Trends in Diabetes Mellitus, Obesity, and Insufficient Physical Activity over Three Decades in Sri Lanka

Abstract Background: Diabetes mellitus (DM) is a chronic metabolic disorder and a major cause of morbidity and mortality. Its rising prevalence, along with modifiable risk factors like obesity and insufficient physical activity (PA), is a growing concern. This narrative review provides the evidence on the exponential trend in diabetes, obesity, and insufficient PA in Sri Lanka during the last three decades. Materials and Methods: A search on epidemiological surveys on diabetes, obesity, and insufficient PA among adults in Sri Lanka between 1990 and 2025 was conducted. Results: Earliest evidence on diabetes prevalence was from a rural community, 2.5% (1993). National level prevalence steadily increased from 10.3% (95% CI: 9.4–11.2) in 2005–2006 to 21.8% (95% CI: 20.1–23.5) in 2023, largely due to obesity and insufficient PA. This far exceeds the 2021 International Diabetes Federation (IDF) estimate of 11.3% (95% CI: 9.1–14.5). Obesity more than tripled from 3.7% (95% CI: 3.4–4.0) to 11% (95% CI: 10.0–12.0) between 2005–2006 and 2021, while the prevalence of overweight increased from 16.8% (95% CI: 16.2–17.4) to 39.4% (95% CI: 37.9–40.9). In 2005–2006, 60% of individuals in Sri Lanka were classified as highly physically active, while 11% were considered insufficiently active. By 2021, however, 34.8% (95% CI: 33.1–36.4) of Sri Lankan adults aged 18–70 years reported insufficient PA. Conclusion: Diabetes has markedly increased in Sri Lanka over the past three decades. From 2005 to 2021, adult obesity and insufficient PA have both tripled. The trends in epidemiological links between obesity, insufficient PA, and diabetes underscore the urgent need for effective preventive strategies.