Obesity among adults living in post-earthquake container settlements: a cross-sectional study in Malatya, Türkiye

To estimate the prevalence of obesity and identify the factors independently associated with it among adults living in container settlements established after the 6 February 2023 Kahramanmaraş earthquakes.

Population-based, descriptive, cross-sectional field study using stratified random sampling.

Eight container settlements in Malatya, Türkiye, with on-site primary health services. Fieldwork was conducted between June and October 2025, 24-32 months after the earthquakes.

Participants were adults aged ≥18 years permanently residing in the settlements (source population, n=27 997). Of 682 individuals randomly selected from settlement resident lists, 62 could not be contacted and were replaced by further random draws; of the 620 adults then approached, 57 were excluded for non-eligibility, incomplete data or refusal, yielding a final analytic sample of 563 (84.0% of all eligible selected individuals; 94.6% of those contacted).

Primary outcome: obesity (body mass index (BMI) ≥30.0 kg/m²) from measured height and weight.

distribution of BMI categories and factors associated with obesity assessed by logistic regression and, as a sensitivity analysis, by modified Poisson regression yielding prevalence ratios.

Obesity prevalence was 28.8% (162/563; 95% CI 25.2 to 32.6), falling to 24.4% (21.1 to 27.9) after standardisation to an equal sex distribution. Prevalence was markedly higher in women than in men (35.5% vs 13.5%) and differed across settlements (18.8%-66.7%; χ²=29.21, p<0.001) although estimates for the three smallest sites were imprecise. Six factors were independently associated with obesity: female sex (adjusted OR (AOR) 3.46, 95% CI 1.86 to 6.44), age ≥55 years (AOR 2.44, 95% CI 1.17 to 5.09), fast eating (AOR 2.28, 95% CI 1.39 to 3.74), self-reported childhood overweight (AOR 1.93, 95% CI 1.21 to 3.07), chronic disease (AOR 1.85, 95% CI 1.17 to 2.94) and low household income (AOR 1.73, 95% CI 1.05 to 2.86); the income association was sensitive to model specification (Nagelkerke R²=0.267; apparent, in-sample discrimination AUC=0.775, 95% CI 0.732 to 0.818). Associations persisted when settlement was added as a fixed effect, when cluster-robust variance was used and when prevalence ratios were estimated instead of ORs, with the exception of household income, which lost significance in the settlement-adjusted model.

Obesity is a substantial, identifiable problem during the sub-acute to chronic phase of post-earthquake displacement in the Eastern Mediterranean. The profile of associated factors supports targeted intervention through on-site primary care, with older women who have chronic disease as the clearest priority group; the association with low household income was sensitive to adjustment for settlement and should be treated as provisional. The variation between settlements indicates that settlement-level environments warrant direct measurement in future work.