Determinants of obesity in Ghana

Abstract

Background There is a limited understanding of factors determining obesity in Sub-Saharan Africa, particularly Ghana. This thesis, therefore, aimed to contribute to knowledge on obesity determinants in Ghana to guide evidence-informed obesity policies. Methods Multiple approaches were used in this study. These approaches included a literature review, two stakeholder engagements, a survey, Geospatial Information Systems (GIS) techniques and regression analyses. First, a literature review was conducted to identify literature gaps on determinants of obesity to direct this study. Then, key stakeholders were engaged to prioritise the literature gaps whose exploration was critical for obesity policies in Ghana. After, a multi-stage sampling approach was used to generate a current obesity dataset to address the stakeholder-prioritised research questions. Geospatial Information Systems (GIS) techniques and regression analyses were then conducted to identify single and multi-level determinants of obesity in Ghana. Finally, the stakeholders were engaged again to explore interventions to tackle the identified obesity determinants. Results The literature review showed gaps in multi-level determinants of obesity, the interrelationship between obesity and other lifestyle behaviours and the relationship between religion, culture, and obesity. The analysis of these gaps showed that a unit increase in the number of fast-food joints and supermarkets within a shorter radius (2km & 5km) increases the odds of obesity in Ghana. Additionally, being a Muslim (correlation coefficient (r) = 0.45) or Ga (r = 0.39) is associated with a 11% and 9% increased risk of obesity, respectively. Diet and physical activity are also interconnected lifestyle determinants of obesity. These lifestyle factors are determined by factors like sex, income status and perceptions. For example, individuals who perceive obesity as an inherited condition are less likely to consume a healthy diet (r = -0.24 and engage in physical activity (r = -0.29). However, those earning 2,000 Ghana cedis and above are more likely to eat healthily (r = 0.46) and exercise (r = 0.49). Additionally, men are 16% more likely to engage in physical activity and 5% less likely to consume a healthy diet, indicating that the predictors of the lifestyle determinants are comparable but dissimilar in some instances. Finally, the thesis also showed that obesity is prevalent in Ghana (53%), and about 45% of the population are neither physically active nor consume healthy diets. Conclusion Obesity is determined by religion, ethnicity, physical activity & diet, and the local food environment. These determinants could be mitigated by a trade-off between awareness campaigns and economic regulations, like taxation and food subsidies. Therefore, the government of Ghana and other relevant agencies should factor in these determinants and interventions when reviewing and implementing obesity policies in Ghana.