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Obesity and Overweight in China

Overweight and obesity levels are climbing in China, and government response and access to care via insurance is limited.

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November 14, 2023

Global Guide to Obesity
Obesity rates are rising across the world. This guide explores country-specific challenges as well as ways global employers can support their workforce.
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While China was once considered to have one of the leanest populations in the world, the past 40 years have seen a rapid increase in obesity, which was exacerbated by the COVID-19 pandemic. Strict lockdown protocols contributed to the rising prevalence of overweight and obesity.1 More than half of adults in China now have a BMI in the overweight range, equaling more than half a billion people.

  • The Chinese represent a quarter of the world’s population that is overweight or obese.
  • Obesity prevalence is 15.8% for women and 15.0% for men (Figure 2.1).
  • Individuals with abdominal obesity, where most of the weight is carried around the gut, are twice as prevalent than overall obesity. This is troubling as abdominal obesity has a higher likelihood of developing comorbid conditions and diseases.
  • Obesity prevalence in children (especially boys) is higher than adults.2
Figure 2.1: Projected Trends in the Prevalence of Obesity.  
Figure 2.1: Projected Trends in the Prevalence of Obesity

Source: World Obesity Federation – World Obesity Atlas 2023.

Employer Opportunity

As companies build their health and well-being programs, employers should consider providing well-being programing that incorporates families and dependents and its impact on overall health.


Cost Impact of Overweight and Obesity

With increasing prevalence of overweight and obesity, the financial impact will be felt in the health care system contributing to more than a fifth of medical costs by 2030. People with obesity have higher rates of absenteeism, which can be related to longer recovery times from illness. Individuals with obesity also potentially have more serious injuries due to their weight.4

At a societal level, direct medical costs attributed to obesity and overweight is expected to rise substantially from 33.8 billion in 2019 up to $482.1 billion in 2060 (Table 2.1):5

Table 2.1: Impact of Overweight

 

Health care impact of BMI ≥ 25kb/m2, US$ million

Total economic impact of BMI ≥ 25kb/m2, US$ million

Estimated GDP US$ billion

Impact of BMI ≥ 25kb/m2 on GDP

2020

36,815

 283,306 15,662

1.9%

2025

55.891

 458,913 19,171

2.4%

2030

82,832

 766,352 27,072

2.8%

2035

118.490

 1,268,157 41,087

3.1%

Source: World Obesity Federation – World Obesity Atlas 2023.

If absenteeism, premature death and other indirect costs are factored in, the total economic impact is predicted to increase to more than $10 trillion in 2060.5 (Figure 2.2)

Figure 2.2: Projected Economic Impact of Overweight. If absenteeism, premature death and other indirect costs are factored in, the total economic impact is predicted to increase to more than $10 trillion in 2060. 
Figure 2.2: Projected Economic Impact of Overweight

Source: World Obesity Federation – World Obesity Atlas 2023.

BMI Designation Differences

Compared to other populations, Chinese people are generally more sensitive to certain health issues at lower health risk levels. Therefore, it is recommended that lower BMI cutoffs of 24.0 kg/m2 and 28·0 kg/m2 are used to define overweight and obesity respectively in adults in China.6,19


Employer Opportunity

Focusing on prevention as well as supporting employees with weight loss will have a substantial impact on the company’s bottom line by reducing the costs of medical insurance plans and disability claims improving rates of presenteeism and absenteeism and improving the overall health of employees. Existing programming is rather limited and will require innovation and becoming a trusted source for employees to have the desired health impact. Addressing obesity will have the added impact of reducing health care costs associated with the most prevalent health conditions impacting the Chinese workforce. Employers can leverage China’s National Nutrition Week, observed in the third week of May, to make people aware of the importance of nutrition for human health.7


Risk Factors and Related Health Issues Impacting Obesity

Over the last three decades, the Chinese economy has grown quite substantially and coinciding with a profound transition in the population's lifestyles, wealth, and dietary habits.8 A wider variety of foods and drinks have become available in the Chinese market, thus increasing rates of consumption of fat-rich and energy-dense foods and sweetened carbonated beverages.8 For example, in a study of Hangzhou’s food environment, unhealthy options were four times as prevalent than healthy options. Between this plethora of unhealthy available food and the proliferation of food delivery, these are likely causes of increase in BMI.9

Traditional Chinese dietary pattern consists of high intakes of rice, red meat, fish, poultry, organ meat, and leafy green vegetables combined with low intakes of wheat, corn, coarse grain, and buns and bread. This diet is associated with a trend toward a lower risk of obesity among men.20

Physical activity levels across China have decreased and been replaced with sedentary behaviors. Factors impacting physical activity, include a substantial increase in urbanization and car traffic, making it difficult to exercise outside safely.8 One other factor is that while the population is decreasing it is aging rapidly as a result of the now defunct One Child Policy.10

With the population both aging and increasing its BMI, noncommunicable diseases will increase in prevalence. Hypertension, dyslipidemia, diabetes, stroke, and myocardial infarction among those with obesity is about twice that in the normal weight population, with stroke, ischemic heart disease and diabetes the top first, second and eighth health issues for the Chinese population respectively.11,12 All of these factors indicate China that will need to spend more resources on addressing obesity.

Employer Opportunity

There are numerous programs employers can put in place to support employees including:

  • 1 | Providing nutritional counseling to all employees, especially to those living with obesity;
  • 2 | Incorporating traditional Chinese foods in cafeterias to provide healthy alternatives;
  • 3 | Encouraging physical activities through on-site fitness centers, gym subsidies and physical activity challenges;
  • 4 | Sponsoring peer support groups and creating solutions that are meaningful to the employees and integrate with the local community; and
  • 5 | Implementing multiple channels of communication that incorporate email, WeChat or telephone, especially for multi-generational households.

Weight Stigma Is Very Real Especially for Women

According to a Business Group survey, weight stigma is very high in China compared to Canada, India, Mexico and the U.K. Almost half of employer respondents in China are not addressing that stigma. In Chinese culture, higher BMI is still viewed as a positive attribute and a symbol of prosperity for men, making the implementation of weight management initiatives perhaps more challenging than in other nations.21 This may be a factor in why obesity is prevalent among Chinese boys. Among women, however, overweight individuals with a higher BMI suffer severe economic consequences in finding and keeping jobs..13 Social media has put a lot of pressure on women to be thin resulting in dangerous practices.14 Weight stigma has the psychological impact of increasing cortisol levels which in turn increases body fat storage.15 If an individual has anxiety issues, it can exacerbate weight gain.15

Employer Opportunity

Employers have a unique opportunity to educate both employees and managers on stigma surrounding obesity and to provide an encouraging environment for people living with obesity to seek care and provide career growth opportunities. Some examples could include counseling and employee assistance programs (EAP) services in a culturally adept, holistic weight management program.8


Employer Efforts to Address Obesity

According to Business Group on Health’s Global Weight Management Survey, 36% of responding employers consider weight management a priority in China but only 20% cover a program (n=10-12). The main reason for not offering weight management programs is lack of support from senior management followed by lack of demand. Obesity management can be improved through use of a tiered system involving health management centers, integrated lifestyle interventions and medical treatments, strengthened obesity education and training, and use of advanced electronic health technologies.6 Employers who do provide coverage include services such as outpatient services/nutrition counseling and bariatric surgery. Weight management programs are provided through digital apps, telephone and on-site clinics. Other supportive programs include:

  • Stress management initiatives
  • Initiatives that encourage healthy nutrition
  • Onsite fitness center or subsidy/reimbursement for fitness center membership
  • Initiatives that encourage healthy sleep; and
  • Biometric screening/weight management advice during health checks.

Employer Opportunity

Leverage the employee annual checkup as an engagement opportunity to direct employees towards relevant health interventions.


Government Response to Obesity Varies by Location and Is in Its Early Stages

Health care coverage for obesity varies by province and/or city and is limited to cases where there are comorbid diseases such as metabolic syndrome or diabetes. In these instances, government insurance reimburses patients at a certain percentage.

Current guidelines for obesity treatment are not adequately supported by evidence from clinical studies in Chinese populations. Effective lifestyle interventions suitable for Chinese populations are scarce, insufficient weight-loss medications have been approved by regulatory bodies, and there is low acceptance of non-lifestyle interventions (i.e., medications and surgery) among both health care providers and the public.6 Even with those restrictions, bariatric surgery rates have risen exponentially, but the base line is still quite small.22 In some provinces, bariatric surgery is not covered and where it is, there are minimal guidelines to ensure healthy outcomes.  Patient access to pharmacotherapy is limited, with Orlistat as the only approved drug for weight loss in China prior to 2017.16 At the time, Beijing included Liragultide, a GLP-1 medication, into the national insurance list for reimbursement, leading to a surge in utilization in the country to treat diabetes and obesity.17 New GLP-1 medications are being fast tracked to keep up with demand.16 There are several treatments for overweight and obesity available through traditional Chinese medicine. Limited research shows they have a positive impact on weight loss, but more research is needed.6

Employer Opportunity

Educate employees on pharmacotherapy and surgical options to limit misinformation and prevent abuse. Incorporate traditional Chinese medicine into plan design offerings for weight management and work through existing communities to understand the needs and appropriate communication methods for diverse sets of employees.


Given that a quarter of the world’s population that is obese or overweight is in China, there is a strong need for the government to address and find remedies for overnutrition and sedentary lifestyles. More studies on the impact of interventions on the Chinese population are needed, especially for traditional Chinese medicine practices. Employers have an opportunity to educate, reduce stigma and guide employees to programming that will help them manage obesity and overweight. Employers should keep a pulse on the changes in the bariatric surgery and pharmacology space given employee interest.

Obesity and Overweight in China

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TABLE OF CONTENTS

  1. Cost Impact of Overweight and Obesity
  2. Risk Factors and Related Health Issues Impacting Obesity
  3. Weight Stigma Is Very Real Especially for Women
  4. Employer Efforts to Address Obesity
  5. Government Response to Obesity Varies by Location and Is in Its Early Stages