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BMC Public Health

, 19:1293 | Cite as

The prevalence and increasing trends of overweight, general obesity, and abdominal obesity among Chinese adults: a repeated cross-sectional study

  • Yongjie Chen
  • Qin Peng
  • Yu Yang
  • Senshuang Zheng
  • Yuan Wang
  • Wenli LuEmail author
Open Access
Research article
  • 529 Downloads
Part of the following topical collections:
  1. Energy balance-related behaviors

Abstract

Background

The prevalence of general and abdominal obesity has increased rapidly in China. The aims of this study were to estimate the dynamic prevalence of overweight, general obesity, and abdominal obesity and the distribution of body mass index (BMI) and waist circumference (WC) among Chinese adults.

Methods

Data were obtained from the China Health and Nutrition Survey (CHNS). According to the suggestions of the WHO for Chinese populations, overweight was defined as a 23 kg/m2 ≤ BMI < 27.5 kg/m2 and general obesity as a BMI ≥ 27.5 kg/m2. Abdominal obesity was defined as a WC ≥ 90 cm for males and ≥ 80 cm for females. Grade 1, grade 2, and grade 3 obesity were defined as 27.5 kg/m2 ≤ BMI < 32.5 kg/m2, 32.5 kg/m2 ≤ BMI < 37.5 kg/m2, and BMI ≥ 37.5 kg/m2, respectively. Generalized estimation equations were used to estimate the prevalence and trends of overweight, general and abdominal obesity.

Results

This study included 12,543 participant. From 1989 to 2011, the median BMI of males and females increased by 2.65 kg/m2 and 1.90 kg/m2, respectively; and WC increased by 8.50 cm and 7.00 cm, respectively. In 2011, the age-adjusted prevalence of overweight, general obesity, and abdominal obesity were 38.80% (95% CI: 37.95–39.65%), 13.99% (95% CI: 13.38–14.59%), and 43.15% (95% CI: 42.28–44.01%), respectively, and significantly increased across all cycles of the survey among all subgroups (all P < 0.0001). The age-adjusted prevalence of grade 1–3 obesity significantly increased in total sample and sex subgroups (all P < 0.0001). For all indicators, there were significant increases in annual ORs among all subgroups (all P < 0.0001), with the exception of grade 2 obesity. Significant differences were observed in ORs across the three age groups in males. And ORs significantly decreased with age.

Conclusions

The age-adjusted prevalence of overweight, general obesity, and abdominal obesity significantly increased among Chinese adults from 1989 to 2011. The obesity population is trending toward an increased proportion of males and younger individuals in China.

Keywords

Body mass index Waist circumference General obesity Abdominal obesity 

Abbreviations

BMI

Body mass index

CCDC

Center for Disease Control and Prevention

CHNS

China Health Nutrition Survey

CI

Confident interval

NYRBS

National Youth Risk Behavior Surveillance

ORs

Odds ratios

WC

Waist circumference

Background

Overweight and obesity are important lifestyle-related public health problems worldwide [1, 2]. Since obesity is associated with the common chronic diseases, including cardiovascular disease, type 2 diabetes, hypertension, dyslipidemia, and certain types of cancer, and considered as the fifth leading risk factors for mortality globally [2, 3, 4, 5, 6, 7, 8], obesity-related issues have drawn more and more attention from researchers in recent decades. Therefore, it is necessary to investigate and monitor the trends in the prevalence of overweight and obesity to improve awareness and make preventive strategies in the public health field.

In recent years, the prevalence of overweight and obesity has reached epidemic proportions in China [9, 10]. Approximately 20% obesity individuals worldwide are Chinese [11]. The considerable increase in the prevalence of obesity is attributed to the adoption of a Western lifestyle and decreased physical activity [12]. The traditional Chinese diet, characterized by a high carbohydrate content composed of rice, wheat, and cooked vegetables, is shifting to a diet with higher fat [13, 14]. The high intake of energy and fat combined with a decrease in physical activity are responsible for the increasing prevalence of overweight and obesity in the Chinese population, especially among urban inhabitants [15, 16]. Depicting the trends in the prevalence of obesity will help elucidate the prevalence of obesity-related chronic diseases and alert health care professionals and the public to prevent the epidemic.

Body mass index (BMI) is a common indicator used to identify general obesity [9]. Waist circumference (WC) can provide information on the distribution of body fat and is strongly correlated with central fat localization [17, 18, 19]. Therefore, BMI and WC were used to define general and abdominal obesity in this study, respectively. Since ethnicities and dietary patterns are different in different countries, the prevalence and extent of obesity vary. Previous studies have reported that Asians have higher body fat content than Western people with the same BMI [20, 21]. Therefore, specific cut-offs of BMI should be used to define overweight and obesity in different countries. In this study, ethnicity-based cut-offs for BMI were used to define overweight and obesity according to the WHO recommendations for Chinese people. Based on the China Health and Nutrition Survey (CHNS), the aims of this study were to investigate the trends in the prevalence of overweight, general obesity, and abdominal obesity as well as the distributions of BMI and WC among the Chinese population. As a result, this study would provide more comprehensive and accurate evidence of the trend and distribution of general and abdominal obesity during the last three decades in China.

Methods

Study design

As an ongoing open cohort and international collaborative project between the Carolina Population Center at the University of North Carolina at Chapel Hill and the National Institute for Nutrition and Health (NINH, formerly the National Institute of Nutrition and Food Safety) at the Chinese Center for Disease Control and Prevention (CCDC), the CHNS was designed to examine the effects of the health, nutrition, and family planning policies and programs implemented by national and local governments. Furthermore, how the social and economic transformation of the Chinese society is affecting the health and nutritional status of its population is explored in this survey. Nine provinces varying substantially in geography, economic development, public resources, and health indicators are covered in the CHNS. A multistage, random cluster process was used to obtain the samples in each province. Counties in the nine provinces were stratified by income (low, middle, and high). And a weighted sampling scheme was used to randomly select four counties from each province. In addition, the provincial capital and a lower income city were selected when feasible; however, other large cities rather than provincial capitals had to be selected in two provinces. Villages and townships within the counties and urban/suburban neighborhoods within the cities were selected randomly. The sample is diverse, with variation in a wide-ranging set of socioeconomic factors (income, employment, education, and modernization) and other related health, nutritional, and demographic measures. Because of the long duration and wide geographic coverage, the CHNS can represent the population demographics of China and document the dramatic economic, social, behavioral, and health status changes that have impacted China. The first round of the CHNS was conducted in 1989, and the survey was subsequently conducted in 1991, 1993, 1997, 2000, 2004, 2006, 2009, and 2011. A detailed description of the survey design and procedures has been published elsewhere [22].

Study population

Data were obtained from all nine waves of the CHNS conducted from 1989 to 2011. The inclusion criteria was as following: those aged ≥18 years at baseline; those with available data on sex and detailed physical examination (e.g., weight and height). The exclusion criteria was as following: those being pregnant or lactating at the time of survey; and those with missing or implausible outlying data (e.g., weight > 300 kg or < 20 kg, WC < 20 cm).

Measurements and definitions of overweight, general obesity, and abdominal obesity

Weight, height, and WC were measured by trained healthcare workers following standardized protocols and performed at the same location as well as followed the same protocol at each survey visit. Height was measured to the nearest 0.1 cm without wearing shoes using a portable stadiometer. Weight was measured to the nearest 0.1 kg using a calibrated beam scale while wearing lightweight clothing. BMI was calculated as weight (in kg) divided by the square of height (in m). WC was measured at a point midway between the lowest rib and the iliac crest in a horizontal plane using nonelastic tape.

Since the WHO proposed the additional trigger points to define overweight and obesity for public health action in Asian populations, it was more significant to reflect the trends of overweight and obesity according to the suggestions of the WHO for Chinese population [23]. Therefore, overweight was defined as a 23.0 kg/m2 ≤ BMI < 27.5 kg/m2, and general obesity was defined as a BMI ≥ 27.5 kg/m2. Abdominal obesity was defined as a WC ≥ 90 cm for males and ≥ 80 cm for females. Grade 1, grade 2, and grade 3 obesity were defined as 27.5 kg/m2 ≤ BMI < 32.5 kg/m2, 32.5 kg/m2 ≤ BMI < 37.5 kg/m2, and BMI ≥ 37.5 kg/m2, respectively [23].

Statistical analysis

Data are reported as the median (interquartile range) for BMI and WC and the frequency and percent (95% confidence interval (CI)) for overweight, general obesity, grade 1–3 obesity, and abdominal obesity. Since there was clustering for the subjects from the same household, generalized estimated equations were employed to correct the random effect and analyze the linear trends in the prevalence of overweight, general and abdominal obesity [24, 25]. Analyses were stratified by sex and age, which was defined as 18–39 years, 40–59 years, and ≥ 60 years. Generalized linear mixed models were used to obtain the annual odds ratios (ORs) [26]. In this study, the direct method was used to obtain the age-adjusted prevalence of general and abdominal obesity. The data from the Chinese population census in 2010 were considered as the reference. First, the expected number of individuals with obesity was calculated as the prevalence of obesity in each age- subgroup multiplied by the number from the population censuses in the corresponding age- subgroup. Second, the total expected number of individuals with obesity was calculated as the sum of the expected number of obesity individuals in each age- subgroup. Third, the age-adjusted prevalence of obesity was calculated as the total expected number of obesity individuals divided by the total number of individuals from the population census. Similarly, the age-adjusted prevalence of overweight, grade 1–3 obesity, and abdominal obesity were obtained. All analyses were conducted in SAS 9.4 (SAS Institute Inc., Cary, NC, USA). A two-tailed test was used, and the significance level was set at α = 0.05.

Results

The characteristics of the nine waves of the CHNS conducted from 1989 to 2011 are presented in Table 1. The sample sizes of the nine waves were 5080 in 1989, 8382 in 1991, 8017 in 1993, 8473 in 1997, 9374 in 2000, 9100 in 2004, 9039 in 2006, 9426 in 2009, and 12,543 in 2011.
Table 1

The characteristics of CHNS from 1989 to 2011

Characteristics

1989

1991

1993

1997

2000

2004

2006

2009

2011

N

5080

8382

8017

8473

9374

9100

9039

9426

12,543

Age

 18–39

4206(82.80)

4395(52.43)

3945(49.21)

3689(43.54)

3773(40.25)

2890(31.76)

2555(28.27)

2425(25.73)

2957(23.57)

 40–59

866(17.05)

2718(32.43)

2786(34.75)

3245(38.30)

3807(40.61)

4125(45.33)

4221(46.70)

4391(46.58)

5896(47.01)

 60–100

8(0.16)

1269(15.14)

1286(16.04)

1539(18.16)

1794(19.14)

2085(22.91)

2263(25.04)

2610(27.69)

3690(29.42)

Sex

 Males

2401(47.26)

4052(48.34)

3867(48.24)

4171(49.23)

4520(48.22)

4348(47.78)

4255(47.07)

4485(47.58)

5890(46.96)

 Females

2679(52.74)

4330(51.66)

4150(51.76)

4302(50.77)

4854(51.78)

4752(52.22)

4784(52.93)

4941(52.42)

6653(53.04)

CHNS China Health and Nutrition Survey

The trends in the distributions of BMI and WC from 1989 to 2011 are displayed in Table 2. The median BMI and WC at the follow- up were 23.31 kg/m2 and 80 cm, respectively. The median BMI increased significantly from 1989 to 2011 in all subgroups (all P < 0.0001). The median BMI increased by 2.65 kg/m2 in males and 1.90 kg/m2 in females. In the stratified analyses by age, there were linear increasing trends in all subgroups (all P < 0.0001), with the exception of the 18–39 years group in women, which did not fall within the linearly increasing trend. The trends in WC were similar with those in BMI. The median WC increased by 8.50 cm in men and 7.00 cm in women. Significant increases in the median WC were observed in all subgroups (all P < 0.0001).
Table 2

The distribution of body mass index and waist circumference among Chinese adults from the CHNS: 1989–2011

Indicators

1989

1991

1993

1997

2000

2003

2006

2009

2011

Z

P

n

M (Q)

n

M (Q)

n

M (Q)

n

M (Q)

n

M (Q)

n

M (Q)

n

M (Q)

n

M (Q)

n

M (Q)

BMI (kg/m2)

 Total

5080

21.20(3.06)

8382

21.20(3.58)

8017

21.40(3.62)

8473

21.80(4.04)

9374

22.40(4.36)

9100

22.60(4.53)

9039

22.80(4.47)

9426

23.04(4.63)

12,543

23.50(4.74)

61.74

<.0001

 Men

  Overall

2401

21.01(2.83)

4052

21.05(3.26)

3867

21.30(3.26)

4171

21.73(3.77)

4520

22.31(4.26)

4348

22.67(4.36)

4255

22.84(4.43)

4485

23.09(4.53)

5890

23.66(4.59)

47.09

<.0001

 Age (years)

  18–39

1969

20.91(2.73)

2150

20.87(2.90)

1918

21.05(2.93)

1888

21.47(3.34)

1878

21.97(3.90)

1413

22.27(4.13)

1219

22.50(4.19)

1189

22.57(4.86)

1354

23.39(5.15)

33.19

<.0001

  40–59

431

21.55(3.28)

1304

21.46(3.54)

1335

21.72(3.50)

1559

22.10(3.93)

1809

22.71(4.21)

1955

23.05(4.21)

1987

23.18(4.18)

2068

23.53(4.35)

2782

24.00(4.33)

26.43

<.0001

  60–100

1

22.96(0.00)

598

21.09(4.09)

614

21.21(4.08)

724

21.77(4.74)

833

22.23(4.86)

980

22.44(4.91)

1049

22.49(4.89)

1228

22.80(4.64)

1754

23.24(4.72)

11.12

<.0001

 Women

  Overall

2679

21.48(3.30)

4330

21.44(3.93)

4150

21.58(4.07)

4302

22.02(4.23)

4854

22.61(4.45)

4752

22.74(4.72)

4784

22.82(4.52)

4941

22.99(4.72)

6653

23.38(4.86)

40.47

<.0001

Age (years)

  18–39

2237

21.37(3.17)

2245

21.14(3.26)

2027

21.19(3.44)

1801

21.47(3.47)

1895

21.76(3.78)

1477

21.69(3.82)

1336

21.64(3.88)

1236

21.55(4.29)

1603

21.72(4.07)

15.49

<.0001

  40–59

435

22.07(3.88)

1414

22.04(4.52)

1451

22.31(4.42)

1686

22.73(4.41)

1998

23.48(4.30)

2170

23.42(4.45)

2234

23.41(4.40)

2323

23.61(4.38)

3114

24.03(4.56)

21.03

<.0001

  60–100

7

20.08(3.63)

671

21.27(5.05)

672

21.62(5.09)

815

22.03(5.33)

961

22.48(5.22)

1105

22.83(5.22)

1214

23.10(5.08)

1382

23.20(5.15)

1936

23.57(4.98)

11.12

<.0001

WC (cm)

 Total

8017

75.00(11.00)

8473

76.00(12.00)

9374

78.00(14.00)

9100

80.00(14.00)

9039

80.30(14.00)

9426

82.00(15.00)

12,543

83.50(14.80)

70.59

<.0001

 Men

 Overall

3867

75.00(12.00)

4171

78.00(13.00)

4520

80.00(13.00)

4348

82.00(14.00)

4255

82.40(14.00)

4485

84.00(14.00)

5890

86.00(13.80)

55.64

<.0001

 Age (years)

  18–39

1918

74.00(9.50)

1888

76.00(11.00)

1888

78.00(12.00)

1413

80.00(13.00)

1219

80.50(13.00)

1189

81.50(15.10)

1354

84.00(15.60)

34.70

<.0001

  40–59

1335

77.00(11.00)

1559

79.00(13.00)

1559

81.00(13.00)

1955

83.00(13.00)

1987

83.60(13.00)

2068

85.00(13.20)

2782

87.00(13.00)

33.55

<.0001

  60–100

614

78.00(13.00)

724

80.00(16.00)

724

82.00(15.00)

980

82.50(14.90)

1049

83.00(15.00)

1228

84.50(14.60)

1754

86.00(13.90)

15.56

<.0001

 Women

  Overall

4150

74.00(12.00)

4302

75.00(12.00)

4854

77.00(14.00)

4752

78.50(14.00)

4784

79.00(13.00)

4941

80.00(14.00)

6653

81.00(14.60)

45.51

<.0001

 Age (years)

  18–39

2027

72.00(9.00)

1801

72.00(10.00)

1895

74.00(11.00)

1477

74.00(11.00)

1477

74.00(10.50)

1477

75.00(13.00)

1603

76.00(12.80)

20.57

<.0001

  40–59

1451

76.00(13.00)

1686

77.00(12.00)

1998

80.00(13.00)

2170

80.00(13.00)

2170

80.00(13.00)

2170

81.00(12.80)

3114

82.00(13.30)

23.96

<.0001

  60–100

672

78.00(15.00)

815

79.00(16.00)

961

81.00(15.00)

1105

82.00(16.00)

1105

82.00(15.00)

1105

84.00(14.20)

1936

84.50(14.30)

14.42

<.0001

CHNS China Health and Nutrition Survey; BMI body mass index; WC waist circumference

The prevalence of overweight, general obesity, and abdominal obesity are reported in Table 3. In total, the age-adjusted prevalence of overweight increased significantly from 23.82 to 38.80% (P < 0.0001). The age- adjusted prevalence of overweight increased significantly from 16.49 to 42.04% in men (P < 0.0001) and from 27.44 to 36.06% in women (P < 0.0001). Moreover, the prevalence of overweight in men (95% CI: 40.78–43.30%) was greater than that in women (95% CI: 34.91–37.22%) in 2011. In all age groups, significant increases in the prevalence of overweight were observed in both men and women (P < 0.0001). Similarly, the age-adjusted prevalence of general obesity increased from 2.15 to 13.99% in total, from 1.46 to 14.99% in men, and from 2.78 to 13.22% in women (all P < 0.0001). There were significant increases in the prevalence of general obesity among all subgroups (all P < 0.0001). There were significant increases in the age-adjusted prevalence of abdominal obesity in the total sample (from 19.84 to 43.15%, P < 0.0001), in men (from 9.17 to 34.70%, P < 0.0001), and in women (from 29.75 to 50.75%, P < 0.0001). Compared to men, there was a higher prevalence of abdominal obesity among women across all age groups and cycles of surveys.
Table 3

The prevalence of overweight, obesity and abdominal obesity among Chinese adults from the CHNS: 1989–2011

Indicators

1989

1991

1993

1997

2000

2004

2006

2009

2011

Z

P

n

%(CI)

n

%(CI)

n

%(CI)

n

%(CI)

n

%(CI)

n

%(CI)

n

%(CI)

n

%(CI)

n

%(CI)

Overweight

 Total

1080

21.26 (20.13–22.38)

1983

23.66 (22.75–24.57)

2032

25.35 (24.39–26.30)

2469

29.14 (28.17–30.11)

3270

34.88 (33.92–35.85)

3335

36.65 (35.66–37.64)

3405

37.67 (36.67–38.67)

3654

38.77 (37.78–39.75)

5141

40.99 (40.13–41.85)

32.51

<.0001

 Adjusteda

1080

23.82 (22.65–25.00)

1983

24.15 (23.23–25.06)

2032

25.64 (24.68–26.59)

2469

28.93 (27.97–29.90)

3270

34.34 (33.38–35.30)

3335

35.38 (34.39–36.36)

3405

36.01 (35.02–37.00)

3654

36.27 (35.30–37.24)

5141

38.80 (37.95–39.65)

  

 Men

  Overall

422

17.58 (16.05–19.10)

839

20.71 (19.46–21.95)

885

22.89 (21.56–24.21)

1144

27.43 (26.07–28.78)

1529

33.83 (32.45–35.21)

1607

36.96 (35.52–38.39)

1640

38.54 (37.08–40.01)

1797

40.07 (38.63–41.50)

2535

43.04 (41.77–44.30)

29.03

<.0001

  Adjusteda

422

16.49 (15.01–17.97)

839

21.19 (19.93–22.45)

885

23.17 (21.84–24.50)

1144

27.38 (26.03–28.74)

1529

33.47 (32.10–34.85)

1607

36.26 (34.83–37.69)

1640

37.59 (36.14–39.05)

1797

38.36 (36.94–39.78)

2535

42.04 (40.78–43.30)

  

 Age (years)

  18–39

318

16.15 (14.52–17.78)

376

17.49 (15.88–19.09)

365

19.03 (17.27–20.79)

435

23.04 (21.14–24.94)

546

29.07 (27.02–31.13)

468

33.12 (30.67–35.58)

415

34.04 (31.38–36.70)

395

33.22 (30.54–35.90)

526

38.85 (36.25–41.44)

18.88

<.0001

  40–59

104

24.13 (20.09–28.17)

334

25.61 (23.24–27.98)

381

28.54 (26.12–30.96)

514

32.97 (30.64–35.30)

706

39.03 (36.78–41.28)

795

40.66 (38.49–42.84)

852

42.88 (40.70–45.05)

909

43.96 (41.82–46.09)

1298

46.66 (44.80–48.51)

14.74

<.0001

  60–100

0

0.00

129

21.57 (18.28–24.87)

139

22.64 (19.33–25.95)

195

26.93 (23.70–30.17)

277

33.25 (30.05–36.45)

344

35.10 (32.11–38.09)

373

35.56 (32.66–38.45)

493

40.15 (37.40–42.89)

711

40.54 (38.24–42.83)

9.80

<.0001

 Women

  Overall

658

24.56 (22.93–26.19)

1144

26.42 (25.11–27.73)

1147

27.64 (26.28–29.00)

1325

30.80 (29.42–32.18)

1741

35.87 (34.52–37.22)

1728

36.36 (35.00–37.73)

1765

36.89 (35.53–38.26)

1857

37.58 (36.23–38.93)

2606

39.17 (38.00–40.34)

17.18

<.0001

  Adjusteda

658

27.44 (25.75–29.13)

1144

26.90 (25.58–28.22)

1147

27.93 (26.56–29.29)

1325

30.40 (29.03–31.77)

1741

35.10 (33.76–36.45)

1728

34.50 (33.15–35.85)

1765

34.59 (33.24–35.94)

1857

34.27 (32.95–35.59)

2606

36.06 (34.91–37.22)

  

 Age (years)

  18–39

515

23.02 (21.28–24.77)

507

22.58 (20.85–24.31)

454

22.40 (20.58–24.21)

446

24.76 (22.77–26.76)

547

28.87 (26.83–30.91)

403

27.29 (25.01–29.56)

364

27.25 (24.86–29.63)

308

24.92 (22.51–27.33)

445

27.76 (25.57–29.95)

6.17

<.0001

  40–59

141

32.41 (28.02–36.81)

457

32.32 (29.88–34.76)

502

34.60 (32.15–37.04)

632

37.49 (35.17–39.80)

877

43.89 (41.72–46.07)

948

43.69 (41.60–45.77)

955

42.75 (40.70–44.80)

1037

44.64 (42.62–46.66)

1393

44.73 (42.99–46.48)

8.83

<.0001

  60–100

2

28.57 (0.00–62.04)

180

26.83 (23.47–30.18)

191

28.42 (25.01–31.83)

247

30.31 (27.15–33.46)

317

32.99 (30.01–35.96)

377

34.12 (31.32–36.91)

446

36.74(34.03–39.45)

512

37.05 (34.50–39.59)

768

39.67 (37.49–41.85)

5.90

<.0001

Obesity

 Total

100

1.97 (1.59–2.35)

331

3.95 (3.53–4.37)

333

4.15 (3.72–4.59)

553

6.53 (6.00–7.05)

803

8.57 (8.00–9.13)

901

9.90 (9.29–10.51)

940

10.40 (9.77–11.03)

1102

11.69 (11.04–12.34)

1855

14.79 (14.17–15.41)

32.27

<.0001

 Adjusteda

100

2.15 (1.75–2.54)

331

4.24 (3.81–4.67)

333

4.26 (3.82–4.71)

553

6.41 (5.89–6.93)

803

8.31 (7.76–8.87)

901

9.20 (8.61–9.79)

940

9.69 (9.08–10.30)

1102

11.02 (10.39–11.65)

1855

13.99 (13.38–14.59)

  

 Men

  Overall

30

1.25 (0.81–1.69)

125

3.08 (2.55–3.62)

119

3.08 (2.53–3.62)

238

5.71 (5.00–6.41)

334

7.39 (6.63–8.15)

389

8.95 (8.10–9.80)

401

9.42 (8.55–10.30)

495

11.04 (10.12–11.95)

853

14.48 (13.58–15.38)

24.18

<.0001

  Adjusteda

30

1.46 (0.98–1.94)

125

3.30 (2.75–3.85)

119

3.15 (2.59–3.70)

238

5.65 (4.95–6.35)

334

7.32 (6.56–8.08)

389

8.60 (7.76–9.43)

401

9.53 (8.64–10.41)

495

11.44 (10.51–12.37)

853

14.99(14.08–15.90)

  

 Age (years)

  18–39

18

0.91 (0.49–1.33)

33

1.53 (1.02–2.05)

36

1.88 (1.27–2.48)

77

4.08 (3.19–4.97)

124

6.60 (5.48–7.73)

101

7.15 (5.80–8.49)

118

9.68 (8.02–11.34)

142

11.94 (10.10–13.79)

212

15.66 (13.72–17.59)

20.55

<.0001

  40–59

12

2.78 (1.23–4.34)

55

4.22 (3.13–5.31)

49

3.67 (2.66–4.68)

94

6.03 (4.85–7.21)

138

7.63 (6.41–8.85)

199

10.18 (8.84–11.52)

197

9.91 (8.60–11.23)

255

12.33 (10.91–13.75)

430

15.46 (14.11–16.80)

13.19

<.0001

  60–100

0

0.00

37

6.19 (4.26–8.12)

34

5.54 (3.73–7.35)

67

9.25(7.14–11.37)

72

8.64 (6.74–10.55)

89

9.08 (7.28–10.88)

86

8.20 (6.54–9.86)

98

7.98 (6.46–9.50)

211

12.03(10.51–13.55)

4.03

<.0001

 Women

  Overall

70

2.61(2.01–3.22)

206

4.76(4.12–5.39)

214

5.16 (4.48–5.83)

315

7.32 (6.54–8.10)

469

9.66 (8.83–10.49)

512

10.77 (9.89–11.66)

539

11.27 (10.37–12.16)

607

12.28 (11.37–13.20)

1002

15.06 (14.20–15.92)

21.38

<.0001

  Adjusteda

70

2.78 (2.16–3.40)

206

5.10 (4.45–5.76)

214

5.30 (4.62–5.98)

315

7.11 (6.34–7.87)

469

9.19 (8.38–10.00)

512

9.75 (8.90–10.59)

539

9.83 (8.98–10.67)

607

10.60 (9.74–11.46)

1002

13.22 (12.40–14.03)

  

 Age (years)

  18–39

49

2.19 (1.58–2.80)

44

1.96 (1.39–2.53)

55

2.71 (2.01–3.42)

77

4.28 (3.34–5.21)

104

5.49 (4.46–6.51)

90

6.09 (4.87–7.31)

75

5.61 (4.38–6.85)

79

6.39 (5.03–7.76)

138

8.61 (7.24–9.98)

11.49

<.0001

  40–59

21

4.83 (2.81–6.84)

111

7.85 (6.45–9.25)

105

7.24 (5.90–8.57)

152

9.02 (7.65–10.38)

238

11.91 (10.49–13.33)

263

12.12 (10.75–13.49)

286

12.80 (11.42–14.19)

317

13.65 (12.25–15.04)

536

17.21 (15.89–18.54)

10.92

<.0001

  60–100

0

0.00

51

7.60 (5.60–9.61)

54

8.04 (5.98–10.09)

86

10.55 (8.44–12.66)

127

13.22 (11.07–15.36)

159

14.39 (12.32–16.46)

178

14.66 (12.67–16.65)

211

15.27 (13.37–17.16)

328

16.94 (15.27–18.61)

7.06

<.0001

Abdominal obesity

 Total

1477

19.33 (18.44–20.22)

1982

24.05 (23.13–24.97)

2901

31.36 (30.41–32.30)

3200

35.67 (34.68–36.66)

3350

37.86 (36.85–38.87)

3994

42.82 (41.81–43.82)

5933

47.34 (46.47–48.22)

51.31

<.0001

 Adjusteda

1477

19.84 (18.96–20.71)

1982

23.56 (22.65–24.46)

2901

30.18 (29.25–31.11)

3200

32.73 (31.76–33.69)

3350

34.41 (33.43–35.39)

3994

38.68 (37.7–39.66)

5933

43.15 (42.28–44.01)

  

 Men

  Overall

330

8.96 (8.04–9.88)

595

14.64 (13.55–15.73)

921

20.63 (19.44–21.81)

1017

23.75 (22.47–25.02)

1064

25.53 (24.21–26.86)

1344

30.30 (28.95–31.66)

2139

36.34 (35.11–37.57)

35.57

<.0001

 Adjusteda

330

9.17 (8.26–10.08)

595

14.49 (13.42–15.56)

921

20.20 (19.03–21.37)

1017

22.43 (21.19–23.67)

1064

24.06 (22.77–25.34)

1344

28.61 (27.29–29.94)

2139

34.70 (33.49–35.92)

  

 Age (years)

  18–39

92

5.04 (4.04–6.05)

181

9.85 (8.49–11.22)

295

15.91 (14.25–17.58)

242

17.39 (15.39–19.38)

233

19.55 (17.30–21.80)

281

23.94 (21.49–26.38)

414

30.60 (28.14–33.05)

21.60

<.0001

  40–59

141

11.09 (9.37–12.82)

246

16.19 (14.34–18.05)

395

22.14 (20.21–24.07)

509

26.44 (24.47–28.41)

546

28.04 (26.05–30.04)

674

32.88 (30.84–34.91)

1083

38.96 (37.14–40.77)

21.14

<.0001

  60–100

97

16.47 (13.47–19.46)

168

23.73 (20.06–26.86)

231

27.93 (24.87–30.99)

266

27.54 (24.72–30.35)

285

27.72 (24.99–30.46)

389

32.12 (29.49–34.75)

642

36.62 (34.37–38.88)

10.21

<.0001

 Women

  Overall

1147

28.99 (27.57–30.40)

1387

33.21 (31.78–34.63)

1980

41.36 (39.97–42.76)

2183

46.57 (45.14–47.99)

2286

48.83 (47.39–50.26)

2650

54.16 (52.76–55.56)

3794

57.09 (55.90–58.28)

37.81

<.0001

  Adjusteda

1147

29.75 (28.36–31.14)

1387

32.18 (30.78–33.57)

1980

39.32 (37.95–40.70)

2183

42.13 (40.73–43.54)

2286

43.66 (42.26–45.07)

2650

47.85 (46.46–49.24)

3794

50.75 (49.55–51.95)

  

 Age (years)

  18–39

308

15.97 (14.33–17.60)

333

19.09 (17.25–20.94)

442

23.76 (21.83–25.70)

381

26.13 (23.88–28.39)

373

28.56 (26.11–31.01)

395

32.30 (29.68–34.92)

574

35.85 (33.50–38.20)

16.19

<.0001

  40–59

540

38.71 (36.15–41.27)

674

41.22 (38.84–43.61)

1003

50.76 (48.55–52.96)

1157

53.89 (51.78–56.00)

1193

54.50 (52.41–56.59)

1348

58.53 (56.52–60.54)

1901

61.11 (59.39–62.82)

18.03

<.0001

  60–100

299

47.24 (43.35–51.12)

380

47.62 (44.15–51.08)

535

56.26 (53.10–59.41)

645

59.56 (56.63–62.48)

720

60.66 (57.88–63.44)

907

66.35 (63.84–68.85)

1319

68.20 (66.13–70.28)

12.05

<.0001

aAdjusted by the direct method to the year 2010 Census population using the age groups 18–39 years, 40–59 years, and 60–100 years

CHNS China Health and Nutrition Survey

Table 4 shows the prevalence of overweight, general obesity, and abdominal obesity in different smoking status, marital status, and educational levels. In all subgroups, the prevalence of the three indicators increased significantly, with the exception of overweight in the divorced group (P = 0.2193). The higher prevalence of overweight, general obesity, and abdominal obesity were found in non- smoking group. The higher prevalence of abdominal obesity was found in the widowed group and the group with a primary education or no degree.
Table 4

The prevalence of overweight, obesity and abdominal obesity among Chinese adults in different smoking status, married status, and education degree from the CHNS: 1989–2011

Indicators

1989

1991

1993

1997

2000

2004

2006

2009

2011

Z

P

n

%(CI)

n

%(CI)

n

%(CI)

n

%(CI)

n

%(CI)

n

%(CI)

n

%(CI)

n

%(CI)

n

%(CI)

Overweight

 Smoking status

  No smoking

1371

25.61 (24.44–26.78)

1407

27.04 (25.84–28.25)

1733

30.57 (29.37–31.77)

2261

35.67 (34.49–36.85)

2274

37.04 (35.83–38.24)

2359

37.94 (36.74–39.15)

2485

38.42 (37.23–39.61)

3575

41.13 (40.10–42.17)

21.23

<.0001

  Smoking

603

20.11 (18.67–21.54)

612

22.34 (20.78–23.90)

718

26.19 (24.54–27.83)

982

33.20 (31.50–34.90)

1056

35.82 (34.09–37.55)

1046

37.07 (35.28–38.85)

1169

39.52 (37.76–41.28)

1565

40.64 (39.09–42.19)

20.99

<.0001

 Married status

  Never married

89

11.38 (9.16–13.61)

173

13.32 (11.47–15.17)

169

14.02 (12.06–15.99)

213

18.08 (15.88–20.28)

242

21.67 (19.25–24.08)

189

23.68 (20.73–26.63)

154

24.25 (20.92–27.59)

107

17.86 (14.8–20.93)

169

24.28 (21.1–27.47)

9.43

<.0001

  Married

982

23.07 (21.81–24.34)

1697

26.15 (25.08–27.22)

1738

27.98 (26.87–29.10)

2110

31.94 (30.81–33.06)

2714

37.52 (36.40–38.63)

2873

38.54 (37.44–39.65)

2964

39.21 (38.11–40.31)

3206

40.72 (39.64–41.81)

4505

42.80 (41.85–43.74)

26.59

<.0001

  Divorced

4

21.05 (2.72–39.38)

18

30.00 (18.40–41.60)

15

35.71 (21.22–50.21)

14

20.90 (11.16–30.63)

28

30.77 (21.29–40.25)

51

43.59 (34.60–52.57)

43

36.13 (27.50–44.77)

62

37.58 (30.19–44.97)

93

32.98 (27.49–38.47)

1.23

0.2193

  Widowed

5

23.81 (5.59–42.03)

93

18.24 (14.88–21.59)

100

19.88 (16.39–23.37)

123

22.49 (18.99–25.98)

158

27.67 (24–31.34)

203

29.99 (26.53–33.44)

235

33.86 (30.34–37.38)

267

35.74 (32.31–39.18)

346

35.67 (32.66–38.68)

8.22

<.0001

 Education degree

  Primary school or none

509

21.23 (19.59–22.86)

1184

24.74 (23.52–25.97)

1115

26.03 (24.71–27.34)

1225

28.84 (27.48–30.21)

1433

34.66 (33.21–36.11)

1432

35.60 (34.12–37.07)

1414

36.59 (35.08–38.11)

1489

37.30 (35.80–38.80)

1756

38.62 (37.20–40.03)

19.95

<.0001

  Middle school degree

533

21.34 (19.73–22.94)

741

21.93 (20.53–23.32)

844

24.43 (23.00–25.86)

1098

29.23 (27.78–30.69)

1589

34.98 (33.59–36.36)

1761

37.54 (36.15–38.93)

1788

38.44 (37.04–39.83)

1960

39.89 (38.52–41.26)

2754

42.82 (41.61–44.03)

23.77

<.0001

  College or above

22

19.64 (12.28–27.00)

54

30.86 (24.01–37.70)

47

35.34 (27.21–43.46)

76

37.07 (30.46–43.68)

142

37.27 (32.42–42.13)

136

37.06 (32.12–42.00)

198

39.76 (35.46–44.06)

201

39.64 (35.39–43.90)

623

40.43 (37.98–42.88)

4.52

<.0001

Obesity

 Smoking status

  No smoking

243

4.54 (3.98–5.10)

238

4.57 (4.01–5.14)

410

7.23 (6.56–7.91)

587

9.26 (8.55–9.97)

657

10.70 (9.93–11.47)

687

11.05 (10.27–11.83)

812

12.55 (11.75–13.36)

1315

15.13 (14.38–15.88)

23.48

<.0001

  Smoking

88

2.93 (2.33–3.54)

86

3.14 (2.49–3.79)

137

5.00 (4.18–5.81)

209

7.07 (6.14–7.99)

242

8.21 (7.22–9.20)

253

8.97 (7.91–10.02)

290

9.80 (8.73–10.88)

540

14.02 (12.93–15.12)

18.31

<.0001

 Married status

  Never married

3

0.38 (0.00–0.82)

8

0.62 (0.19–1.04)

9

0.75 (0.26–1.23)

20

1.70 (0.96–2.44)

42

3.76 (2.64–4.88)

38

4.76 (3.28–6.24)

23

3.62 (2.17–5.08)

34

5.68 (3.82–7.53)

68

9.77 (7.56–11.98)

12.22

<.0001

  Married

94

2.21 (1.77–2.65)

293

4.51 (4.01–5.02)

294

4.73 (4.21–5.26)

483

7.31 (6.68–7.94)

680

9.40 (8.73–10.07)

779

10.45 (9.76–11.15)

833

11.02 (10.31–11.73)

958

12.17 (11.45–12.89)

1594

15.14 (14.46–15.83)

26.58

<.0001

  Divorced

2

10.53 (0.00–24.33)

4

6.67 (0.35–12.98)

1

2.38 (0.00–6.99)

5

7.46 (1.17–13.76)

4

4.40 (0.18–8.61)

7

5.98 (1.69–10.28)

6

5.04 (1.11–8.97)

14

8.48 (4.23–12.74)

36

12.77 (8.87–16.66)

2.10

0.0354

  Widowed

1

4.76 (0.00–13.87)

26

5.10 (3.19–7.01)

25

4.97 (3.07–6.87)

41

7.50 (5.29–9.70)

51

8.93 (6.59–11.27)

72

10.64 (8.31–12.96)

76

10.95 (8.63–13.27)

88

11.78 (9.47–14.09)

154

15.88 (13.58–18.18)

6.96

<.0001

 Education degree

  Primary school or none

56

2.34 (1.73–2.94)

230

4.81 (4.20–5.41)

210

4.90 (4.26–5.55)

294

6.92 (6.16–7.69)

356

8.61 (7.76–9.47)

417

10.37 (9.42–11.31)

429

11.10 (10.11–12.09)

510

12.78 (11.74–13.81)

688

15.13 (14.09–16.17)

20.54

<.0001

  Middle school degree

41

1.64 (1.14–2.14)

91

2.69 (2.15–3.24)

108

3.13 (2.55–3.71)

218

5.80 (5.06–6.55)

371

8.17 (7.37–8.96)

439

9.36 (8.52–10.19)

468

10.06 (9.20–10.92)

539

10.97 (10.10–11.84)

968

15.05 (14.18–15.92)

23.17

<.0001

  College or above

2

1.79 (0.00–4.24)

7

4.00 (1.10–6.90)

4

3.01 (0.10–5.91)

18

8.78 (4.91–12.65)

36

9.45 (6.51–12.39)

44

11.99 (8.67–15.31)

41

8.23 (5.82–10.65)

52

10.26 (7.62–12.9)

196

12.72 (11.06–14.38)

4.66

<.0001

Abdominal obesity

 Smoking status

  No smoking

1194

24.08 (22.89–25.27)

1578

28.65 (27.46–29.84)

2252

36.00 (34.81–37.19)

2491

41.13 (39.89–42.37)

2625

43.19 (41.94–44.43)

3115

48.66 (47.44–49.89)

4494

51.74 (50.69–52.79)

39.93

<.0001

  Smoking

263

10.06 (8.91–11.21)

391

14.58 (13.25–15.92)

620

21.24 (19.76–22.72)

705

24.29 (22.73–25.85)

725

26.16 (24.53–27.80)

879

30.03 (28.37–31.69)

1439

37.42 (35.89–38.94)

28.06

<.0001

 Married status

  Never married

71

6.18 (4.79–7.58)

98

8.54 (6.93–10.16)

153

13.97 (11.92–16.03)

130

16.65 (14.03–19.26)

98

15.68 (12.83–18.53)

94

15.91 (12.96–18.85)

160

23.02 (19.89–26.15)

11.85

<.0001

  Married

1247

21.04 (20.00–22.07)

1691

26.29 (25.22–27.37)

2397

33.52 (32.42–34.61)

2713

36.87 (35.77–37.97)

2874

38.84 (37.73–39.95)

3415

43.81 (42.71–44.91)

5094

48.42 (47.46–49.37)

42.19

<.0001

  Divorced

13

33.33 (18.54–48.13)

14

21.54 (11.54–31.53)

18

20.00 (11.74–28.26)

39

33.91 (25.26–42.57)

35

30.17 (21.82–38.53)

55

33.54 (26.31–40.76)

106

37.86 (32.18–43.54)

2.82

0.0049

  Widowed

138

29.36 (25.24–33.48)

167

31.69 (27.72–35.66)

233

41.31 (37.25–45.38)

301

45.40 (41.61–49.19)

336

49.56 (45.79–53.32)

411

55.77 (52.18–59.35)

548

56.61 (53.49–59.73)

11.95

<.0001

 Education degree

  Primary school or none

971

23.86 (22.55–25.17)

1150

27.90 (26.53–29.27)

1449

35.45 (33.98–36.91)

1615

40.73 (39.20–42.26)

1615

42.79 (41.21–44.37)

1935

48.95 (47.39–50.51)

2345

51.63 (50.18–53.08)

32.90

<.0001

  Middle school degree

447

13.54 (12.37–14.71)

695

19.00 (17.73–20.28)

1210

27.02 (25.72–28.32)

1457

31.52 (30.18–32.86)

1578

34.57 (33.19–35.95)

1879

38.67 (37.30–40.04)

2961

46.06 (44.85–47.28)

37.90

<.0001

  College or above

31

23.48 (16.25–30.72)

59

28.92 (22.70–35.14)

108

28.88 (24.28–33.47)

123

33.79 (28.93–38.65)

147

30.31 (26.22–34.40)

178

35.46 (31.27–39.64)

616

40.00 (37.55–42.45)

5.47

<.0001

CHNS China Health and Nutrition Survey

The prevalence of grade 1, grade 2, and grade 3 combined obesity are presented in Table 5. The age-adjusted prevalence of grade 1 obesity increased significantly in the total sample (from 2.08 to 12.01%, P < 0.0001), in men (from 1.38 to 13.25%, P < 0.0001), and in women (from 2.74 to 11.03%, P < 0.0001). In all age groups, the prevalence of grade 1 obesity increased significantly. Similar trends in the age-adjusted prevalence of grade 2 obesity and grade 3 obesity combined were observed in the total sample as well as both men and women. There were significant increases in the prevalence of grade 2 obesity and grade 3 obesity combined in all age groups except the prevalence of grade 2 obesity in the 60–100 years group (P = 0.0629 in men and 0.2130 in women).
Table 5

The prevalence of grade 1, grade 2, and grade 2 and grade 3 combined among the Chinese adults from the CHNS: 1989–2011

Indicators

1989

1991

1993

1997

2000

2004

2006

2009

2011

Z

P

n

%(CI)

n

%(CI)

n

%(CI)

n

%(CI)

n

%(CI)

n

%(CI)

n

%(CI)

n

%(CI)

n

%(CI)

Grade 1

 Total

97

1.91 (1.30–2.90)

308

3.67 (3.27–4.08)

308

3.84 (3.42–4.26)

516

6.09 (5.58–6.60)

739

7.88 (7.34–8.43)

825

9.07 (8.48–9.66)

858

9.49 (8.89–10.10)

1009

10.70 (10.08–11.33)

1599

12.75 (12.16–13.33)

29.02

<.0001

 Adjusteda

97

2.08 (1.69–2.47)

308

3.93 (3.51–4.34)

308

3.94 (3.51–4.36)

516

5.99 (5.48–6.49)

739

7.66 (7.13–8.20)

825

8.40 (7.83–8.97)

858

8.81 (8.23–9.40)

1009

10.09 (9.48–10.70)

1599

12.01 (11.44–12.58)

  

 Men

  Overall

29

1.21 (0.77–1.64)

123

3.04 (2.51–3.56)

114

2.95 (2.41–3.48)

226

5.42 (4.73–6.11)

310

6.86 (6.12–7.60)

368

8.46 (7.64–9.29)

377

8.86 (8.01–9.71)

456

10.17 (9.28–11.05)

751

12.75 (11.90–13.60)

22.09

<.0001

  Adjusteda

29

1.38 (0.91–1.84)

123

3.24 (2.70–3.79)

114

3.01 (2.47–3.55)

226

5.37 (4.69–6.06)

310

6.81 (6.08–7.55)

368

8.10 (7.29–8.91)

377

8.90 (8.04–9.75)

456

10.58 (9.68–11.48)

751

13.25 (12.38–14.11)

  

 Age (years)

  18–39

18

0.91 (0.49–1.33)

33

1.53 (1.02–2.05)

35

1.82 (1.23–2.42)

76

4.03 (3.14–4.91)

119

6.34 (5.23–7.44)

93

6.58 (5.29–7.87)

108

8.86 (7.26–10.45)

132

11.10 (9.32–12.89)

189

13.96 (12.11–15.80)

19.17

<.0001

  40–59

11

2.55 (1.06–4.04)

55

4.22 (3.13–5.31)

46

3.45 (2.47–4.42)

90

5.77 (4.62–6.93)

127

7.02 (5.84–8.20)

191

9.77 (8.45–11.09)

188

9.46 (8.17–10.75)

237

11.46 (10.09–12.83)

377

13.55 (12.28–14.82)

11.87

<.0001

  60–100

0

0.00

35

5.85 (3.97–7.73)

33

5.37 (3.59–7.16)

60

8.29 (6.28–10.30)

64

7.68 (5.87–9.49)

84

8.57 (6.82–10.32)

81

7.72 (6.11–9.34)

87

7.08 (5.65–8.52)

185

10.55 (9.11–11.98)

3.340

0.0008

 Women

  Overall

68

2.54 (1.94–3.13)

185

4.27 (3.67–4.87)

194

4.67 (4.03–5.32)

290

6.74 (5.99–7.49)

429

8.84 (8.04–9.64)

457

9.62 (8.78–10.46)

481

10.05 (9.20–10.91)

553

11.19 (10.31–12.07)

848

12.75 (11.94–13.55)

19.00

<.0001

  Adjusteda

68

2.74 (2.12–3.36)

185

4.56 (3.94–5.18)

194

4.79 (4.14–5.44)

290

6.55 (5.81–7.28)

429

8.41 (7.63–9.19)

457

8.67 (7.87–9.47)

481

8.73 (7.93–9.53)

553

9.60 (8.78–10.42)

848

11.03 (10.27–11.78)

  

 Age (years)

  18–39

47

2.10 (1.51–2.70)

44

1.96 (1.39–2.53)

55

2.71 (2.01–3.42)

71

3.94 (3.04–4.84)

95

5.01 (4.03–6.00)

78

5.28 (4.14–6.42)

64

4.79 (3.65–5.94)

69

5.58 (4.30–6.86)

108

6.74 (5.51–7.96)

9.24

<.0001

  40–59

21

4.83 (2.81–6.84)

98

6.93 (5.61–8.25)

93

6.41 (5.15–7.67)

144

8.54 (7.21–9.88)

223

11.16 (9.78–12.54)

242

11.15 (9.83–12.48)

265

11.86 (10.52–13.20)

295

12.70 (11.35–14.05)

458

14.71 (13.46–15.95)

9.60

<.0001

  60–100

0

0.00

43

6.41 (4.56–8.26)

46

6.85 (4.94–8.75)

75

9.2 (7.22–11.19)

111

11.55 (9.53–13.57)

137

12.40 (10.46–14.34)

152

12.52 (10.66–14.38)

189

13.68 (11.86–15.49)

282

14.57 (12.99–16.14)

6.52

<.0001

Grade 2

 Total

3

0.06 (0.00–0.13)

21

0.25 (0. 14–0.36)

23

0.29 (0. 17–0.40)

34

0.40 (0. 27–0.54)

60

0.64 (0. 48–0.80)

69

0.76 (0. 58–0.94)

75

0.83 (0. 64–1.02)

88

0.93 (0. 74–1.13)

163

1.30 (1.10–1.50)

10.07

<.0001

 Adjusteda

3

0.06 (0.01–0.13)

21

0.28 (0.17–0.40)

23

0.30 (0.18–0.42)

34

0.39 (0.26–0.52)

60

0.61 (0.45–0.77)

69

0.72 (0.54–0.89)

75

0.81 (0.62–0.99)

88

0.88 (0.69–1.07)

163

1.24 (1.05–1.43)

  

 Men

  Overall

1

0.04 (0.00–0.12)

1

0.02 (0.00–0.07)

4

0.10 (0.00–0.20)

12

0.29 (0.13–0.45)

23

0.51 (0.30–0.72)

21

0.48 (0.28–0.69)

22

0.52 (0.30–0.73)

38

0.85 (0.58–1.12)

58

0.98 (0.73–1.24)

7.40

<.0001

  Adjusteda

1

0.09 (0.00–0.20)

1

0.03 (0.00–0.08)

4

0.11 (0.00–0.21)

12

0.28 (0.12–0.44)

23

0.49 (0.28–0.69)

21

0.50 (0.29–0.71)

22

0.57 (0.35–0.80)

38

0.84 (0.58–1.11)

58

1.03 (0.77–1.29)

  

 Age (years)

  18–39

0

0.00

0

0.00

1

0.05 (0.00–0.15)

1

0.05 (0.00–0.16)

5

0.27 (0.03–0.50)

8

0.57 (0.17–0.96)

9

0.74 (0.26–1.22)

10

0.84 (0.32–1.36)

15

1.11 (0.55–1.67)

6.10

<.0001

  40–59

1

0.23 (0.00–0.69)

0

0.00

3

0.22 (0.00–0.48)

4

0.26 (0.01–0.51)

11

0.61 (0.25–0.97)

8

0.41 (0.13–0.69)

9

0.45 (0.16–0.75)

17

0.82 (0.43–1.21)

29

1.04 (0.67–1.42)

4.51

<.0001

  60–100

0

0.00

1

0.17 (0.00–0.49)

0

0.00

7

0.97 (0.25–1.68)

7

0.84 (0.22–1.46)

5

0.51 (0.06–0.96)

4

0.38 (0.01–0.75)

11

0.90 (0.37–1.42)

14

0.80 (0.38–1.21)

1.86

0.0629

 Women

  Overall

2

0.07 (0.00–0.18)

20

0.46 (0.26–0.66)

19

0.46 (0.25–0.66)

22

0.51 (0.30–0.72)

37

0.76 (0.52–1.01)

48

1.01 (0.73–1.29)

53

1.11 (0.81–1.40)

50

1.01 (0.73–1.29)

105

1.58 (1.28–1.88)

6.94

<.0001

  Adjusteda

2

0.04 (0.00–0.12)

20

0.52 (0.30–0.73)

19

0.49 (0.27–0.70)

22

0.50 (0.29–0.71)

37

0.72 (0.48–0.96)

48

0.92 (0.65–1.19)

53

1.02 (0.73–1.30)

50

0.92 (0.65–1.19)

105

1.43 (1.14–1.71)

  

 Age (years)

  18–39

2

0.09 (0.00–0.21)

0

0.00

0

0.00

6

0.33 (0.07–0.6)

8

0.42 (0.13–0.71)

9

0.61 (0.21–1.01)

11

0.82 (0.34–1.31)

9

0.73 (0.25–1.20)

17

1.06 (0.56–1.56)

6.22

<.0001

  40–59

0

0.00

12

0.85 (0.37–1.33)

11

0.76 (0.31–1.20)

7

0.42 (0.11–0.72)

15

0.75 (0.37–1.13)

20

0.92 (0.52–1.32)

18

0.81 (0.44–1.18)

22

0.95 (0.55–1.34)

54

1.73 (1.28–2.19)

3.33

0.0009

  60–100

0

0.00

8

1.19 (0.37–2.01)

8

1.19 (0.37–2.01)

9

1.10 (0.39–1.82)

14

1.46 (0.70–2.21)

19

1.72 (0.95–2.49)

24

1.98 (1.19–2.76)

19

1.37 (0.76–1.99)

34

1.76 (1.17–2.34)

1.25

0.2130

Grade 2 and 3

 Total

3

0.06 (0.00–0.13)

23

0.27 (0.16–0.39)

25

0.31 (0.19–0.43)

37

0.44 (0.30–0.58)

64

0.68 (0.52–0.85)

76

0.84 (0.65–1.02)

82

0.91 (0.71–1.10)

93

0.99 (0.79–1.19)

256

2.04 (1.79–2.29)

12.59

<.0001

 Adjusteda

3

0.06 (0.00–0.13)

23

0.31 (0.19–0.43)

25

0.33 (0.20–0.45)

37

0.42 (0.28–0.56)

64

0.65 (0.49–0.81)

76

0.80 (0.61–0.98)

82

0.87 (0.68–1.06)

93

0.93 (0.74–1.12)

256

1.98 (1.73–2.22)

  

 Men

  Overall

1

0.04 (0.00–0.12)

2

0.05 (0.00–0.12)

5

0.13 (0.02–0.24)

12

0.29 (0.13–0.45)

24

0.53 (0.32–0.74)

21

0.48 (0.28–0.69)

24

0.56 (0.34–0.79)

39

0.87 (0.60–1.14)

102

1.73 (1.40–2.06)

9.63

<.0001

  Adjusteda

1

0.09 (0.00–0.20)

2

0.05 (0.00–0.13)

5

0.13 (0.02–0.25)

12

0.28 (0.12–0.44)

24

0.51 (0.30–0.71)

21

0.50 (0.29–0.71)

24

0.63 (0.39–0.86)

39

0.86 (0.59–1.13)

102

1.74 (1.41–2.07)

  

 Ag e (years)

  18–39

0

0.00

0

0.00

1

0.05 (0.00–0.15)

1

0.05 (0.00–0.16)

5

0.27 (0.03–0.50)

8

0.57 (0.17–0.96)

10

0.82 (0.31–1.33)

10

0.84 (0.32–1.36)

23

1.70 (1.01–2.39)

6.45

<.0001

  40–59

1

0.23 (0.00–0.69)

0

0.00

3

0.22 (0.00–0.48)

4

0.26 (0.01–0.51)

11

0.61 (0.25–0.97)

8

0.41 (0.13–0.69)

9

0.45 (0.16–0.75)

18

0.87 (0.47–1.27)

53

1.91 (1.40–2.41)

5.80

<.0001

  60–100

0

0.00

2

0.33 (0.00–0.80)

1

0.16 (0.00–0.48)

7

0.97 (0.25–1.68)

8

0.96 (0.30–1.62)

5

0.51 (0.06–0.96)

5

0.48 (0.06–0.89)

11

0.90 (0.37–1.42)

26

1.48 (0.92–2.05)

2.46

0.0139

 Women

  Overall

2

0.07 (0.00–0.18)

21

0.48 (0.28–0.69)

20

0.48 (0.27–0.69)

25

0.58 (0.35–0.81)

40

0.82 (0.57–1.08)

55

1.16 (0.85–1.46)

58

1.21 (0.90–1.52)

54

1.09 (0.80–1.38)

154

2.31 (1.95–2.68)

8.84

<.0001

  Adjusteda

2

0.04 (0.00–0.12)

21

0.54 (0.33–0.76)

20

0.51 (0.29–0.73)

25

0.56 (0.34–0.78)

40

0.78 (0.53–1.03)

55

1.07 (0.78–1.37)

58

1.10 (0.80–1.39)

54

1.00 (0.72–1.27)

154

2.19 (1.84–2.54)

  

 Age (years)

  18–39

2

0.09 (0.00–0.21)

0

0.00

0

0.00

6

0.33 (0.07–0.60)

9

0.47 (0.17–0.78)

12

0.81 (0.35–1.27)

11

0.82 (0.34–1.31)

10

0.81 (0.31–1.31)

30

1.87 (1.21–2.53)

7.35

<.0001

  40–59

0

0.00

13

0.92 (0.42–1.42)

12

0.83 (0.36–1.29)

8

0.47 (0.15–0.80)

15

0.75 (0.37–1.13)

21

0.97 (0.56–1.38)

21

0.94 (0.54–1.34)

22

0.95 (0.55–1.34)

78

2.50 (1.96–3.05)

4.51

<.0001

  60–100

0

0.00

8

1.19 (0.37–2.01)

8

1.19 (0.37–2.01)

11

1.35 (0.56–2.14)

16

1.66 (0.86–2.47)

22

1.99 (1.17–2.81)

26

2.14 (1.33–2.96)

22

1.59 (0.93–2.25)

46

2.38 (1.70–3.05)

2.18

0.0296

aAdjusted by the direct method to the year 2010 Census population using the age groups 18–39 years, 40–59 years, and 60–100 years

CHNS China Health and Nutrition Survey

The results of the trends in all obesity-related indicators are expressed as annual changes in ORs and displayed in Table 6. For all indicators, there were significant increases in the ORs in the total sample and both men and women (all P < 0.0001). Compared to women, higher ORs in all indicators were observed in men with the exception of grade 2 obesity.
Table 6

Estimated annual increase in the odds of obesity profiles prevalence among the Chinese adults by sex and age from the CHNS: 1989–2011

Indicators

Overweight

Obesity

Abdominal obesity

Grade 1 obesity

Grade 2 obesity

Grade 2 and 3 combined obesity

OR(95%CI)

P

OR(95%CI)

P

OR(95%CI)

P

OR(95%CI)

P

OR(95%CI)

P

OR(95%CI)

P

Total

1.041(1.039–1.043)

<.0001

1.074(1.070–1.078)

<.0001

1.073(1.070–1.076)

<.0001

1.07(1.066–1.074)

<.0001

1.087(1.073–1.102)

<.0001

1.108(1.094–1.123)

<.0001

Men

 Overall

1.055(1.052–1.058)

<.0001

1.087(1.081–1.093)

<.0001

1.089(1.083–1.094)

<.0001

1.082(1.075–1.088)

<.0001

1.117(1.089–1.147)

<.0001

1.148(1.120–1.178)

<.0001

Age

 18–39

1.056(1.050–1.061)

<.0001

1.125(1.113–1.137)

<.0001

1.104(1.093–1.114)

<.0001

1.118(1.106–1.130)

<.0001

1.195(1.133–1.261)

<.0001

1.223(1.159–1.290)

<.0001

 40–59

1.045(1.040–1.050)

<.0001

1.077(1.068–1.087)

<.0001

1.085(1.078–1.093)

<.0001

1.072(1.062–1.082)

<.0001

1.099(1.056–1.143)

<.0001

1.147(1.101–1.194)

<.0001

 60–100

1.046(1.038–1.054)

<.0001

1.028(1.016–1.041)

<.0001

1.048(1.039–1.058)

<.0001

1.025(1.011–1.038)

0.0002

1.045(0.997–1.096)

0.0658

1.062(1.017–1.109)

0.0061

Women

 Overall

1.030(1.027–1.033)

<.0001

1.065(1.060–1.070)

<.0001

1.068(1.064–1.072)

<.0001

1.061(1.055–1.066)

<.0001

1.074(1.056–1.091)

<.0001

1.09(1.073–1.107)

<.0001

Age

 18–39

1.013(1.008–1.018)

<.0001

1.065(1.054–1.076)

<.0001

1.060(1.052–1.067)

<.0001

1.055(1.043–1.066)

<.0001

1.136(1.092–1.182)

<.0001

1.164(1.120–1.209)

<.0001

 40–59

1.025(1.020–1.029)

<.0001

1.047(1.040–1.055)

<.0001

1.052(1.046–1.058)

<.0001

1.044(1.036–1.052)

<.0001

1.052(1.026–1.079)

<.0001

1.070(1.045–1.097)

<.0001

 60–100

1.028(1.021–1.035)

<.0001

1.042(1.032–1.052)

<.0001

1.054(1.045–1.062)

<.0001

1.042(1.031–1.053)

<.0001

1.021(0.994–1.048)

0.1354

1.032(1.006–1.059)

0.0146

CHNS China Health and Nutrition Survey

Discussion

The present study showed that there were significant increases in the age-adjusted prevalence of overweight and general obesity defined by BMI as well as abdominal obesity defined by WC in Chinese adults in the past 22 years. Compared to women, the changes in BMI and WC were particularly pronounced in men. Moreover, the age-adjusted prevalence of overweight in men was greater than that in women. However, the age-adjusted prevalence of abdominal obesity was reversed. Notably, according to the annual ORs, the increases in the prevalence of all indicators in men were greater than those in women, with the exception of grade 2 obesity. The annual ORs of general obesity, abdominal obesity, and grade 1 obesity decreased significantly with age in men.

In this study, dramatic increases in the prevalence of overweight, general obesity, and abdominal obesity were observed among Chinese adults from 1989 to 2011. The increases occurred in almost all studied sex and age groups, which was accordance with the previous studies [17, 27, 28] . Moreover, the increasing trends in all indicators appeared to continue but not slow or level off. If no effective intervention is implemented to control the prevalence of obesity, China will follow in the footsteps of the U.S., which will lead to an obesity crisis [29, 30]. A previous study reported that the Chinese diet was shifting toward a Westernized diet, as characterized by the proliferation of fast food chains since the late 1980s [31]. As a result, the consumption of animal food and edible oil has dramatically increased; in contrast, the intake of cereals and starchy roots has declined [15]. Therefore, the obesity epidemic in China is attributed to the increasing availability of food, the lack of physical activity, and the Westernization of the dietary pattern.

WC is a simple and effective measure of abdominal obesity and has often been shown to be a strong predictor of an increased risk of hypertension, diabetes, dyslipidemia, metabolic syndrome, and coronary heart disease, independent of BMI [32, 33]. In this study, the age-adjusted prevalence of abdominal obesity defined by WC considerably increased from 1989 to 2011, especially in women, which was in line with the previous study [27]. However, a previous study reported that the distribution of higher WC greatly increased from 1993 to 2009 in men [17]. In 2011, the age-adjusted prevalence of abdominal obesity in women was 50.75%. Note that the prevalence of abdominal obesity in the 40–59 years old and 60–100 years old groups were 61.11 and 68.20% in 2011, respectively. Therefore, the high prevalence of abdominal obesity poses a serious public health challenge in China.

According to the annual ORs, there were significant increases in the prevalence of all obesity-related indicators. Compared to women, there were more rapid increases in all indicators except grade 2 obesity in men. There were significant differences in the increasing rates of general obesity, abdominal obesity, and grade 1 obesity across the three age groups in men. And the annual ORs decreased significantly with age. Therefore, the obesity population is trending toward a higher proportion of males and younger individuals in China, which should be examined in a well-designed study in the future.

In this study, it was found that the prevalence of all obesity-related indicators increased more rapidly in men than that in women, which was in line with the findings of previous studies [14, 17, 28, 34]. The sex disparity might be explained by sociocultural, socioeconomic, behavioral, and genetic factors. First, obesogenic environmental changes resulting in high calorie intake might have contributed to male dominance in obesity increases. Furthermore, sex hormone responses to obesogenic environmental changes need to be considered [35]. Second, the dietary and physical activity behavioral differences between men and women might partly explain the sex disparity [16]. Third, body image dissatisfaction is more prevalent in women in China [36, 37]. The Chinese 2005 NYRBS (National Youth Risk Behavior Surveillance) showed that 23.6% of girls and 9.1% boys tried to lose weight by restricting their diets [38]. This might explain why the prevalence of obesity increased more slowly in women. The prevalence of abdominal obesity in women was higher than that in men, which might be attributed to hormonal levels. When women experience from menopause, estrogen declines rapidly, and follicle stimulating hormone increases. As a result, the accumulation of visceral fat is exacerbated [39]. Therefore, the prevalence of abdominal obesity would increase more rapidly in women.

The strengths and limitations

Data were obtained from the nationally representative CHNS. Thus, the findings of this study present the true and dynamic description of obesity-related variables in China. Because of the differences in ethnicities and dietary patterns among different countries, the prevalence and extent of obesity vary. Specific cut-offs of BMI should be used to define overweight and obesity in each country. In this study, according to the WHO recommendations for Chinese people, ethnicity-based cut-offs for BMI were used to define overweight and obesity. Therefore, the results of this study provided accurate and realistic estimations of the prevalence of overweight, general obesity, and abdominal obesity in China. However, the limitations of this study should be stated. Since the measurement of WC in the CHNS began in 1993, the prevalence of abdominal obesity and the distribution of WC were not reported in 1989 or 1991. The study population focused on children and adults aged ≤45 years old in 1989, which led to no result presented in the 60–100 years old group.

Conclusions

The prevalence of overweight, general obesity, and abdominal obesity increased significantly among Chinese adults from 1989 to 2011. The median BMI and WC increased rapidly over the 22 years. The annual ORs indicated that the increases in the prevalence of overweight, general obesity, and abdominal obesity in men were more rapid than those in women. Therefore, the obesity population is trending toward a higher proportion of males and younger individuals in China.

Notes

Acknowledgements

This research uses data from China Health and Nutrition Survey (CHNS). We thank the National Institute of Nutrition and Food Safety, China Center for Disease Control and Prevention, Carolina Population Center, the University of North Carolina at Chapel Hill, the NIH (R01-HD30880, DK056350, and R01-HD38700) and the Fogarty International Center, NIH for financial support for the CHNS data collection and analysis files from 1989 to 2006 and both parties plus the China-Japan Friendship Hospital, Ministry of Health for support for CHNS 2009 and future surveys.

Authors’ contributions

YC wrote the draft paper, QP revised the manuscript and improved the language, YY and SZ analyzed the data, YW interpreted the results, and WL designed the study. All authors have approved the final article.

Funding

This work was supported by the National Natural Science Foundation of China (71704131). The funding body did not play any roles in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.

Ethics approval and consent to participate

This study was approved by the IRB of the National Institute for Nutrition and Food Safety, China Center for Disease Control and Prevention, and University of North Carolina at Chapel Hill. Written informed consent was obtained from all subjects.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

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© The Author(s). 2019

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors and Affiliations

  • Yongjie Chen
    • 1
  • Qin Peng
    • 1
  • Yu Yang
    • 1
  • Senshuang Zheng
    • 1
  • Yuan Wang
    • 1
  • Wenli Lu
    • 1
    Email author
  1. 1.Department of Epidemiology and Statistics, School of Public HealthTianjin Medical UniversityTianjinChina

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