Obesidade, insegurança alimentar, gênero e raça/cor: um estudo sobre interseccionalidade na população brasileira

Abstract

Introduction: Obesity is a global public health problem, associated with comorbidities such as diabetes and hypertension, which has advanced rapidly in Brazil, where its prevalence more than doubled between 2006 and 2023. Along with this scenario, Food Insecurity (FI) has also grown, especially between 2017 and 2022, disproportionately impacting women and black populations, reflecting historical structural inequalities. Objective: From an intersectional approach, this thesis investigates how gender, race/color and socioeconomic factors are articulated in the relationship between obesity and FI. Methodology: Based on two types of studies, a systematic literature review and observational epidemiological studies, five articles were produced (two of a methodological nature and three dealing with the results of the research). The systematic review was registered on the PROSPERO platform and carried out following the PRISMA guidelines, with the aim of evaluating the association between food insecurity and excess weight (overweight and obesity) in the Brazilian population from the perspective of gender and race/color. The searches took place in the Virtual Health Library (Lilacs-BVS), PubMed, Web of Science and Embase databases, with the selection and extraction stages carried out by independent researchers. Secondary data from the National Health Survey (2019) was then analyzed to validate the classification of nutritional status based on self-reported anthropometric data and to assess the prevalence of obesity and its relationship with vulnerability indicators among Brazilian population groups. In addition, primary data from a population-based cross-sectional study of households in two municipalities in the northeastern semi-arid region (InqSAN-Semiárido) was used to analyze the relationship between obesity and food insecurity based on intersectional factors. Descriptive, bivariate and multivariate analyses were carried out using Stata software (version 15.0), using the variable of classification of Body Mass Index as Obesity as the outcome. As exposure variables, we used socioeconomic variables (income, schooling, occupation, housing), FI (assessed using the Brazilian Food Inadequacy Scale – EBIA) and gender and race/color factors by creating an intersectional variable (white man, black/brown man, white woman, black/brown woman). Results: From the analysis of 22 articles, the review showed that although the positive association between AI and overweight is consolidated in the literature, there is a gap in the discussion about how intersectionality permeates this association. As for the validation of self-reported data, all the analyses showed positive results, with greater reproducibility among adults (18 to 59 years old) when compared to the elderly and among men when compared to women, thus indicating a concrete possibility of carrying out observational studies of association with reported nutritional status as the outcome variable. As for cross-sectional studies, the PNS data showed that obesity affects intersectional groups unequally and is intensified by other vulnerability factors such as income, schooling and occupation, with black women being the most affected, while the InqSANSemiárido data reinforced the prevalence of this outcome and identified that in the presence of FI, social disparities are amplified. Final considerations: It is essential to implement public health and food security policies aimed at tackling structural and territorial inequalities. It is recommended, among other actions, to expand access to healthy food in areas of high vulnerability, strengthen food security policies with a focus on black women and low-income populations, integrate multidimensional approaches to tackling obesity and adopt affirmative policies that reduce gender and racial inequalities in access to education, work and health. Joint efforts between the state, civil society and the private sector are essential to transform eating environments, reduce privileges and discrimination and build a fairer and more inclusive society.