Abstract
BACKGROUND: A bidirectional relationship between obesity and depression is reported; racial and sex inequities may contribute to this relationship in low- and middle-income countries. METHODS: Cross-sectional study with data from 2019 Pesquisa Nacional de Saude (Brazilian National Health Survey), aiming to investigate the association of obesity and the intersection between depression, sex, and race/skin color in Brazilian adults (n = 87,497). Depression was investigated using the Patient Health Questionnaire-9 and obesity by the Body Mass Index (BMI ≥ 30 kg/m²). Sex and race/skin color were analyzed separately and combined: white men; white women; black men; black women. Odds Ratios (OR) were estimated using Logistic regression models adjusted by sociodemographic data. Obesity was the outcome, while depression and its intersections with sex and race/skin color were explanatory variables. Individuals without depression were the reference group in all models. RESULTS: Depression prevalence was 10.8%, and obesity prevalence was 21.3%. Depression was associated with a higher chance of presenting obesity in the total population (OR:1.37; p < 0.001). Women with depression had higher chance to present obesity (OR:1.55; p < 0.001) compared to those without depression. Black individuals with depression (OR:1.37; p < 0.001) and white individuals with depression (OR:1.38; p < 0.001) had similar higher chances to present obesity. Considering the intersection between sex and race/skin color, compared to individuals without depression, black women with depression presented 59% higher chance of obesity (OR:1.59; p < 0.001), followed by white women with depression (OR:1.50; p < 0.001). CONCLUSIONS: Depression was associated with an increased chance of obesity with this relationship varying by sex and race/skin color. The strongest association was observed among black women.