Nearly 30 percent more people worldwide died from being obese in 2015 than in 1990, according to a new study published today in the New England Journal of Medicine. A quarter-century ago, about 50 deaths out of every 100,000 were related to being overweight. As of 2015, the number is now 54 out of every 100,000.

Researchers analyzed the health data of over 68 million people in 195 countries. First, the team estimated how common being overweight or obese was among both children and adults from 1980 to 2015. Next, they analyzed the cost and health impacts related to high BMI from 1990 to 2015. This means taking into account both deaths and disability-adjusted life-years, or the number of years that you lost or lived with disability due directly to a high BMI.

Since 1980, obesity has doubled in more than 70 countries. In 2015, 5 percent of children overall were obese, and 12 percent of adults. Peak obesity rates were in older adults over 50, and women were more likely to be obese than men in every age bracket. Also as of 2015, there are about 108 million obese children and 604 million obese adults worldwide. There are fewer obese children than adults, but children are getting obese faster, with the rate of obesity growing especially quickly among children in countries like China and Brazil.

The results show that obesity caused four million deaths in 2015 alone, most of these due to cardiovascular disease. (This represents 7.1 percent of the deaths from any cause.) Cardiovascular disease related to high BMI was the leading cause, with chronic kidney disease being the second.

All this said, even though the overall rate of death is increasing, there isn’t a very significant change when you adjust for the age and population. In other words, even though there are more people dying overall from being obese, obese people are healthier and living for longer years than in the past because of better medical care. But in this case, living longer means more years living with obesity and associated diseases, like diabetes. For instance, in 2015, high BMI led to people worldwide living a total of 28.6 million years with a form of disability.

Overall, the authors conclude that obesity remains a growing public health problem, and one that we need to continue keeping track of and fighting.