The study examined the relationship between lung function, obesity, and cardiometabolic multimorbidity (CMM)—the co-occurrence of type 2 diabetes, coronary heart disease, or stroke—in 35,414 older adults aged ≥65 years in China. The results showed that higher lung function was associated with a lower risk of CMM, with participants in the highest quartile of lung function having a 40% lower chance of CMM compared to the lowest quartile. Restrictive spirometry (reduced lung function) was associated with a 56% higher likelihood of CMM. Both general and abdominal obesity significantly increased the risk of CMM – each unit increase in BMI increased the odds by 30% and an increase in waist circumference by 33%. Combined analysis demonstrated that older adults with restrictive spirometry and abdominal obesity had the highest risk of CMM, whereas those with preserved lung function and normal abdominal circumference had a 65% lower likelihood of CMM. The authors recommend simultaneous screening of lung function and obesity status as a tool to identify elderly persons at high risk of cardiometabolic multimorbidity.