Global obesity rates have nearly tripled since 1975, according to WHO. Data from 2017 to 2018 indicate that more than 42·4% of American adults are living with obesity, an increase from 30·5% in 1999-2000. In the UK and Australia, obesity rates are slightly lower, but the trends are on a similar upward trajectory. These worrying figures have been frequently highlighted and discussed by different news outlets and medical journals, including The Lancet Diabetes & Endocrinology. However, the growing rates of obesity are not an exclusive problem of high-income countries. In fact, the prevalence of obesity is increasing at an alarming rate in many low-income and middle-income countries, but these data have been less publicised and evidence-based policies for obesity in these countries are still insufficient.Against this backdrop, The Lancet Diabetes & Endocrinology commissioned a three-paper Series on Obesity in China, led by An Pan, at Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China. The first paper in the Series provides a comprehensive review of the epidemiological trends and determinants of obesity; the second paper discusses clinical management and treatment of obesity; and the third paper reviews current health policies and provides recommendations to prevent and manage obesity in China. To maximise the visibility and impact of this Series, we have also published translations of all three papers in Mandarin Chinese, supplied by the authors.

China was once considered to have one of the leanest populations in the world. However, in the past four decades, the rates of overweight and obesity in China have rapidly increased, alongside with its fast economic growth, globalisation, and urbanisation. When using WHO BMI cutoffs, the prevalence of overweight and obesity in China among children and adolescents aged 7-18 years increased from 1% and 0·1% in 1985, to 14·0% and 6·4% in 2014. Similarly, the prevalence of overweight and obesity in Chinese adults reached 27·1% and 5·2% in 2010-12, an increase from 18·9% and 2·9% in 2002.

Lifestyle interventions are the first-line treatment for obesity in China, but evidence of potential efficacy apply mostly to White people, because the racial and ethnic diversity of these trials, and of most research in clinical medicine, is still largely inadequate. Patient access to pharmacotherapy and to bariatric surgery for severe obesity, is limited due to conservative approaches for the use of pharmacotherapy, few approved weight-loss medications, and a paucity of guidelines on bariatric surgery in China. In Chinese culture, excess bodyweight is still viewed as a positive attribute and a symbol of prosperity, making the implementation and adherence to obesity policies and programmes perhaps more challenging than in other nations.

People living with overweight and obesity are at increased risk of numerous health conditions, many of which are potentially life-threatening. The trend in exposures to high BMI and the obesity-related disease burden continue to increase at a global level, and no country or territory has shown substantial declines in the proportion of people with high BMI in the past 30 years, according to 2019 data from the global burden of disease project. This universal failure suggests that current efforts to tackle obesity and overweight are gravely inadequate. Although China has implemented several national obesity policies and programmes, similar to other global efforts, these also have not slowed down, let alone reverted, the growing trend towards a higher BMI.

With one of the most rapidly-ageing populations in the world and the lowest birth rates since 1960s, China also faces an increased burden of age-related diseases, along with other population health and economic challenges.

Improving the Chinese population's health depends not only on a deeper understanding of disease determinants, risk factors, and effectiveness of available interventions, but also on the recognition of the interdependence of biological, social, behavioural, and political environments. In the Series, An Pan, Youfa Wang, and colleagues propose an integrative framework for obesity prevention and control policies in China, and call for more rigorous research to evaluate the effectiveness of international policies and obesity interventions in Chinese populations.

The prevalence of overweight and obesity in China might still be lower than in other nations, but possibly not for long. The speed with which these rates are increasing, especially in children and adolescents, is deeply concerning. The time to act is now.

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DOI: https://doi.org/10.1016/S2213-8587(21)00150-9

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