Association between diet quality and overweight or obesity among adults with type 2 diabetes at Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia

Background Overweight and obesity are major health challenges among adults with type 2 diabetes mellitus (T2DM), and poor diet quality may contribute to excess body weight. However, evidence regarding the association between overall diet quality and overweight or obesity among adults with T2DM in Ethiopia is limited. This study aimed to assess the association between diet quality and overweight or obesity among adults with T2DM. Methods This was an institution-based cross-sectional study conducted among 392 adults with T2DM attending Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia, from 9 April to May 8, 2026. Participants were selected using systematic random sampling. Data were collected through interviewer-administered questionnaires, medical record review and anthropometric measurements. Diet quality was assessed using the Ethiopia-adapted Diet Quality Questionnaire (DQQ) and Global Dietary Recommendations (GDR) Score. Body Mass Index (BMI) was calculated from measured weight and height and classified according to standard World Health Organization (WHO) categories. Binary logistic regression analyses were conducted to identify factors associated with overweight or obesity. Variables with p ≤ 0.25 in bivariate analysis were included in the multivariate analysis. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were used to measure the strength of associations, and statistical significance was declared at p ≤ 0.05. Results The prevalence of overweight and obesity was 46.7% (95% CI: 41.5–51.8%) and 7.1% (95% CI: 4.8–10.2%), respectively. In the multivariate analysis, poor diet quality was significantly associated with higher odds of overweight or obesity compared with good diet quality (AOR = 2.46, 95% CI: 1.35–4.44). Being female (AOR = 2.36, 95% CI: 1.34–4.15), monthly income >20,000 Ethiopian birr (AOR = 2.38, 95% CI: 1.26–4.49), physical inactivity (AOR = 2.36, 95% CI: 1.22–4.55) and poor glycemic control (AOR = 8.86, 95% CI: 4.67–16.80) were also significantly associated with higher odds of overweight or obesity. Conclusion In this single-center cross-sectional study, more than half of participants met body mass index criteria for overweight or obesity. Poor diet quality, higher reported monthly income, physical inactivity, female sex, and poor glycemic control were associated with higher odds of the combined outcome in the adjusted model. Integrating diet-quality improvement, physical activity promotion, and weight management into routine diabetes care may help address the burden of excess body weight among adults with T2DM.