Objective:

To analyze the global disease burden of high body mass index (BMI) and evaluate the associations between three obesity diagnostic criteria and waist-to-height ratio (WHtR) with fracture risk and cardiovascular diseases (CVD) in diabetic patients.

Approach:

• Data Sources: Data on high BMI burden in China and globally (1990–2021) were sourced from the Global Health Data Exchange (GHDx).
• Study Design: A cross-sectional clinical study enrolled 17,949 diabetic participants from a single center in China.
• Obesity Diagnosis: Obesity was diagnosed using WHO, EASO, and AOU criteria.
• Statistical Analysis: Logistic regression models were employed to analyze associations between WHtR and CVD, high-risk hip fracture (HRHF), and high-risk major osteoporotic fracture (HRMOF), adjusting for multiple covariates.

Key Findings:

• From 1990 to 2021, the age-standardized rate of high BMI in China increased by 146.22%, exceeding the global increase of 70.89%.
• EASO criteria showed significant associations with CVD.
• WHtR was a significant risk factor for CVD and hip fracture across all models.
• The highest WHtR tertile was associated with increased risks of CVD (OR = 1.14, 95% CI: 1.04–1.25) and HF (OR = 1.83, 95% CI: 1.41–2.62) compared to the lowest tertile.

Interpretation:

Elevated WHtR was independently associated with higher risks of CVD and HF in the diabetic population.

Limitations:

• The study is limited to a single center in China, which may affect generalizability.
• Cross-sectional design limits causal inferences.

Conclusion:

The high BMI burden is rising markedly, especially in China. Integrating WHtR into clinical practice could improve risk stratification for obesity-related comorbidities.