Obesity Prevalence Triples in China Over 10-Year Span

The prevalence of obesity is on the rise in China, with the rates varying significantly across the country, according to new data from the Chinese National Center for Disease Control and Prevention.

From 2004 to 2014, the prevalence of obesity increased more than threefold across China, while the rate of abdominal obesity increased by more than 50%, report lead investigator Xiao Zhang, MD, PhD (Chinese National Center for Disease Control and Prevention, Beijing), and colleagues October 28, 2019, in the Annals of Internal Medicine.

Some Chinese provinces have been hit a little harder by the obesity epidemic than others, however. For example, in the small island province of Hainan, the prevalence of obesity was just 4.4% compared with 26.6% in Beijing. Among women, the prevalence of abdominal obesity ranged from 17.7% in the southern province of Guangxi to 49.4% in Tianjin, located in northeastern China. Overall, “a cluster of high prevalence of general and abdominal obesity in both sexes was identified in Beijing, Tianjin, and Hebei—also called the Jing-Jin-Ji metropolitan area,” according to the investigators.

Penny Gordon-Larsen, PhD (UNC Gillings School of Global Public Health, Chapel Hill, NC), a spokesperson for The Obesity Society, praised the investigators for identifying these geographic variations across China. “We’ve been charting and following China and seen this increase in obesity over a number of different studies,” she said. “What’s really unique is the geographic distribution province by province—they are documenting really high obesity.”

Darryl Leong, MD (Population Health Research Institute, Hamilton, Canada), who also was not involved in the study, said it’s not surprising to see rising rates of obesity in countries as wealth increases. “It is concerning because obesity is associated with increased risks of high blood pressure, diabetes, and heart failure,” he said. If obesity is not addressed, a rise in the rates of cardiovascular disease and other noncommunicable diseases would be expected, said Leong.

Abdominal Obesity Seen in More Than 30% of Adults

Using the China Chronic Disease and Risk Factor Surveillance database, the researchers estimated overall and provincial obesity rates in 2013-2014. The overall prevalence of general obesity, defined as a body mass index (BMI) of 28 kg/m², was 14.0%. The prevalence of abdominal obesity, a waist circumference greater than 85 cm for women and 90 cm for men, was 31.5%.

The prevalence of general obesity was highest for men in the northwestern Xinjiang province; the metropolitan Hebei, Beijing, Tianjin provinces; and the northernmost Heilongjiang province. The provincial clustering of obesity was similar in women. The prevalence of obesity, including abdominal obesity, was lower in the southern provinces.

Investigators also assessed obesity using thresholds established by the World Health Organization and the National Heart, Lung, and Blood Institute. Using these definitions, the prevalence of general and abdominal obesity was 6.3% and 14.4%, respectively. While the prevalence of BMI-defined obesity was similar in men and women, the prevalence of abdominal obesity was 5.6% in men and 23.4% in women.

“When international obesity cutoffs are used for better cross-country comparison, the prevalence of general and abdominal obesity in China is much lower than that among US adults—35.4% and 61.5%, respectively, in 2009 to 2010,” write Zhang and colleagues.

This is going in a direction of a real major concern. Penny Gordon-Larsen

Gordon-Larsen noted that while the new report does an excellent job in identifying obesity across the large country, a breakdown in the prevalence of obesity via the rural and urban divide would provide more granular data. Obesity in China, she noted, is heavily tied to urbanization. And with China’s rapid economic boom and urban expansion, the prevalence of obesity has also grown rapidly. Diabetes and hypertension are both on the rise in China, said Gordon-Larsen, and both are related to obesity.

“This is going in a direction of a real major concern,” she said. “There are lots of people affected and it's a huge cost to society and [the] healthcare [system]. It’s concerning for China like it is for every other country that has been facing a rise in obesity over the past couple of decades.” She added that pediatric obesity is on the rise in China, too.

Although the researchers used a Chinese reference for obesity, which makes it difficult to compare across countries, it has the advantage of more accurately capturing obesity levels specific to the population in question.

“For Asians, and for Chinese in particular, there is typically on average higher body fat, particularly abdominal obesity, and this is very clearly related to disease,” said Gordon-Larsen. “If you use the typical BMI of 25 and 30 [kg/m²], you wind up missing people in China who are under those cut points but who are carrying quite a bit of body fat.”  

In 2016, the Chinese government launched the Healthy China 2030 initiative, with the ultimate goal of achieving a health standard equal to developed countries by 2030. The action plan identifies 15 goals with specific targets, including decreasing the adverse health effects of secondhand smoke, reducing obesity, increasing physical activity, and preventing chronic disease, among other goals.