Changes in obesity prevalence across household wealth groups among Peruvian adults: a ten-year analysis of a national survey

Obesity is a major public health problem, and its socioeconomic distribution varies across countries and stages of economic development. Evidence of temporal changes in household wealth inequality and obesity remains limited in Peru. This study aimed to assess the association between household wealth and BMI-defined obesity among Peruvian adults from 2015 to 2024 and to describe temporal trends according to sex and household wealth quintiles. A repeated cross-sectional study using databases from the 2015-2024 Demographic and Family Health Survey (ENDES). Adults aged \\(\\ge\\) 18 years with valid anthropometric and sociodemographic information were included. Obesity was defined as a body mass index \\(\\ge 30\\) kg/m \\(^{2}\\) . Survey-weighted prevalence estimates and 95% confidence intervals were calculated. Crude and adjusted prevalence ratios (PRs) were estimated using survey-weighted Poisson regression with robust variance, accounting for sampling weights, strata, and primary sampling units (PSUs). Multiple imputations were used for the missing data sensitivity analysis. The analytical sample included 278,824 adult participants. The prevalence of obesity increased from 20.4% in 2015 to 29.1% in 2024. Women had a consistently higher prevalence than men, and the poorest wealth quintile had the lowest prevalence throughout the study period. Compared with the poorest quintile, the adjusted PRs were 1.49 (95% CI: 1.44–1.55) for the poorer, 1.68 (95% CI: 1.61–1.75) for the middle, 1.72 (95% CI: 1.64–1.79) for the richer, and 1.68 (95% CI: 1.60–1.77) for the richest quintile. Women had a higher adjusted prevalence than men (PR: 1.39; 95% CI: 1.36–1.42), whereas rural residents had a lower prevalence than urban residents (PR: 0.83; 95% CI: 0.80–0.86). The multiple imputation estimates were generally consistent with the complete case results. The prevalence of obesity increased substantially among Peruvian adults and across all household wealth quintiles. The burden remained greater among women and urban residents, while the association across the upper wealth quintiles was not strictly monotonic.