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The world is in the middle of a major obesity epidemic, and current trends indicate that it’s only going to get worse, reports the CNN.

A recent study found that more than 2 billion adults and children globally are overweight or obese and suffer health problems because of that — but this is nothing new.

There are, however, pockets of the global population who remain somewhat unaware of this public health crisis, despite the growth of waistlines all around them, and this lack of awareness is just one of the underlying problems, according to Frank Hu, professor of nutrition and epidemiology at the Harvard T.H. Chan School of Public Health.

“Different countries have different issues,” Hu said. “You need to mobilize (their) whole society to tackle the problem. … it’s not just a medical problem.”

The Pacific Islands, Middle East and Americas lead the way in terms of regions with the greatest obesity rates. In 2014, more than 48% of the population of the Cook Islands was classified as obese. Qatar led the way in the Middle East with 34%, followed closely by the United States at 33%, according to the World Health Organization.

Obesity is defined using a person’s body mass index, the ratio between weight and height, with a BMI of 25 to 29.9 considered overweight and over 30 obese.

When assigning blame, two factors are common: diet and physical activity, namely poor diets and a lack of physical activity. But a number of smaller factors combine to fill these two large umbrellas, and those need to be understood to truly tackle the problem, Hu believes.

What is behind the obesity problem among countries at the top of the table?

1. Activity inequality

A study published this week in the journal Nature used data from smartphones to analyze the number of steps taken on average each day among people across 111 countries.

Using the Azumio Argus app, which tracks physical activity, researchers monitored the steps of more than 700,000 individuals and ranked countries based on their level of movement in the form of steps — and those numbers varied quite significantly.

Hong Kong topped the rankings with 6,880 average daily steps, followed closely by China with 6,189 steps. At the bottom of the list was Indonesia, with 3,513 steps.

However, the researchers calculated another statistic that they believe is a stronger predictor of obesity within a country, a calculation they called “activity inequality.”

“Activity is not distributed uniformly across a country,” said Scott Delp, professor of bioengineering and mechanical engineering at Stanford University, who led the study.

The larger the difference between the top and bottom walkers within a population, the greater their rates of obesity are likely to be, he explained. “It means there is a subset of a population that is activity-poor.”

When focusing on activity inequality, the list changed, with Saudi Arabia and Australia ranking first and second. The US came in fourth, with levels of activity inequality greatest in more car-oriented cities like Houston and lowest in more walkable cities like New York.

Top 5 countries by ‘activity inequality’

1. Saudi Arabia

2. Australia

3. Canada

4. Egypt

5. United States

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