IntroductionBody mass index (BMI) has a strong correlation with chronic diseases and all-cause mortality. However, few studies have previously reported the longitudinal transition of BMI status and its influential factors, especially among Chinese middle-aged and older adults.MethodsThis population-based cohort study involved 6,507 participants derived from the China Health and Retirement Longitudinal Study from 2011 to 2015, including objectively measured BMI recorded in 26,028 person-year of all observations followed up. Multistate Markov model was performed to estimate the BMI state transition intensity and hazard ratios of each potential exposure risk.ResultsThe mean intensity of the population that shifted from normal to overweight was more than twice than shifted to underweight. Besides, a predicted probability was up to 16.16% that the population with overweight would suffer from obesity and more than half of the population with underweight would return to normal weight over a 6-year interval. The study also implied significant effects of baseline age, gender, marital status, education level, alcohol consumption, smoking, depression symptoms, and activities of daily living impairment on BMI status transition to varying degrees.ConclusionsFindings of this study indicated that the mean transition probability between different BMI statuses varied, specific exposure factors serving as barriers or motivators to future transitions based on current BMI status was clarified for the health promotion strategies.