Epidemiology of Obesity in Croatia - Eh - Uh 2 Study

Objective: Obesity is a chronic disease and a major driver of cardiometabolic morbidity, including arterial hypertension. Despite traditionally healthier dietary patterns, Mediterranean and Eastern European countries report high and rising obesity prevalence. Up-to-date, nationally representative data are essential to identify high-risk groups and inform targeted prevention strategies. This study aimed to provide contemporary estimates of general and central obesity among adults in Croatia and to examine differences by gender, geographic region, and urban–rural residence. Design and method: This cross-sectional analysis was conducted within the nationwide EH-UH 2 project and included a representative sample of non-institutionalized adults from urban and rural areas across continental and Mediterranean regions. Standardized measurements of body height, weight, and waist circumference were performed. Body mass index (BMI) categories were defined according to World Health Organization criteria, and central obesity was assessed using gender-specific waist circumference thresholds. Results: Overall, 40.4%, 30.4% and 27.9% of participants were overweight, obese, and had normal BMI, respectively. Men showed a higher prevalence of both overweight (48.2% vs. 35.9%; p<0.001) and obesity (32.9% vs. 29.7%; p=0.226) compared with women. Rural residents had a lower prevalence of normal weight and a higher prevalence of severe obesity than urban residents. Marked regional variation was observed: Mediterranean regions demonstrated the most favourable anthropometric profile, whereas inland continental regions—particularly North-west Croatia—had the highest burden of excess body weight. Central obesity was highly prevalent nationwide, with women more frequently classified in the highest waist circumference risk category (65.2% vs. 59.9%; p=0.055), although gender differences varied across regions. Conclusions: Excess BMI and abdominal obesity are highly prevalent among Croatian adults, with pronounced disparities by gender, region, and urban–rural residence. Continental vs. Mediterranean, and rural vs. urban populations bear a disproportionate burden. Central adiposity particularly affects men. These findings underscore the urgent need for regionally adapted and gender-responsive public health strategies to reduce obesity-related cardio-kidney-metabolic and hypertensive risk.