<p>Obesity, as a key mediating variable in the association between the built environment and chronic diseases, has long exhibited regional imbalances in research: developed countries have dominated the discussion on the impact of the built environment on obesity and its related diseases such as diabetes and cardiovascular diseases, while the mechanisms in developing countries remain unclear. This paper, through a review of literature from 1990 to 2024, proposes that the built environment affects obesity through pathways like physical activity, lifestyle, and mental health, thereby becoming an intermediate representation of the risk for chronic diseases. The study proposes a framework, integrating land use, spatial form and other planning elements with the chronic disease prevention system for the first time. By optimizing spatial interventions such as functional mixing and pedestrian accessibility, obesity and chronic disease risks can be collaboratively controlled. This marks a shift in research paradigm from single obesity intervention to coordinated governance of multiple diseases including metabolic syndrome and respiratory diseases, providing an interdisciplinary approach for healthy urban planning, especially filling the research gap on the built environment and chronic disease association in developing countries.</p>