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Objective To investigate the influence of socio-economic status (SES) on the incidence of overweight and obesity. Methods By using the method of multi-stage cluster random sampling, a baseline survey was conducted on 9 280 people in Guizhou Province in 2010. All participants in the cohort were followed up from 2016 to 2020. In total 2 681 people were included in the analysis after excluding those who lost follow-up and did not meet the requirements. Univariate analysis and COX proportional regression model were used to analyze the effects of SES comprehensive score and SES single index on the incidence of overweight and obesity. Results The median follow-up was 6.42 years, and the population incidence density was 41.72/1 000 person-years. The results of multivariate COX regression showed that compared with the people with per capita annual income less than 2 667 yuan, the risks of disease for those with income of 5 000 to < 10000 yuan and ≥ 10 000 yuan were HR=0.756 (95%CI: 0.611-0.934) and HR=0.626 (95%CI: 0.498-0.787), respectively (Ptrend < 0.001). Compared with illiterate and semi-illiterate, the disease risk was lower for people with education of primary school (HR=0.740, 95%CI: 0.599-0.914), junior high school (HR=0.666, 95%CI: 0.541-0.820), and senior high school/technical secondary school and above HR=0.634 (95%CI: 0.468-0.859), respectively (Ptrend <0.001). There was no correlation between occupation and disease risk. Compared with the population with SES comprehensive score < 6, the risks of disease in the population with 8 points and ≥ 9 points were HR=0.735 (95%CI: 0.566-0.955) and HR=0.540 (95%CI: 0.417-0.700), respectively (P<0.001). The results of urban and rural subgroup analysis showed that the effect of comprehensive score of SESS on the risk of disease was more significant in rural population. In terms of single index, the incidence of urban population was only related to individual education level (Ptrend =0.008), and the incidence of rural population was only related to family per capita annual income (Ptrend =0.002). Conclusion The risk of overweight and obesity is closely related to SES, and SES inequality causes health differences. Attention should be paid to urban low-education and rural low-income population. [ABSTRACT FROM AUTHOR]