Reversing the Gap: Do Gendered Food Preferences Explain a Historic Shift in Obesity from Women to Men?

Although overweight and obesity (OWOB) rates in China were historically higher among women than men, a reversal occurred around 2003, such that men now exhibit higher OWOB rates than women. This trend aligns with the global transition observed across developing and developed nations. However, the mechanisms underlying this phenomenon remain underexplored. We investigate how food preferences shape dietary intake and whether this explains the reversing gender gap. First, we examine the socio-cultural and physiologically driven mechanisms that shape these preferences. We then quantify whether preferences translate into measurable gaps in food consumption. A clear divergence is identified: adult males demonstrate a stronger preference for animal-sourced foods, fried snacks, sugar-sweetened beverages (SSBs) and alcohol, whereas adult females show a greater preference for dairy and plant-based alternatives. These preferences explain a significant portion of the observed gender gap in consumption patterns. Furthermore, dietary patterns interact with income. At lower income levels, females’ higher starchy food preference elevates their OWOB risk. With rising incomes, males’ specific food preferences are increasingly fulfilled, leading to higher energy intake and OWOB rates that ultimately exceed those of females. We further show that these gendered preferences are moderated by residential context, with urbanization strengthening females’ inclination toward healthy foods and rural settings reinforcing males’ preference for energy-dense items. Finally, while general dietary knowledge has limited impact, targeted health communication linking diet to disease, especially within households, can reduce OWOB odds and mitigate inequalities. Income growth alone does not guarantee healthier choices, particularly among high-income males, underscoring the need for interventions that address both economic and behavioral drivers of dietary risk. • Reveals a reversal in gender disparity in overweight/obesity (OWOB) among Chinese adults, with males exhibiting higher rates than females as income rises. • Identifies gender-specific food preferences: males prefer animal-sourced, specific energy-dense foods (including animal-sourced foods, fried snacks, sugar-sweetened beverages and alcohol), while females favor dairy and plant-based alternatives. • Shows that income moderates dietary risks: at lower income levels, females’ higher starchy food intake increases OWOB risk, whereas rising income enables males’ energy-dense preferences, elevating their OWOB rates. • Highlights the role of residential context: urbanization strengthens females’ healthy food inclinations, while rural settings reinforce males’ energy-dense preferences. • Finds that targeted health communication linking diet to disease, especially within households, can reduce OWOB odds and mitigate related inequalities.