Obesity Control and Cancer Prevention in China: Insights from the Weight Management Year

Ci Song¹, Hongbing Shen^1,2,#

1. Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing City, Jiangsu Province, China.

2. The Chinese Center for Disease Control and Prevention, Beijing, China.

^# Corresponding author: Hongbing Shen, hbshen@njmu.edu.cn.

Obesity has emerged as a critical public health challenge worldwide and in China, substantially contributing to the burden of chronic diseases, including cancer. In response, China launched the "Weight Management Year" initiative in 2024, representing a strategic shift toward upstream interventions in chronic disease control. This perspective examines the essential role of obesity control in cancer prevention across the complete prevention continuum — primordial (zero-level), primary, secondary, and tertiary prevention. The initiative presents a unique opportunity to integrate weight management strategies into health promotion, early risk identification, screening programs, and post-diagnosis rehabilitation. It emphasizes incorporating obesity-related cancer prevention into routine healthcare through digital platforms, multidisciplinary collaboration, and population-wide education campaigns. However, significant challenges persist, including limited public awareness of obesity's carcinogenic risks, insufficient integration between clinical and public health systems, and inadequate multi-sectoral cooperation. Moving forward, cancer prevention in China must transition from a reactive, screening-focused model to a proactive, life-course approach centered on behavioral and lifestyle interventions. Strengthening risk communication, institutionalizing weight management across all prevention levels, and fostering cross-sectoral collaboration are essential for building a sustainable, population-wide cancer prevention framework.

“体重管理年”背景下我国肥胖控制对癌症防控的意义

宋词¹；沈洪兵^1,2,#

1. 流行病学系，公共卫生学院，南京医科大学，南京市，江苏省，中国；

2. 中国疾病预防控制中心，北京，中国。

^# 通讯作者：沈洪兵，hbshen@njmu.edu.cn。

肥胖已成为全球及中国面临的重大公共卫生挑战，显著加重了包括癌症在内的慢性疾病负担。为应对这一问题，中国于2024年启动“体重管理年”倡议，标志着慢性病防控战略正从下游治疗向上游干预转型。本文重点探讨肥胖控制在癌症全程预防（零级、一级、二级和三级预防）中的关键作用。该倡议为体重管理策略融入健康促进、早期风险识别、筛查项目以及诊断后的康复管理提供了重要契机，并强调通过数字化平台、多学科协作和全民健康教育，将肥胖相关癌症的预防纳入常规医疗实践。然而，仍面临诸多挑战：公众对肥胖与癌症风险的认知不足，临床与公共卫生体系衔接不畅，多部门协作机制尚未健全。未来，中国的癌症防控亟需从以筛查为主的被动模式，转向以行为和生活方式干预为核心的主动、全生命周期预防模式。加强风险沟通、将体重管理制度化并贯穿各预防层级，以及推动跨部门协作，将是构建可持续的全民癌症预防体系的关键。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.189

Evaluation of the Long-Term Benefits and Cost-Effectiveness of Colorectal Cancer Screening for Populations with Excess Weight — China, 2023

Jiaxin Xie^1,&; Xuesi Dong^2,&; Chenran Wang^1,2; Yadi Zheng^1,2; Zilin Luo^1,2; Xiaolu Chen^1,2; Zeming Guo^1,2; Xiaoyue Shi^1,2; Wei Cao^1,2; Fei Wang^1,2; Ni Li^1,2,3,#

1. National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China;

2. Chinese Academy of Medical Sciences Key Laboratory for National Cancer Big Data Analysis and Implement, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China;

3. Department of Epidemiology, Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing City, Jiangsu Province, China.

^& Joint first authors.

^# Corresponding author: Ni Li, nli@cicams.ac.cn.

Individuals with excess body weight have elevated colorectal cancer (CRC) risk. This study aimed to evaluate the long-term efficacy and cost-effectiveness of CRC screening strategies in populations with excess weight. A multistate Markov model was used to evaluate the efficacy and cost-effectiveness of CRC screening. Three hypothetical cohorts were simulated based on body mass index (BMI) subgroups: normal, overweight, and obese. Screening strategies included colonoscopy (every 10 years) or an annual fecal immunochemical test, initiated at ages 45 and 50. Key outcomes included CRC cases, deaths, quality-adjusted life-year (QALY), lifetime costs, endoscopic resource use, and incremental cost-effectiveness ratios. QALY gains increased from 0.097 [95% confidence interval (CI): 0.091–0.102] in individuals with normal weight to 0.104 (0.101–0.107) in those who were overweight and 0.108 (0.105–0.111) in those who were obese. Individuals who were overweight or obese demonstrated 6%–14% greater colonoscopy efficiency compared with those of normal weight. All screening strategies were cost-effective (incremental cost-effectiveness ratio=$671–$949 per QALY gained), with a marginal decrease in cost per QALY gained observed at higher BMI. Despite improved cost-effectiveness, lifetime healthcare expenditures were higher in individuals who were overweight ($845.19–$955.00) and obese ($1,358.00–$1,467.37) than in those with normal weight ($119.62–$229.20). CRC screening in China demonstrated effectiveness and cost-effectiveness across BMI groups, with populations with excess weight showing high colonoscopy resource efficiency. Amid rising lifetime healthcare costs attributable to high BMI, integrating weight management with CRC screening is critical for optimizing health and economic benefits.

超重及肥胖人群结直肠癌筛查的长期健康获益与成本效益分析 — 中国，2023年

谢嘉欣^1,&；董学思^2,&；王晨冉^1,2；郑亚迪^1,2；罗姿麟^1,2；陈晓露^1,2；郭赜铭^1,2；史晓月^1,2；曹巍^1,2；王飞^1,2；李霓^1,2,3,#

1. 国家癌症中心/国家恶性肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院，北京，中国；

2. 中国医学科学院国家肿瘤大数据分析与应用重点实验室，中国医学科学院北京协和医学院，北京，中国；

3. 流行病学教研室，江苏省癌症生物标志物预防与治疗重点实验室，肿瘤个性化医疗协同创新中心，公共卫生学院，南京医科大学，南京市，江苏省，中国。

^& 共同第一作者。

^# 通信作者：李霓，nli@cicams.ac.cn。

超重和肥胖已成为我国重大公共卫生挑战。作为结直肠癌的独立危险因素，超重及肥胖人群结直肠癌发病风险显著升高。本研究旨在评估中国超重及肥胖人群结直肠癌筛查的长期健康获益与成本效益。基于多状态马尔可夫模型，对比分析不同体重指数人群（正常体重组、超重组和肥胖组）接受结直肠癌筛查的长期生物学效果和成本收益。研究模拟了两种筛查方案：每10年一次结肠镜检查和每年一次粪便免疫化学检测，筛查起始年龄设定为45岁和50岁。主要评价指标包括：结直肠癌病例数、死亡数、质量调整生命年、终生医疗费用、内镜资源使用效率和增量成本效益比。质量调整生命年获益随体质指数升高而增加。正常体重人群的质量调整生命年获益为0.097 (95% CI: 0.091–0.102)，超重人群增加至0.104 (0.101–0.107)，肥胖人群则为0.108 (0.105–0.111)。与正常体重人群相比，超重和肥胖人群的结肠镜使用效率提高了6%–14%。所有筛查策略均具成本效益（增量成本效益比：671–949美元/质量调整生命年获益），且随体质指数升高，单位质量调整生命年获益支出成本递减。值得注意的是，尽管超重和肥胖人群的筛查成本效益更高，但其终生医疗支出仍显著高于正常体重人群，其中超重人群为845.19–955.00美元，肥胖人群为1,358.00–1,467.37美元，而正常体重人群仅为119.62–229.20美元。对正常体重、超重和肥胖人群进行结直肠癌筛查均可获得良好的健康效益且符合成本效益。其中，超重人群的结肠镜资源利用效率更高。然而，肥胖和超重状态会导致终生医疗费用显著增加。因此，将体重管理干预整合至结直肠癌筛查体系，有望在提升健康获益的同时优化医疗资源利用效率，并提升经济学获益。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.190

Longitudinal Trajectories of Adiposity Indicators and Cancer Risk Over 14 Years: Evidence from Repeated Health Check-Ups of 10 Times or More — China, 2010–2023

Le Wang^1,&; Tingting Fu^2,&; Yong Yang³; Yifei Lin^3,4,#; Jin Huang ^1,5,#

1. Department of Urology, Innovation Institute for Integration of Medicine and Engineering, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China;

2. Department of Urology, Lab of Health Data Science, West China Hospital, Key Laboratory of Bio-Resource and Eco-Environment of the Ministry of Education, College of Life Sciences, Sichuan University, Chengdu City, Sichuan Province, China;

3. Department of Urology, Lab of Health Data Science, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China;

4. Program in Genetic Epidemiology and Statistical Genetics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA;

5. Sichuan Public Health General Clinical Center, Chengdu City, Sichuan Province, China.

^& Joint first authors.

^# Corresponding author: Yifei Lin, ylin@wchscu.edu.cn; Jin Huang, huangjin@scu.edu.cn.

Obesity, particularly central adiposity, has been associated with elevated cancer risk. However, longitudinal data on adiposity trajectories and cancer incidence in Chinese populations remain limited. We analyzed data from 25,653 adults with ≥10 health check‑ups in the West China Hospital Alliance Longitudinal Epidemiology (WHALE) Study (2010–2023). Five adiposity indicators—body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), BMI-‑adjusted WC (WCadjBMI), and BMI-adjusted WHR (WHRadjBMI) — were evaluated using Poisson regression and generalized linear mixed-effects models. Latent class mixed modeling identified long-term adiposity trajectories. Analyses were stratified by sex and age (≥50 years). Over 14 years, 393 participants developed cancer. Higher BMI [risk ratio (RR)=0.873, P=0.019] was associated with lower cancer risk, whereas central adiposity indicators (e.g., WCadjBMI, RR=1.175, P=0.001) showed positive associations, particularly among men and those aged ≥50 years. WCadjBMI was significantly associated with lung cancer (RR=1.246, P=0.009), with similar trends for breast and liver cancers. Inverted U-shaped trajectories of BMI-adjusted waist measures were linked to elevated cancer risk, highlighting the relevance of long-term fat distribution. Central adiposity and its trajectories are associated with cancer risk in Chinese adults, supporting dynamic obesity monitoring and targeted prevention in older adults and men.

基于10次以上健康体检的体脂指标14年纵向轨迹与癌症风险研究 — 中国，2010–2023年

王乐^1,&，付婷婷^2,&，杨勇³，林逸飞^3,4,#，黄进^1,5,#

1. 泌尿外科，医工结合创新转化中心，疾病分子网络前沿科学中心，华西医院，四川大学，成都市，四川省，中国；

2. 泌尿外科，健康数据科学研究室，华西医院，四川大学生命科学学院教育部生物资源与生态环境重点实验室，四川大学，成都市，四川省，中国；

3. 泌尿外科，健康数据科学研究室，华西医院，四川大学，成都市，四川省，中国；

4. 基因流行病学和统计基因学项目，流行病学系，陈曾熙公共卫生学院，哈佛大学，波士顿，马赛诸塞州，美国。

5. 四川省公共卫生综合临床中心，成都市，四川省，中国。

^& 共同第一作者。

^# 通讯作者: 黄进，huangjin@scu.edu.cn；林逸飞，ylin@wchscu.edu.cn。

肥胖是多种癌症的重要危险因素，尤其是以腹部脂肪堆积为特征的中心性肥胖。然而，基于中国人群长期随访数据，探讨体脂指标动态变化与新发癌症风险关系的研究仍相对匮乏。本研究依托“华西医联体健康管理（WHALE）”队列2010—2023年随访资料，自约68万人次体检记录中剔除随访＜10次、指标缺失或诊断前记录不足10次者，最终纳入25653名成年人作为研究对象。以确诊恶性肿瘤者为病例（n=393），其余随访至研究终点或失访者为对照。系统评估体质指数（BMI）、腰围（WC）、腰臀比（WHR）、BMI校正后腰围（WCadjBMI）及BMI校正后腰臀比（WHRadjBMI）五项指标与癌症发生的关联；采用泊松回归和广义线性混合效应模型量化关联强度，并利用潜类别混合效应模型刻画体脂长期变化轨迹，按性别及年龄（≥50岁）分层分析。14年随访期间，共确诊新发癌症393例。结果显示，较高的BMI与较低的癌症风险相关（RR=0.873，P=0.019），而中心性肥胖指标，尤以WCadjBMI为甚（RR=1.175，P=0.001），则与癌症风险呈正相关；该关联在男性及年龄≥50岁人群中更为突出。WCadjBMI与肺癌风险显著相关（RR=1.246，P=0.009），乳腺癌与肝癌亦呈相似趋势。与轻微上升轨迹相比，呈倒U型变化的WCadjBMI轨迹显著增加癌症风险；与U型轨迹相比，呈倒U型变化的WHRadjBMI轨迹亦显著升高癌症风险，提示长期的脂肪分布模式较单次测量具有更高的预测价值。在中国成年人中，中心性肥胖指标（WCadjBMI、WHRadjBMI升高）及其长期变化轨迹与癌症发生密切相关。研究强调，慢性非传染性疾病防控策略应将腰围相关指标的动态监测纳入重点，并优先对男性及老年群体实施早期干预。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.191

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

Weixi Deng^1,&; Wenqi Xia^2,&; Xiaomin Sun³; Xinyi Zheng¹; Sichen Zhang³; Zhaozhang Sun³; Wen Peng⁴; Bo Gou⁵; Youfa Wang^3,#; Jianduan Zhang^1,6,#

¹ School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, Hubei Province, China;

² Maternal, Child and Adolescent Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, Hubei Province, China;

³ Global Health Institute, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an City, Shaanxi Province, China;

⁴ Nutrition and Health Promotion Center, Department of Public Health, Medical College, Qinghai University, Xining City, Qinghai Province, China;

⁵ School of Exercise and Health Sciences, Xi'an Physical Education University, Xi'an City, Shaanxi Province, China;

⁶ Key Laboratory of Environment and Health (Huazhong University of Science and Technology), Ministry of Education, Wuhan City, Hubei Province, China.

^& Joint first authors.

^# Corresponding authors: Jianduan Zhang, jd_zh@hust.edu.cn; Youfa Wang, youfawang@xjtu.edu.cn.

Obesity has emerged as a critical public health challenge in China, with prevalence rates rising steadily across all age groups and threatening both long-term health outcomes and economic sustainability. This study examines China's current obesity prevention and control landscape, comparing it with international practices to provide evidence-based recommendations for strengthening national strategies. Between July and October 2023, we conducted a comprehensive literature review and engaged 19 experts [9 from China; 10 from the United States (US), Japan, the United Kingdom (UK), and Spain] through purposive, criterion-based sampling. We collected data using a semi-structured questionnaire covering personal information, obesity-related policies and service status, and recommendations for China. Quantitative data underwent descriptive analysis, while qualitative data were examined using thematic analysis. Experts identified persistent barriers in China's obesity control efforts, including fragmented policies, insufficient public awareness, suboptimal service quality, and limited healthcare facilities. Compared with high-income countries, China's approach lacks robust regulatory frameworks and effective multisectoral coordination mechanisms. These findings underscore the urgent need for China to strengthen evidence-based, integrated approaches to obesity prevention and management. Adapting successful international experiences to local contexts will be essential for enhancing national obesity control efforts and advancing the Healthy China initiative goals.

国际与国内肥胖防治战略、政策与实践的启示 — 中国，2023年

邓唯希^1,&；夏雯琪^2,&；孙晓敏³；郑欣怡¹；张思晨³；孙照彰³；彭雯⁴；苟波⁵；王友发^3,#；张建端^1,6,#

1. 公共卫生学院，同济医学院，华中科技大学，武汉市，湖北省，中国；

2. 儿少与妇幼保健学系，公共卫生学院，同济医学院，华中科技大学，武汉市，湖北省，中国；

3. 全球健康研究院，西安交通大学，西安市，陕西省，中国；

4. 营养健康促进中心，医学部，青海大学，西宁市，青海省，中国；

5. 西安体育学院运动与健康科学学院，西安市，陕西省，中国；

6. 环境与健康教育部重点实验室（华中科技大学），武汉市，湖北省，中国。

^& 共同第一作者。

^# 通信作者：张建端，jd_zh@hust.edu.cn；王友发，youfawang@xjtu.edu.cn。

肥胖已成为我国重大公共卫生问题，其患病率在各年龄群体中持续上升，对长期健康及经济可持续发展构成威胁。本研究旨在分析中国肥胖防治现状，并与国际实践对比，为完善国家战略提供循证建议。于2023年7月至10月期间，采用文献综述和目的性标准化抽样，对19位中外专家（中国9位，美日英西10位）进行访谈。数据通过半结构化问卷收集，内容涵盖个人信息、肥胖相关政策与服务现状及对中国的建议。定量数据采用描述性分析，定性数据采用主题分析。专家指出，中国在肥胖防控中仍面临多重障碍，包括政策碎片化、公众认知不足、服务质量欠佳及设施资源有限。与高收入国家相比，中国缺乏强效监管框架与多部门协同机制。研究强调中国亟需加强循证化和综合性的肥胖防治策略。因地制宜地借鉴国际成功经验，对提升国家肥胖防控水平、推动"健康中国"战略目标实现具有重要意义。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.192