With a deeper understanding of the harms of obesity and its association with cardiovascular disease (CVD), a relatively systematic scientific consensus has been formed in the academic community. Against this background, the Chinese Cardiometabolic Alliance organized multidisciplinary experts to formulate and issue the Expert Consensus on Weight Management in Patients with Cardiovascular Disease (2025) (hereinafter referred to as “the Consensus”), aiming to provide targeted diagnosis and treatment guidance for CVD patients with overweight or obesity.
As understanding of obesity and its associated disease risks advances, it has been increasingly recognized that although BMI can reflect body weight status, it fails to comprehensively evaluate fat distribution characteristics and related metabolic risks. For instance, at the same BMI level, Asian populations often have higher visceral fat content than Caucasians, resulting in a significantly increased risk of metabolic diseases such as CVD, type 2 diabetes mellitus (T2DM), and fatty liver disease. This indicates that relying solely on BMI is insufficient to assess the multiple health hazards caused by obesity.
Therefore, more indicators reflecting fat distribution and metabolic risks have been gradually introduced into clinical practice, including waist circumference, waist-to-hip ratio, waist-to-height ratio, body fat percentage, and visceral fat area. These parameters may be superior to BMI in predicting obesity-related disease risks. Based on the above progress, current relevant guidelines no longer take BMI as the sole criterion for cardiovascular risk assessment in the Chinese population. Instead, they clarify its limitations and recommend the integrated use of multidimensional indicators to achieve a more comprehensive and accurate evaluation of obesity and related health risks.
At present, body weight issues have attracted widespread attention, mainly because weight gain is closely associated with CVD risk. Studies have shown that overweight or obesity significantly increases the risk of atherosclerotic cardiovascular disease (ASCVD), heart failure with preserved ejection fraction (HFpEF), and renal function impairment.
The fundamental mechanism is that excess body weight is often accompanied by insulin resistance, which further induces multi-organ dysfunction and promotes chronic metabolic inflammation, ultimately leading to pathological changes such as atherosclerosis, renal damage, and non-alcoholic fatty liver disease (NAFLD). Accordingly, overweight and obesity are regarded as important risk factors for many diseases, especially CVD, and serve as a common breeding ground for chronic diseases.
The epidemic trend of related diseases in China also reflects this severe challenge. An epidemiological survey of 300,000 people across 14 provinces and cities in 1980 showed that the prevalence of diabetes was only 0.67%, but it rose to 12.4% in 2018–2019, an increase of about 19 times in nearly 40 years.
Meanwhile, the adult obesity rate surged from 0.1% in 1982 to 15.6% in 2015–2019, an increase of more than 150 times; the overweight rate also rose from 5.4% to 34.3%, an increase of more than 6 times [4]. This demonstrates that with the improvement of material living standards, metabolic abnormalities have become increasingly prominent.
These metabolic changes have posed a major threat to the health of Chinese residents. In 2021, CVD deaths accounted for 48.98% and 47.35% of all deaths in rural and urban areas, respectively, meaning that nearly 1 in 2 deaths was attributable to CVD. Further studies found that approximately 70% of CVD deaths were accompanied by abnormal glucose metabolism (including prediabetes or diabetes).
It should be emphasized that the vast majority of overweight or obese individuals have insulin resistance and are essentially in a prediabetic state. Thus, as an upstream risk factor, metabolic dysfunction is closely linked to downstream cardiovascular outcomes, jointly constituting a major health challenge currently facing China.