Author(s)

Qiancheng Zhao ¹, Qiao Zhang ¹, Hong Xu ¹

Affiliation(s)

¹ School of Public Health, Chongqing Medical University, Chongqing, People's Republic of China

Corresponding Author

Hong Xu

ABSTRACT

Waist circumference (WC) is a key indicator of central obesity, yet longitudinal evidence regarding its state fluctuations in older Chinese populations is limited. This study utilized a nationally representative cohort of adults aged ≥45 years from the China Health and Retirement Longitudinal Study (CHARLS, 2011–2015) to investigate this dynamic process. By applying a continuous-time multi-state Markov model, we tracked bidirectional transitions among normal, borderline, and central obesity states. The analysis showed that WC status is highly reversible, with frequent shifts occurring mainly between normal and borderline levels. Furthermore, the determinants of these shifts are strongly state- and direction-specific. Female sex and multimorbidity were found to increase the risk of WC deterioration while reducing the likelihood of improvement. Additionally, lower education, instrumental activities of daily living (IADL) impairment, and depression showed asymmetric associations across the progression and regression pathways of central obesity. These findings underscore that WC changes are highly dynamic and asymmetric, emphasizing the importance of continuous monitoring and stage-tailored strategies for effective central obesity management in aging populations.

KEYWORDS

Waist circumference, Central obesity, Multi-state Markov model

CITE THIS PAPER

Qiancheng Zhao, Qiao Zhang, Hong Xu. The Reversibility of Central Obesity: Longitudinal Transitions and Determinants among Older Chinese Adults. Social Medicine and Health Management (2026). Vol. 7, No.1, 48-54. DOI: http://dx.doi.org/10.23977/socmhm.2026.070106.

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