The unparalleled rise of obesity in China: a call to action

Abstract

Whenever civilisations ignore a problem, they will inevitably experience increasingly louder wake-up calls, of which the year 2020 is certainly a telling example. When it comes to obesity in the Western hemisphere, mainly North America and Europe, there have been many such instances over the decades, most of them thoroughly ignored, to the countries clear detriment. A recent example from February 2020 was when obesity in the US (data from 2017 to 2018) reached 42% among adults, with severe obesity (BMI ≥ 40 kg/m 2) approaching double digits at 9% [1]. While European nations are behind the US, the same upward trajectory is certainly present, especially in socially vulnerable populations [2, 3]. The corresponding numbers in the Eastern hemisphere, mainly Asia, are generally lower still, but this appears to be changing. In this issue of the journal Ma et al. [4], convincingly show that China is in the midst of a severely alarming increase in obesity, particularly abdominal obesity. When these increases are combined with the sheer size of China's population, we are likely witnessing an unparalleled development, at least in scope. Using a series of cross-sectional surveys between 1993 and 2015, including~70,000 adults from different regions of China, Ma et al. calculated overall and subgroup trends, using standardisation to account for variations between surveys in important prognostic variables, such as age, gender, etc. They also carried out extensive sensitivity analyses to test the robustness of their findings. While there are always limitations in using multiple crosssectional surveys to study population trends, which the authors discuss and acknowledge, we can nevertheless be reasonably confident that the findings are both valid and representative of the development of obesity and abdominal obesity in Chinese adults since 1993. A particularly

Sex Differences in Adiposity and Cardiovascular Diseases

“…Of the world’s population, one-third are currently overweight or obese ( , accessed on 1 July 2022). The rapid increase in obesity is threatening public health globally, including in China [ 1 ], where the prevalence has risen from approximately 0 to 16.4% (1982–2019) over the past ~40 years [ 2 ]. The pandemic of obesity has greatly burdened individuals, society, and the healthcare system.…”

Lifestyle choices mediate the association between educational attainment and BMI in older adults in China: A cross-sectional study

“…Increased screen time is associated with a sedentary lifestyle, which increases the risk of obesity (36,37); among older adults, screen time is a risk factor for obesity (38,39). Lifestyle choices reflect older adults' attitude to health (8,9). For most older adults, educational attainment and socioeconomic status tend to be stable variables; consequently, the association between educational attainment and obesity follows a relatively fixed pattern (40).…”

“…China's economy has undergone rapid growth in the past three decades, while the rate of urbanization has increased, affecting lifestyle choices and living standards. Lifestyle choices are a significant contributor to obesity ( 8 ). For example, lifestyle risk factors such as smoking, unhealthy diet (e.g., insufficient intake of vegetables and fruits, excessive intake of fat and sodium), lack of physical activity, sedentary behavior, and the prevalence of alcohol use all influence obesity ( 2 , 8 , 9 ).…”

“…Lifestyle choices are a significant contributor to obesity ( 8 ). For example, lifestyle risk factors such as smoking, unhealthy diet (e.g., insufficient intake of vegetables and fruits, excessive intake of fat and sodium), lack of physical activity, sedentary behavior, and the prevalence of alcohol use all influence obesity ( 2 , 8 , 9 ). Behavioral interventions targeting these factors may help achieve weight loss and reduce obesity risks ( 10 – 12 ).…”

Lixisenatide is effective and safe as add-on treatment to basal insulin in Asian individuals with type 2 diabetes and different body mass indices: a pooled analysis of data from the GetGoal Studies

“…[11][12][13] However, with the increase in obesity seen in Asia over the last four decades, the influence of insulin resistance in Asian individuals with T2D is rising. [14][15][16][17][18] While the prevalence of obesity in China and other Asian countries is still lower than in the USA and Europe, 19 at any given body mass index (BMI), an Asian person will have more visceral fat, which can be associated with a heightened risk of dysglycemia, 20 than a non-Asian person of the same age and sex. 10 Due to all of these differences, the pathophysiology of T2D in Asian individuals with T2D is now characterized by both more impaired β-cell function and worse insulin resistance than in non-Asian individuals, [15][16][17][18] meaning that more intensive and customized treatment strategies for Asian individuals with T2D are needed.…”