The aim of the present study was to examine the association between dietary patterns and weight change prospectively. We followed up 1231 adults aged 20 years and older (mean age 49·3 years) from 2002 to 2007. Food intake was assessed at baseline by an FFQ. Factor analysis was used to identify dietary patterns. Nutrient intake was measured by food weighing plus consecutive individual 3 d food records. Body weight and height were measured. The mean 5-year weight gain among all participants was 0·8 (sd 4·7) kg. The mean weight changes across quartiles of the ‘traditional’ pattern (rice, fresh vegetables, pork and wheat flour) were 2·0, 0·6, 0·6 and 0·0 kg. The corresponding values were 0·4, 0·5, 0·7 and 1·6 kg across quartiles of the ‘vegetable-rich’ pattern. No significant association between the ‘macho’ dietary pattern (meat and alcohol), the ‘sweet tooth’ pattern (drinks and cake) and weight gain was found. In multivariate linear regression, using the first quartile as the reference, participants in the highest quartile of the ‘traditional’ pattern had a β of − 2·18 (95 % CI − 2·91, − 1·45) for weight gain. However, the β from weight change of the highest quartile of the ‘vegetable-rich’ pattern was 1·00 (95 % CI 0·25, 1·74). In conclusion, the ‘traditional’ dietary pattern was negatively and the ‘vegetable-rich’ pattern was positively associated with weight gain in Chinese adults.