What factors explain the increase in obesity in Brazil? An ecological analysis of contextual and behavioural...

It has been suggested that contextual factors may be related to obesity; however, they have not yet been widely investigated. The main objective of this ecological time-series study was to analyse factors associated with the increase in obesity in the adult and elderly population in Brazil from 2006 to 2020.

This is an ecological time-series study. Data were collected by the Surveillance System for Risk and Protection Factors for Chronic Diseases by Telephone Survey (VIGITEL), the main health survey in Brazil.

The outcome was the annual obesity growth rate (in percentage points). Independent variables were behavioural and contextual factors. Data analysis was performed using Prais-Winsten regression for temporal analyses, and Spearman correlation and crude and adjusted linear regression (beta and 95% confidence intervals [CIs]).

The annual obesity growth rate was 0.58 percentage points (p.p.) (95% CI: 0.54; 0.63) per year. Demographic density and the percentage of the population employed showed an inverse association with the growth of obesity. Variables such as Gross Domestic Product (GDP) per capita, Gini coefficient, urbanisation rate, percentage of the population with low level of education and percentage of the population without an income were directly associated with the increase in obesity rates. The variables maintained in the final model explained 81% of the growth in obesity in Brazil over the last 15 years (2006-2020).

The growth of obesity in Brazil was mostly explained by contextual factors, especially those of a socio-economic nature. Therefore, interventions to mitigate the increase in obesity must go beyond behavioural factors.