean region over the last decade divided by geographical location, income, age and sex. In addition, it attempts to answer the following research question: what are the factors (geographical, economic, sex and age) that either separately or jointly act as best predictors of the variation of obesity prevalence in the Mediterranean region? obesity reviews doi: 10.1111/j.1467-789X.2007.00466.x 1 © 2008 The Authors Journal compilation © 2008 The International Association for the Study of Obesity. obesity reviews