Disease burden of non-communicable diseases attributable to high body mass index in China and its provinces, 1990–2021: A systematic analysis for the Global Burden of Disease Study 2021

Background: Overweight and obesity have been identified as significant modifiable behavioral risk factors for non-communicable diseases (NCDs), necessitating increased public health attention. While the prevalence of overweight and obesity has risen substantially in China, their quantitative impact on NCDs burden remains systematically unassessed. Therefore, this study aimed to quantify the burden of NCDs attributable to high BMI in China using data from the Global Burden of Disease Study 2021. Methods: Based on the methodology framework and standard analytical methods applied in the Global Burden of Disease Study 2021, we analyzed the deaths and disability-adjusted life years (DALYs) of NCDs attributable to high body mass index (BMI) across different years, age groups, sexes, provinces, and specific chronic diseases. Results: From 1990 to 2021, the number and rate of deaths and DALYs due to high BMI in China exhibited an overall upward trend. In 2021, a total of 572.58 (95% uncertainty interval [UI], 290.60–916.40) thousand deaths and 20,754.05 (95% UI, 8465.89–33,284.56) thousand DALYs from NCDs were attributable to high BMI in China, accounting for 5.19% (95% UI, 2.58–8.19%) and 5.45% (95% UI, 2.27–8.52%) of the total NCD deaths and DALYs, respectively. Generally, a higher burden was observed among males, the elderly, and the population residing in the northern part of China. The province with the highest age-standardized mortality due to high BMI was Hebei (55.45 per 100,000 population, 95% UI, 29.19–90.51 per 100,000 population), while the province with the highest age-standardized DALY rate was Xinjiang (1728.34 per 100,000 population, 95% UI, 802.44–2720.79 per 100,000 population). Diabetes and cardiovascular disease were the leading causes of death and DALYs attributable to high BMI at the national level in China in 2021. Conclusions: High BMI is a significant contributor to the burden of NCDs in China, especially in cardiovascular diseases and diabetes mellitus. The disease burden varies by age, sex, and provinces, thereby indicating the need for tailored interventions.