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Health News of Monday, 16 February 2015


Obesity in the Ghanaian society

Once upon a time, overweight and obesity were uncommon among the Ghanaian population but that is no longer the case. Over the last few decades, overweight and obesity have been increasing gradually among Ghanaians.

The results of a study published in 1997 shows that in the late 1980s, less than one out of 100 adult Ghanaians were obese. By 2003, another study found that about one in six adult Ghanaians were obese.

Obesity is assessed using an indicator called body mass index (BMI). The BMI method is used as an international standard of assessing obesity among adult populations. The index is calculated using an individual’s weight and height. To obtain BMI, the weight of an individual in kilogramme is divided by his/her height in meters squared.

The rising prevalence of overweight and obesity is a major health concern because overweight and obesity pose major health and economic challenges to individuals, families, societies and nations at large.

The World Health Organisation uses standard cut-off points to classify individuals based on their BMI. An individual with a BMI less than 18.50kg/m2 is underweight; an individual with a BMI between 18.50 - 24.99 kg/m2 is of normal weight; an individual with a BMI between 25.00 - 29.99 kg/m2 is overweight, while an individual with a BMI of 30.00kg/m2 or more is obese.

The results of periodic nationwide surveys show that overweight and obesity among Ghanaian women have been increasing steadily since 1993. Even though the prevalence of overweight and obesity is increasing among the general population, different sections of the Ghanaian population are affected differently. While females, urban dwellers, the highly educated, the wealthy and those who are married have higher levels of overweight and obesity, males, rural dwellers, the less educated, the poor and those who are not married have lower levels of overweight and obesity.

Obesity is also less common in the northern part of Ghana compared to the southern part. Among the 10 administrative regions, the Greater Accra Region has the highest prevalence of overweight and obesity.Some reasons why there is a north-south divide in the prevalence of obesity in Ghana is the level of urbanisation.

The southern part of the country is more urbanised than the north. Accompanying the differences in urbanisation is the difference in lifestyle behaviours. Physical activity level, for instance, is higher in the north due to greater engagement in agricultural types of occupation and manual commuting patterns, including walking or riding bicycles. Also, people in the north consume more green leafy diets than people in the south.

Risk factors

Overweight and obesity are risk factors for conditions such as diabetes, hypertension, heart diseases, stroke and some cancers. Individuals who are overweight or obese have a higher risk of developing these conditions and once individuals develop these conditions, they live with it for the rest of their lives.

The financial cost of treating conditions such as diabetes puts families of affected individuals under socio-economic stress. The national healthcare expenditure also increases as the healthcare system needs to be adequately resourced with medication, equipment and personnel for the treatment of these conditions.

Overweight and obesity are the results of two principal factors; poor dietary practices and physical inactivity which lead to the accumulation of excess fat in the body. Physical activity helps to burn the excess fat in the body, while poor dietary practices on the other hand lead to the accumulation of excess fat. The consumption of foods with a lot of fat, salt, oil or sugar content increases the risk of overweight and obesity.

Processed foods such as sweetened carbonated drinks, white bread, refined sugar, refined oil and polished grains have high energy contents. The consumption of such food items increases the risk of obesity.With the ongoing processes of globalisation and urbanisation, processed foods have become more abundant and affordable, especially, for the poor.

The results of a study conducted between November 2011 and June 2013 in three urban poor communities (James Town, Ussher Town and Agbogbloshie) in Accra indicate that an increase in the availability of convenience stores in these communities increases the risk of obesity among residents.

The type of physical activities people engage in has been changing over time due to changes in both work and recreational physical activity. More people are increasingly engaging in sedentary types of work as more and more people move from occupations that involve expending energy e.g.agriculture to occupations that involve expending little or no energy.

Also, people are increasingly engaging in recreational or leisure-time activities that do not involve physical activity e.g. spending long hours watching television. The reliance on motorised means of transportation instead of walking has also contributed to a reduction in physical activity levels among the general population. These changes in physical activity coupled with the increased consumption of energy-dense foods could exacerbate the problem of overweight and obesity among Ghanaians.

Socio-cultural perceptions

Another potential contributing factor to the problem of overweight and obesity is the socio-cultural perception about body size and certain social behaviours. In some African cultures, being fat is associated with beauty, wealth and prestige. These socio-cultural perceptions and preference for large body sizes have been found to be associated with a higher risk of overweight and obesity.

A study conducted among adult women in the Kumasi metropolis in 2014 shows that preference for large body size could contribute to a high prevalence of overweight/obesity.

Certain lifestyle behaviours such as eating western-type fast foods is seen as living a luxurious life and the rich are usually found consuming such foods. However, the poor are also consuming foods such as “check-check” which may not be as expensive as the western-type fast foods but which are equally energy-dense and may contribute to overweight/obesity.

Other lifestyle behaviours, including alcohol consumption, also contribute to the risk of overweight/obesity.These socio-cultural behaviours and unhealthy lifestyle behaviours have the potential to contribute to overweight/obesity even if they are deemed prestigious.

Ghanaians can reduce the risk of becoming overweight or obese by adopting healthy lifestyle behaviours.People should engage in physically activity, both at work and during their leisure-time. Making basic changes in our daily activities e.g. walking to short destinations instead of driving and taking the stairs can be an avenue for physical activity. Engaging in a regular physical activity routine e.g. jogging or aerobics can help reduce the risk of overweight/obesity.

Changes in our physical activity patterns should be combined with changes in our dietary practices. People should consume whole and unpolished grains instead of polished grains. The consumption of food items such as refined white sugar and white bread should be replaced with the consumption of brown sugar and bread made from unrefined flour. The consumption of refined carbohydrates should also be replaced with the consumption of complex unrefined carbohydrates.

Oil consumption should be minimised. Cooking methods such as grilling or boiling can be used in cooking food instead of frying. Excessive consumption of alcohol should also be avoided.

Overweight and obesity are conditions that can be prevented by practising healthy lifestyle behaviours. Ghanaians should live healthy, check their weight regularly and maintain a normal weight to prevent becoming overweight or obese.

The writer is a researcher at the Regional Institute for Population Studies, University of Ghana.