title: Prevalence of overweight and obesity and perception of healthy and desirable body size in urban, Ghanaian women.
abstract: OBJECTIVE
  To determine if the perceived ideal body size of urban women in Accra, Ghana influences current body size.
  
  
  METHODS
  The sample (n=2,814) consisted of Ghanaian women aged 18 years and older, living in the Accra Metropolitan Area. Data were collected between October 2008 and June 2009 in the Women's Health Study of Accra, Wave II household survey. Height (m), weight (kg), waist (cm) and hip (cm) measurements were used to calculate body mass index (BMI, measured in kg/m(2)), waist circumference, and waist-to-hip ratio. In addition to reported socio-demographic characteristics, medical history, and exercise and diet history, the standardized Stunkard Figure Rating Scale (FRS) was used to identify silhouettes of varying body sizes that most closely resemble a woman's current body image (CBI), the body image she sees as the ideal for Ghanaian women (IBI), and the body image she sees as healthiest (HBI). The validity of using the standardized Stunkard FRS to assess body image in a population of Ghanaian women was assessed using Receiver Operating Curve (ROC) analysis. Household wealth, a proxy for income, was assessed using an index derived by principal components analysis from a selection of 20 variables measuring quality of the dwelling (e.g water source, sewage arrangements, type of housing, roof etc.) and possession of household durable goods (e.g. television, radio, iron, refrigerator and car).1 Logistic and linear regression was used to test the association between various socio-demographic characteristics, BMI and body image satisfaction.
  
  
  RESULTS
  Using the WHO criteria for BMI, 3.6% (95) of women were underweight, 31.5% (828) normal weight, 27.8% (730) overweight and 37.1% (973) obese. In total, 64.9% of women sampled were either overweight or obese. A WC of greater than 88 cm revealed 78.7% (2,113) obesity. A WHR cut-off for obesity of 0.8 revealed 78.9% (2,119) obesity. ROC analysis confirmed the validity of using the standardized Stunkard FRS to assess body image in a population of Ghanaian women. Age, relative wealth, being married, having grown up in an urban environment and having parity >2 are associated with higher risk of overweight or obesity. Education level is not associated with overweight status. Overall, 72.2% (1,936) of women were dissatisfied with their current body size and 41.8% of women preferred a smaller figure. Overweight and obese women were significantly more likely than normal weight women to desire weight loss (OR: 10.12, CI: 8.04 - 12.72).
  
  
  CONCLUSIONS
  Ideal body image in urban, Ghanaian women should not be viewed as an inhibitor to healthy weight maintenance. Interventions should be designed to help women achieve their ideal and healthy weights.
authors.affiliation: Harvard School of Public Health, Boston, MA, USA. r.benskeser@gmail.com
authors.forename: R M
authors.initials: RM
authors.lastname: Benkeser
authors.forename: R
authors.initials: R
authors.lastname: Biritwum
authors.forename: A G
authors.initials: AG
authors.lastname: Hill
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001828:Body Image / Q000523:psychology*; D015992:Body Mass Index; D049628:Body Size; D005260:Female; D005869:Ghana / Q000453:epidemiology; D006801:Humans; D016014:Linear Models; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology*; D050177:Overweight / Q000453:epidemiology*; D015995:Prevalence; D025341:Principal Component Analysis; D012372:ROC Curve; D013851:Thinness / Q000453:epidemiology