With the accelerating aging of the population, multimorbidity has become a major public health challenge in Beijing. Obesity serves as a key pathological basis for multimorbidity, and weight management is an important strategy for improving the health of patients with multimorbidity. However, the current status of integrated diagnosis and treatment for obesity and multimorbidity remains unclear.

To assess the availability of health services related to obesity comorbidities in medical institutions of Beijing, and to provide scientific evidence for the formulation of clinical guidelines and hierarchical medical policies targeting obesity combined with three highs (hypertension, diabetes mellitus, and hyperlipidemia).

From October to December 2025, a multi-stage random sampling method was adopted to select 60 primary health service institutions and 16 tertiary hospitals in Beijing. Fourteen secondary hospitals were enrolled via purposive sampling as research subjects. Based on policy review, literature review and expert consultation, three versions of questionnaires (for primary medical and health institutions, secondary hospitals and tertiary hospitals, respectively) were self-developed. The questionnaire covered infrastructure and resource allocation related to weight management, hierarchical diagnosis and treatment positioning, construction of referral pathways, and practical difficulties in hierarchical medical service delivery.

Weight management clinics were established in 22 (36.7%) primary medical and health institutions, 7 (7/14) secondary hospitals and 14 (14/16) tertiary hospitals. The linear-by-linear association chi-square test revealed that the establishment rate of weight management clinics increased with the elevation of hospital grade (P<0.01). In terms of weight management equipment, among basic assessment equipment, only the possession rate of tape measures in secondary hospitals was less than 80.0%. As for specialized equipment, secondary hospitals had a possession rate of body fat analyzers below 60.0%, dietary guidance tools below 50.0%, sports venues below 40.0%, and professional weight management software below 10.0%. With regard to weight management service programs, 17 (28.3%) primary medical and health institutions and 5 (5/14) secondary hospitals failed to provide systematic weight management services, whereas all 16 tertiary hospitals offered such systematic services. For patients with obesity-related comorbidities, merely 7 (7/14) secondary hospitals could deliver services including supporting primary care institutions and transferring stable patients back to primary settings, and only 9 (9/14) secondary hospitals were capable of providing technical support to primary medical and health institutions. In respect of referrals for patients with obesity and comorbidities, no clear referral criteria or procedures were formulated in medical institutions at all levels. The primary barrier to referrals in tertiary hospitals was difficult follow-up of downward-transferred patients (7 hospitals). The main obstacles for secondary hospitals included patients’ reluctance to accept referrals and tendency to directly visit their preferred hospitals (11 hospitals), as well as unobstructed referral pathways (8 hospitals). For primary medical and health institutions, the predominant challenges were insufficient timely and effective information sharing among medical institutions at different levels (42 institutions) and inadequate feedback on referred patients from higher-level hospitals (37 institutions).

Under the context of tiered diagnosis and treatment, the availability of health services for patients with obesity-related comorbidities in Beijing is inadequate and structurally imbalanced. It is recommended to strengthen the hub function of secondary hospitals, establish regional fixed referral networks, promote specialized equipment deployment in primary and secondary institutions, and develop unified clinical pathways and information-sharing standards, so as to enhance the overall system efficiency and support the implementation of the "Healthy China" strategy.