When skin color/race and education matter: disparities in obesity among Brazilians (2013-2019).

Abstract

Background: Despite the growing burden of obesity in middle-income settings, evidence integrating socioeconomic and racial dimensions remains insufficient. This study examined educational inequalities in obesity prevalence among Brazilian adults in 2013 and 2019, assessing intersections with race/skin color and sex.

Methods: Cross-sectional study with a representative sample of Brazilian adults aged ≥ 23 years, using data from the National Health Survey (PNS), 2013 and 2019 editions. Obesity was assessed using BMI, calculated from self-identified weight and height. Descriptive data and complex measures of inequality (Slope Index of Inequality - SII and Relative Index of Inequality - RII) were used. Analyses were stratified by sex, race/skin color, and educational level, with an intersectional approach when analytically possible.

Results: A difference in the magnitude of relative educational inequality was observed only for Brown women (RII = 0.5 in 2013 and 0.7 in 2019), largely reflecting greater increases in obesity prevalence among women with secondary and tertiary education. Among Black men, both absolute and relative inequality were higher in 2019 survey than in 2013, with a shift in higher obesity prevalence from the less educated to the more educated. In 2019, White and Brown women showed negative SII values (-15.0 and - 9.7, respectively) and RII values less than one (0.5 and 0.7, respectively), indicating a lower obesity prevalence among those with higher educational attainment, which was not significant for Black women. Among men, educational inequality was greater for Black and Brown individuals, with higher obesity prevalence among the more educated (SII = 9.9 and 8.5, respectively); among White men, there was no significant inequality.

Conclusion: Educational inequality in obesity prevalence in Brazil shows patterns consistent with the nutritional transition observed in high-income countries with higher obesity prevalences among less educated subgroups. However, racial intersections revealed significant differences, placing Black and Brown individuals at a disadvantage in both sexes. Among women, education appears to have a less protective effect against obesity among Black women, whereas among men-where a positive educational gradient in obesity is commonly observed-this pattern is more pronounced among Black and Brown men.