Desigualdades sociais no Brasil: Uma abordagem interseccional sobre obesidade e consumo alimentar

Abstract

Introduction: Brazil is experiencing rapid obesity growth amid significant changes in the global food system. Social inequalities strongly influence both obesity and food consumption; however, the interaction between sex, race/skin color, and socioeconomic position remains underexplored. Objectives: To analyze social inequalities in obesity and food consumption among Brazilian adults, considering the intersection of sex, race/skin color, and socioeconomic position in the years 2013 and 2019 for obesity and in 2019 for food consumption. Methods: Cross-sectional data from the 2013 and 2019 National Health Survey (PNS), representative of the Brazilian adult population (≥ 23 years), were used. Obesity was defined as BMI ≥ 30 kg/m². Food consumption was assessed based on regular intake (≥ 5x/week) of fruits, vegetables, and legumes (FLV) and high intake (≥ 5 different items/day before the interview) of ultra-processed foods (UPF). Inequality was evaluated using complex measures (SII, RII, and CIX – Slope Index, Relative Index, and Concentration Index of Inequality, respectively), with SII and RII applied to education for obesity and SII and CIX to education and wealth index for food consumption. Analyses were stratified by the intersection of sex and race/skin color. Results: In 2019, white and brown women had a higher prevalence of obesity among the less educated (SII=-15.0 and -9.7; RII=0.5 and 0.7), while this inequality was not significant for black women. Among men, obesity was more prevalent in those with higher education, especially among blacks and browns (SII=9.9 and 8.5, respectively), while among whites, inequality was lower (SII=3.8, not significant). Between 2013 and 2019, a change in inequality was observed only for brown women (RII=0.5 in 2013 and 0.7 in 2019), due to increased obesity among the more educated. Among black men, absolute and relative inequality may have increased in this period, shifting the highest obesity prevalence from the less educated to the more educated, although the small sample size in 2013 may have influenced this result. Regarding food consumption, educational and wealth inequalities favored the most privileged in FLV consumption, with relative inequality for wealth being higher among black men and women (CIX=15.4 and 13.8, respectively) compared to their white counterparts (CIX=10 and 8.4, respectively). In educational inequality, black women showed a higher relative disparity compared to white women (CIX=10.3 vs. 7.1). High UPF consumption was more prevalent in higher wealth quintiles across all groups, except among white women (non-significant inequality). Relative educational inequality in UPF consumption was higher among black men (CIX=24.4) than white men (CIX=17.4). The intermediate education level stood out for its high UPF consumption and low fruits, legumes and vegetables (FLV) consumption, especially among black men. Conclusion: Social inequalities affect obesity and food consumption in an intersectional manner. Historically disadvantaged groups, such as black men and women, face greater challenges in avoiding obesity and accessing a healthy diet, even when they reach higher socioeconomic levels.