Zhang J, Xu L, Li J, et al. - Data from the fifth Health Service Survey of Shandong Province, which was part of China’s National Health Service Survey of a total of 27,257 adults aged 18 and over was extracted by the researchers in order to evaluate the correlation between BMI and health-related quality of life (HRQOL), and to further investigate gender variations in BMI-HRQOL relationship among adults. In men and women, respectively, the prevalence of underweight and overweight/obesity were 3.2 and 5.3% and 35.7 and 34.6%. The HRQOL was calculated using the EuroQOL-5 Dimensions (EQ-5D) utility values and visual analogue scale (VAS) scores vs women. In obese men and normal-weight women, respectively, the mean EQ-5D utility value and VAS score was maximum. Among adults, being underweight was markedly and negatively correlated with lower HRQOL, following controlling potential confounders. In women, obesity was negatively and significantly correlated with HRQOL, whereas in men the former relationship was positive, however, not statistically important. The results of gender by BMI interaction in the regression model exhibited that this variation between men and women in this respect was important. Hence, the relationship between BMI and HRQOL varied by gender and the so-called “obesity-HRQOL paradox” phenomenon was validated in male adults. Moreover, while implementing targeted weight control programs and relevant interventions to enhance HRQOL, gender differences should be acknowledged.