Background: Central obesity nowadays is becoming a chronic non-communicable disease that is an indicator of mortality and morbidity. ‎In Ethiopia obesity becomes a major public health problem. As far as we are concerned, there is no evidence in the study area on the prevalence of central obesity and factors affecting central obesity. Objective: To assess the magnitude of central obesity and its associated factors among adults aged 18-64 years in Debre Tabor Town, northeast, Ethiopia, 2021. Methods: A community-based cross-sectional study was conducted. A total of 616 study participants were included in this study. Systematic random sampling was employed to select the study participants. Waist circumference was measured to declare central obesity. The level of physical activity was measured using the global physical activity questionnaire (GPAQ). Depression, Anxiety and Stress Scale (DASS-21) was used to screen depression among adults. Data were entered using EpiData and analyzed using STATA/MP version 16 software. Bi-variable and multivariable logistic regression was employed to identify factors affecting central obesity. A P-value less than 0.05 was used to declare statistical significance. Results: A total 582 study participants recruited with a response rate of 94.48%. The overall prevalence of central obesity among adults in Debre Tabor town 37.80% (95% CI: 33.94 – 41.82). Higher prevalence of obesity was observed among females (55.08 %) than male adults (26.01%). Female sex (Adjusted odds ratio (AOR) = 5.81, 95% Confidence interval (CI): 3.01 – 11.20), aged 18 - 35 years (AOR = 3.84, 95% CI: 2.30 – 6.41), aged 56-64 years (AOR = 5.90, 95% CI: 2.76 – 12.64), mild depressed (AOR = 9.72, 95% CI: 3.99 – 23.64) , and physical inactive (AOR = 1.58, 95% CI:1.01 – 2.51) were had high odds for central obesity; while daily labor workers (AOR =0.43, 95% CI: 0.20 – 0.91) was low odds for central obesity. Conclusion: More than one-third of adults in Debre Tabor town had central obesity. Physically inactive and mild depression were modifiable factors for central obesity. Age and sex were non-modifiable factors for central obesity. Individuals and policymakers should give prior attention to modifiable factors for central obesity. Health promoters and policymakers should give primary attention for females. Keywords: Central Obesity, Central Obesity, Physical Activity, Adults, Ethiopia.