Central obesity in regional and remote Australian adults: a population-based Bayesian study

Q: What are the key findings of this study?

Outer Regional and Remote Australian adults had a higher prevalence of central obesity than those in Major Cities (46.2% vs 36.2%, p<0.001), including 6.7% among those with normal BMI.

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Central obesity (n=18655). Intervention: Residence in regional and remote areas, socioeconomic disadvantage, physical inactivity, and psychosocial factors vs. Major cities and favorable sociodemographic/lifestyle reference groups. Primary outcome: Central obesity (waist circumference ≥ 102 cm for males and ≥ 88 cm for females) (p=<0.001).

Q: What question did this study set out to answer?

To identify sociodemographic, lifestyle, and psychosocial risk factors associated with central obesity across regional and remote Australia.

Setognal Birara Aychiluhm; Kedir Yimam Ahmed; Allen Guy Ross; Subash Thapa; Feleke Hailemichael Astawesegn; Vivian Isaac; Fentaw T. Berhe; Zekariyas S. Nezenega; Cheru Tesema Leshargie; Zemenu Yohannes Kassa; M. Mamun Huda; Shakeel Mahmood; Utpal Kumar Mondal; Anayochukwu Edward Anyasodor; Tebikew Yeneabat Mengist; Birhanu Wondimeneh Demissie; Meless Gebrie Bore

doi:10.1186/s12889-026-29863-z

October 20, 2026BMC Public HealthOpen Access

Central obesity in regional and remote Australian adults: a population-based Bayesian study

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Key result

Remote Australian residence is linked to a ~10-point higher prevalence of central obesity than major cities.

P<0.001
n=18,655

Why the study?

What are the prevalence and associated sociodemographic, lifestyle, and psychosocial risk factors of central obesity among Australian adults across remoteness areas?

Key Points

To identify sociodemographic, lifestyle, and psychosocial risk factors associated with central obesity across regional and remote Australia.
Analyzed cross-sectional data from the 2017–18 Australian National Health Survey with a weighted total sample of 18,655 adults aged 18 years and older (5,071 from regional and remote areas).
Defined central obesity as a waist circumference ≥ 102 cm for males and ≥ 88 cm for females.
Used Bayesian multivariable logistic regression models to evaluate associations across remoteness areas.
The overall prevalence of central obesity in Australian adults was 38.8%, peaking at 46.2% in Outer Regional and Remote areas compared to 36.2% in Major Cities.
Among individuals with normal BMI, central obesity prevalence was 6.7% in Outer Regional and Remote areas and 6.9% in Inner Regional areas, compared to 4.4% in Major Cities (P < 0.001).
Higher odds of central obesity in Outer Regional and Remote areas were linked to socioeconomic disadvantage (OR = 1.54; 95% CrI: 1.13, 2.13), physical inactivity (OR = 1.51; 95% CrI: 1.19, 1.93), and daily sugary drink consumption (OR = 1.38; 95% CrI: 1.08, 1.77).

Study Design

Type

Cross-Sectional (n=18,655)

Multicenter

Yes

Structured PICO

What are the prevalence and associated sociodemographic, lifestyle, and psychosocial risk factors of central obesity among Australian adults across remoteness areas?

P

Population

18,655 Australian adults aged 18 years and older (mean age 46.7 years, 51.1% female) surveyed across urban, inner regional, and outer regional/remote areas in the 2017–18 National Health Survey.

E

Exposure

Geographic remoteness (Inner Regional, Outer Regional and Remote areas) and associated sociodemographic (education below Year 12, socioeconomic disadvantage), lifestyle (physical inactivity, daily sugary drink consumption), and psychosocial (depression, anxiety, psychological distress) exposures.

C

Comparator

Major Cities and reference categories (attained Year 12 or higher, least socioeconomically disadvantaged [Quintile 5], physically active, not daily sugary drink consumers, no depression/anxiety).

O

Outcome

Prevalence and odds of central obesity, objectively defined as waist circumference ≥ 102 cm for males and ≥ 88 cm for females, including normal-weight central obesity (BMI 18.5–24.9 kg/m² with central obesity).surrogate

Main Result

Absolute Event Rate: 46.2% vs 36.2%

p-value: p=<0.001

Limitations

Cross-sectional design precludes conclusions about temporality or causality.
Self-reported explanatory variables (smoking, alcohol intake, physical activity, sugary drink consumption, depression, anxiety, psychological distress) are subject to recall, reporting, and social desirability biases.
Voluntary participation and imputation of missing physical measurement data by the ABS may introduce selection bias and measurement uncertainty.
Bayesian regression models were fitted to the unweighted analytic sample without accounting for survey weights or stratification.
Exclusion of Very Remote areas and discrete Aboriginal and Torres Strait Islander communities limits generalisability to these populations.
Cross-sectional design precludes conclusions about temporality or causality
Explanatory variables (smoking, alcohol, physical activity, sugary drinks, mental health) were self-reported and subject to recall and social desirability biases
Voluntary participation for physical measurements and ABS imputation of missing data may introduce selection bias and measurement uncertainty
Bayesian regression models were fitted to the unweighted sample without survey weights or stratification
Excluded Very Remote areas and discrete Aboriginal and Torres Strait Islander communities

Implication

Central obesity affects nearly half of adults in outer regional and remote Australia—including 1 in 15 with normal BMI—underscoring the need to incorporate waist circumference measurement alongside BMI in routine cardiometabolic risk screening.

Abstract

Regional and remote Australians have a higher burden of type 2 diabetes, hypertension, and cardiovascular diseases. Central obesity is a major risk factor for these conditions. Public health policies in regional and remote Australia often fail to address the specific needs of these communities. This study identified the sociodemographic, lifestyle, and psychosocial risk factors associated with central obesity in regional and remote Australia. We used data from the 2017–18 Australian National Health Survey, which included a total weighted sample of 18,655 adults aged 18 years and older. Central obesity was defined as a waist circumference (WC) ≥ 102 cm for males and ≥ 88 cm for females. Bayesian multivariable logistic regression models were used to estimate associations between sociodemographic, lifestyle, and psychosocial factors and central obesity across remoteness areas. The overall prevalence of central obesity in Australian adults was 38.8%, with the highest prevalence observed in Outer Regional and Remote areas (46.2%). Among adults with normal BMI, the prevalence of central obesity was 6.7% in Outer Regional and Remote areas. In Inner Regional areas, adults who did not complete Year 12 (OR = 1.27; 95% CrI: 1.09, 1.50), lived in the most socioeconomically disadvantaged areas (OR = 1.71; 95% CrI: 1.26, 2.34), were physically inactive (OR = 2.15; 95% CrI: 1.73, 2.69), or had depression (OR = 1.96; 95% CrI: 1.49, 2.60) had higher odds of central obesity. In Outer Regional and Remote areas, socioeconomic disadvantage (OR = 1.54; 95% CrI: 1.13, 2.13), physical inactivity (OR = 1.51; 95% CrI: 1.19, 1.93), and daily sugary drink consumption (OR = 1.38; 95% CrI: 1.08, 1.77) were also associated with higher odds of central obesity. Central obesity is more prevalent among adults in regional and remote Australia, including among adults not classified as obese by BMI. Approximately one in fifteen adults with normal BMI in Outer Regional and Remote areas had central obesity, highlighting a subgroup that may be missed by BMI-based assessment alone. These findings support targeted regional and remote health strategies that promote physical activity, reduce sugary drink consumption, address socioeconomic disadvantages, and integrate mental health considerations into cardiometabolic risk prevention.

Discussion

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Cite This Study

Aychiluhm et al. (2026) conducted a cross-sectional in Central obesity (n=18,655). Residence in regional and remote areas, socioeconomic disadvantage, physical inactivity, and psychosocial factors vs. Major cities and favorable sociodemographic/lifestyle reference groups was evaluated on Central obesity (waist circumference ≥ 102 cm for males and ≥ 88 cm for females) (p=<0.001). Outer Regional and Remote Australian adults had a higher prevalence of central obesity than those in Major Cities (46.2% vs 36.2%, p<0.001), including 6.7% among those with normal BMI.

synapsesocial.com/papers/6ad9a724361370fd88dbba85 https://doi.org/10.1186/s12889-026-29863-z

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Central obesity in regional and remote Australian adults: a population-based Bayesian study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Central obesity in regional and remote Australian adults: a population-based Bayesian study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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