Objective To analyze the association between alcohol dependence and overweight and obesity among high school students.

Methods This study adopted stratified cluster sampling method. Four high schools （one vocational high school included） were selected as the research sites. We used self-designed questionnaires to investigate the drinking behavior of high school students. This study used propensity score matching method to control confounding factors （e.g gender， school type， etc.）. Then we compared the differences in drinking behavior between obese/overweight group and normal weight group after matching， and used a multivariate logistic regression model to analyze the relationship between drinking behavior and overweight and obesity.

Results A total of 811 high school students participated in the survey. 60 people were excluded due to mild and moderate weight loss， and 751 people were normal or obese/overweight. After 1：1 propensity score matching， there were 217 people each in obese/overweight group and normal group. The characteristics of gender， school type， grade and family economic level of the two groups were balanced after matching. The difference was statistically significant （P<0.05） between obese/overweight and normal group in the following： drinking of alcohol at high school， alcohol dependence， the maximum drinks at one time， drinking of alcohol at family gatherings， whether bought alcohol for others， whether their family members recommended drinking， whether they have tried to quit drinking in the past year， and the time of blush after drinking. The multivariate logistic regression analysis indicated that the degree of alcohol dependence （the alcohol use disorder score ≥ 8） was a risk factor for overweight and obesity （OR=3.600， 95%CI： 1.244‒10.424）. Besides， having bought alcohol for others and family members advising alcohol consumption were suggested to be protective factors for overweight and obesity （OR=0.525， 95%CI： 0.309‒0.890 and OR=0.377， 95%CI：0.222‒0.641）.

Conclusion High school students who have alcohol dependence suffer a higher risk of obesity/overweight， while high school students who may have drinking behaviors but do not have alcohol dependence have a lower risk of obesity/overweight. It is critical to guide young people on drinking in terms of health.