How China is addressing its obesity epidemic: a cultural perspective

Across China, authorities are working diligently to encourage citizens to shrink their waistlines. They are promoting light menus tailored to regional tastes and have even released weight management-themed emojis for messaging apps. Local officials and community volunteers have been enlisted to educate residents through door-to-door visits about the health risks associated with obesity. Hotels are installing scales in guest rooms to encourage travellers—particularly businessmen—to pay attention to their weight.

In Guangdong, a province with a population of 127 million that is home to numerous manufacturing and tech giants, local government officials are urging companies to implement mandatory workout breaks, establish sports teams, and find innovative ways to motivate employees to stay fit. Meanwhile, the Southern University of Science and Technology in Shenzhen has launched a competition to see who can lose the most weight in a month through exercise and a balanced diet—both increasingly uncommon among beleaguered students, especially those in STEM majors.

“Our undergraduate students are getting heavier each year, and the proportion who are overweight is rising among juniors and seniors,” said Dong Lunhong, director of physical education at the university. “We need to get everyone moving and staying in shape.” The winner of the competition will receive a prize worth several hundred dollars, including headphones and a massage gun, as well as bonus university credits. More than 1,000 students and staff members have signed up.

The weight loss drive is not a new phenomenon in a country where waistlines have been rapidly expanding, but it has gained momentum since the Chinese Communist Party made healthy weights a key priority at its recent National People’s Congress. China has launched a three-year campaign to raise public awareness about obesity, with top health officials urging more hospitals to offer weight management services among other measures.

“Lifestyle intervention,” which includes promoting exercise and a healthy diet, will be “critical” to reversing the rising occurrence of cancer and other chronic diseases associated with obesity, said Lei Haichao, director of the National Health Commission, during China’s most important annual political meetings. While it may take time to deliver results, the anti-obesity campaign will benefit from coordinated efforts among the government, businesses, and the public, Lei added.

Obesity is a relatively new but fast-growing issue in a nation that has long struggled to feed its people. When the U.S. National Institutes of Health declared obesity a disease in 1998, more people in China were undernourished (over 10 percent of the population) than obese (around 8 percent for adults). As Chinese diets have shifted to high-protein, high-fat options during three decades of robust economic growth, more than half of adults in China have become overweight or obese, according to the National Health Commission.

Without proper intervention, the obesity rate could exceed 70 percent by 2030, approaching the proportion of people in the United States considered overweight. This could cost China’s healthcare system more than $58 billion a year, or over a fifth of the country’s total annual medical expenditure. In China, individuals with a body mass index (BMI) over 24 are considered overweight, while those over 28 are classified as obese. The U.S. standard is over 25 for overweight and over 30 for obesity.

China employs a stricter measurement because East Asians have a higher percentage of body fat and a greater risk of cardiometabolic disease even at relatively low BMI levels, according to Pan Xiongfei, a professor at a Sichuan University-affiliated hospital who studies noncommunicable diseases. However, Chinese authorities face the challenge of changing mindsets shaped by recent history. As many as 30 million people died during the famine caused by the Great Leap Forward agricultural reform policies introduced in 1958. In the 1990s, being overweight became associated with wealth.

Even today, Chinese men with a spare tire do not refer to it as a “beer belly”; instead, they call it the “belly of a general.” In some regions, pregnant women are still advised to maximise their nutritional intake and minimise physical activity, while chubby children are often seen as symbols of family prosperity. This means that Beijing must drive home the message that obesity is a disease, not a symbol of wealth and good health.

The government’s message has quickly spread across social media platforms, with a hashtag—“The country’s calling you to drop those pounds”—topping trending topics and inspiring a wave of memes on Weibo, the microblogging site. Institutions across the country have rapidly joined the initiative, especially universities. In Yunnan province, 92 colleges will issue certificates of good health to graduates who achieve an average score of 80 percent in physical education classes, according to Xinhua News Agency.

Health authorities have also issued localized guidelines for weight-loss diets. A recommended summer menu for residents in China’s southwest, known for their love of spicy and sour food, includes dishes like steamed egg and skim milk for breakfast, braised eel for lunch, and small chicken stew with mashed potatoes for dinner. There are seven versions of the menu tailored to different regions, but they all share a common theme: moderate use of oil, salt, and sugar, with a daily caloric intake of no more than 1,600 calories.

Fitness influencers are capitalising on this trend. Magic Club, a weight-loss boot camp that claims to be China’s largest, has quickly introduced new packages featuring customised meals, private trainers, and five-star hotel stays. A programme priced at $1,800 (excluding accommodation) promises participants can easily lose 22 pounds in 28 days.

However, the biggest beneficiaries may be pharmaceutical companies producing weight-loss drugs. Novo Nordisk has not released sales figures since launching Wegovy in China last year, but it reports a “significant unmet medical need” for obesity prevention and treatment in the country. The company’s other main weight-loss product, Ozempic, accounted for nearly three-quarters of the Chinese market at the end of last year.

Beijing appears to favour solutions that address multiple issues. Highlighting the obesity trend could stimulate domestic consumption and encourage lifestyle changes, according to Jennifer Bouey, chair of the department of international health at Georgetown University. However, the government campaign may also reflect social controls on gender norms and reinforce mainstream beauty standards that favour slimness.

Lynne Liang, a 20-year-old college student in Guangzhou who has weighed over 176 pounds since middle school, has been taking Wegovy since November after struggling to maintain weight loss through various methods, including low-carb dieting, intermittent fasting, daily gym visits, and even acupuncture. She has lost 24 pounds and is confident she will lower her BMI from 31 to below 24. “People can be whatever body shape, and we shouldn’t judge. The look that I feel most comfortable with happens to be not too fat and not too thin,” Liang said.

The Washington Post