Obesity among adults living in post-earthquake container settlements: a cross-sectional study in Malatya, Türkiye
Osman Kurt, Aleyna Aslan, Ahmet Burak Avcu, Ayşe Baran, Ali Özer, Metin Fikret Genç, Harun KurtObjectives
To estimate the prevalence of obesity and identify the factors independently associated with it among adults living in container settlements established after the 6 February 2023 Kahramanmaraş earthquakes.
Design
Population-based, descriptive, cross-sectional field study using stratified random sampling.
Setting
Eight container settlements in Malatya, Türkiye, with on-site primary health services. Fieldwork was conducted between June and October 2025, 24–32 months after the earthquakes.
Participants
Participants were adults aged ≥18 years permanently residing in the settlements (source population, n=27 997). Of 682 individuals randomly selected from settlement resident lists, 62 could not be contacted and were replaced by further random draws; of the 620 adults then approached, 57 were excluded for non-eligibility, incomplete data or refusal, yielding a final analytic sample of 563 (84.0% of all eligible selected individuals; 94.6% of those contacted).
Primary and secondary outcome measures
Primary outcome: obesity (body mass index (BMI) ≥30.0 kg/m²) from measured height and weight. Secondary outcomes: distribution of BMI categories and factors associated with obesity assessed by logistic regression and, as a sensitivity analysis, by modified Poisson regression yielding prevalence ratios.
Results
Obesity prevalence was 28.8% (162/563; 95% CI 25.2 to 32.6), falling to 24.4% (21.1 to 27.9) after standardisation to an equal sex distribution. Prevalence was markedly higher in women than in men (35.5% vs 13.5%) and differed across settlements (18.8%–66.7%; χ²=29.21, p<0.001) although estimates for the three smallest sites were imprecise. Six factors were independently associated with obesity: female sex (adjusted OR (AOR) 3.46, 95% CI 1.86 to 6.44), age ≥55 years (AOR 2.44, 95% CI 1.17 to 5.09), fast eating (AOR 2.28, 95% CI 1.39 to 3.74), self-reported childhood overweight (AOR 1.93, 95% CI 1.21 to 3.07), chronic disease (AOR 1.85, 95% CI 1.17 to 2.94) and low household income (AOR 1.73, 95% CI 1.05 to 2.86); the income association was sensitive to model specification (Nagelkerke R²=0.267; apparent, in-sample discrimination AUC=0.775, 95% CI 0.732 to 0.818). Associations persisted when settlement was added as a fixed effect, when cluster-robust variance was used and when prevalence ratios were estimated instead of ORs, with the exception of household income, which lost significance in the settlement-adjusted model.
Conclusions
Obesity is a substantial, identifiable problem during the sub-acute to chronic phase of post-earthquake displacement in the Eastern Mediterranean. The profile of associated factors supports targeted intervention through on-site primary care, with older women who have chronic disease as the clearest priority group; the association with low household income was sensitive to adjustment for settlement and should be treated as provisional. The variation between settlements indicates that settlement-level environments warrant direct measurement in future work.