Healthy China: Implications of International and Domestic Strategies, Policies, and Practices for Obesity Prevention and Control — China, 2023

We implemented a comprehensive dual-approach methodology combining a systematic literature review with targeted expert consultations to gather comprehensive data on domestic and international obesity-related policies, service delivery systems, and clinical guidelines. The literature review fulfilled two strategic objectives: first, informing the development of our semi-structured questionnaire instrument, and second, identifying relevant official policy documents that directly supplemented the policy and guideline information presented in Tables 1 and 2, alongside questionnaire-derived data. Our finalized semi-structured questionnaire comprised 17 carefully designed items organized into three distinct modules: (1) demographic and professional background information (age, country, education level, professional positions, years of obesity-related experience, specific obesity prevention and treatment projects); (2) a comprehensive assessment of obesity prevention and control status within respondents’ respective countries (existing policies, service utilization patterns and quality metrics, clinical guidelines, primary implementation challenges); and (3) strategic recommendations (specific recommendations for China’s context, successful international practices for potential adaptation). Between July and October 2023, we employed a purposive sampling methodology to engage 19 experts selected from an initial pool of 33 qualified candidates (Supplementary Table S1). To ensure both professional authority and geographic representativeness, we included experts from five countries representing diverse institutional sectors, including government agencies, academic research institutions, and international health organizations. Questionnaire responses were systematically entered into Excel databases and organized for comprehensive analysis. Open-ended qualitative responses underwent thematic analysis, while quantitative multiple-choice data were evaluated using descriptive statistical methods.

As summarized in Table 1, a cross-national analysis reveals divergent policy approaches to obesity prevention, with the included policies reflecting those explicitly highlighted by experts during consultations, thus representing authoritative consensus priorities rather than a comprehensive catalogue of all measures. Experts from China, the UK, the US, and Spain consistently reported established national policies explicitly targeting obesity. In contrast, Japanese experts indicated their nation currently lacks dedicated obesity-specific policies. However, based on expert consultations, one relevant national health policy (Health Japan 21) that addresses obesity-related risk factors was included in Table 1.

Expert responses to the “service utilization and quality” section revealed significant cross-national variations in obesity treatment service availability and utilization, reflecting distinct differences in healthcare priorities, resource allocation, and policy commitments. The US and Japan maintain well-established obesity management services, while UK experts reported insufficient national prioritization of obesity treatment. International experts consistently highlighted substantial regional and individual disparities in both service access and utilization patterns. China’s obesity treatment infrastructure remains in early developmental stages, characterized by limited service availability, absence of standardized treatment protocols, and marked inconsistencies in service quality. Although existing interventions may yield short-term benefits, experts emphasized the critical need to prioritize long-term outcomes while enhancing nationwide accessibility and service uptake.

Health insurance coverage for obesity treatment demonstrates pronounced international disparities. The US incorporates obesity treatment within its national health insurance framework. However, the UK, Japan, and Spain provide no comparable coverage. China exhibits highly fragmented insurance coverage for obesity management. Experts noted that the lack of an official disease classification for obesity excludes it from National Healthcare Security Administration coverage. Nevertheless, reimbursement remains available for specific procedures, including bariatric surgery, under particular clinical circumstances such as morbid obesity or metabolic syndrome.

Table 2 summarizes selected domestic and international guidelines for obesity diagnosis and treatment. However, implementing these recommendations encounters substantial challenges, including inadequate funding, poor patient compliance, and multifactorial etiology of obesity. China faces additional implementation barriers, including insufficient healthcare professional training, limited institutional guideline adoption, and the absence of government-led initiatives to promote and enforce standardized treatment practices.

International experts identified three major challenges in obesity management: difficulty in maintaining weight loss, limited economic affordability, and low levels of patient participation and adherence (Figure 1). Notably, eight experts emphasized long-term weight maintenance as a particularly significant hurdle. Similar challenges exist in China, where obesity treatment faces barriers including poor patient adherence, suboptimal long-term outcomes, insufficient public recognition of obesity’s metabolic risks, and systemic constraints from the shortage of specialized treatment facilities.

Figure 1. 

Major challenges in obesity treatment identified by domestic and international experts (July–October 2023). (A) Opinions of Domestic Experts; (B) Opinions of International Experts.

Note: Bar heights represent the number of consulted experts who cited each challenge in obesity treatment. Data were collected via semi-structured questionnaires between July and October 2023.

This study provides a comprehensive examination of expert perspectives on current obesity prevention and control strategies, focusing on the implementation of global policy frameworks. The findings reveal that despite variations in national approaches, countries face common structural and systematic challenges when addressing obesity. In China, key obstacles include fragmented policies, insufficient public awareness, suboptimal service quality, and limited treatment facilities, all of which significantly hinder the effectiveness of prevention and management efforts.

Our findings highlight the inadequacy of China’s current obesity treatment policies, which remain fragmented and inconsistently implemented across regions. Currently, no dedicated health insurance policy covers obesity treatment, and bariatric medications are excluded from the Interim Measures for the Administration of Basic Medical Insurance Drugs. As documented in Liang Hui’s study, although bariatric surgery is gaining recognition in China, its acceptance remains limited, with significant regional disparities in health insurance reimbursement (4). Furthermore, the obesity treatment market lacks effective regulatory oversight. A coordinated, government-led, multisectoral framework has yet to be established, and the persistent gap between policy formulation and implementation continues to constrain meaningful progress.

Public awareness of obesity in China remains inadequate, with poor treatment compliance presenting a significant barrier to effective management. Many individuals fail to recognize obesity as a serious medical condition and frequently overlook its long-term health consequences (5). Weight loss motivation is often driven by aesthetic rather than health considerations, reducing what should be a medical necessity to a cosmetic concern (6). Additionally, widespread misconceptions about available treatments and concerns regarding potential risks lead many patients to resist medical interventions (7-8). A lack of confidence in long-term weight management and self-regulation frequently results in irregular medication adherence or non-compliance with medical recommendations, contributing to weight regain following initial loss (9).

The overall quality of obesity treatment services in China remains suboptimal despite various initiatives promoting lifestyle modifications. Persistent issues include “insufficient prevention and treatment efforts” and “limited systematic diagnostic and treatment capabilities.” The healthcare system lacks professional organizations dedicated specifically to obesity care, authoritative clinical guidelines, and standardized treatment pathways. No national interdisciplinary obesity treatment centers have been established. Furthermore, a comprehensive, tiered obesity diagnosis and treatment network has yet to be developed. Regional disparities in economic development and uneven distribution of healthcare resources further compound these challenges, leaving certain areas significantly underserved.

To effectively improve obesity prevention and control in China, several key policy recommendations were proposed. First, relevant laws and regulations should be strengthened. This includes implementing taxes on unhealthy foods, restricting or banning advertisements for high-sugar and high-fat products, and introducing a dedicated medical insurance program for obesity treatment. Improving monitoring and evaluation mechanisms is also essential to ensure efficient allocation of healthcare resources. Second, public education on obesity prevention should be reinforced, with greater emphasis on patient-provider communication. A comprehensive policy framework should support nationwide health education efforts and reduce obesity-related stigma. Medical institutions should provide evidence-based guidance and share success stories to boost patient confidence and improve treatment adherence. Finally, medical services must be better equipped to address obesity prevention and treatment. A multi-sectoral collaboration platform should be established, including the development of multidisciplinary weight management clinics and the integration of digital technology into diagnostic and therapeutic processes (10).

This study has several strengths. It provides a comparative analysis of obesity prevention and treatment policies and practices in China and other countries, offering a global perspective. By reviewing the experiences across multiple contexts in obesity prevention policies, treatment services, and guideline development, the study provides valuable insights for optimizing obesity-related policies in China.

The study also has limitations. First, the sample size was relatively small, and the consulted experts may not fully represent the global landscape. Second, regional variations in China’s obesity prevention and control efforts were not thoroughly explored. Lastly, as a qualitative study, the interpretation of open-ended responses relied on researchers’ subjective analysis. Future research should adopt larger sample sizes and mixed-methods designs to provide more comprehensive and data-driven insights.

In conclusion, there is an urgent need for China to strengthen obesity-related policies and regulations, enhance public education, and improve the accessibility and quality of healthcare services. Comprehensive and coordinated strategies must be developed to curb the rising burden of obesity and related chronic diseases. Lessons learned from China’s experience can also provide valuable guidance for other countries facing similar public health challenges.

The experts who provided invaluable insights and expert opinions for this study, including Donna Ryan (Past President, World Obesity Federation) and Johanan Ralston (CEO, World Obesity Federation).