Objective To our knowledge, the independent association between central obesity, defined by waist circumference (WC) or waist-to-hip ratio (WHR), and diabetic retinopathy (DR) remains unknown in Chinese individuals. Method The study was conducted in two stages. First, the relationship between WC or WHR and DR was estimated in a case-control set (DR vs. non-DR) for the whole population before and after propensity score matching. Subsequently, a systematic review and meta-analysis was performed on evidence from the literature to validate the relationship. Results Of 511 eligible patients, DR (N = 156) and non-DR (N = 156) patients with similar propensity scores were included in the propensity score matching analyses. Central obesity (defined by WC) was associated with risk of DR (odds ratio [OR] 1.07, 95% confidence interval [95% CI] (1.03-1.10). The meta-analysis showed that central obesity significantly increased the risk of DR by 12% (OR 1.12, 95% CI 1.02-1.22). Analysis of data from 18 studies showed a significant association between continuous body mass index and risk of proliferative DR (OR 0.95, 95% CI 0.93-0.98; I-2 = 50%). Conclusion Central obesity, particularly as defined by WC, is associated with the risk of DR in the Chinese population.