The Local Food Environment and Body Mass Index among the Urban Poor in Accra, Ghana.
Obesity in the sub-Saharan Africa region has been portrayed as a problem of affluence, partly because obesity has been found to be more common in urban areas and among the rich. Recent findings, however, reveal rising prevalence among the poor particularly the urban poor. A growing body of literature mostly in Western countries shows that obesity among the poor is partly the result of an obesogenic-built environment. Such studies are lacking in the African context. This study examines the characteristics of the local food environment in an urban poor setting in Accra, Ghana and further investigates the associated risk of obesity for residents. Data on the local food environment was collected using geographic positioning system (GPS) technology. The body mass indices (BMI) of females (15-49 years) and males (15-59 years) were calculated from measured weight and height. Data on the socio-demographic characteristics and lifestyle behaviors of respondents was also collected through a household survey. Spatial analysis tools were used to examine the characteristics of the local food environment while the influence of the food environment on BMI was examined using a two-level multilevel model. The measures of the food environment constituted the level 2 factors while individual socio-demographic characteristics and lifestyle behaviors constituted the level 1 factors. The local food environment in the study communities is suggestive of an obesogenic food environment characterized by an abundance of out-of-home cooked foods, convenience stores, and limited fruits and vegetables options. The results of the multilevel analysis reveal a 0.2 kg/m(2) increase in BMI for every additional convenience store and a 0.1 kg/m(2) reduction in BMI for every out-of-home cooked food place available in the study area after controlling for individual socio-demographic characteristics, lifestyle behaviors, and community characteristics. The findings of this study indicate that the local food environment in urban poor Accra is associated with increased risk of obesity through providing access to convenience stores. In order to reduce the risk of obesity in these urban poor communities, there is the need to regulate the availability of and access to convenience stores while also encouraging healthier offerings in convenience stores.
Regional Institute for Population Studies, University of Ghana, P.O. Box LG 96, Legon, Accra, Ghana. phydeliadake@gmail.com.
Fidelia A A
FA
Dake
Department of Anthropology and Carolina Population Center, University of North Carolina at Chapel Hill, CB # 8120, 137 East Franklin St., Chapel Hill, NC, 27516, USA.
Amanda L
AL
Thompson
Department of Nutrition and Carolina Population Center, University of North Carolina at Chapel Hill (UNC), CB # 8120, 137 East Franklin St., Chapel Hill, NC, 27516, USA.
Shu Wen
SW
Ng
Department of Geography and Resource Development, University of Ghana, P.O. Box LG 59, Legon, Accra, Ghana.
Samuel
S
Agyei-Mensah
Regional Institute for Population Studies, University of Ghana, P.O. Box LG 96, Legon, Accra, Ghana.
Samuel N A
SN
Codjoe
D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D004777:Environment; D005260:Female; D019649:Food Industry; D005523:Food Supply; D005869:Ghana; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D011204:Poverty Areas; D036301:Qualitative Research; D058012:Small Business; D014505:Urban Population; D055815:Young Adult
Body mass index; Food environment; Ghana; Obesity; Urban poor