Child and adolescent obesity: challenges and responses in China_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHAO Li ¹ , XIONG Zhihan ¹ , FAN Linlin ¹ , JIANG Lihua ² , SONG Geyang ³ , TANG Qi ⁴ , PAN Xiongfei ⁵ , LI Sheyu ⁶ ,  CHEN Yi ⁷

1. Department of Health Policy and Management, West China School of Public Health / West China Fourth Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Center of General Practice / Department of General Practice, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
3. Sichuan University HI-TECH Group Co., Ltd, Chengdu 610065, P. R. China;
4. Department of Rehabilitation Medicine, West China School of Public Health / West China Fourth Hospital, Sichuan University, Chengdu 610041, P. R. China;
5. Ministry of Education Key Laboratory of Birth Defects and Related Diseases of Women and Children,West China Second University Hospital, Sichuan University, Chengdu 610041, P. R. China;
6. Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
7. Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

CHEN Yi, Email: toddy@scu.edu.cn

Keywords：

obesity; child / adolescent; health promotion; health policy

DOI：

10.7507/1007-9424.202506026

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To systematically review the current prevalence, key determinants, and prevention strategies of child and adolescent obesity in China. Method A systematic review of the epidemiological trends, health impacts, risk factors, and intervention strategies for child and adolescent obesity was performed by analyzing recent domestic and international literature and policy documents, supplemented with national surveillance data and developments in clinical practice. Results The prevalence of child and adolescent obesity in China has been rising continuously over the past four decades, with particularly high rates observed among primary school children and boys. Recent trends show a “provincial reversal” and an “urban-rural reversal”. This high-risk environment stems from complex interactions among family, school, and societal factors. China has developed a relatively comprehensive policy framework for obesity prevention and control and is promoting a three-tiered prevention strategy. Clinically, pharmacological and surgical interventions are being gradually adopted. However, challenges remain, including limited health insurance coverage for obesity management. Conclusions Child and adolescent obesity has become a significant public health issue in China, threatening national health and social development. Future efforts should focus on enhancing intersectoral governance, improving early intervention capabilities, expanding health insurance support, and standardizing clinical practices. A multi-level, multi-pathway integrated prevention and control system is essential for effectively curbing child and adolescent obesity under the healthy China strategy.

Citation： ZHAO Li, XIONG Zhihan, FAN Linlin, JIANG Lihua, SONG Geyang, TANG Qi, PAN Xiongfei, LI Sheyu, CHEN Yi. Child and adolescent obesity: challenges and responses in China. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2025, 32(9): 1141-1147. doi: 10.7507/1007-9424.202506026 Copy

1.	国家卫生健康委疾病预防控制局. 中国居民营养与慢性病状况报告: 2020年. 北京: 人民卫生出版社, 2021.
2.	Sun X, Yan AF, Shi Z, et al. Health consequences of obesity and projected future obesity health burden in China. Obesity (Silver Spring), 2022, 30(9): 1724-1751.
3.	Xing X, Hu L, Guo Y, et al. Interactions between ambient air pollution and obesity on lung function in children: the Seven Northeastern Chinese Cities (SNEC) Study. Sci Total Environ, 2020, 699: 134397. doi: 10.1016/j.scitotenv.2019.134397.
4.	Yuan S, Ruan X, Sun Y, et al. Birth weight, childhood obesity, adulthood obesity and body composition, and gastrointestinal diseases: a Mendelian randomization study. Obesity (Silver Spring), 2023, 31(10): 2603-2614.
5.	Wang S, Sun Q, Zhai L, et al. The prevalence of depression and anxiety symptoms among overweight/obese and non-overweight/non-obese children/adolescents in China: a systematic review and meta-analysis. Int J Environ Res Public Health, 2019, 16(3): 340. doi: 10.3390/ijerph16030340.
6.	Liu D, Hao YX, Zhao TZ, et al. Childhood BMI and adult obesity in a Chinese sample: a 13-year follow-up study. Biomed Environ Sci, 2019, 32(3): 162-168.
7.	Wang J, Freire D, Knable L, et al. Childhood and adolescent obesity and long-term cognitive consequences during aging. J Comp Neurol, 2015, 523(5): 757-768.
8.	Ma G, Meyer CL, Jackson-Morris A, et al. The return on investment for the prevention and treatment of childhood and adolescent overweight and obesity in China: a modelling study. Lancet Reg Health West Pac, 2023, 43: 100977. doi: 10.1016/j.lanwpc.2023.100977.
9.	Dennett CC, Simon J. The role of polycystic ovary syndrome in reproductive and metabolic health: overview and approaches for treatment. Diabetes Spectr, 2015, 28(2): 116-120.
10.	董彦会, 陈力, 刘婕妤, 等. 1985–2019年中国7~18岁儿童青少年超重与肥胖的流行趋势及预测研究. 中华预防医学杂志, 2023, 57(4): 461-469.
11.	张丽琼, 耿兴星, 田源. 儿童超重肥胖的关注与防治. 中国乡村医药, 2024, 31(10): 77-78.
12.	马淑婧, 张艳青, 羊柳, 等. 1991–2015年中国9个省份儿童青少年超重和肥胖率的变化趋势分析. 中华预防医学杂志, 2020, 54(2): 133-138.
13.	Ma S, Hou D, Zhang Y, et al. Trends in abdominal obesity among Chinese children and adolescents, 1993–2015. J Pediatr Endocrinol Metab, 2020, 34(2): 163-169.
14.	Zhang L, Chen J, Zhang J, et al. Regional disparities in obesity among a heterogeneous population of Chinese children and adolescents. JAMA Netw Open, 2021, 4(10): e2131040. doi: 10.1001/jamanetworkopen.2021.31040.
15.	Pan XF, Wang L, Pan A. Epidemiology and determinants of obesity in China. Lancet Diabetes Endocrinol, 2021, 9(6): 373-392.
16.	袁金娜, 金冰涵, 斯淑婷, 等. 2009至2019年6~15岁中国儿童超重和肥胖趋势分析. 中华儿科杂志, 2021, 59(11): 935-941.
17.	Shah B, Tombeau Cost K, Fuller A, et al. Sex and gender differences in childhood obesity: contributing to the research agenda. BMJ Nutr Prev Health, 2020, 3(2): 387-390.
18.	Jia P, Ma S, Qi X, et al. Spatial and temporal changes in prevalence of obesity among Chinese children and adolescents, 1985–2005. Prev Chronic Dis, 2019, 16: E160. doi: 10.5888/pcd16.190290.
19.	Dang J, Shi D, Li X, et al. Artificial light-at-night exposure and overweight and obesity across GDP levels among Chinese children and adolescents. Nutrients, 2023, 15(4): 939. doi: 10.3390/nu15040939.
20.	马军, 蔡赐河, 王海俊, 等. 1985–2010年中国学生超重与肥胖流行趋势. 中华预防医学杂志, 2012, 46(9): 776-780.
21.	Yuan C, Dong Y, Chen H, et al. Determinants of childhood obesity in China. Lancet Public Health, 2024, 9(12): e1105-e1114. doi: 10.1016/S2468-2667(24)00246-9.
22.	Zhang J, Xu P, Liu F. One-child policy and childhood obesity. China Econ Rev, 2020, 59: Article 100938. doi: 10.1016/j.chieco.2019.100938.
23.	闫银坤, 高利旺, 彭雯. 中国儿童肥胖防控现状与对策. 健康中国观察, 2025, (5): 44-46.
24.	Ge W, Hu J, Xiao Y, et al. COVID-19‒related childhood BMI increases in China: a health surveillance‒based ambispective cohort analysis. Am J Prev Med, 2022, 63(4): 647-655.
25.	Wu QZ, Xu SL, Tan YW, et al. Exposure to ultrafine particles and childhood obesity: a cross-sectional analysis of the Seven Northeast Cities (SNEC) Study in China. Sci Total Environ, 2022, 846: 157524. doi: 10.1016/j.scitotenv.2022.157524.
26.	Li L, Xu S, Lian Q. The mediating function of obesity on endocrine-disrupting chemicals and insulin resistance in children. J Pediatr Endocrinol Metab, 2022, 35(9): 1169-1176.
27.	Boyland E. Would reducing children’s exposure to food advertising prevent unhealthy weight gain?. Curr Obes Rep, 2025, 14(1): 55. doi: 10.1007/s13679-025-00648-6.
28.	Hu X. Analysis of the influence of the social network on childhood obesity. HBEM, 2023, 23: 1206-1211.
29.	Oduro MS, Katey D, Morgan AK, et al. Problematic social media use and overweight/obesity: explanatory pathway analysis of 124 667 in-school adolescents in 39 high-income countries. Pediatr Obes, 2023, 18(11): e13073. doi: 10.1111/ijpo.13073.
30.	Liu S, Lan Y, Chen B, et al. Smartphone use time and total screen time among students aged 10–19 and the effects on academic stress: a large longitudinal cohort study in Shanghai, China. Front Public Health, 2022, 10: 869218. doi: 10.3389/fpubh.2022.869218.
31.	Ma L, Chu M, Li Y, et al. Bidirectional relationships between weight stigma and pediatric obesity: a systematic review and meta-analysis. Obes Rev, 2021, 22(6): e13178. doi: 10.1111/obr.13178.
32.	Tang D, Bu T, Dong X. Are parental dietary patterns associated with children’s overweight and obesity in China?. BMC Pediatr, 2020, 20(1): 12. doi: 10.1186/s12887-020-1910-z.
33.	Wen B, Yang Z, Li Y, et al. Association of paternal smoking with adolescent obesity. China School Health, 2019, 40: 330-332.
34.	An R, Xiang X, Xu N, et al. Influence of grandparental child care on childhood obesity: a systematic review and meta-analysis. Child Obes, 2020, 16(3): 141-153.
35.	Zhu H, Yi X, He M, et al. Exploring the interplay of genetic variants and environmental factors in childhood obesity: a systematic review and meta-analysis. Metabolism, 2025, 170: 156303. doi: 10.1016/j.metabol.2025.156303.
36.	Huang H, Yang Y, Liang YW, et al. Genetic etiology and clinical features of non-syndromic pediatric obesity in the Chinese population: a large cohort study. BMC Pediatr, 2025, 25(1): 358. doi: 10.1186/s12887-025-05702-9.
37.	Kalinderi K, Goula V, Sapountzi E, et al. Syndromic and monogenic obesity: new opportunities due to genetic-based pharmacological treatment. Children (Basel), 2024, 11(2): 153. doi: 10.3390/children11020153.
38.	Fu L, Zhang M, Hu YQ, et al. Gene-gene interactions and associations of six hypertension related single nucleotide polymorphisms with obesity risk in a Chinese children population. Gene, 2018, 679: 320-327.
39.	Stratakis N, Rock S, La Merrill MA, et al. Prenatal exposure to persistent organic pollutants and childhood obesity: a systematic review and meta-analysis of human studies. Obes Rev, 2022, 23 Suppl 1(Suppl 1): e13383. doi: 10.1111/obr.13383.
40.	Huo J, Yang Z, Dong B, et al. Association between breastfeeding and obesity types in children and adolescents. China School Health, 2020, 41: 1711-1715.
41.	Gan Q, Xu P, Yang T, et al. Sugar-sweetened beverage consumption status and its association with childhood obesity among Chinese children aged 6–17 years. Nutrients, 2021, 13(7): 2211. doi: 10.3390/nu13072211.
42.	赵博雅, 李惟怡, 刘梦冉, 等. 1989–2018年中国18~35岁青年人膳食模式变迁状况. 卫生研究, 2024, 53(3): 419-426.
43.	Niu J, Li B, Zhang Q, et al. Exploring the traditional Chinese diet and its association with health status—a systematic review. Nutr Rev, 2025, 83(2): e237-e256. doi: 10.1093/nutrit/nuae013.
44.	Sun X, Zhao B, Liu J, et al. A 3-year longitudinal study of the association of physical activity and sedentary behaviours with childhood obesity in China: the childhood obesity study in China mega-cities. Pediatr Obes, 2021, 16(6): e12753. doi: 10.1111/ijpo.12753.
45.	Dong X, Ding L, Zhang R, et al. Physical activity, screen-based sedentary behavior and physical fitness in Chinese adolescents: a cross-sectional study. Front Pediatr, 2021, 9: 722079. doi: 10.3389/fped.2021.722079.
46.	Fan J, Ding C, Gong W, et al. Association of sleep duration and overweight/obesity among children in China. Int J Environ Res Public Health, 2020, 17(6): 1962. doi: 10.3390/ijerph17061962.
47.	Fu Y, Ren W, Liang Z. Perceived academic stress and depressive symptoms among Chinese adolescents: a moderated mediation analysis of overweight status. J Affect Disord, 2022, 296: 224-232.
48.	Verhaegen AA, Van Gaal LF. Drugs affecting body weight, body fat distribution, and metabolic function-mechanisms and possible therapeutic or preventive measures: an update. Curr Obes Rep, 2021, 10(1): 1-13.
49.	Wang Y, Zhao L, Gao L, et al. Health policy and public health implications of obesity in China. Lancet Diabetes Endocrinol, 2021, 9(7): 446-461.
50.	Chen TJ, Dong B, Dong Y, et al. Matching actions to needs: shifting policy responses to the changing health needs of Chinese children and adolescents. Lancet, 2024, 403(10438): 1808-1820.
51.	Norris SA, Frongillo EA, Black MM, et al. Nutrition in adolescent growth and development. Lancet, 2022, 399(10320): 172-184.
52.	Zeng Q, Li N, Pan XF, et al. Clinical management and treatment of obesity in China. Lancet Diabetes Endocrinol, 2021, 9(6): 393-405.
53.	Li C, Maimaiti S, Zhou Z, et al. Secular trends and urban-rural disparities in height of Chinese adolescents aged 18 years from 1985 to 2019. Am J Hum Biol, 2024, 36(1): e23988. doi: 10.1002/ajhb.23988.
54.	中华医学会健康管理学分会, 中国营养学会, 中国医疗保健国际交流促进会生殖医学分会, 等. 超重或肥胖人群体重管理专家共识及团体标准. 中华健康管理学杂志, 2018, 12(3): 200-207.
55.	国家卫生健康委员会肥胖症诊疗指南编写委员会, 张忠涛, 纪立农. 肥胖症诊疗指南(2024年版). 中国循环杂志, 2025, 40(1): 6-30.
56.	Wilding JPH, Batterham RL, Calanna S, et al. Once-weekly semaglutide in adults with overweight or obesity. N Engl J Med, 2021, 384(11): 989-1002.
57.	Pi-Sunyer X, Astrup A, Fujioka K, et al. A randomized, controlled trial of 3.0 mg of liraglutide in weight management. N Engl J Med, 2015, 373(1): 11-22.
58.	Kadowaki T, Isendahl J, Khalid U, et al. Semaglutide once a week in adults with overweight or obesity, with or without type 2 diabetes in an east Asian population (STEP 6): a randomised, double-blind, double-dummy, placebo-controlled, phase 3a trial. Lancet Diabetes Endocrinol, 2022, 10(3): 193-206.
59.	Gu W, Lu Y, Ye X, et al. Efficacy and safety of once-weekly semaglutide 2.4 mg for weight management in participants from China: a prespecified analysis of the STEP 7 randomized clinical trial. Diabetes Obes Metab, 2025, 27(5): 2540-2551.
60.	Davies M, Færch L, Jeppesen OK, et al. Semaglutide 2.4 mg once a week in adults with overweight or obesity, and type 2 diabetes (STEP 2): a randomised, double-blind, double-dummy, placebo-controlled, phase 3 trial. Lancet, 2021, 397(10278): 971-984.
61.	Rubino D, Abrahamsson N, Davies M, et al. Effect of continued weekly subcutaneous semaglutide vs placebo on weight loss maintenance in adults with overweight or obesity: the STEP 4 randomized clinical trial. JAMA, 2021, 325(14): 1414-1425.
62.	Clément K, van den Akker E, Argente J, et al. Efficacy and safety of setmelanotide, an MC4R agonist, in individuals with severe obesity due to LEPR or POMC deficiency: single-arm, open-label, multicentre, phase 3 trials. Lancet Diabetes Endocrinol, 2020, 8(12): 960-970.
63.	Çamtosun E, Akıncı A, Kayaş L, et al. Liraglutide treatment in a morbidly obese adolescent with a MC4R gene variant: side effects reduce success. J Clin Res Pediatr Endocrinol, 2023, 15(2): 225-229.
64.	Gou H, Zhai Y, Guo J. Efficacy and safety of liraglutide for weight management in children and adolescents: a systematic review and meta-analysis of randomized controlled trials. Eur J Pediatr, 2023, 182(11): 5095-5108.
65.	Mastrandrea LD, Witten L, Carlsson Petri KC, et al. Liraglutide effects in a paediatric (7–11 y) population with obesity: a randomized, double-blind, placebo-controlled, short-term trial to assess safety, tolerability, pharmacokinetics, and pharmacodynamics. Pediatr Obes, 2019, 14(5): e12495. doi: 10.1111/ijpo.12495.
66.	Fox CK, Barrientos-Pérez M, Bomberg EM, et al. Liraglutide for children 6 to <12 years of age with obesity—a randomized trial. N Engl J Med, 2025, 392(6): 555-565.
67.	Nguyen NT, Varela JE. Bariatric surgery for obesity and metabolic disorders: state of the art. Nat Rev Gastroenterol Hepatol, 2017, 14(3): 160-169.
68.	Doumouras AG, Hong D, Lee Y, et al. Association between bariatric surgery and all-cause mortality: a population-based matched cohort study in a Universal Health Care System. Ann Intern Med, 2020, 173(9): 694-703.
69.	王存川, 张鹏, 杨景哥, 等. 中国儿童和青少年肥胖症外科治疗指南(2019版). 中华肥胖与代谢病电子杂志, 2019, 5(1): 3-9.
70.	Inge TH, Courcoulas AP, Jenkins TM, et al. Weight loss and health status 3 years after bariatric surgery in adolescents. N Engl J Med, 2016, 374(2): 113-123.
71.	Olbers T, Beamish AJ, Gronowitz E, et al. Laparoscopic Roux-en-Y gastric bypass in adolescents with severe obesity (AMOS): a prospective, 5-year, Swedish nationwide study. Lancet Diabetes Endocrinol, 2017, 5(3): 174-183.
72.	Wu Z, Gao Z, Qiao Y, et al. Long-term results of bariatric surgery in adolescents with at least 5 years of follow-up: a systematic review and meta-analysis. Obes Surg, 2023, 33(6): 1730-1745.
73.	Al-Mohaidly MT, Al-Asmari AK, Khan HA, et al. Laparoscopic sleeve gastrectomy for obesity treatment in adolescents and young adults: a systematic review and meta-analysis. Langenbecks Arch Surg, 2023, 408(1): 158. doi: 10.1007/s00423-023-02894-5.
74.	Stanford FC, Mushannen T, Cortez P, et al. Comparison of short and long-term outcomes of metabolic and bariatric surgery in adolescents and adults. Front Endocrinol (Lausanne), 2020, 11: 157. doi: 10.3389/fendo.2020.00157.
75.	Ogle SB, Dewberry LC, Jenkins TM, et al. Outcomes of bariatric surgery in older versus younger adolescents. Pediatrics, 2021, 147(3): e2020024182. doi: 10.1542/peds.2020-024182.
76.	Paulus GF, de Vaan LE, Verdam FJ, et al. Bariatric surgery in morbidly obese adolescents: a systematic review and meta-analysis. Obes Surg, 2015, 25(5): 860-878.
77.	Yuan C, Dong Y, Chen H, et al. Public health interventions against childhood obesity in China. Lancet Public Health, 2024, 9(12): e1115-e1124. doi: 10.1016/S2468-2667(24)00245-7.
78.	Kong X, Zhang Y, Li R, et al. Factors influencing the bariatric surgery treatment of bariatric surgery candidates in underdeveloped areas of China. BMC Surg, 2024, 24(1): 82. doi: 10.1186/s12893-024-02373-8.
79.	Gomez G, Stanford FC. US health policy and prescription drug coverage of FDA-approved medications for the treatment of obesity. Int J Obes (Lond), 2018, 42(3): 495-500.
80.	Bae JP, Nelson DR, Boye KS, et al. Prevalence of complications and comorbidities associated with obesity: a health insurance claims analysis. BMC Public Health, 2025, 25(1): 273. doi: 10.1186/s12889-024-21061-z.
81.	Griauzde DH, Carter EW, Oshman L, et al. Understanding insurance coverage policies for incretin mimetics for weight management. Am J Manag Care, 2025, 31(7): 342-349.
82.	Liang H, Li C. Bariatric and metabolic surgery and medical insurance payment in China. Curr Obes Rep, 2023, 12(3): 365-370.
83.	Choi WI, Shi H, Bian Y, et al. Development of commercial health insurance in China: a systematic literature review. Biomed Res Int, 2018, 2018: 3163746. doi: 10.1155/2018/3163746.

1. 国家卫生健康委疾病预防控制局. 中国居民营养与慢性病状况报告: 2020年. 北京: 人民卫生出版社, 2021.
2. Sun X, Yan AF, Shi Z, et al. Health consequences of obesity and projected future obesity health burden in China. Obesity (Silver Spring), 2022, 30(9): 1724-1751.
3. Xing X, Hu L, Guo Y, et al. Interactions between ambient air pollution and obesity on lung function in children: the Seven Northeastern Chinese Cities (SNEC) Study. Sci Total Environ, 2020, 699: 134397. doi: 10.1016/j.scitotenv.2019.134397.
4. Yuan S, Ruan X, Sun Y, et al. Birth weight, childhood obesity, adulthood obesity and body composition, and gastrointestinal diseases: a Mendelian randomization study. Obesity (Silver Spring), 2023, 31(10): 2603-2614.
5. Wang S, Sun Q, Zhai L, et al. The prevalence of depression and anxiety symptoms among overweight/obese and non-overweight/non-obese children/adolescents in China: a systematic review and meta-analysis. Int J Environ Res Public Health, 2019, 16(3): 340. doi: 10.3390/ijerph16030340.
6. Liu D, Hao YX, Zhao TZ, et al. Childhood BMI and adult obesity in a Chinese sample: a 13-year follow-up study. Biomed Environ Sci, 2019, 32(3): 162-168.
7. Wang J, Freire D, Knable L, et al. Childhood and adolescent obesity and long-term cognitive consequences during aging. J Comp Neurol, 2015, 523(5): 757-768.
8. Ma G, Meyer CL, Jackson-Morris A, et al. The return on investment for the prevention and treatment of childhood and adolescent overweight and obesity in China: a modelling study. Lancet Reg Health West Pac, 2023, 43: 100977. doi: 10.1016/j.lanwpc.2023.100977.
9. Dennett CC, Simon J. The role of polycystic ovary syndrome in reproductive and metabolic health: overview and approaches for treatment. Diabetes Spectr, 2015, 28(2): 116-120.
10. 董彦会, 陈力, 刘婕妤, 等. 1985–2019年中国7~18岁儿童青少年超重与肥胖的流行趋势及预测研究. 中华预防医学杂志, 2023, 57(4): 461-469.
11. 张丽琼, 耿兴星, 田源. 儿童超重肥胖的关注与防治. 中国乡村医药, 2024, 31(10): 77-78.
12. 马淑婧, 张艳青, 羊柳, 等. 1991–2015年中国9个省份儿童青少年超重和肥胖率的变化趋势分析. 中华预防医学杂志, 2020, 54(2): 133-138.
13. Ma S, Hou D, Zhang Y, et al. Trends in abdominal obesity among Chinese children and adolescents, 1993–2015. J Pediatr Endocrinol Metab, 2020, 34(2): 163-169.
14. Zhang L, Chen J, Zhang J, et al. Regional disparities in obesity among a heterogeneous population of Chinese children and adolescents. JAMA Netw Open, 2021, 4(10): e2131040. doi: 10.1001/jamanetworkopen.2021.31040.
15. Pan XF, Wang L, Pan A. Epidemiology and determinants of obesity in China. Lancet Diabetes Endocrinol, 2021, 9(6): 373-392.
16. 袁金娜, 金冰涵, 斯淑婷, 等. 2009至2019年6~15岁中国儿童超重和肥胖趋势分析. 中华儿科杂志, 2021, 59(11): 935-941.
17. Shah B, Tombeau Cost K, Fuller A, et al. Sex and gender differences in childhood obesity: contributing to the research agenda. BMJ Nutr Prev Health, 2020, 3(2): 387-390.
18. Jia P, Ma S, Qi X, et al. Spatial and temporal changes in prevalence of obesity among Chinese children and adolescents, 1985–2005. Prev Chronic Dis, 2019, 16: E160. doi: 10.5888/pcd16.190290.
19. Dang J, Shi D, Li X, et al. Artificial light-at-night exposure and overweight and obesity across GDP levels among Chinese children and adolescents. Nutrients, 2023, 15(4): 939. doi: 10.3390/nu15040939.
20. 马军, 蔡赐河, 王海俊, 等. 1985–2010年中国学生超重与肥胖流行趋势. 中华预防医学杂志, 2012, 46(9): 776-780.
21. Yuan C, Dong Y, Chen H, et al. Determinants of childhood obesity in China. Lancet Public Health, 2024, 9(12): e1105-e1114. doi: 10.1016/S2468-2667(24)00246-9.
22. Zhang J, Xu P, Liu F. One-child policy and childhood obesity. China Econ Rev, 2020, 59: Article 100938. doi: 10.1016/j.chieco.2019.100938.
23. 闫银坤, 高利旺, 彭雯. 中国儿童肥胖防控现状与对策. 健康中国观察, 2025, (5): 44-46.
24. Ge W, Hu J, Xiao Y, et al. COVID-19‒related childhood BMI increases in China: a health surveillance‒based ambispective cohort analysis. Am J Prev Med, 2022, 63(4): 647-655.
25. Wu QZ, Xu SL, Tan YW, et al. Exposure to ultrafine particles and childhood obesity: a cross-sectional analysis of the Seven Northeast Cities (SNEC) Study in China. Sci Total Environ, 2022, 846: 157524. doi: 10.1016/j.scitotenv.2022.157524.
26. Li L, Xu S, Lian Q. The mediating function of obesity on endocrine-disrupting chemicals and insulin resistance in children. J Pediatr Endocrinol Metab, 2022, 35(9): 1169-1176.
27. Boyland E. Would reducing children’s exposure to food advertising prevent unhealthy weight gain?. Curr Obes Rep, 2025, 14(1): 55. doi: 10.1007/s13679-025-00648-6.
28. Hu X. Analysis of the influence of the social network on childhood obesity. HBEM, 2023, 23: 1206-1211.
29. Oduro MS, Katey D, Morgan AK, et al. Problematic social media use and overweight/obesity: explanatory pathway analysis of 124 667 in-school adolescents in 39 high-income countries. Pediatr Obes, 2023, 18(11): e13073. doi: 10.1111/ijpo.13073.
30. Liu S, Lan Y, Chen B, et al. Smartphone use time and total screen time among students aged 10–19 and the effects on academic stress: a large longitudinal cohort study in Shanghai, China. Front Public Health, 2022, 10: 869218. doi: 10.3389/fpubh.2022.869218.
31. Ma L, Chu M, Li Y, et al. Bidirectional relationships between weight stigma and pediatric obesity: a systematic review and meta-analysis. Obes Rev, 2021, 22(6): e13178. doi: 10.1111/obr.13178.
32. Tang D, Bu T, Dong X. Are parental dietary patterns associated with children’s overweight and obesity in China?. BMC Pediatr, 2020, 20(1): 12. doi: 10.1186/s12887-020-1910-z.
33. Wen B, Yang Z, Li Y, et al. Association of paternal smoking with adolescent obesity. China School Health, 2019, 40: 330-332.
34. An R, Xiang X, Xu N, et al. Influence of grandparental child care on childhood obesity: a systematic review and meta-analysis. Child Obes, 2020, 16(3): 141-153.
35. Zhu H, Yi X, He M, et al. Exploring the interplay of genetic variants and environmental factors in childhood obesity: a systematic review and meta-analysis. Metabolism, 2025, 170: 156303. doi: 10.1016/j.metabol.2025.156303.
36. Huang H, Yang Y, Liang YW, et al. Genetic etiology and clinical features of non-syndromic pediatric obesity in the Chinese population: a large cohort study. BMC Pediatr, 2025, 25(1): 358. doi: 10.1186/s12887-025-05702-9.
37. Kalinderi K, Goula V, Sapountzi E, et al. Syndromic and monogenic obesity: new opportunities due to genetic-based pharmacological treatment. Children (Basel), 2024, 11(2): 153. doi: 10.3390/children11020153.
38. Fu L, Zhang M, Hu YQ, et al. Gene-gene interactions and associations of six hypertension related single nucleotide polymorphisms with obesity risk in a Chinese children population. Gene, 2018, 679: 320-327.
39. Stratakis N, Rock S, La Merrill MA, et al. Prenatal exposure to persistent organic pollutants and childhood obesity: a systematic review and meta-analysis of human studies. Obes Rev, 2022, 23 Suppl 1(Suppl 1): e13383. doi: 10.1111/obr.13383.
40. Huo J, Yang Z, Dong B, et al. Association between breastfeeding and obesity types in children and adolescents. China School Health, 2020, 41: 1711-1715.
41. Gan Q, Xu P, Yang T, et al. Sugar-sweetened beverage consumption status and its association with childhood obesity among Chinese children aged 6–17 years. Nutrients, 2021, 13(7): 2211. doi: 10.3390/nu13072211.
42. 赵博雅, 李惟怡, 刘梦冉, 等. 1989–2018年中国18~35岁青年人膳食模式变迁状况. 卫生研究, 2024, 53(3): 419-426.
43. Niu J, Li B, Zhang Q, et al. Exploring the traditional Chinese diet and its association with health status—a systematic review. Nutr Rev, 2025, 83(2): e237-e256. doi: 10.1093/nutrit/nuae013.
44. Sun X, Zhao B, Liu J, et al. A 3-year longitudinal study of the association of physical activity and sedentary behaviours with childhood obesity in China: the childhood obesity study in China mega-cities. Pediatr Obes, 2021, 16(6): e12753. doi: 10.1111/ijpo.12753.
45. Dong X, Ding L, Zhang R, et al. Physical activity, screen-based sedentary behavior and physical fitness in Chinese adolescents: a cross-sectional study. Front Pediatr, 2021, 9: 722079. doi: 10.3389/fped.2021.722079.
46. Fan J, Ding C, Gong W, et al. Association of sleep duration and overweight/obesity among children in China. Int J Environ Res Public Health, 2020, 17(6): 1962. doi: 10.3390/ijerph17061962.
47. Fu Y, Ren W, Liang Z. Perceived academic stress and depressive symptoms among Chinese adolescents: a moderated mediation analysis of overweight status. J Affect Disord, 2022, 296: 224-232.
48. Verhaegen AA, Van Gaal LF. Drugs affecting body weight, body fat distribution, and metabolic function-mechanisms and possible therapeutic or preventive measures: an update. Curr Obes Rep, 2021, 10(1): 1-13.
49. Wang Y, Zhao L, Gao L, et al. Health policy and public health implications of obesity in China. Lancet Diabetes Endocrinol, 2021, 9(7): 446-461.
50. Chen TJ, Dong B, Dong Y, et al. Matching actions to needs: shifting policy responses to the changing health needs of Chinese children and adolescents. Lancet, 2024, 403(10438): 1808-1820.
51. Norris SA, Frongillo EA, Black MM, et al. Nutrition in adolescent growth and development. Lancet, 2022, 399(10320): 172-184.
52. Zeng Q, Li N, Pan XF, et al. Clinical management and treatment of obesity in China. Lancet Diabetes Endocrinol, 2021, 9(6): 393-405.
53. Li C, Maimaiti S, Zhou Z, et al. Secular trends and urban-rural disparities in height of Chinese adolescents aged 18 years from 1985 to 2019. Am J Hum Biol, 2024, 36(1): e23988. doi: 10.1002/ajhb.23988.
54. 中华医学会健康管理学分会, 中国营养学会, 中国医疗保健国际交流促进会生殖医学分会, 等. 超重或肥胖人群体重管理专家共识及团体标准. 中华健康管理学杂志, 2018, 12(3): 200-207.
55. 国家卫生健康委员会肥胖症诊疗指南编写委员会, 张忠涛, 纪立农. 肥胖症诊疗指南(2024年版). 中国循环杂志, 2025, 40(1): 6-30.
56. Wilding JPH, Batterham RL, Calanna S, et al. Once-weekly semaglutide in adults with overweight or obesity. N Engl J Med, 2021, 384(11): 989-1002.
57. Pi-Sunyer X, Astrup A, Fujioka K, et al. A randomized, controlled trial of 3.0 mg of liraglutide in weight management. N Engl J Med, 2015, 373(1): 11-22.
58. Kadowaki T, Isendahl J, Khalid U, et al. Semaglutide once a week in adults with overweight or obesity, with or without type 2 diabetes in an east Asian population (STEP 6): a randomised, double-blind, double-dummy, placebo-controlled, phase 3a trial. Lancet Diabetes Endocrinol, 2022, 10(3): 193-206.
59. Gu W, Lu Y, Ye X, et al. Efficacy and safety of once-weekly semaglutide 2.4 mg for weight management in participants from China: a prespecified analysis of the STEP 7 randomized clinical trial. Diabetes Obes Metab, 2025, 27(5): 2540-2551.
60. Davies M, Færch L, Jeppesen OK, et al. Semaglutide 2.4 mg once a week in adults with overweight or obesity, and type 2 diabetes (STEP 2): a randomised, double-blind, double-dummy, placebo-controlled, phase 3 trial. Lancet, 2021, 397(10278): 971-984.
61. Rubino D, Abrahamsson N, Davies M, et al. Effect of continued weekly subcutaneous semaglutide vs placebo on weight loss maintenance in adults with overweight or obesity: the STEP 4 randomized clinical trial. JAMA, 2021, 325(14): 1414-1425.
62. Clément K, van den Akker E, Argente J, et al. Efficacy and safety of setmelanotide, an MC4R agonist, in individuals with severe obesity due to LEPR or POMC deficiency: single-arm, open-label, multicentre, phase 3 trials. Lancet Diabetes Endocrinol, 2020, 8(12): 960-970.
63. Çamtosun E, Akıncı A, Kayaş L, et al. Liraglutide treatment in a morbidly obese adolescent with a MC4R gene variant: side effects reduce success. J Clin Res Pediatr Endocrinol, 2023, 15(2): 225-229.
64. Gou H, Zhai Y, Guo J. Efficacy and safety of liraglutide for weight management in children and adolescents: a systematic review and meta-analysis of randomized controlled trials. Eur J Pediatr, 2023, 182(11): 5095-5108.
65. Mastrandrea LD, Witten L, Carlsson Petri KC, et al. Liraglutide effects in a paediatric (7–11 y) population with obesity: a randomized, double-blind, placebo-controlled, short-term trial to assess safety, tolerability, pharmacokinetics, and pharmacodynamics. Pediatr Obes, 2019, 14(5): e12495. doi: 10.1111/ijpo.12495.
66. Fox CK, Barrientos-Pérez M, Bomberg EM, et al. Liraglutide for children 6 to <12 years of age with obesity—a randomized trial. N Engl J Med, 2025, 392(6): 555-565.
67. Nguyen NT, Varela JE. Bariatric surgery for obesity and metabolic disorders: state of the art. Nat Rev Gastroenterol Hepatol, 2017, 14(3): 160-169.
68. Doumouras AG, Hong D, Lee Y, et al. Association between bariatric surgery and all-cause mortality: a population-based matched cohort study in a Universal Health Care System. Ann Intern Med, 2020, 173(9): 694-703.
69. 王存川, 张鹏, 杨景哥, 等. 中国儿童和青少年肥胖症外科治疗指南(2019版). 中华肥胖与代谢病电子杂志, 2019, 5(1): 3-9.
70. Inge TH, Courcoulas AP, Jenkins TM, et al. Weight loss and health status 3 years after bariatric surgery in adolescents. N Engl J Med, 2016, 374(2): 113-123.
71. Olbers T, Beamish AJ, Gronowitz E, et al. Laparoscopic Roux-en-Y gastric bypass in adolescents with severe obesity (AMOS): a prospective, 5-year, Swedish nationwide study. Lancet Diabetes Endocrinol, 2017, 5(3): 174-183.
72. Wu Z, Gao Z, Qiao Y, et al. Long-term results of bariatric surgery in adolescents with at least 5 years of follow-up: a systematic review and meta-analysis. Obes Surg, 2023, 33(6): 1730-1745.
73. Al-Mohaidly MT, Al-Asmari AK, Khan HA, et al. Laparoscopic sleeve gastrectomy for obesity treatment in adolescents and young adults: a systematic review and meta-analysis. Langenbecks Arch Surg, 2023, 408(1): 158. doi: 10.1007/s00423-023-02894-5.
74. Stanford FC, Mushannen T, Cortez P, et al. Comparison of short and long-term outcomes of metabolic and bariatric surgery in adolescents and adults. Front Endocrinol (Lausanne), 2020, 11: 157. doi: 10.3389/fendo.2020.00157.
75. Ogle SB, Dewberry LC, Jenkins TM, et al. Outcomes of bariatric surgery in older versus younger adolescents. Pediatrics, 2021, 147(3): e2020024182. doi: 10.1542/peds.2020-024182.
76. Paulus GF, de Vaan LE, Verdam FJ, et al. Bariatric surgery in morbidly obese adolescents: a systematic review and meta-analysis. Obes Surg, 2015, 25(5): 860-878.
77. Yuan C, Dong Y, Chen H, et al. Public health interventions against childhood obesity in China. Lancet Public Health, 2024, 9(12): e1115-e1124. doi: 10.1016/S2468-2667(24)00245-7.
78. Kong X, Zhang Y, Li R, et al. Factors influencing the bariatric surgery treatment of bariatric surgery candidates in underdeveloped areas of China. BMC Surg, 2024, 24(1): 82. doi: 10.1186/s12893-024-02373-8.
79. Gomez G, Stanford FC. US health policy and prescription drug coverage of FDA-approved medications for the treatment of obesity. Int J Obes (Lond), 2018, 42(3): 495-500.
80. Bae JP, Nelson DR, Boye KS, et al. Prevalence of complications and comorbidities associated with obesity: a health insurance claims analysis. BMC Public Health, 2025, 25(1): 273. doi: 10.1186/s12889-024-21061-z.
81. Griauzde DH, Carter EW, Oshman L, et al. Understanding insurance coverage policies for incretin mimetics for weight management. Am J Manag Care, 2025, 31(7): 342-349.
82. Liang H, Li C. Bariatric and metabolic surgery and medical insurance payment in China. Curr Obes Rep, 2023, 12(3): 365-370.
83. Choi WI, Shi H, Bian Y, et al. Development of commercial health insurance in China: a systematic literature review. Biomed Res Int, 2018, 2018: 3163746. doi: 10.1155/2018/3163746.

Previous Article
Advances in weight-loss medications for cardiovascular-kidney-metabolic syndrome
Next Article
Research progress on metabolic and bariatric surgery in older obese patients

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Child and adolescent obesity: challenges and responses in China

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content