University of Ghana http://ugspace.ug.edu.gh
REGIONAL INSTITUTE FOR POPULATION STUDIES 
UNIVERSITY OF GHANA, LEGON 
 
 
 
DETERMINANTS OF OVERWEIGHT AND OBESITY AMONG THE YOUTH IN 
GHANA 
 
 
 
 
BY 
 
 
DANIEL KWAME YIN 
10286290 
 
 
A DISSERTATION SUBMITTED TO THE UNIVERSITY OF GHANA, LEGON 
IN PARTIAL FULFILLMENT OF THE REQUIREMENT FOR THE AWARD OF 
MASTER OF ARTS IN POPULATION STUDIES DEGREE 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
NOVEMBER 2020 
University of Ghana http://ugspace.ug.edu.gh
DECLARATION 
 
I, DANIEL KWAME YIN, hereby declare that, except for references to other people's 
work, which have been duly acknowledged, this is the result of my research, and it has been 
neither in part nor in whole been presented for another degree. 
 
 
 
 
 
……………………………………… 
DANIEL KWAME YIN 
20 NOVEMBER 2020 
 i 
University of Ghana http://ugspace.ug.edu.gh
ACCEPTANCE 
 
Accepted by the Regional Institute for Population Studies (RIPS), College of Humanities, 
University of Ghana, Legon, in partial fulfillment of the requirements for the award of the 
degree of Master of Arts in Population Studies. 
 
 
 
 
 
 
 
SUPERVISOR: DR. FIDELIA A. A. DAKE                            DATE: 20 NOVEMBER, 2020 
 
        
 ii 
University of Ghana http://ugspace.ug.edu.gh
DEDICATION 
 
This dissertation is dedicated to my Dad, Mum, and Siblings. May the good Lord richly 
bless you.
 iii 
University of Ghana http://ugspace.ug.edu.gh
ACKNOWLEDGEMENTS 
 
 
I am grateful to the almighty God for seeing me through the beginning to the end of this 
stage of my academic journey. I am extremely grateful to my supervisor, Dr. Fidelia Dake, 
who diligently gave me guidance and support right from the beginning of the study to the 
end. This study would not have been done without her professional academic input. 
 
I also want to acknowledge the great contributions from my parents, Mr. and Mrs. Yin, my 
brothers, Patrick and Peter Yin, and their wives, Ama and Lillian Yin. Your support and 
prayers have made this come true. 
 
I also want to show my profound gratitude to Mr. Charles Kwapong and his family, Mrs. 
Duchess Hinson, and her family for their immense support, and encouragement during my 
stay on campus. 
 
To my friends at work and home, thank you for your encouragement. To Charles Asabere, 
Martin Agyekum, and Evans Kurubuni. Thank you for your assistance and suggestions. May 
God richly bless you. I also want to thank all the lecturers at RIPS, staff, and Ph.D. students 
for their guidance and support during my stay here. 
 
Finally, to my colleagues at RIPS (2019/2020 academic year), I appreciate having you 
around as a family. The unity and togetherness we shared will be forever remembered. 
 iv 
University of Ghana http://ugspace.ug.edu.gh
TABLE OF CONTENTS 
DECLARATION .................................................................................................................... i 
ACCEPTANCE ..................................................................................................................... ii 
DEDICATION ..................................................................................................................... iii 
ACKNOWLEDGEMENTS .................................................................................................. iv 
TABLE OF CONTENTS ...................................................................................................... v 
LIST OF TABLES ............................................................................................................... ix 
LIST OF FIGURES ............................................................................................................... x 
LIST OF ABBREVIATIONS ............................................................................................... xi 
ABSTRACT ........................................................................................................................ xii 
CHAPTER ONE .................................................................................................................... 1 
INTRODUCTION ................................................................................................................. 1 
1.0 Background .................................................................................................................. 1 
1.1 Statement of the Problem ............................................................................................. 4 
1.2 Rationale of the Study ................................................................................................. 6 
1.3 Research Questions ...................................................................................................... 8 
1.4 Objectives .................................................................................................................... 8 
1.4.1 General Objective .................................................................................................. 8 
1.4.2 Specific Objectives ................................................................................................ 8 
1.5 Organisation of the Study ............................................................................................ 8 
CHAPTER TWO ................................................................................................................... 9 
 v 
University of Ghana http://ugspace.ug.edu.gh
LITERATURE REVIEW ...................................................................................................... 9 
2.0 Introduction .................................................................................................................. 9 
2.1 Concept of BMI ........................................................................................................... 9 
2.2 Socio-demographic factors, overweight and obesity .................................................. 10 
2.2.1 Age, overweight and obesity ............................................................................... 10 
2.2.2 Sex, overweight and obesity ............................................................................... 11 
2.2.3 Education, overweight and Obesity .................................................................... 12 
2.2.4 Place of residence, Obesity and Overweight ....................................................... 13 
2.2.5 Region of residence, overweight and obesity...................................................... 14 
2.2.6 Wealth quintile, overweight and obesity ............................................................. 15 
2.2.7 Occupation, overweight and obesity ................................................................... 16 
2.2.8 Marital status, overweight and obesity ................................................................ 17 
2.2.9 Religion, overweight and obesity ........................................................................ 18 
2.3 Health related risk of overweight and obesity ........................................................... 18 
2.4 Theoretical framework ............................................................................................... 19 
2.5 Conceptual Framework .............................................................................................. 22 
2.6 Hypotheses ................................................................................................................. 26 
CHAPTER THREE ............................................................................................................. 27 
METHODOLOGY .............................................................................................................. 27 
3.0 Introduction ................................................................................................................ 27 
3.1 Study Area ................................................................................................................. 27 
3.2 Data Source ................................................................................................................ 28 
 vi 
University of Ghana http://ugspace.ug.edu.gh
3.3 Study design and size ................................................................................................. 29 
3.4 Selection procedure .................................................................................................... 29 
3.5 Measurement of Variables ......................................................................................... 30 
3.5.1 Dependent variable .............................................................................................. 30 
3.5.2 Independent variables.......................................................................................... 30 
3.6 Methods of analysis ................................................................................................... 33 
3.7 Limitation of Data ...................................................................................................... 33 
CHAPTER FOUR ............................................................................................................... 34 
RESULTS ............................................................................................................................ 34 
4.0 Introduction ................................................................................................................ 34 
4.1 BMI Status of Study Sample ...................................................................................... 34 
4.2 Socio-demographic characteristics of the study sample ............................................ 34 
4.3 Association between age, overweight and obesity .................................................... 37 
4.4 Association between sex, overweight and obesity ..................................................... 38 
4.5 Association between the level of educational attainment, overweight and obesity ... 38 
4.6 Association between place of residence, overweight and obesity ............................. 39 
4.7 Association between marital status, overweight and obesity ..................................... 40 
4.8 Association between wealth quintile, overweight and obesity .................................. 40 
4.9 Association between main occupation, overweight and obesity ............................... 41 
4.10 Association between religion, overweight and obesity ............................................ 42 
4.11 Association between region of residence, overweight and obesity ......................... 42 
4.5 Socio-demographic predictors of overweight and obesity among Ghanaian youth .. 43 
 vii 
University of Ghana http://ugspace.ug.edu.gh
4.5.1 The influence of socio-demographic characteristics on overweight and obesity 
among Ghanaian youth ................................................................................................ 44 
CHAPTER FIVE ................................................................................................................. 50 
DISCUSSION OF FINDINGS ............................................................................................ 50 
5.0 Introduction ................................................................................................................ 50 
5.1 Discussion of results .................................................................................................. 50 
CHAPTER SIX ................................................................................................................... 55 
SUMMARY, CONCLUSION, AND RECOMMENDATIONS ......................................... 55 
6.0 Introduction ................................................................................................................ 55 
6.1 Summary .................................................................................................................... 55 
6.2 Conclusion ................................................................................................................. 57 
6.3 Recommendations ...................................................................................................... 58 
REFERENCES .................................................................................................................... 59 
 viii 
University of Ghana http://ugspace.ug.edu.gh
LIST OF TABLES 
 
Table 1: Measurement of Variables..................................................................................... 32 
 
Table 2: Percentage distribution of study sample by BMI status ........................................ 34 
 
Table 3: Percentage distribution of study sample by socio-demographic characteristics.... 35 
 
Table 4: Percentage distribution of Ghanaian youth by age group, overweight and obesity 
 
. ............................................................................................................................................ 38 
 
Table 5: Percentage distribution of Ghanaian youth by sex, overweight and obesity ......... 38 
 
Table 6: Percentage distribution of Ghanaian youth by level of educational attainment, 
overweight and obesity ........................................................................................................ 39 
Table 7: Percentage distribution of Ghanaian youth by place of residence, overweight and 
obesity ................................................................................................................................. 39 
Table 8: Percentage distribution of Ghanaian youth by marital status, overweight and 
obesity ................................................................................................................................. 40 
Table 9: Percentage distribution of Ghanaian youth by wealth quintile, overweight and 
obesity ................................................................................................................................. 41 
Table 10: Percentage distribution of Ghanaian youth by occupation, overweight and 
obesity ................................................................................................................................. 41 
Table 11: Percentage distribution of Ghanaian youth by religion, overweight and obesity 
 
. ............................................................................................................................................ 42 
 
Table 12: Percentage distribution of Ghanaian youth by region of residence, overweight 
and obesity .......................................................................................................................... 43 
Table 13 Results of multinomial logistic regression analysis showing the influence of 
socio-demographic characteristics of overweight and obesity among youth...................... 45 
 ix 
University of Ghana http://ugspace.ug.edu.gh
LIST OF FIGURES 
Figure 1 Socio-ecological model depicting the interaction of factors at different levels and 
their influence on overweight and obesity ........................................................................... 20 
Figure 2: A Conceptual framework for studying socio-demographic determinants of 
overweight and obesity among Ghanaian youth. ................................................................ 24 
Figure 3 Map of Ghana Showing the Administrative Regions ............................................ 28 
 x 
University of Ghana http://ugspace.ug.edu.gh
LIST OF ABBREVIATIONS 
 
BMI Body Mass Index 
CT Computerized Tomography 
DEXA Dual Energy X-Ray Absorptiometry 
GDHS Ghana Demographic and Health Survey 
GHS Ghana Health Service 
GSS Ghana Statistical Service 
IASO International Association for the Study of Obesity 
IPAQ International Physical Activity Questionnaire 
kg/m2 Kilogram Per Meter Squared 
MRI Magnetic Resonance Imaging 
NCDs Non-Communicable Diseases 
UN United Nations 
WHO World Health Organisation 
 xi 
University of Ghana http://ugspace.ug.edu.gh
ABSTRACT 
 
Overweight and obesity, and associated conditions such as hypertension and diabetes, are 
global health issues that have an enormous financial burden on individuals and families at 
large. The prevalence of obesity and overweight is growing at an alarming rate in Ghana. 
The rising prevalence of these conditions affects the quality of life, increases mortality, and 
reduces productivity in the country. Unhealthy lifestyle behaviours, such as poor dietary 
habits and sedentary activities, are some of the factors that influence overweight and obesity. 
This study examined the socio-demographic factors associated with obesity and overweight 
among Ghanaian youth and how these factors could be addressed. 
The study analysed data on 12856 youth aged 15–34 years who were interviewed in the 
seventh round of the Ghana Living Standard Survey. Obesity and overweight were 
measured using body mass index as the primary indicator. Univariate, bivariate, and 
multivariate techniques were employed in analysing the data. The overall prevalence of 
overweight and obesity was 16.1% and 9.4%, respectively. Obesity and overweight were 
more common among females (22.9% and 15.9%) compared to males (17.0% and 10.1%). 
Also, older, educated, rich, and urban-dwelling youth were found to be at a higher risk of 
being overweight or obese. At the multivariate level, females were 2.56 (p = 0.000) times 
more likely to be obese as compared to males, while youth in the richest wealth quintile 
were 1.76 (p = 0.000) more likely to be obese as compared to youth in the poorest wealth 
quintile. 
Policymakers should help increase educational campaigns on the causes and health 
consequences of obesity and overweight among youth and the general population to create 
the needed awareness about these conditions. This can help the youth adopt healthy lifestyles 
such as exercising and eating healthy foods to prevent overweight and obesity. 
 xii 
University of Ghana http://ugspace.ug.edu.gh
CHAPTER ONE 
INTRODUCTION 
 
1.0 Background 
 
The World Health Organisation (WHO) has reported that obesity and being overweight are 
some of the most blatantly visible but most neglected public health concerns that have 
become a global epidemic (WHO, 2017). Obesity has gained much attention and academic 
interest in public health discourse. This is because the global prevalence of obesity and 
overweight continues to increase among adults and children. Obesity and overweight are 
defined as the abnormal and excessive accumulation of fat that presents a health risk to an 
individual and has been identified as a risk factor for non-communicable diseases (NCDs) 
such as stroke, hypertension, type 2 diabetes, and some forms of cancer (WHO, 2010a, 
2010b). 
 
According to WHO (2017), the global prevalence of overweight and obesity among children 
and adults has increased more than four-fold between 1975 and 2016, from 4% to 18%. 
From the 1980s to the 2000s, obesity has increased more than threefold in regions such as 
North America, the United Kingdom, Australia, and China (WHO, 2003). Prentice (2006) 
further found that obesity and overweight are high among middle-aged adults but are 
increasingly affecting those in the youthful age group. In 2014, almost 2 billion young 
people aged 18 and above were projected to be overweight, of which more than 600 million 
were obese (WHO, 2017). In recent years, obesity and overweight have been viewed more 
among the adult population, yet recent reports show a developing pattern of overweight and 
obesity among children and young people. The WHO (2017) report on obesity indicated 
that, in 2014, around 41 million children under the age of five were 
 1 
University of Ghana http://ugspace.ug.edu.gh
overweight or obese. This, according to De-Onis, Blossner and Borghi (2020), was projected 
to increase to about 60 million by 2020 if trends continued unabated. 
 
The prevalence of obesity is not only limited to advanced countries; developing countries 
are also experiencing a rise in obesity and overweight (Pearce & Witten, 2010). Unhealthy 
lifestyle behaviours such as eating refined carbohydrates, fatty foods, and lack of physical 
activity are factors that can influence obesity and overweight (Arojo & Osungbade, 2013). 
 
According to scholars, obesity, overweight, and their associated conditions generally 
develop in middle age after long exposure to unhealthy lifestyle such as engaging in 
sedentary activities and poor eating habits, mostly at younger ages (Nelson et al., 2009). 
Therefore, the continuous poor eating habits and sedentary activities that individuals go 
through starting at an early age could have detrimental effects on their weight status even in 
later years (Steyn & Damasceno, 2006). Younger individuals (from the age of 15–19) going 
through the transition from adolescence to adulthood are mostly found to be engaging in 
unhealthy lifestyle behaviours. 
 
The transition of younger youth from 19 to 24 years of age to older youth aged 25–29 years 
is by rapid physical development and also vital social and mental changes (Poobalan et al., 
2012). These interactions form a complex ecological network that may predispose youth to 
developing unhealthy eating habits and activities, leading to the development of overweight 
and obesity (Poobalan & Aucott, 2016). 
 
Ghana is no exception to the increase in obesity and overweight and its associated 
conditions. Obesity and overweight, and associated conditions such as hypertension and 
diabetes, are currently among the top ten hospital-related reasons for death in the nation 
(Bosu, 2007). The treatment of overweight and obesity is placing an additional financial 
 2 
University of Ghana http://ugspace.ug.edu.gh
burden on the health system. This financial burden leads to the faster deterioration of 
inadequate health facilities and poor health service delivery that compounds to poor 
treatment of patients. Similarly, WHO (2010), reported a significant number of deaths in 
Ghana of about 86,200 related to NCDs, of which obesity has been noted to be a risk factor. 
This explains how obesity-related conditions are gradually impacting the human resources 
of the country, particularly the youth. 
 
Unhealthy lifestyles such as the increased consumption of foods that are energy-dense, high 
in salt, and refined carbohydrates are contributing to the high incidence of obesity and 
overweight in Ghana (Ministry of Health (MOH), 2007; WHO, 2015). Besides, automated 
machines and sedentary activities mainly in urban areas have replaced practices such as 
walking long distances to work and also human labour for farming (Steyn & Damasceno, 
2006). This leads to lower physical activity and less energy expenditure, which increases fat 
accumulation and contributes to the risk of being obese. The growing number of obesity-
related deaths and conditions among the youth in developing countries such as Ghana makes 
it a very important topic for research. Studies on the prevalence of obesity and overweight 
among youth would go a long way to help explore the various ways in which the problem 
can be addressed (Wells, 2012; WHO, 2017). 
 
The youth category is the most fluid category by definition. This makes it very difficult to 
find a definite age range for young people. Different countries have their own age ranges 
for which they base decisions to meet their intended objectives. According to the United 
Nations, the youth comprise people between 15 and 24 years of age who form the bulk of 
most countries' total population (UN General Assembly, 2008). Ghana has one of the largest 
youth populations, which forms one-third of the total population. In Ghana, youth are 
defined as individuals who fall within the age bracket of 15–34 years (Ghana National 
 3 
University of Ghana http://ugspace.ug.edu.gh
Youth Policy, 2010). This age group is expected to advance the current technology, 
education, politics, and peace of the country to attain growth. They are the backbone of 
every country’s development and have the power to help a country develop and move 
towards progress. So, the health problems that come with being overweight or obese, 
especially among young people, can slow down a country's progress. This is because young 
people decide the future of a country. 
 
1.1 Statement of the Problem 
 
The epidemic of obesity and overweight is growing among all age groups in the world, but 
developing countries are having to contend with some of the highest rates of people affected 
by obesity and overweight compared to developed countries (Stevens et al., 2012; Ng et al., 
2014; WHO, 2017). WHO (2005) found that about three-quarters of the obese population in 
the world will be in the developing world, and Africa is estimated to have 20–50% of its 
urban population as either overweight or obese by 2025. 
 
In terms of the impact of obesity and overweight, several studies have shown that children 
and adolescents who are obese are most likely to be obese adults (Ziraba et al., 2009; 
Freedman et al., 2009; Singh et al., 2008). The rising prevalence of overweight and obesity 
in both adults and youth is an important public health concern and is of particular interest 
because of possible long-term associations with adult weight and morbidities such as 
diabetes and hypertension, which are likely to lead to reduced quality of life (Wells, 2012). 
The economic burden of overweight and obesity on the individual, family, and nation as a 
whole is enormous, which can affect development and productivity (Dixon, 2010; Park et 
al., 2012). The rising prevalence of obesity and overweight can affect the life journey of 
youth with debilitating health conditions such as stroke as well as social and psychological 
implications such as low self-esteem and depression (Park et al., 2012; 
 4 
University of Ghana http://ugspace.ug.edu.gh
Cooke et al., 2007). This is likely to impact development negatively, which affects 
production and may lead to reduced gross domestic product (GDP). In a recent review of 
literature among youth in developing countries, the prevalence of being overweight was 
28.8%, while that of obesity was found to range between 2.3% and 12% (Poobalan & 
Aucott, 2016). 
 
In Ghana, the prevalence of overweight and obesity has increased from 0.9% in the 1980s 
to about 14.1% (Amoah, 2003). Studies in Ghana have also shown a great increase in the 
prevalence of overweight and obesity, particularly among women (GDHS, 2014; Tuoyire et 
al., 2016). Tuoyire (2020) found that there was a gradual increase in obesity and overweight 
prevalence among the adult age range of 15–24 years over a study period of 21 years. The 
rise in the proportion of obese and overweight adults was about 49% of the total adult 
population, which if not checked would have adverse effects on the nation. 
 
According to Minicuci et al. (2014), about 10% of Ghanaian youth are obese. This is a very 
critical conclusion. Having such a huge number of youth being obese would burden the 
already inadequate health facilities in the country. These obese and overweight individuals 
can be affected by poorer mental health outcomes and low self-esteem, which would affect 
their productivity in their place of work. 
 
While there have been many studies on obesity and overweight in Ghana (Dake et al., 2011; 
Doku & Neupane, 2015; Benkeser et al., 2012), literature on the prevalence of obesity and 
overweight and its associated effects on youth aged 15–34 years is limited. This gap in the 
literature is critical because the youthful stage is considered to be the period for optimal 
health and well-being as well as health promotion and disease prevention (Nelson et al., 
2008). In bridging this gap, it is vital to shed light on obesity and overweight among 
Ghanaian youth aged 15–34 years. In that regard, it is imperative 
 5 
University of Ghana http://ugspace.ug.edu.gh
to investigate the socio-demographic factors associated with obesity and overweight among 
the youth as well as the prevalence of obesity and overweight among the youth in Ghana. 
This is very vital because the high prevalence of obesity and overweight among youth leads 
to psychological issues such as depression and low self-esteem, which affect the 
productivity of such people. Those with low self-esteem often experience anxiety and self-
criticism that can lead to negative thinking, a lack of satisfying relationships, and reluctance 
to pursue future goals. The high prevalence of obesity and overweight also leads to high 
cardiovascular diseases such as stroke and high mortality, which significantly reduces the 
quality of life of the youthful population and in turn directly affects the workforce needed 
to develop the nation and contribute to resource mobilisation. Also, an additional burden is 
placed on the government to use the scarce resources to build additional health facilities to 
cater to obese patients and also import drugs to cater for these individuals. Most of these 
drugs are subsidised so that obese patients can afford them. This is one of the factors that 
lead to a high exchange rate where the government imports more than it export, which is a 
factor of high inflation, thereby slowing development. 
 
1.2 Rationale of the Study 
 
The study of obesity and overweight among youth is very imperative because it is at this 
stage that the youth need optimal health and wellbeing, so the prevention of such conditions 
needs to be important. This would help to reduce the health impact on youth and prevent 
negative health consequences. This study is important because it is during this period of 
development among youth that skills are developed for careers and aspirations, which would 
help the youth achieve their life goals. The study would provide the needed knowledge to 
help understand the different complexities and dimensions of overweight and obesity 
among youth, which would be very important for the development of effective 
 6 
University of Ghana http://ugspace.ug.edu.gh
public health strategies to manage the increasing prevalence of obesity and overweight 
conditions. 
 
Also, studies have found an association between socio-demographic factors and obesity, 
which makes this very important to examine, particularly among the youth. So, a study on 
how common obesity and overweight are among youth and the social and demographic 
factors that contribute to them would help us understand the health effects of obesity and 
overweight among youth and how to make them less common. 
 
Obesity is a threat to human life and development. The increasing prevalence of obesity and 
overweight and their associated conditions should be explored to help manage the growing 
mortality rate in the country. The prevention of obesity and overweight should be a focus 
for the country and individuals in the country because it’s a condition that one carries along 
on his or her life journey (WHO, 2010). 
 
The older population is growing in numbers and is gradually exiting the productive sectors 
of the economy due to improvements in health and technological advancements (Minicuci 
et al., 2014). This leads to a reduction of labour in the economy, which contributes to 
development. Therefore, the youthful population is needed to fill the vacuum that is left by 
the aged population, who are not economically active to continue with the developmental 
agenda of the country. 
 7 
University of Ghana http://ugspace.ug.edu.gh
1.3 Research Questions 
 
This study seeks to answer the following research questions: 
 
1. What is the prevalence of obesity and overweight among Ghanaian youth aged 15– 
34 years? 
 
2. Which socio-demographic factors are associated with obesity among the youth 
(15–34 years) in Ghana? 
 
1.4 Objectives 
 
1.4.1 General Objective 
The main aim of this study is to examine the socio-demographic factors that influence 
obesity and overweight among youth in Ghana. 
 
1.4.2 Specific Objectives 
 
1. To estimate the prevalence of obesity and overweight among Ghanaian youth aged 
15–34 years, 
2. To examine how socio-demographic factors influence obesity and overweight 
among Ghanaian youth. 
 
1.5 Organisation of the Study 
 
This study is organised into six chapters. The first chapter introduces the study and provides 
the statement of the problem, research questions, the rationale for the study, and the 
objectives of the study. The second chapter presents a review of important literature, the 
theoretical and conceptual framework, as well as the proposed hypotheses. Chapter three 
elaborates on the methodology that was used for the study. Chapter four presents the results 
that were found in the study. Chapter five discusses the findings from the results of the 
study. In chapter six, the study's results are summed up, a conclusion is reached, and 
suggestions are made based on what was found. 
 8 
University of Ghana http://ugspace.ug.edu.gh
CHAPTER TWO 
LITERATURE REVIEW 
 
2.0 Introduction 
 
This chapter reviewed the literature on the relationship between socio-demographic 
characteristics of youth and how they influence obesity and overweight among youth. The 
references to some of these studies provided avenues to access other studies. 
 
2.1 Concept of BMI 
 
Body Mass Index (BMI) is a tool that is used to measure and indicate the nutritional status 
of adults and children. BMI is an international indicator that is used to assess the general 
prevalence of obesity and overweight among the general population. It is calculated by using 
the weight of the person in kilograms divided by the squared height of that person in metres 
(WHO, 2017; Cote et al., 2013). 
 
BMI categories for adults are categorized as follows Underweight = < 18.5 Kg/m2, Normal 
weight =18.5 Kg/m2 ≤ BMI ≤ 24.9 Kg/m2, overweight = 25.0 Kg/m2 ≤ BMI ≤ 29.9 Kg/m2, 
Obese = ≥ 30.0 Kg/m2 (WHO, 2010). BMI among teenagers is expressed in relation to other 
children of the same sex and age as age and height change in relation to the body (WHO, 
2017; Gibson, 2005; Bacha et al., 2016).WHO (2020), Cote et al. (2013), and Bacha et al. 
(2016) classify BMI for children and teens ages 5 to 19 years as follows: underweight at the 
5th percentile, normal weight at the 5th to 85th percentile, overweight at the 85th to 95th 
percentile, and obese at the 95th percentile. 
 
There are various anthropometric ways of measuring body weight. The internationally 
accepted measure of obesity and overweight is the body mass index (BMI). BMI 
measurements are easier and quicker for calculating obesity and overweight status. 
 9 
University of Ghana http://ugspace.ug.edu.gh
BMI can also be measured in other ways, such as waist circumference and waist to hip ratio 
(Nyamdorj et al., 2008). The waist circumference and waist to hip ratio are used to estimate 
the abdominal fat, which is usually used to express central obesity. The waist circumference 
and waist to hip ratio measurements are mostly used to distinguish between fatness in the 
lower trunk (hip and buttocks) and fatness in the upper trunk (waist and abdominal areas). 
Due to their better accuracy in results (Gibson, 2005; Nyamdorj et al., 2008), they are mostly 
used to predict the risk of cardiovascular diseases due to their waist circumference and waist 
to hip ratio. 
 
2.2 Socio-demographic factors, overweight and obesity 
 
2.2.1 Age, overweight and obesity 
 
Weight tends to increase with age (Muhihi et al., 2012). This can be attributed to the 
transition from puberty to adulthood, which leads to more fat accumulation. As individuals 
transition to older age, there is a tendency to engage in less physical activity, which can 
predispose people to being overweight or obese (Schutzer & Graves, 2004). Also, a study 
done by Biritwum (2005) and Amoah (2003) in Ghana among people aged 18 and older 
found that the prevalence of obesity and overweight increased with age up to 60 years. The 
reason is the fact that as an individual grows older, there is a reduction in muscle mass, 
which exposes the body to fat accumulation, which predisposes an individual to obesity and 
being overweight. 
 
Musaiger et al. (2014) also found that older females aged 25 and older were more at risk of 
becoming obese and overweight than younger females. This can be attributed to older 
females who have gone through their puberty transition having accumulated more fat than 
younger females. Also, older females were more obese and overweight than younger 
females because they may have gone through various cycles of childbirth due to marriage. 
 10 
University of Ghana http://ugspace.ug.edu.gh
2.2.2 Sex, overweight and obesity 
 
The idea of having a large body size is a sign of affluence and prosperity in Ghanaian culture 
(Appiah et al., 2014). Women who are obese or overweight are more desired, admired, and 
seen as marriage prospects than slimmer women. This cultural mind-set influences women 
to eat more to achieve a certain body weight, which in the long run exposes them to obesity 
and being overweight (Cohen et al., 2013). Additionally, studies have reported that many 
Ghanaian communities show great admiration for large body sizes. Often, large body size 
is considered a sign of affluence, and women also tend to perceive this as constituting 
beauty, good health, and happiness in marriage (Appiah et al., 2014). This social and cultural 
idea of the ideal body size may be a factor in the growing number of overweight and obese 
people in the U.S. 
 
A study conducted by Biritwum et al. (2005) for ages 18 and older also found that in Ghana, 
females are more likely to be obese and overweight than males. This was attributed to less 
physical activity by the females compared to the males. In Ghana, women tend to settle for 
more sedentary occupations (e.g., table-top trading), and research has documented lower 
levels of physical activity among Ghanaian women than men. Appiah et al. (2016) looked 
at the factors that lead to overweight and obesity in a group of 18-year-old and older urban 
Ghanaian women and found that only about 21% of them were active enough. 
 
Men and women have different degrees of becoming overweight or obese. Research has 
shown that females are more likely to be overweight or obese as compared to males. This 
can be attributed to women going through the cycle of childbirth where fat is mostly 
accumulated as a result of eating more and also being less physically active during this 
period (Al-Nuaim et al., 2012). According to Ersoy & Imamoglu (2006), women are more 
 11 
University of Ghana http://ugspace.ug.edu.gh
obese and overweight than men due to the accumulation of fat deposits among females at 
an earlier stage in life during puberty when men go through more muscle development. At 
this stage, men develop higher levels of testosterone hormones than women, which helps 
with muscle growth and less fat accumulation. Because men and women have different 
hormones, this difference can be linked to obesity and being overweight in women. 
 
2.2.3 Education, overweight and Obesity 
 
Education plays a very important role in how people understand healthy living. Some studies 
have found a positive relationship between obesity and education. Education equips people 
with knowledge and information to make better healthy lifestyle decisions that would help 
reduce obesity and overweight. This can be in the form of healthy lifestyle habits such as 
eating healthy foods, less alcohol consumption and taking up sports like football (Al-Haqwi 
et al., 201; Bharmal et al., 2013; Memish et al., 2014). Studies by Dinsa et al. (2012), 
Neuman et al. (2013), and Doku & Neupane (2015) conclude that education plays a role in 
predisposing an individual to becoming obese and overweight. Education empowers 
individuals to get better jobs, which enables them to have a higher income and gives them 
the ability to access and consume more, as can be seen through the purchase of fast foods. 
This, however, would lead to higher obesity and overweight prevalence. 
 
Biritwum et al. (2005) looked at people in Ghana who were 18 years old or older and found 
that people with tertiary education were more likely to be obese or overweight than people 
with little or no education. 
 
A study by Anyanwu et al. (2010) in Nigeria among the Ibos found among the youth aged 
20 and older an inverse association between education and the chances of being obese and 
overweight among the youth. The study found that a year of education reduces the chances 
 12 
University of Ghana http://ugspace.ug.edu.gh
of being overweight and obese and that education enables the young to make better decisions 
on healthy living to reduce the risk of becoming obese and overweight. For instance, the 
costs of being overweight or obese, in terms of the reduced labour market or marriage 
opportunities, seem to be higher for women than for men. So, education helps a person get 
better access to information about how to live a healthy life, which lets them make better 
decisions and choices that can help keep them from getting sick from being overweight. 
 
2.2.4 Place of residence, Obesity and Overweight 
 
The location of an individual can influence their obesity and overweight status. Studies by 
Amoah (2003) in Ghana among older adults 25 years and older found that rural dwellers 
had lower obesity and overweight rates than urban dwellers. The lower rate of obesity 
among rural dwellers was a result of long-distance walking to farms to work on farm lands 
due to less access to the use of automobiles. Walking and working on farms use up more 
energy, which helps keep young people in rural areas from becoming overweight or obese. 
People in urban areas are more likely to own cars and board vehicles rather than walk, and 
this has resulted in lower physical activity levels in urban areas compared to rural areas, 
where people walk over long distances to the farm or to fetch water. As a result, urban 
dwellers are more susceptible to becoming overweight and having an obese prevalence due 
to little to no physical activity. This gives credence to the westernisation and urbanisation 
theory. 
 
A study by Dake et al. (2011) in Ghana among women aged 15–49 years on the socio- 
demographic factors that can influence obesity found that women who leave the urban areas 
were more likely to be obese than women who leave the rural areas. This can be attributed 
to urbanisation and westernisation theory. The westernisation theory states that 
 13 
University of Ghana http://ugspace.ug.edu.gh
due to globalization, a western diet has been adopted in the country, which involves foods 
high in saturated fat, refined sugar, refined grains, and less consumption of fruits and 
vegetables, which predisposes an individual to becoming obese and overweight. Women 
who live in urban areas are more predisposed to becoming obese and overweight due to the 
consumption of and easier access to these foods high in fat and sugar. A study by Al- Nsour 
et al. (2013) among Jordanian women aged 15–49 years found that women who live in the 
rural areas are more likely to be obese and overweight as compared to women who live in 
the urban areas. The key to women in the rural areas being obese and overweight was that 
they had better economic power than the women in the rural areas. Economic power gives 
urban women the ability to purchase and consume more than their fellow women living in 
rural areas. This, in the long run, increases the weight of women in urban areas. 
 
2.2.5 Region of residence, overweight and obesity 
 
According to research by Dake et al. (2011) among Ghanaian women aged 15–49 years, 
there is an increase in obesity and overweight prevalence in the three northern regions of 
Ghana. This can be attributed to the low economic status of women who consume more 
foods such as refined carbohydrates and frozen meat products. Because of globalisation and 
open market economies, people in these areas are more likely to adopt Western lifestyles 
and eat high-energy foods like refined fat, sugar, and salt. This is why the number of obese 
and overweight people is rising. 
 
A study by Ofori-Asenso et al. (2016) in Ghana among adults 18 years and older found that 
obesity was highest in more developed regions than in developing regions. Greater Accra 
had the highest obesity prevalence of 30.1%, the Ashanti region at 26.9%, the Northern 
region at 21.9%, and the Central region at 16.0%. In recent times, more 
 14 
University of Ghana http://ugspace.ug.edu.gh
Ghanaians are exposed to changes in telecommunication, transportation, and exposure to 
global markets. (Agyei-Mensah et al., 2010; Agbeko et al., 2013) These factors have led to 
drastic changes in lifestyle, such as eating more foods from the West and being less active. 
These changes have gained a lot of momentum, especially in these major regions of Ghana. 
 
2.2.6 Wealth quintile, overweight and obesity 
Studies have shown that there is a positive correlation between income status and obesity 
and being overweight (Agbeko et al., 2013). Agbeko et al. (2013) postulated that 
Ghanaian women 15 years and older who have greater wealth can access and consume 
more food that exposes them to overweight and obesity conditions. Wealth enables people 
to afford luxury foods (meat, fried foods such as chips, sugar, and chocolate) regularly. 
Individuals who consume these fast foods regularly are at risk of becoming overweight or 
obese (Renzaho, 2004). Moreover, evidence suggests that in Ghana, most fast-food joints 
and restaurants are crowded in wealthy neighbourhoods and tend to target high-class 
clients (Omari et al., 2013). Agyei-Mensah and de-Graft Aikins (2010) also report that 
among the working (middle to high class) population in Ghana, aged 18 and older, there is 
an emerging trend of individuals working late or hanging out at after-work bars to beat the 
heavy evening traffic. These practices are implicated in late eating and increased alcohol 
intake, and by extension, increased obesity and overweight conditions. 
 
In a study among youth in developing countries aged 18 and older, Dinsa et al. (2012) found 
that youth with lower socioeconomic status were more likely to become obese and 
overweight. This can be attributed to young people with lower incomes purchasing and 
consuming more cheap foods such as refined carbohydrates, red meat, and high-sugar foods 
that contribute to obesity and overweight. The fast growth of globalisation and open 
 15 
University of Ghana http://ugspace.ug.edu.gh
market economies has made it easier for these kinds of products to be sold and consumed 
in these areas, which has led to a rise in the number of obese and overweight people. 
 
In his study of obesity in developed and developing countries, Mclaren (2007) found that 
men and women aged 25 and older in developed countries with higher socioeconomic status 
are less likely to be obese and overweight as compared to those with lower socioeconomic 
status. In developed countries, wealthy people can afford nutritious food, but they are under 
greater social pressure to remain slim, and they have more opportunities along with greater 
prospects for physical fitness. On the other hand, Agbeko et al. (2013) in their study in 
Ghana among women aged 15–49 years found a positive relationship between wealth status 
and obesity and overweight. In a country like Ghana, where the rich are expected to put on 
weight as proof of their success and prestige, chubbiness in successful individuals is 
expected. This is due to the increased income and purchasing power of women. 
 
2.2.7 Occupation, overweight and obesity 
 
Occupation can determine the obesity and overweight status of a person. Scott (2012) found 
that sub-Saharan countries such as Ghana are experiencing a high rate of urbanisation and 
globalisation, which is changing the more manual occupation of farming into more 
sedentary occupations such as legislators, managers, and bankers. These jobs are more 
sedentary, which means they use less energy and make people more likely to become obese 
or overweight. 
 
Abdulai (2010) in his study of Ghanaian women 18 years and older in Accra found that 
people who are involved in highly demanding physical occupations such as farming and 
fishing are less likely to be obese and overweight as compared to people with no occupation 
or women who sell at the market. When compared to selling in the market, 
 16 
University of Ghana http://ugspace.ug.edu.gh
farming and fishing use more energy, which keeps people from becoming overweight or 
obese. 
 
A study by Ofori-Asenso et al. (2016) in Ghana found globalisation has changed the 
landscape of the Ghanaian transportation and telecommunication system. People are getting 
their food delivered, and cars have become the most common way to get to their 
destinations. These changes in lifestyle make it more likely for people to be overweight or 
obese because they spend so much time sitting down and don't do much physical activity. 
 
In their study in the United States among adults 18 years and older, Bonauto et al. (2014) 
found that occupations that are more physically demanding, involving heavy labour and 
sports, had significantly lower obesity and overweight prevalence as compared to those with 
less physically demanding occupations such as sales. Sportsmen and women are always 
expending energy through training and competitions, which safeguards them against 
becoming obese or overweight. The study also postulated that adults who work in the sales 
industry are more likely to be obese and overweight due to long hours of sitting, which is 
less physically demanding. 
 
2.2.8 Marital status, overweight and obesity 
 
In their research in Ghana among urban women aged 18 and older, Appiah et al. (2014) 
found that the marital status of a woman influences her obesity and overweight status. At 
this stage of married life, couples tend to do house chores together, such as washing and 
cleaning, which would reduce the energy expenditure an individual would have used to 
complete such chores, which leads to obesity and being overweight. Married couples also 
tend to eat together, which can increase the desire to consume more food. According to 
Agbeko et al. (2013), Ghanaian women, 15 years and older, who are married tend to have 
higher obesity and overweight prevalence as compared to women who have never been 
 17 
University of Ghana http://ugspace.ug.edu.gh
married. Married women have financial support from their husbands, which gives them 
access to purchase and consume more. This could be because married women made and ate 
a lot of food when they were pregnant, which made them gain weight. 
 
In their study of Ghanaian women aged 15–49 years, Dake et al. (2010) found a relationship 
between married women and obesity and overweight conditions. In Ghana, where most 
married women live, being overweight and obese is seen as a sign of beauty, health, and 
status. This is why many married women in Ghana are overweight. 
 
A recent study by Agne et al. (2012) among Latino women aged 19 and older, irrespective 
of their marital status, found a gradual change in the cultural perception of weight gain that 
is associated with beauty and prestige. This is due to the health-related consequences 
associated with obesity and being overweight. So, women want to live in a healthy way and 
are willing to lose weight to avoid diseases like diabetes and heart attacks that are linked to 
obesity. 
 
2.2.9 Religion, overweight and obesity 
 
Religious practices affect the lives of people through diverse ways of teaching and 
practicing. Studies by Amo-Adjei & Kumi Kyereme (2014) found a relationship between 
the Christian and Muslim faith and the prevalence of obesity and being overweight. Most of 
these Muslim and Christian platforms are used to promote healthy lifestyles that guard 
against obesity and overweight. Muslims are told to eat more fruits and vegetables during 
Ramadan, which can affect whether or not they are overweight or obese. 
 
2.3 Health related risk of overweight and obesity 
 
Obesity and being overweight are conditions that lead to non-communicable diseases such 
as strokes, heart attacks, high blood pressure, etc. These noncommunicable diseases cause 
 18 
University of Ghana http://ugspace.ug.edu.gh
a slew of health issues for individuals. Obesity or being overweight is a combination of 
different factors such as dietary patterns, culture, and physical activity. (Van Cleave et al., 
2010; Swinburn et al., 2011) This has become a global health problem that needs to be dealt 
with to stop the rise in sickness and death around the world. 
 
Overweight and obesity affect all categories of people: infants, adolescents, and adults. 
People in these groups are more likely to get diabetes, cognitive heart failure, prostate cancer 
(in men), and colorectal cancer because they are overweight or obese (WHO, 2010). 
 
Obesity and being overweight harm pregnant women and their unborn children. Such 
women are at risk of developing health conditions such as gestational diabetes and 
preeclampsia. This also affects their children, who might get non-communicable diseases 
like heart problems as they get older (Mighty & Fahey, 2007). 
 
2.4 Theoretical framework 
 
The socio-ecological framework is a framework for explaining the interaction of personal 
and environmental factors that determine behaviour. The framework conceptualises and 
integrates the built environment as a mediator of obesogenic behaviour (Richard et al., 
2011). The socio-ecological model shows obesity at the individual level as an outcome of 
the interaction between an individual’s characteristics (age, sex, genetics, dietary habits), 
and interpersonal factors (culture, family, peers), organisational factors, and the built 
environment (the built environment includes the natural and manmade environment where 
physical activity is performed). The physical environment comprises the availability and 
access to playgrounds, sports facilities, gyms, etc. At the policy level, laws are made on the 
types of food that can be imported and accessed in the country, which affects energy 
consumption and expenditure where they are accessed. 
 19 
University of Ghana http://ugspace.ug.edu.gh
 
 
 
 
 
Figure 1 Socio-ecological model depicting the interaction of factors at different levels and their influence on overweight and obesity. 
Source: Willows et al., 2012 
 
 
 
20 
 
University of Ghana http://ugspace.ug.edu.gh
The socio-ecological model explains the network of interactions between factors at different 
levels acting together to influence energy balance at the individual level. Applying the socio-
ecological model to the conceptualisation of obesity research highlights the need to examine 
the factors beyond the individual level that influence obesity. For example, in understanding 
weight-related conditions among Aboriginal children in Canada, Willows et al. (2012) 
applied the socio-ecological framework to explain obesity. Willows et al. (2012) in 
explaining the prevalence of obesity among Aboriginal children in Canada saw several 
factors operating at different levels, including individual-level factors, interpersonal factors 
(family, peers), the built environment, societal factors, and historical factors. At the 
individual level, the main issue deals with the knowledge and skills the person have about 
obesity and being overweight, which would help him or her to understand more about the 
condition. It helps them understand how susceptible they are to obesity, its seriousness, and 
its threat. Their communications and conversations can help individuals understand the 
consequences and adverse effects of obesity and being overweight. At the organisational 
level, more people in different sectors of the community can be reached. Schools and 
workplaces can advocate for healthy lifestyles among people, providing counselling and 
making people aware of the health implications of obesity and being overweight. The built 
environment deals with how society creates a climate that can help curb or promote obesity 
and overweight. This can be done through the development of physical facilities such as 
football pitches, recreational parks, and also the availability of healthy food stores in the 
community. At the policy level, the government is in charge of developing policies that 
would help prevent the increase in obesity. The expansion of natural food products on the 
market, the development of national parks, and increasing the cost of refined products would 
go a long way to help curb obesity and overweight. The socio-ecological model has 
various levels 
 21 
University of Ghana http://ugspace.ug.edu.gh
that influence obesity and overweight, but based on this study among Ghanaian youth, all 
the factors that can influence obesity and overweight can be found only in the individual 
and interpersonal levels of influence. These socio-demographic factors are sex, age, wealth 
quintile, and educational level, as well as marital status, place of residence, region of 
residence, religion, and occupation. This makes all these socio-demographic factors direct 
variables that can influence obesity and overweight among the Ghanaian youth, which this 
study seeks to explore. 
 
2.5 Conceptual Framework 
 
The conceptual framework for this study is guided by the socio-ecological framework, 
which shows the linkages between socio-demographic variables on the one hand and BMI 
status on the other hand. The conceptual framework analyses and organises the various 
factors that influence obesity and overweight among youth. Literature has shown that some 
socio-demographic characteristics, such as age, wealth status, marital status, and sex, have 
a relationship with BMI status. 
 
The socio-demographic characteristics such as the sex of an individual can influence their 
obesity status. Studies conducted by Kanter & Cabellero (2012) indicate that females have 
a higher risk of being obese compared to males. This can be attributed to childbirth, parity, 
and pregnancy, which influence weight gain in women. In developing countries such as 
Ghana, highly educated people have a higher risk of becoming obese and overweight, as 
found by Cohen et al. (2013), Dake et al. (2011), and de-Graft Aikins (2010). This is mainly 
because higher education comes with a better job and a higher income. This gives an 
individual the ability to purchase and consume unhealthy foods. Additionally, the age of an 
individual can influence their obesity status. Older individuals are more sedentary in nature 
and are less likely to engage in vigorous activities that expend more energy. This 
 22 
University of Ghana http://ugspace.ug.edu.gh
would gradually lead to the accumulation of fat, which leads to obesity, as found by Muhihi 
et al. (2012). Moreover, the area where an individual resides can have an impact on their 
weight. Respondents in urban areas are more likely to be obese than their rural counterparts. 
These lifestyle attitudes among urban dwellers contribute to the higher prevalence of obesity 
and overweight among urban dwellers as found by Tuoyire (2020). Regions that are more 
urbanized are more likely to have a higher risk of obesity as compared to regions that are 
less urbanized. 
 
In their study among Ghanaian adults 25 years and older in urban areas, they found that 
wealth gives people the ability to buy more, which can influence consumption, making 
wealthy people more likely to become obese. The purchasing power of an individual 
increases with wealth, so these fast foods high in sugar and salt found in the cities are easily 
accessible to them for consumption, leading to obesity and overweight. 
 
Also, the kind of occupation a person engages in can influence their risk of obesity and 
being overweight. People who are into agriculture and fishing are less likely to be obese 
because this kind of occupation is more physically demanding with higher energy 
expenditure. However, people who are in managerial occupations are more likely to 
become obese due to less physical expenditure in their jobs. This is consistent with studies 
done by Abdulai (2010). 
 
Also, people who are married are more likely to be overweight and obese as compared to 
never-married individuals (Dake et al., 2011). de-Graft Aikins (2010) and Dake et al. (2011) 
found that married people have a higher prevalence of obesity. This can be due to the culture 
of beauty, health, and the prestige associated with weight gain, particularly for married 
women. Also, married couples have financial support from their partners, which increases    
their    chances    of    buying    and    consuming    more 
 23 
University of Ghana http://ugspace.ug.edu.gh
 
 
 
Interperson 
al level 
Wealth status 
Individual 
level 
Age, sex, level of education, 
Outcome occupation, place of residence, 
region of residence, marital 
status, religion 
 
BMI status (Overweight /obesity) 
 
Figure 2: A Conceptual framework for studying socio-demographic determinants of overweight and obesity among Ghanaian 
youth. 
Source: Authors construct 2020 
 
 
 
 
24 
 
University of Ghana http://ugspace.ug.edu.gh
2.6 Hypotheses 
 
1. Female youth are more likely to be obese as compared to male youth. 
 
 
2. Youth who belong to the richest wealth quintile are more likely to be obese as compared to 
youth who belong to the poorest wealth quintile. 
 
3. Older youth aged 25–34 years are more likely to be obese as compared to younger youth aged 
15–24 years. 
 
4. Youth who are currently married are more likely to be obese than youth who have never 
married. 
 26 
University of Ghana http://ugspace.ug.edu.gh
CHAPTER THREE 
METHODOLOGY 
 
3.0 Introduction 
 
This chapter describes the study area, sources of data, the variables of interest, and the analytical 
methods employed in analysing the data. For the purpose of this study, the youth category would range 
between 15-24 years. They form the majority of the country's total population. 
 
3.1 Study Area 
 
Ghana is a West African country with a land area of 238,537 square kilometres. Before 2018, Ghana 
had only ten administrative regions. But on December 27, 2018, a referendum was held across 47 
districts in the country, leading to a landslide of yes voters to create a new six regions in addition to 
the previous ten regions (GSS, 2021). The current population of Ghana is a little over 33 million 
people, with a youthful population of 34%. Ghana is a multilingual country with several ethnic groups, 
with the Akan constituting the largest proportion (48%), followed by the Mole-Dagbani (17%), Ewe 
(14%), Ga-Dangme (7%), and others (GSS, 2021). The general sex ratio in 2020 was 97 males per 100 
females (GSS, 2021). The total life expectancy at birth as recorded in 2020 was about 69.37%. The 
sex structure shows a higher number of females than males, with a higher life expectancy for women 
compared to men. The top causes of death in Ghana include malaria, stroke, HIV/AIDS, and neonatal 
disorders (GSS, 2021). 
 27 
University of Ghana http://ugspace.ug.edu.gh
 
 
 
Figure 3 Map of Ghana Showing the Administrative Regions 
Source: Population and housing census, 2010 
 
Adopted from the Ghana Statistical Service, 2010 
 
3.2 Data Source 
 
The data for this study is drawn from the seventh round of the Ghana Living Standard Survey. Data 
for GLSS 7 was collected using different sets of instruments, including a household questionnaire, 
a community questionnaire, and a questionnaire on the prices of food and non-food items. The 
household questionnaire includes different modules (A, B, C, and D) with different segments. The 
sections of module A of the household questionnaire included demographic characteristics, 
education and skills training, health and fertility behaviour, and migration, among others. The section 
on demographic characteristics of household members included sex, age, marital status, and level 
of education of household members. Section B contained the height and 
weight measurements for calculating the BMI. The household questionnaire was used for the study 
 28 
University of Ghana http://ugspace.ug.edu.gh
(GLSS 7, 2017). The GLSS 7 data set is used in this study because it covers the entire country as 
well as all population subgroups in the country. The data set was best suited for this study because 
the height and weight of both males and females were needed to calculate the obesity and overweight 
status of youth (BMI), which cannot be found in other nationally available data sets. The height and 
weight information on males and females are duly represented in GLSS 7 as compared to other data 
sets, which makes it very vital for this study. 
 
3.3 Study design and size 
 
The GLSS 7 sampled 15,000 households nationwide and collected 14,009 interviews successfully. 
The urban and rural areas were selected as the main sampling strata using the two stages of the census 
enumeration areas as guide. The sampling frame was the 2010 Ghana population and housing census, 
where the systematic probability sampling technique used for selection. About 43.9% were rural areas 
and 56.9% were urban. 
The age category for the youth in this study is 15-34 years because these categories of individuals are 
the backbones of institutions and have the propensity to change the dynamics of a country’s 
development. The sample size for this study is 12,856 respondents who had their BMI calculated for 
the purpose of this study. This is the sample size for respondents who fall within the three categories 
of analysis which are normal weight, overweight and obesity. 
 
3.4 Selection procedure 
 
Based on the age of interest (15–34) a sample of 14,576 was extracted for the present study with 
7,666 females and 6,910 males. This was done by filtering respondents whose ages were greater than 
14 years, but less than 35 years. To ensure representativeness, and as well as correct for the issue of 
non-response; the data is weighted to ensure representativeness. Two files (B and D) from the 
household questionnaire were merged to form a single file. These two files B and D were relevant 
because each one of them contained the most relevant socio-demographic variables that were 
important to this study. Each file either had one variable or two but not all the variables on 
which this study is based, thus the two files were merged. The data were also weighted to ensure 
 29 
University of Ghana http://ugspace.ug.edu.gh
representation. Using a multilevel analysis procedure, this study examines obesity and overweight as 
an outcome of socio-demographic indicators at the individual level. 
The interest of the study is predicting obesity and overweight among the youth. As a result, after 
extracting the total sample from the GLSS 7 data set, BMI was computed for the total sample of 
14,576. The BMI categories are four namely underweight, normal weights, overweight and obese. 
The focus of this study is on the factors that influence obesity and overweight among youth in Ghana. 
Therefore, at the bivariate and multivariate levels of analysis, all underweight categories were 
dropped to allow the study to focus on overweight and obese youth only. The final total sample for 
the bivariate and multivariate analysis is 12,856. 
 
3.5 Measurement of Variables 
 
3.5.1 Dependent variable 
 
Obesity was measured using the body mass index (BMI).Weight was measured in kilograms, while 
height was measured in centimetres. The height in centimetres was converted into metres by dividing 
it by 100, and the resulting height was then squared. BMI was generated for all respondents by 
dividing their weight in kilograms by their height in metres squared. Respondents were categorised 
based on three BMI values, namely normal weight (18.5 - 24.9 kg/m2), overweight (25.0 - 29.9 kg/m2), 
and obese (≥ 30.0 kg/m2) based on the standard WHO classifications. The number of dependent 
variables in this study is one with three BMI categories namely overweight, normal weight and 
obesity. 
 
3.5.2 Independent variables 
 
With reference to age, respondents were asked to indicate their ages in completed years. Age in the 
data was coded as a continuous variable, but per the purpose of this study, age was recoded into two 
groups, 15–24 years and 25–34 years, with codes 1 and 2 respectively (Table1). The sex of the 
respondents was categorised as males and females with codes 1 and 2 respectively, as shown in Table 
1. With regards to respondents' place of residence, they were asked about their place of 
 30 
University of Ghana http://ugspace.ug.edu.gh
residence. The place of residence was categorised as urban and rural, with codes 1 and 2 respectively. 
 
Respondents were asked about the region they reside in. The region of residence was coded based on 
the 10 administrative regions namely Western (1), Central (2), Greater Accra (3), Volta(4), Eastern 
(5), Ashanti (6), Brong Ahafo (7), Northern (8), Upper East (9), and Upper West (10). The household 
wealth quintile was grouped into five categories as poorest (1), poor (2), middle (3), rich (4), and 
richest (5). The categories were married (1), consensual union (2), separated (3), divorced (4), 
widowed (5), and never married (6). The variables were recoded into currently in union (1) (married 
and consensual union). Never married (2) was maintained while separated, widowed, and divorced 
were recoded as formerly married (3) (Table 1). 
 
The religious denominations of respondents were maintained in this study as other religion (1) 
Catholics (2), Protestants (3), Pentecost/Charismatics (4), Other Christians (5), Islam (6), 
Traditionalist (7) and other religion (8) with codes. The occupations of respondents were coded as no 
occupation (1), mangers (2) which includes, legislators, clerks, professionals, technicians, 
sales/service (3), skilled agric/fishery (4), artisans (5) which includes, craftwork, plant machine 
operators, elementary occupation, other occupation (6). 
 
Respondents were asked to indicate whether they have been to school. Those who answered yes were 
further asked about their highest level of education with responses as kindergarten (1), primary  (2),  
JSS/JHS  (3),  middle  (4),  SSS/SHS  (5),  secondary  (6),  Voc/Tech  (7), 
Teacher/Agric/nursing t r a i n i n g  ( 8), p o l y t e c h n i c  ( 9), university (bachelor) (10), university 
 
(postgraduate) (11), professional (12), and don’t know (13) with codes 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 
12, and 13. The level of education was recoded as no education (1), primary and below (kindergarten, 
nursery =2), Junior high school (middle =3), Senior high school (vocational, technical, =4), Tertiary 
(teacher training, nursing, polytechnic, university bachelors, university graduate, and professionals 
=5). 
 31 
University of Ghana http://ugspace.ug.edu.gh
Table 1: Measurement of Variables 
 
Variables Measurements 
 
Age 1= 15-24 years 
2= 25-34 years 
Sex 1= Male 
2= female 
Place of Residence 1= Urban 
2= rural 
 
Region 1= Western 
2= Central 
3= Greater Accra 
4= Volta 
5= Eastern 
6= Ashanti 
7= Brong Ahafo 
8= Northern 
9= Upper East 
10= Upper West 
Marital Status 1= Currently in union (married, consensual) 
2=Formerly married (divorced, widowed, separated) 
3= Never married 
Educational Level 1= No education (don’t know) 
2= primary and below (kindergarten, nursery) 
3= junior high school (middle) 
4= senior high school (vocational, technical) 
5= tertiary (teacher training, nursing, polytechnic, 
university bachelors and graduate, professional) 
 
Occupation 1= No occupation 
2= managers (legislators, professionals, technicians) 
3= sales/service 
4= skilled agric/fishery 
5= artisans (craftwork, plant operators, elementary) 
6= other occupation) 
 
Religion 1= other religion 
2= Catholics 
3= protestants 
4= Pentecostal/charismatics 
5= Other Christians 
6= Islam 
7= traditionalists 
8= no religion 
Wealth quintile 1= poorest 
2= poor 
3= middle 
4= rich 
5= richest 
 
BMI Status 1= (normal weight 18.5 ≤BMI≤ 24.9) 
2= (overweight 25.0 ≤BMI≤29.9) 
3= (obese ≥ 30.0) 
 32 
University of Ghana http://ugspace.ug.edu.gh
3.6 Methods of analysis 
 
Three levels of analysis were employed in analyzing the data univariate, bivariate, and multivariate 
levels of analysis. The characteristics of the study sample and the distribution of BMI status were 
described using descriptive statistics such as percentage distribution. The association between the 
socio-demographic characteristics of the youth and their BMI status was examined using chi-
square analysis. The factors associated with overweight and obesity was analysed using 
multinomial logistic regression analysis. BMI status was used as the dependent variable in the 
regression analysis, and normal weight was used as the reference category for the dependent 
variable. The statistical significance for the bivariate and multivariate analyses was set at the 0.05 
alpha levels. 
 
3.7 Limitation of Data 
 
The major shortcoming of the study is the availability of other factors that can influence 
overweight and obesity among the youth. Factors such as physical activity and dietary habits of 
the youth has a great impact on how an individual can be predisposed to overweight and obesity. 
As such the GLSS 7 did not capture such information to make it available for analysis for this 
study. This therefore limits the different dimensions and aspects by which overweight and obesity 
can influence the youth in Ghana. 
 33 
University of Ghana http://ugspace.ug.edu.gh
CHAPTER FOUR 
RESULTS 
 
4.0 Introduction 
 
This chapter presents the results of the descriptive statistics of all independent variables and the 
dependent variable provided in the conceptual framework and also the association between the 
variables as presented in the conceptual framework. The factors associated with being overweight 
and obesity are also presented. 
 
4.1 BMI Status of Study Sample 
 
Table 2 shows that approximately one in ten (13.3%) of the youth were obese. However, 
approximately 6 out of 10 (66.6%) of the youth had a normal BMI, while approximately 1 out of 5 
(20.1%) were overweight. 
Table 2: Percentage distribution of study sample by BMI status 
 
BMI status Percentage (%) Number (n) 
Normal weight 66.6 8,950 
Overweight 20.1 2,422 
Obese 13.3 1,484 
Total (%) (n) 100.0 12,856 
 
 
 
4.2 Socio-demographic characteristics of the study sample 
 
The results in Table 3 indicate that respondents aged 15–24 years constituted a little more than half 
(54.0%) of the total sample. Similarly, female and urban-dwelling respondents constituted a little 
more than half of the total sample, representing 53.1% and 54.4%, respectively. 
 34 
University of Ghana http://ugspace.ug.edu.gh
Table 3: Percentage distribution of study sample by socio-demographic characteristics 
 
Variables Percentage (%) Number (n) 
Age Group   
15-24 54.0 7,010 
25-34 46.0 5,846 
Sex   
Male 46.9 5,974 
Female 53.1 6,882 
Educational Level   
No Education 8.8 943 
Primary and below 14.2 1,731 
Junior high school 39.9 5,477 
Senior high school 27.1 3,616 
Tertiary 10.0 1,089 
Marital Status   
Currently in Union 34.8 4,324 
Formerly Married 2.7 399 
Never Married 62.5 8,133 
Place of Residence   
Urban 54.4 6,974 
Rural 45.6 5,882 
Main occupation   
No occupation 31.3 4,165 
Managers 8.3 921 
Service/sales 14.7 1,874 
Skilled agric/fishery 21.7 2,875 
Artisans 21.0 2,738 
Other occupations 4.2 283 
Wealth Quintile   
Poorest 16.4 2,040 
Poorest 18.4 2,331 
Middle 19.8 2,543 
Rich 20.9 2,713 
Richest 24.5 3,229 
Religion   
Other Religion 2.1 91 
Catholics 12.0 1,282 
Protestants 15.0 2,090 
Pentecost/Charismatics 37.0 5,255 
Other Christians 12.6 1,671 
Islam 17.6 2,351 
Traditionalists 1.9 68 
No religion 1.8 48 
 35 
University of Ghana http://ugspace.ug.edu.gh
Region   
Western 10.0 1,293 
Central 10.0 1,253 
Greater Accra 17.8 2,427 
Volta 8.2 1,027 
Eastern 10.3 1,335 
Ashanti 19.8 2,715 
Brong Ahafo 9.3 1,184 
Northern 8.0 1,000 
Upper East 3.9 392 
Upper West 2.7 230 
Total (%) (n) 100 12,856 
 
 
 
With regards to the educational level of respondents, about 2 out of 5 (39.9%) of the respondents 
have completed junior high school, while 10% have attained a tertiary level of education. Also, 
more than quarters (27.1%) of the respondents have completed senior high school, while more than 
a tenth (14.2%) has completed the primary level of education. Additionally, respondents with no 
formal education constituted 8.8% of the total sample. With reference to Table 3, the results show 
that never-married respondents were about two-thirds (62.5%) of the total sample, while those who 
were formerly married constituted only (2.7%) of the total sample. Those who were currently in a 
union constituted more than a third (34.8%) of the total sample. 
 
Regarding occupation, respondents with no occupation constituted just over a third (34.4%) of the 
total sample, while respondents who are engaged in the agriculture or fishing sector formed about 
(21.7%) of the total sample. Also, managers constituted about a tenth (8.3%) of the total sample, 
while about one-fifth (21%) of the respondents were artisans. Service/sales workers made up 
(14.7%) of the total sample (Table 3). 
 
Respondents in the richest wealth quintile category made up just about a quarter (24.5%) of the 
total sample, while those in the poorest wealth quintile category formed a proportion of 16.4%. 
Additionally, those belonging to the rich wealth quintile category made up about one-fifth (20.9%) 
of the total sample, while those in the middle wealth quintile category constituted 19.8% 
 36 
University of Ghana http://ugspace.ug.edu.gh
of the total sample. Respondents in the poor wealth quintile category constituted 18.4% of the total 
sample. 
 
The results from Table 3 further show that Pentecostal/Charismatic respondents constituted more 
than a third (37%) of the total sample, while Traditionalists constituted a proportion of 1.9%. In 
addition, those of the Islamic faith formed about one-fifth (17.6%) of the total sample, while those 
of other religions also formed 3.9% of the total sample. Also, those belonging to the Catholic faith 
constituted 12.0% of the total sample, while those of the Protestant faith constituted 15.0% of the 
total sample. More than a tenth (12.6%) of the total sample was made up of people who follow 
other Christian faiths. 
 
The distribution by residence indicates that 1 in 10 of the youth were from the Western and Central 
regions respectively. The Ashanti region, however, recorded the highest proportion of 19.8% of 
the total sample as compared to the Upper West, which had the lowest proportion of 2.7%. A little 
less than one-fifth (17.8%) of the total sample of the respondents were from Greater Accra, while 
respondents from the Upper East region constituted 3.9% of the total sample. Also, every 1 out of 
10 (10.3%) of the respondents was from the Eastern region while the Volta and Northern regions 
had a proportion of 8.2% and 8.0% respectively. 
 
4.3 Association between age, overweight and obesity 
 
The results presented in Table 4 show that there is a significant association between age and obesity 
and being overweight. Table 4 shows that about 15.7% of youth aged 15–24 years were 
overweight, as compared to a quarter (25.0%) of youth aged 25–34 years. And 12.3% aged 15-24 
years were obese, while 14.8% of the youth aged 25-34 were obese. 
 37 
University of Ghana http://ugspace.ug.edu.gh
Table 4: Percentage distribution of Ghanaian youth by age group, overweight and obesity 
 
Variable  BMI Status (%)  Total (n) 
Age group Normal weight Overweight Obese  
15-24 72.0 15.7 12.3 6486 
25-34 60.2 25.0 14.8 6,370 
Total (%) 66.7 20.1 13.2 12856 
 
χ2 = 677.78, df = 2, p-value < 0.001 
 
4.4 Association between sex, overweight and obesity 
 
The results presented in Table 5 show that being overweight was more common among females (22.9%) 
as compared to males (17.0%). In the same way, it was found that more women (15.9%) than men 
(10.0%) were overweight. 
Table 5: Percentage distribution of Ghanaian youth by sex, overweight and obesity 
 
Variable  BMI Status (%)  Total (n) 
Sex Normal Weight Overweight Obese  
Male 72.9 17.0 10.1 5,834 
Female 62.2 22.9 15.9 7,022 
Total (%) 66.6 20.1 13.3 12,856 
 
χ2 = 377.57, df = 2 p-value < 0.001 
 
4.5 Association between the level of educational attainment, overweight and obesity 
The results from Table 6 show that obesity and overweight were more common among respondents with 
a tertiary level of education (13.9% and 24.8%) respectively, compared to respondents with no formal 
education (11.1% and 17.5%) respectively. Those with no education and those with only senior high 
education had a higher proportion of respondents who were of normal weight (71.4% and 69.6%), 
respectively. 
 38 
University of Ghana http://ugspace.ug.edu.gh
Table 6: Percentage distribution of Ghanaian youth by level of educational attainment, 
overweight and obesity 
 
Variable  BMI Status (%)  Total (n) 
Educational Level Normal Weight Overweight Obese  
No Education 71.4 17.5 11.1 1,176 
Primary 63.8 20.7 15.5 1,716 
Junior high school 65.9 19.9 14.2 5,006 
Senior high school 69.6 19.1 11.3 3,592 
Tertiary 61.3 24.8 13.9 1,366 
Total (%) 66.6 20.0 13.4 12,856 
 
χ2 = 354.36, df = 8, p-value < 0.001 
 
4.6 Association between place of residence, overweight and obesity 
 
The distribution of obesity and overweight by place of residence shows that obesity is more common 
among youth residing in urban areas (14.4%) as compared to those residing in rural areas (12.3%). 
Also, over a fifth (22.5%) of the urban residents were overweight, as compared to 17.4% of youth 
who live in rural areas. Also, more people in rural areas (70.3%) were of normal weight than in urban 
areas (63.1%). 
Table 7: Percentage distribution of Ghanaian youth by place of residence, overweight and obesity 
Variable BMI Status (%) Total (n) 
 
Place of Residence Normal Weight Overweight Obese  
Urban 63.1 22.5 14.4 7,106 
Rural 70.3 17.4 12.3 5,750 
Total (%) 66.6 20.0 13.4 12,856 
χ2 = 330.45, df = 2, p- value < 0.001     
 39 
University of Ghana http://ugspace.ug.edu.gh
4.7 Association between marital status, overweight and obesity 
 
The results in Table 8 show that obesity and overweight were more common among youth who are currently 
in unions (15.0%) and (25.1%) compared to youth who have never been married (12.2%) and (17.0%) 
respectively. On the other hand, youth who have never been married had a higher proportion of respondents 
who are of normal weight (70.8%) as compared to youth who are currently in a union (59.9%). More than a 
quarter of respondents who are formerly married were overweight (25.9%). 
Table 8: Percentage distribution of Ghanaian youth by marital status, overweight and obesity 
 
Variable  BMI Status (%)  Total (n) 
Marital Status Normal Weight Overweight Obese  
Currently in union 59.9 25.1 15.0 4,367 
Formerly Married 59.8 25.9 14.3 1,335 
Never Married 70.8 17.0 12.2 7,154 
Total (%) 66.6 20.0 13.4 12,856 
 
χ2 = 632.06, df = 4, p-value < 0.001 
 
4.8 Association between wealth quintile, overweight and obesity 
 
The results in Table 9 show that there is a correlation between wealth quintile, overweight and obesity among 
respondents. The table shows a positive association between wealth quintile, overweight and obesity. The 
proportion of respondents who are normal weight decreased as the wealth quintile increased. Obesity was 
more common among youth found in the richest wealth quintile category (14.7%) as compared to those in the 
poorest wealth quintile category (11.0%). Youth found in the rich wealth quintile category had a higher 
proportion of overweight respondents (21.7%), while youth in the poor wealth quintile category had a lower 
proportion (17.9%). Overweight and obesity were more common among the richest people. 
 40 
University of Ghana http://ugspace.ug.edu.gh
Table 9: Percentage distribution of Ghanaian youth by wealth quintile, overweight and obesity 
 
Variable  BMI Status (%)  Total (n) 
Wealth quintile Normal Weight Overweight Obese  
Poorest 74.7 14.3 11.0 1,984 
Poor 69.6 17.9 12.5 2,286 
Middle 67.4 18.8 13.8 2,541 
Rich 65.2 21.7 13.1 2,784 
Richest 60.0 25.3 14.7 3,261 
Total (%) 66.7 20.1 13.2 12,856 
 
χ2 = 648.6, df = 8, p-value < 0.001 
 
4.9 Association between main occupation, overweight and obesity 
 
Table 10 shows that obesity and overweight were less common among respondents who work in the skilled 
agriculture and fishing sectors (9.2% and 13.2%, respectively). Also, about three-quarters of those who work 
in agriculture or fishing (77.6%) were of healthy weight, while just over half of those who work in sales and 
service (59.5%) were of healthy weight. 
Table 10: Percentage distribution of Ghanaian youth by occupation, overweight and obesity 
 
Variable  BMI Status (%)  Total (n) 
Occupation Normal Weight Overweight Obese  
No Occupation 65.4 19.4 15.2 4,155 
Managers 60.8 21.8 12.8 1,030 
Service/Sales 59.5 23.4 17.1 2,036 
Skilled agrci/fishery 77.6 13.2 9.2 2,749 
Artisans 64.9 22.4 12.7 2,784 
Other occupation 64.5 21.8 13.7 102 
Total (%) 66.5 19.9 13.6 12,856 
 
χ2 = 807.67, df = 10, p-value < 0.001 
 41 
University of Ghana http://ugspace.ug.edu.gh
4.10 Association between religion, overweight and obesity 
 
From Table 11, respondents who were traditionalists, 77.9% were of normal weight, as compared to 70.6% 
of Catholics. On the other hand, about 1 out of 10 respondents who are Pentecostals were obese, while just 
about a fifth (16.1%) of Islamic respondents were obese. In relation to being overweight, just under one-fifth 
of Protestants (22.5%) were overweight compared to traditionalists (13.1%). 
Table 11: Percentage distribution of Ghanaian youth by religion, overweight and obesity 
 
Variable BMI Status (%)  Total (n) 
Religion Normal Weight Overweight Obese  
Other Religion 60.2 24.3 15.5 264 
Catholic 70.6 17.9 11.5 1,302 
Protestant 69.9 19.8 10.3 2,035 
Pentecost 63.8 22.5 13.7 4,848 
Other Christians 64.6 19.5 15.9 1,635 
Islam 65.9 18.0 16.1 2,290 
Traditionalist 77.9 13.1 9.0 247 
No religion 74.4 16.4 9.2 235 
Total (%) 66.6 20.0 13.4 12,856 
χ2 = 167.19, df = 14, p-value < 0.001    
 
4.11 Association between region of residence, overweight and obesity 
Table 12 shows that the Central region had the highest proportion of obese respondents (17.3%), while the 
Brong Ahafo had the least proportion (8.7%). The Greater Accra region had a higher proportion of overweight 
respondents (26.2%) than the Upper East region, which had the least proportion of overweight respondents 
(13.6%). On the other hand, Ashanti region youth had slightly higher obesity proportions (14.5%) as compared 
to Upper West region youth (12.6%). The Volta region had more youth (17.8%) who were overweight as 
compared to youth from the northern region (15.0%). 
 42 
University of Ghana http://ugspace.ug.edu.gh
Table 12: Percentage distribution of Ghanaian youth by region of residence, overweight and obesity 
 
Variable  BMI Status (%)  Total (n) 
Region Normal Weight Overweight Obese  
Western 67.7 20.4 11.9 1,274 
Central 60.2 22.5 17.3 1,282 
Greater Accra 59.6 26.2 14.2 2,293 
Volta 71.8 17.8 10.4 1,034 
Eastern 67.5 19.2 13.3 1,339 
Ashanti 66.8 18.7 14.5 2,552 
Brong Ahafo 70.4 20.9 8.7 1,284 
Northern 73.1 15.0 11.9 996 
Upper East 71.1 13.6 15.3 452 
Upper West 74.7 12.7 12.6 350 
Total (%) 66.6 20.1 13.3 12,856 
 
χ2 = 547.95, df = 18 p-value < 0.001 
 
4.5 Socio-demographic predictors of overweight and obesity among Ghanaian youth 
 
At the multivariate level, a multinomial logistic regression model was used to assess the influence of the socio-
demographic factors on the BMI of respondents. In specifying the model, all the socio-demographic factors 
were used as predictor variables to predict the BMI status of respondents. Normal weight was used as the base 
category (reference category) for the dependent variable. For each of the socio-demographic variables, one 
category was selected as the reference category. The results were interpreted using the relative risk ratio, which 
represents the chance of a respondent being overweight or obese as compared to being normal weight. 
Respondents in every category aside from the reference category were compared to those in the reference 
category. Relative risk ratios greater than one denote an increased chance or greater likelihood of an outcome 
occurring, and those less than 1.0 indicate a decreased likelihood or chance of an outcome occurring. Statistical 
significance was set at 0.05. Any p-value less than 0.05 were considered significant. 
 43 
University of Ghana http://ugspace.ug.edu.gh
4.5.1 The influence of socio-demographic characteristics on overweight and obesity among Ghanaian 
youth 
 
The results in Table 13 show a multinomial logistic regression analysis of factors associated with overweight 
and obesity among youth aged 15–34 years in Ghana. 
 
The results show that, compared to males, females were 1.75 (p=0.001) times more likely to be overweight 
rather than be of normal weight. Similarly, females were 2.56 (p=0.001) times more likely to be obese rather 
than be of normal weight compared to males. Respondents who are 25-34 years were 1.65 (p= 0.001) times 
more likely to be overweight as compared to respondents who are 15-24 years. Also, respondents who are 25-
34 years are 2.01(p=0.001) times more likely to be obese as compared to respondents who are 25-34 years. 
 
Concerning education, there were varied results among the various categories. Comparing those with primary 
education to those with no education, respondents with primary education were 0.28 (p=0.001) times less 
likely to be overweight. Also, respondents with primary education were 0.62 (p=0.001) times less likely to be 
obese as compared to those with no education. Similarly, respondents who had junior high school level of 
education were 0.50 times less likely to be obese as compared to respondents with no education. 
 44 
University of Ghana http://ugspace.ug.edu.gh
Table 13 Results of multinomial logistic regression analysis showing the influence of socio-demographic characteristics of overweight 
and obesity among youth 
 
(Relative Risk Ratio) 
 
Overweight Obese 
Characteristics RR P-value 95% CI RR P-value 95% CI 
Sex       
Males (R.C) 1.00   1.00   
Female 1.75 0.01 1.52-2.02 2.56 0.01 2.16-3.04 
Age Group       
15-24 (R.C)       
25-34 1.95 0.01 1.64-2.32 2.01 0.01 1.66-2.44 
Educational Level       
No Education (R.C) 1.00   1.00   
Primary 0.28 0.01 0.97-1.68 0.62 0.01 1.15-2.28 
Junior high school 1.18 0.20 0.91-1.54 0.50 0.02 1.07-2.09 
Senior high school 1.24 0.14 0.93-1.65 1.23 0.27 0.86-1.76 
Tertiary 1.32 0.12 0.93-1.86 1.31 0.22 0.85-2.00 
Place of Residence       
Urban (R.C) 1.00   1.00   
Rural 0.71 0.01 0.78-1.07 0.93 0.01 0.78-1.11 
Marital Status       
Currently in Union (R.C) 1.00   1.00   
Formerly married 0.72 0.01 0.59-0.88 0.71 0.01 0.56-0.91 
Never married 0.53 0.01 0.44-0.64 0.62 0.01 0.51-0.77 
 45 
University of Ghana http://ugspace.ug.edu.gh
 
 Overweight   Obese  
Characteristics RR P-value 95% CI RR P-value 95% CI 
Main Occupation       
No Occupation (R.C) 1.00   1.00   
Managers 1.02 0.87 0.78-1.34 1.08 0.67 0.77-1.49 
Service/Sales 1.11 0.32 0.91-1.35 0.97 0.80 0.76-1.23 
Skilled Agric/Fishery 0.53 0.00 0.42-0.67 0.42 0.00 0.33-0.53 
Artisans 1.07 0.46 0.89-1.29 0.73 0.01 0.57-0.93 
Other occupation 2.01 0.55 0.95-1.56 0.77 0.95 0.65-0.78 
Religion       
Other Religion (R.C) 1.00   1.00   
Catholic 1.08 0.68 0.74-1.58 1.14 0.58 0.71-1.84 
Protestants 1.03 0.86 0.72-1.48 0.86 0.52 0.54-1.37 
Pentecost 1.26 0.17 0.90-1.77 1.39 0.13 0.91-2.15 
Other Religion 1.17 0.43 0.80-1.71 1.72 0.02 1.09-2.73 
Islam 0.21 0.50 0.84-1.72 0.95 0.01 1.23-3.10 
Traditionalist 0.81 0.43 0.48-1.36 0.88 0.71 0.45-1.71 
No religion 0.62 0.53 0.72-1.56 0.59 0.98 0.55-1.81 
Wealth Quintile       
Poorest (R.C) 1.00   1.00   
Poor 1.29 0.03 1.03-1.62 1.30 0.06 0.99-1.70 
Middle 1.27 0.01 1.00-1.62 1.47 0.01 1.10-1.97 
Rich 1.41 0.01 1.11-1.79 1.43 0.02 1.06-1.92 
Richest 1.67 0.01 1.29-2.14 1.76 0.01 1.29-2.40 
 46 
University of Ghana http://ugspace.ug.edu.gh
 
  Overweight   Obese  
Characteristics RR P-value 95% CI RR P-value 95% CI 
REGION       
Western (R.C) 1.00 1.00 
Central 1.40 0.01 1.08-1.82 2.06 0.00 1.53-2.75 
Greater Accra 1.25 0.12 0.94-1.65 1.14 0.46 0.81-1.60 
Volta 0.92 0.55 0.69-1.22 0.85 0.37 0.60-1.21 
Eastern 1.07 0.63 0.80-1.44 1.30 0.11 0.94-1.79 
Ashanti 0.84 0.22 0.64-1.11 1.11 0.50 0.82-1.52 
Brong Ahafo 1.21 0.18 0.91-1.61 0.67 0.03 0.46-0.96 
Northern 0.76 0.08 0.55-1.04 0.89 0.56 0.61-1.31 
Upper East 0.63 0.01 0.45-0.88 1.45 0.03 1.03-2.04 
Upper West 0.75 0.07 0.54-1.02 1.35 0.10 0.95-1.91 
Total (n) = 12856       
      
Log Likelihood = -6950520.3 
      
Pseudo R2 = 0.0893 
      
RC=Reference Category 
      
CI= Confidence Interval 
       
RR= Relative risk ratio 
 47 
University of Ghana http://ugspace.ug.edu.gh
Concerning occupation, there were also varied results among the various occupational 
categories. Respondents who are engaged in the agriculture/fishery sector were 0.53 less 
likely to be obese as compared to respondents with no occupation. Respondents who were 
artisans were also 0.73 times less likely to be obese as compared to respondents with no 
occupation. Regarding religion, those of the Islamic faith were 0.95 times less likely to be 
obese as compared to respondents who have other religious affiliations, while those of other 
Christian faiths were 1.72 times more likely to be obese as compared to respondents with 
no religious affiliation. 
 
Compared to respondents from the Western region, respondents from the Central region 
were 1.40 and 2.06 times more likely to be overweight and obese, respectively. Also, 
compared to respondents from the Western region, those from the Upper East were 0.63 less 
likely to be overweight. Northern and Upper West respondents had a lower relative risk ratio 
of becoming overweight (0.76 and 0.75, respectively). This means respondents from the 
Northern and Upper West are less likely to be obese as compared to respondents from the 
Western region. Also, compared to respondents from the Western region, respondents from 
Brong Ahafo were 0.67 times less likely to be obese. 
 
According to the findings, the relative risk ratio for being overweight or obese increased 
significantly with wealth quintile (Table 13). Respondents from the richest wealth quintile 
were 1.67 (p = 0.001) and 1.76 (p = 0.001) times more likely to be overweight and obese, 
respectively, compared to respondents from the poorest wealth quintile. Similarly, 
respondents from the rich wealth quintile were 1.41 (p = 0.001) and 1.43 (p = 0.001) times 
more likely to be overweight and obese compared to respondents from the poorest wealth 
quintile. Again, respondents in the middle and rich wealth quintile were 1.27 (p = 0.001) 
and 1.47 (p = 0.001) times more likely to be overweight as compared to respondents in the 
 48 
University of Ghana http://ugspace.ug.edu.gh
poorest wealth quintile, respectively. Also, respondents from the poorer quintile had a 
relative risk ratio of 1.29 and 1.30 of becoming overweight and obese, respectively. This 
indicates that respondents in the poorer wealth quintile are also more likely to be overweight 
and obese as compared to the poorest respondents. 
 
In terms of marital status, never married respondents were 0.62 (p= 0.001) times less likely 
to be obese compared to respondents who were in a union. Also, compared to respondents 
who were in a union, respondents who were formerly married were 0.72 (p=0.001) times 
less likely to be overweight. Table 13 shows that youth who reside in rural areas are 0.71 
(p=0.001) and 0.93 (p=0.001) less likely to be overweight and obese as compared to youth 
who reside in urban areas. The results clearly show a positive correlation between urban 
respondents and overweight and obesity among the youth. 
 
The findings of the multivariate analysis as shown in Table 13 indicate that socio- 
demographic characteristic such as age, sex, religion, marital status, region of residence, 
level of education, and wealth status of youth influence or predict their obesity and 
overweight status. 
 49 
University of Ghana http://ugspace.ug.edu.gh
CHAPTER FIVE 
DISCUSSION OF FINDINGS 
 
5.0 Introduction 
 
Obesity and being overweight are gradually becoming a problem among youth. There is a 
scarcity of studies on obesity and overweight among Ghanaian youth aged 15–34 years. 
This chapter presents the discussion of the key findings of this study in comparison to 
previous studies. 
5.1 Discussion of results 
The first objective of the study sought to examine the prevalence of obesity and 
overweight among youth in Ghana. The results from the data presented so far show that 
there is a high obesity (9.4%) and overweight (16.1%) prevalence among Ghanaian youth. 
Overweight and obese Ghanaian youth from this study form about one-fourth of the study 
sample, which is very alarming and critical. These young people are susceptible to such 
health-related conditions such as stroke and heart attack, which affect their quality of life. 
The second objective of the study was to examine the socio-demographic factors that 
influence obesity and overweight among youth in Ghana. The results, as expected, 
indicated that the sex of a respondent was a significant predictor of obesity and overweight 
among youth. The results of this study conform to the findings in the literature which 
indicate that females are more likely to be obese compared to their male counterparts. 
Females during their growth development have a higher tendency to accumulate fat than 
males in their puberty stage. Also, the cycle of pregnancy and childbirth among females 
tends to influence obesity and overweight among females more than males (Ersoy & 
Imamoglu, 2006). In Ghana, it has been discovered that during pregnancy, women 
consume fat-inducing foods for breast milk such as palm nut soup, which is a risk factor 
 50 
University of Ghana http://ugspace.ug.edu.gh
for female obesity and overweight (de-Graft Aikins, 2010). Support and care for postpartum 
women during this period constitute a risk factor for obesity and overweight among females 
due to low physical activity. 
Also, the idea of having a large body size as a sign of affluence and prosperity in Ghanaian 
culture can be a factor that leads to obesity and overweight among women (Cohen et al., 
2013). Fat is seen as beautiful among females in African settings, and it is a sign of men's 
desire to marry such women. This puts females in the mindset of increasing weight to attract 
males for marriage. What this does is women go to all lengths to consume more food to 
achieve a bodyweight that influences obesity and overweight among females. The findings 
are also consistent with previous studies done by de-Graft Aikins (2010) and Dake et al. 
(2011) in Ghana. Additionally, this affirms the first study hypothesis, which states that 
female youth are more likely to be obese compared to male youth. 
Concerning marital status, never married respondents were less likely to become obese and 
overweight as compared to respondents who are currently married. Married couples have 
the tendency to become overweight or obese because eating together influences people to 
eat more as compared to eating alone (Hassapidou et al., 2010). These findings in this study 
are in tandem with previous studies done by Dake et al. (2011) and de-graft Aikins (2010), 
who explain that married women are more likely to be overweight and obese due to socio-
cultural perceptions about being fat and beautiful as well as obesogenic factors associated 
with pregnancy and childbirth. This affirms the fourth hypothesis, which states that "youth 
who are currently married are more likely to be obese as compared to youth who have never 
been married." 
The results from the multinomial logistic regression showed that other Christians and 
Islamic youth were less likely to be obese as compared to respondents with no religious 
faith. The Islamic religion preaches against alcoholism and smoking, which positively 
 51 
University of Ghana http://ugspace.ug.edu.gh
Influences the obesity and overweight of youth. If the youth can abstain from such a habit, 
they will be less likely to be exposed to becoming obese and overweight (Mozaffarian et al., 
2011). 
The study shows that age has a greater influence on obesity and overweight among the 
Ghanaian youth who are 25–34 years old as compared to those who are 15–24 years old. 
This could be because, as an individual grows, they undergo hormonal and physical changes. 
As the younger youth (15–24) years transition into older youth (25-34) years, they become 
less active physically, which leads to less energy expenditure, which would have helped 
curb weight gain. This can increase their risk of obesity and overweight status (Tuoyire et 
al., 2016; Muhihi et al., 2012). This, therefore, affirms the third hypothesis of the study, 
which states that older youth are more likely to be obese compared to younger age groups. 
The occupational status of youth was positively associated with obesity and overweight 
(Abdulai, 2010). Youth who were engaged in the agriculture and fishing sector as well as 
respondents who work as artisans were the only categories that were found to be 
significantly associated with obesity and overweight. Also, globalisation has resulted in 
easier ways of transport where individuals do not have to walk and carry goods to their place 
of destination. The use of automobiles to transport individuals to their place of destination 
is also a factor that influences the obesity and overweight status of youth due to lower 
energy expenditure (Tuoyire et al., 2016). 
Education is a major factor in influencing overweight and obesity among youth. The 
educational level of youth can be associated with a higher risk of being overweight or obese. 
The findings in this study are in agreement with previous studies done by Dinsa et al. (2012). 
The finding is plausible because, education empowers people to get better jobs, which 
enable them to have higher incomes. This gives them the ability to buy and 
 52 
University of Ghana http://ugspace.ug.edu.gh
Consume more. This, therefore, contributes to higher obesity and overweight prevalence 
among the youth in Ghana. 
 
The wealth status of an individual can be associated with a higher risk of being overweight 
or obese (Doku & Neupane, 2015). From the study, the wealth status of youth was positively 
correlated to obesity and overweight. The rich are particularly susceptible to obesity and 
overweight due to their access to surplus and excess food for consumption and a lower level 
of engagement in manual labour-intensive occupations because the rich individuals are in 
less physically demanding jobs such as banking (Dinsa et al., 2012). The findings in this 
study corroborate with previous studies done by Neuman et al. (2013) and Yeshaw et al. 
(2020), who found an association between wealth status and obesity in developing countries. 
This also affirms the second hypothesis of the study, which states that "youth who belong 
in the richest wealth quintile are more likely to be obese as compared to youth who belong 
in the poorest wealth quintile." 
 
The youth in the Central, Brong Ahafo, Upper East, Upper West, and Northern regions were 
found to be overweight and obese in this study. This can be due to the gradual urbanisation 
of these regions, which has changed the traditional ways of living into western ways of 
living. The development of fast-food joints where foods high in sugar and salt are sold has 
sprung up and is easily accessible to people who reside in these regions, which when 
consumed has the potential to influence the risk of obesity and overweight among youth. 
Also, a study by the United Nations Population Fund (2008) found that in the Northern 
region of Ghana, there was a gradual rise in obesity and overweight prevalence among adult 
women. This was due to the gradual change of occupation that these women were involved 
in. Farming and fetching of water over long distances, which 
 53 
University of Ghana http://ugspace.ug.edu.gh
Involved expending high energy, were replaced by the usage of machines to undertake these 
activities, which led to obesity and overweight among adult women. 
 
This study shows that the place of residence of youth can influence obesity and overweight 
among youth. The study shows that youth who reside in rural areas are less likely to be 
obese and overweight as compared to youth in urban areas. The high rate of urbanisation 
and westernisation in the urban areas has gradually led to an unhealthy lifestyle of eating 
more fried, fatty, and sugary foods. These foods are very high in energy and their frequent 
consumption can influence obesity and overweight (de-Graft Aikins, 2010). Urban areas are 
characterised by many people owning their vehicles and also boarding cars to their places 
of destination rather than walking. This has resulted in reduced physical activity levels in 
urban areas compared to rural areas where people walk over long distances to the farm or to 
fetch water. These urban areas are also prone to high levels of vehicular traffic congestion 
due to their densely populated nature. As a result, spending long periods in traffic and not 
engaging in physical activities can influence the obesity and overweight status of youth due 
to urbanisation (Dake et al., 2011). These lifestyle behaviours associated with living in 
urban areas contribute to the increasing prevalence of obesity and overweight in urban areas. 
 
Overweight and obesity are conditions that should be high on the agenda of national policy 
makers. This growing condition among the youth is gradually having adverse effects on the 
human resources of the country on which development is built. The study shows that all 
socio-demographic factors that were considered had an influence on whether the youth 
became overweight or obese. This therefore shows that socio- demographic factors are 
predictors of overweight and obesity. 
 54 
University of Ghana http://ugspace.ug.edu.gh
CHAPTER SIX 
 
SUMMARY, CONCLUSION, AND RECOMMENDATIONS 
 
6.0 Introduction 
 
This chapter presents the summary, conclusion, and recommendations of this study. The 
chapter highlights the key findings of the study, draws conclusions based on the findings, 
and makes recommendations to help expand knowledge on obesity, overweight, and 
related topics among youth. 
 
6.1 Summary 
 
This study explored the prevalence of overweight and obesity among Ghanaian youth and 
also examined the socio-demographic characteristics of youth and how these influence 
overweight and obesity. The study was a quantitative study based on data from the GLSS 
7, with a total sample of 12,856 youth aged 15–34 years for the analysis. 
The objective of the study is to examine the factors that influence obesity and overweight 
among Ghanaian youth. The socio-demographic factors examined were sex, age, and level 
of education, occupation, place of residence, region of residence, marital status, wealth 
quintile, and religion. The methodologies used in analysing the data include univariate, 
bivariate, and multivariate methods of analysis. The first stage of analysis involved the use 
of percentage and frequency distributions to interrogate the socio-demographic 
characteristics of respondents. In the second stage of analysis, the Pearson chi-square test 
statistic was used to explore the association between each socio-demographic 
characteristic and overweight and obesity. In the third stage of analysis, a multinomial 
logistic regression analysis was used to explore the association between the socio- 
demographic characteristics of the youth and their obesity and overweight status, with 
significance set at the 95% confidence level. 
 55 
University of Ghana http://ugspace.ug.edu.gh
The first objective was to estimate the prevalence of obesity and overweight among youth 
aged 15–34 years. The prevalence of obesity was found to be 9.4%, while being overweight 
was 16.1%. The second objective was to examine the relationship between socio-
demographic characteristics of overweight and obesity among youth in Ghana. The study 
found that obesity was more common among females compared to males. Also, the 25-34 
age groups had a higher obesity prevalence of 13.0% as compared to the 15–24 age groups, 
whose prevalence was 6.3%. Respondents who reside in urban areas showed a higher 
obesity prevalence of 10.9% as compared to respondents who reside in rural areas (7.5%). 
On the other hand, respondents who worked as fisher folks and farmers had lower obesity 
prevalence (4.8%) as compared to respondents who worked as service or sales personnel 
(14.5%). Respondents who were in a union at the time of the survey had higher obesity 
prevalence (13.1%) as compared to respondents who had never been married (7.1%). 
Respondents who fall within the poorest wealth quintile category had lower obesity 
prevalence (5.4%) as compared to respondents who fall into the richest wealth quintile 
category (12.0%). Also, respondents who had no formal education had the lowest obesity 
prevalence (8.2%) as compared to respondents who had completed tertiary education 
(12.3%). The results indicate that these socio-demographic characteristics are factors that 
can influence obesity and overweight among youth. 
At the multivariate level, the multinomial logistic regression results showed that age, sex, 
region of residence, religion, marital status, level of education, occupation, place of 
residence, and wealth status are significant predictors of obesity and overweight among 
youth. Therefore, all the socio-demographic factors that were explored in this study 
highlighted their importance in how they influence obesity and overweight among the youth 
in Ghana. The study, therefore, accepts the first hypothesis that states that females are more 
likely to be obese as compared to males. The second hypothesis, which states 
 56 
University of Ghana http://ugspace.ug.edu.gh
that youth who belong to the richest wealth quintile category are more likely to be obese as 
compared to youth who belong to the poorest wealth quintile category, was also accepted. 
The third hypothesis, which states that the older youth aged (25–34) years are more likely 
to be obese as compared to the younger youth aged (15-24) years, was also accepted. Lastly, 
the fourth hypothesis, which states that respondents who are currently in a union are more 
likely to be obese as compared to respondents who have never been married, was also 
accepted. 
The findings show that socio-demographic characteristics are significant predictors of 
obesity and overweight among Ghanaian youth. Also, the findings show that obesity and 
overweight among Ghanaian youth are high and need policy attention to help manage the 
increasing prevalence. 
 
6.2 Conclusion 
 
This study shows that the prevalence of obesity and overweight among Ghanaian youth is 
high. The study found that socio-demographic factors, including wealth quintile, place of 
residence, region of residence, and religion, were all significant predictors of obesity and 
overweight among Ghanaian youth. Married youth and older (25-34) year olds were found 
to be more prone to obesity and overweight than never married and younger (15-24) year 
olds. The high prevalence of obesity and overweight among youth has health implications 
that affect their self-esteem and quality of life. The high trend of health conditions such as 
stroke and diabetes is very much associated with obesity and overweight, which needs 
public health attention. The youth should therefore be encouraged to take up a healthy 
lifestyle, including exercising and eating healthy foods that can curb the increase in 
overweight and obesity. 
 57 
University of Ghana http://ugspace.ug.edu.gh
6.3 Recommendations 
 
The findings show a high prevalence of obesity and overweight among youth and therefore 
the need for greater attention from policymakers to help manage the growing conditions of 
overweight and obesity among youth. As a result, the following recommendations can be 
proposed. 
 
Policymakers should drive educational campaigns on the causes, conditions, and health 
consequences of obesity and overweight targeted at youth to create the needed awareness 
among the Ghanaian youth and the general population at large. This would go a long way 
to enable the youth to adopt healthy lifestyles such as exercising and eating healthy foods 
to help curb obesity and overweight among the youth. The government should also develop 
audio and visual programmes on healthy living that would be shown and played on 
television and radio nationwide in all Ghanaian languages to drive the needed knowledge 
on obesity and overweight. 
 
The government can also help to change the built environment by creating more open parks 
and playgroups to promote physical activities such as volleyball and soccer, which can help 
the youth exercise and expend energy, thereby helping to reduce obesity and overweight. 
Lastly, the government should help subsidise healthy foods such as fruits and vegetables 
that are high in vitamins and minerals so more young people can consume such foods to 
help manage overweight and obesity in the long term. 
 58 
University of Ghana http://ugspace.ug.edu.gh
REFERENCES 
 
Abalkhail, B. (2002). Overweight and Obesity Among Saudi Arabian Children and 
Adolescents Between 1994 And 2000. Emhj-Eastern Mediterranean Health 
Journal, 8 (4-5), 470-479, 2002. 
Abdulai, A. (2010). Socio-Economic Characteristics and Obesity in Underdeveloped 
Economies: Does Income Matter? Applied Economics, 42(2), 157-169. 
Abubakari, A. R., Lauder, W., Agyemang, C., Jones, M., Kirk, A., & Bhopal, R. S. (2008). 
Prevalence and Time Trends In Obesity Among Adult West African Populations: A 
Meta‐ Analysis. Obesity Reviews, 9(4), 297-311. 
Addo, J., Smeeth, L., & Leon, D. A. (2009). Obesity in urban civil servants in Ghana: 
association with pre-adult wealth and adult socioeconomic status. Public health, 
123(5), 365-370. 
Adeboye, B., Bermano, G., & Rolland, C. (2012) Obesity and Its Health Impact in Africa: 
A Systematic Review. Cardiovascular Journal of Africa. 23(9), 512-21. 
Agyei-Mensah, S., & Aikins, A. D. G. (2010). Epidemiological Transition and The Double 
Burden of Disease in Accra, Ghana. Journal of Urban Health, 87(5), 879- 897. 
Agyemang, C., Owusu-Dabo, E., De Jonge, A., Martins, D., Ogedegbe, G., & Stronks, K. 
(2009). Overweight and obesity among Ghanaian residents in The Netherlands: how 
do they weigh against their urban and rural counterparts in Ghana? Public health 
nutrition, 12(7), 909-916. 
Agyemang, C., Boatemaa, S., Frempong, G. A., & Aikins, A. (2016). Obesity in sub- 
Saharan Africa. Metabolic syndrome. Switzerland: Springer International 
Publishing, 1-13. 
Aikins, A. D. G. (2007). Ghana's Neglected Chronic Disease Epidemic: A Developmental 
Challenge. Ghana Medical Journal, 41(4), 154. 
Aikins, A. D. G., Unwin, N., Agyemang, C., Allotey, P., Campbell, C., & Arhinful, D. 
(2010). Tackling Africa's Chronic Disease Burden: From the Local to The Global. 
Globalization and Health, 6(1), 1-7. 
Al-Haqwi, A. I., Al-Nasir, M., Ahmad, N., Masaudi, E., Alotaibi, S. S., & Hamad, B. (2015). 
Obesity and overweight in a major family practice centre, central region, Saudi 
Arabia. Saudi Journal of Obesity, 3(1), 12. 
 59 
University of Ghana http://ugspace.ug.edu.gh
Ali, A. T., & Crowther, N. J. (2009). Factors Predisposing to Obesity; A Review of The 
Literature. Jemdsa, 14 (2), 81, 84. 
Allman-Farinelli, M. A., Chey, T., Merom, D., & Bauman, A. E. (2010). Occupational Risk 
of Overweight and Obesity: An Analysis of The Australian Health Survey. 
Journal of Occupational Medicine and Toxicology, 5(1), 1-9. 
Al Nsour, M., Al Kayyali, G., & Naffa, S. (2013). Overweight and obesity among Jordanian 
women and their social determinants. East Mediterr Health J, 19(12), 1014-9. 
Al-Nuaim, A. A., Al-Nakeeb, Y., Lyons, M., Al-Hazzaa, H. M., Nevill, A., Collins, P., & 
Duncan, M. J. (2012). The Prevalence of Physical Activity and Sedentary 
Behaviours Relative to Obesity Among Adolescents from Al-Ahsa, Saudi Arabia: 
Rural Versus  Urban  Variations. Journal  of  Nutrition  and Metabolism, 2012. 
Alvanides, S., Townshend, T. G., & Lake, A. A. (2010). 14 Obesogenic Environments: 
Challenges and Opportunities. Obesogenic Environments, 215. 
Alwan, H., Viswanathan, B., Williams, J., Paccaud, F., & Bovet, P. (2010). Association 
Between Weight Perception and Socioeconomic Status Among Adults in Seychelles. 
Bmc Public Health, 10(1), 467. 
Amidu, N., Owiredu, W. K. B. A., Saaka, M., Quaye, L., Wanwan, M., Kumibea, P. D., ... 
& Mogre, V. (2013). Determinants of Childhood Obesity Among Basic School 
Children Aged 6–12 Years in Tamale Metropolis. Journal of Medical and 
Biomedical Sciences, 2(3), 26-34. 
Amin, T. T., Al-Sultan, A. I., & Ali, A. (2008). Overweight and Obesity And Their Relation 
To Dietary Habits And Socio-Demographic Characteristics Among Male Primary 
School Children In Al-Hassa, Kingdom Of Saudi Arabia. European Journal of 
Nutrition, 47(6), 310. 
Amoah, A. G. (2003). Socio-demographic Variations in Obesity Among Ghanaian Adults. 
Public Health Nutrition, 6(8), 751-757. 
Amo-Adjei, J., & Kumi-Kyereme, A. (2015). Fruit and vegetable consumption by ecological 
zone and socioeconomic status in Ghana. Journal of Biosocial Science, 47(5), 
613. 
Anyanwu, G. E., Ekezie, J., Danborno, B., & Ugochukwu, A. I. (2010). Impact of Education 
on Obesity and Blood Pressure in Developing Countries: A Study on The Ibos Of 
Nigeria. North American Journal of Medical Sciences, 2(7), 320. 
 60 
University of Ghana http://ugspace.ug.edu.gh
Appiah, C. A., Otoo, G. E., & Steiner-Asiedu, M. (2016). Preferred body size in urban 
Ghanaian women: implication on the overweight/obesity problem. Pan African 
Medical Journal, 23. 
Arojo, O. O., & Osungbade, K. O. (2013). Trends of Obesity Epidemic and Its Socio- 
Cultural Dimensions in Africa: Implications for Health Systems and Environmental 
Interventions. Concept Journal of Emerging Issues in Medical Diagnosis and 
Treatment, 1(7), 1-9. 
Aryeetey, R. N. O. (2016). Perceptions and Experiences of Overweight Among Women in 
The Ga East District, Ghana. Frontiers in Nutrition, 3, 13. 
Baranowski, T., Cullen, K. W., Nicklas, T., Thompson, D., & Baranowski, J. (2003). Are 
our Current Health Behavioral Change Models Helpful in Guiding Prevention of 
Weight Gain Efforts? Obesity Research, 11(S10), 23s-43s. 
Basu, M., Sarkar, K., Shahbabu, B., Ray, S., Barik, G., Chatterjee, S., & Misra, R. N. (2016). 
Pattern and Determinants of Overweight And Obesity Among Medical Students Of 
Kolkata. Int J Pharma Sci Res, 7, 377-86 
Basu, M. (2007). Diabetes, obesity and soft drinks. 
Basu (2007). Ghana national NCD programme: history, prospects and challenges. 
Proceedings of the First Annual workshop British Academy UK Africa Academic 
Partnership of chronic disease in Africa, Noguchi Memorial Institute for Medical 
Research 
Benkeser, R. M., Biritwum, R., & Hill, A. G. (2012). Prevalence of Overweight and Obesity 
and Perception Of Healthy And Desirable Body Size In Urban, Ghanaian Women. 
Ghana Medical Journal, 46(2), 66-75. 
Berrios, X., Koponen, T., Huiguang, T., Khaltaev, N., Puska, P., & Nissinen, A. (1997). 
Distribution and Prevalence of Major Risk Factors of Noncommunicable Diseases 
In Selected Countries: The WHO Inter-Health Programme. Bulletin of The World 
Health Organization, 75(2), 99 
Biritwum, R. B., Gyapong, J., & Mensah, G. (2005). The Epidemiology Of Obesity In 
Ghana. Ghana Medical Journal, 39(3), 82. 
Birks, K. A. T. H. E. R. I. N. E. (2012). The ‘Double Burden’of Undernutrition and 
Overnutrition Disease In Ghana'. Africa Portal Backgrounder, 35. 
Biswas, T., Garnett, S. P., Pervin, S., & Rawal, L. B. (2017). The prevalence of underweight, 
overweight and obesity in Bangladeshi adults: Data from a national survey. PloS 
one, 12(5), e0177395. 
 61 
University of Ghana http://ugspace.ug.edu.gh
Bharmal, N., Kaplan, R. M., Shapiro, M. F., Kagawa-Singer, M., Wong, M. D., Mangione, 
C. M., ... & McCarthy, W. J. (2013). The association of religiosity with 
overweight/obese body mass index among Asian Indian immigrants in California. 
Preventive medicine, 57(4), 315-321. 
Bonauto, D. K., Lu, D., & Fan, Z. J. (2014). Peer-reviewed: obesity prevalence by 
occupation in Washington State, behavioural risk factor surveillance system. 
Preventing chronic disease, 11. 
Boutayeb, A. (2006). The Double Burden Of Communicable And Non-Communicable 
Diseases In Developing Countries. Transactions Of The Royal Society Of Tropical 
Medicine And Hygiene, 100(3), 191-199. 
Boyington, J. E., Carter-Edwards, L., Piehl, M., Hutson, J., Langdon, D., & Mcmanus, S. 
(2008). Cultural Attitudes Toward Weight, Diet, And Physical Activity Among 
Overweight African American Girls. Preventing Chronic Disease, 5(2). 
Brener, N. D., Eaton, D. K., Flint, K. H., Hawkins, J., Kann, L., Kinchen, S., & Shanklin, 
S. L. (2004). The Methodology Of The Youth Risk Behavior Surveillance System- 
2013. 
Caballero, B. (2007). The Global Epidemic Of Obesity: An Overview. Epidemiologic 
Reviews, 29(1), 1-5. 
Caldwell, J. C. (1980). Mass Education As A Determinant Of The Timing Of Fertility 
Decline. Population And Development Review, 225-255. 
Campbell, T., & Campbell, A. (2007). Emerging Disease Burden and the Poor in Cities of 
the Developing World. Journal of urban health: Bulletin of the New York Academy 
of Medicine, 84(suppl 1), 54-64 
Case, A., & Menendez, A. (2009). Sex Differences In Obesity Rates In Poor Countries: 
Evidence From South Africa. Economics & Human Biology, 7(3), 271-282. 
Center For Disease Control And Prevention/National Center For Health Statistics Data Brief 
Report No. 360 2020 February. 
Christakis, N. A., & Fowler, J. H. (2007). The Spread Of Obesity In A Large Social Network 
Over 32 Years. New England Journal Of Medicine, 357(4), 370-379. 
Cline, K. M., & Ferraro, K. F. (2006). Does religion increase the prevalence and incidence 
of obesity in adulthood?. Journal for the scientific study of religion, 45(2), 269- 281. 
 62 
University of Ghana http://ugspace.ug.edu.gh
Cohen, E., Boetsch, G., Palstra, F. P., & Pasquet, P. (2013). Social valorisation of stoutness 
as a determinant of obesity in the context of nutritional transition in Cameroon: The 
Bamiléké case. Social Science & Medicine, 96, 24-32. 
Cooke, L., & Wardle, J. (2007). Depression and obesity. 
Coreil, J., Bryant, C. A., & Henderson, J. N. (2001). Social Epidemiology. Social And 
Behavioral Foundations Of Public Health, 10-11. 
Cutler, D. M., & Lleras-Muney, A. (2006). Education And Health: Evaluating Theories And 
Evidence (No. W12352). National Bureau Of Economic Research. 
Dake, F. A., Tawiah, E. O., & Badasu, D. M. (2011). Socio-Demographic Correlates Of 
Obesity Among Ghanaian Women. Public Health Nutrition, 14(7), 1285-1291. 
Desalew, A., Mandesh, A., & Semahegn, A. (2017). Childhood Overweight, Obesity And 
Associated Factors Among Primary School Children In Dire Dawa, Eastern 
Ethiopia; A Cross-Sectional Study. Bmc Obesity, 4(1), 20. 
De Onis, M., Blössner, M., & Borghi, E. (2010). Global prevalence and trends of overweight 
and obesity among preschool children. The American journal of clinical nutrition, 
92(5), 1257-1264. 
Di Milia, L., Vandelanotte, C., & Duncan, M. J. (2013). The association between short sleep 
and obesity after controlling for demographic, lifestyle, work and health- related 
factors. Sleep medicine, 14(4), 319-323. 
Dinsa, G. D., Goryakin, Y., Fumagalli, E., & Suhrcke, M. (2012). Obesity and 
socioeconomic status in developing countries: a systematic review. Obesity Reviews, 
13(11), 1067-1079. 
Dixon, J. B. (2010). The effect of obesity on health outcomes. Molecular and cellular 
endocrinology, 316(2), 104-108. 
Dodson, E. A., Fleming, C., Boehmer, T. K., Haire-Joshu, D., Luke, D. A., & Brownson, 
R. C. (2009). Preventing Childhood Obesity Through State Policy: A Qualitative 
Assessment Of Enablers And Barriers. Journal Of Public Health Policy, 30(1), 
S161- S176. 
Doku, D. T., & Neupane, S. (2015). The double burden of malnutrition: increasing 
overweight and obesity and stall underweight trends among Ghanaian women. 
BMC public health, 15(1), 670. 
Dodor, B. (2012). The impact of religiosity on health behaviours and obesity among African 
Americans. Journal of Human Behavior in the Social Environment, 22(4), 451-462. 
 63 
University of Ghana http://ugspace.ug.edu.gh
Drewnowski, A. (2004). Obesity And The Food Environment: Dietary Energy Density And 
Diet Costs. American Journal Of Preventive Medicine, 27(3), 154-162. 
Drewnowski, A. (2010). Healthier Foods Cost More. Nutrition Reviews, 68(3), 184-185. 
Duda, R. B., Jumah, N. A., Hill, A. G., Seffah, J., & Biritwum, R. (2007). Assessment Of 
The Ideal Body Image Of Women In Accra, Ghana. Tropical Doctor, 37(4), 241- 
244. 
Duda, R. B., Darko, R., Seffah, J., Adanu, R. M., Anarfi, J. K., & Hill, A. G. (2007). 
Prevalence Of Obesity In Women Of Accra, Ghana. African Journal Of Health 
Sciences, 14(3), 154-159. 
Dugas, L. R., Carstens, M. A., Ebersole, K., Schoeller, D. A., Durazo-Arvizu, R. A., 
Lambert, E. V., & Luke, A. (2009). Energy Expenditure In Young Adult Urban 
Informal Settlement Dwellers In South Africa. European Journal Of Clinical 
Nutrition, 63(6), 805-807. 
El-Bayoumy, I., Shady, I., & Lotfy, H. (2009). Prevalence Of Obesity Among Adolescents 
(10 To 14 Years) In Kuwait. Asia Pacific Journal Of Public Health, 21(2), 153- 159. 
Ersoy, C., & Imamoglu, S. (2006). Comparison of the obesity risk and related factors in 
employed and unemployed (housewife) premenopausal urban women. Diabetes 
research and clinical practice, 72(2), 190-196. 
Ezzati, M., Lopez, A. D., Rodgers, A. A., & Murray, C. J. (2004). Comparative 
Quantification Of Health Risks: Global And Regional Burden Of Disease 
Attributable To Selected Major Risk Factors. World Health Organization. 
Faber, M., & Kruger, H. S. (2005). Dietary Intake, Perceptions Regarding Body Weight, 
And Attitudes Toward Weight Control Of Normal Weight, Overweight, And Obese 
Black Females In A Rural Village In South Africa. Ethn Dis, 15(2), 238- 245. 
Fezeu, L., Minkoulou, E., Balkau, B., Kengne, A. P., Awah, P., Unwin, N., ... & Mbanya, 
J. C. (2006). Association Between Socioeconomic Status And Adiposity In Urban 
Cameroon. International Journal Of Epidemiology, 35(1), 105-111. 
Flegal, K. M., Graubard, B. I., Williamson, D. F., & Gail, M. H. (2005). Excess deaths are 
associated with being underweight, overweight, and obese. Jama, 293(15), 1861- 
1867. 
Flegal, K. M., Carroll, M. D., Ogden, C. L., & Curtin, L. R. (2010). Prevalence And Trends 
In Obesity Among Us Adults, 1999-2008. Jama, 303(3), 235-241. 
 64 
University of Ghana http://ugspace.ug.edu.gh
Gibson, R. S. (2005). Principles of nutritional assessment. Oxford university press, USA. 
Ghana Demographic And Health Survey (GDHS 2014) Report. 
Ghana Health Service (GHS 2009) Regenerative Health And Nutrition. 
Ghana National Youth Policy. 2010 
Ghana Statistical Service (GSS) (2009). Ghana Demographic And Health Survey 2008. 
Noguchi Memorial Institute For Medical Research (NMIMR) 
Ghana Statistical Service (GSS 2013), 2010 Population And Housing Census Of Ghana. 
National Analytical Report. GSS 
Gu, J. K., Charles, L. E., Bang, K. M., Ma, C. C., Andrew, M. E., Violanti, J. M., & 
Burchfiel, C. M. (2014). Prevalence of obesity by occupation among US workers: 
the National Health Interview Survey 2004–2011. Journal of occupational and 
environmental medicine/American College of Occupational and Environmental 
Medicine, 56(5), 516. 
Gortmaker, S. L., Swinburn, B. A., Levy, D., Carter, R., Mabry, P. L., Finegood, D. T., ... 
& Moodie, M. L. (2011). Changing The Future Of Obesity: Science, Policy, And 
Action. The Lancet, 378(9793), 838-847. 
Gretchen, S. A., Singh, G. M., Lu, Y., Danaei, G., Lin, J. K., Finucane, M. M., Bahalim, 
A. N. et al. (2012): "National, regional, and global trends in adult overweight and 
obesity prevalences." Population health metrics, 10(1), 22. 
Grøholt, E. K., Stigum, H., & Nordhagen, R. (2008). Overweight And Obesity Among 
Adolescents In Norway: Cultural And Socio-Economic Differences. Journal Of 
Public Health, 30(3), 258-265. 
Grossman, M., & Kaestner, R. (1997). Effects Of Education On Health. The Social Benefits 
Of Education, 12, 69. 
Gueorguieva, R., Sindelar, J. L., Wu, R., & Gallo, W. T. (2011). Differential changes in 
body mass index after retirement by occupation: hierarchical models. International 
journal of public health, 56(1), 111-116. 
Guerra, F., Stringhini, S., Vollenweider, P., Waeber, G., & Marques-Vidal, P. (2015). Socio-
demographic and behavioural determinants of weight gain in the Swiss population. 
BMC Public Health, 15(1), 73. 
Hall, K. D., Sacks, G., Chandramohan, D., Chow, C. C., Wang, Y. C., Gortmaker, S. L., & 
Swinburn, B. A. (2011). Quantification Of The Effect Of Energy Imbalance On 
Bodyweight. The Lancet, 378(9793), 826-837. 
 65 
University of Ghana http://ugspace.ug.edu.gh
Hill, A. G., Darko, R., Seffah, J., Adanu, R. M., Anarfi, J. K., & Duda, R. B. (2007). Health 
Of Urban Ghanaian Women As Identified By The Women’s Health Study Of   
Accra. International Journal Of Gynecology & Obstetrics, 99(2), 150-156. 
Hill, J. L., Yu, W., & Zoellner, J. M. (2014). Disparities in obesity among rural and urban 
residents in a health disparate region. BMC public health, 14(1), 1051. 
Holdsworth, M., Gartner, A., Landais, E., Maire, B., & Delpeuch, F. (2004). Perceptions Of  
Healthy  And  Desirable  Body  Size  In  Urban  Senegalese Women. 
International Journal Of Obesity, 28(12), 1561-1568. 
Hu, F. B. (2008). Measurements Of Adiposity And Body Composition. Obesity 
Epidemiology, 53-83. 
International Association for the Study of Obesity, (IASO). (2012) 
International  Diabetes  Foundation  (IDF).  Diabetes  Atlas  (2010). Http://Www. 
Diabetesatlas.Org/Map 
James, W. P. T., Jackson-Leach, R., Mhurchu, C. N., Kalamara, E., Shayeghi, M., Rigby, 
N. J., ... & Rodgers, A. (2004). Overweight And Obesity (High Body Mass 
Index). Comparative Quantification Of Health Risks: The Global And Regional 
Burden Of Disease Attributable To Selected Major Risk Factors, 1, 497-596. 
Joosen, A. M., & Westerterp, K. R. (2006). Energy Expenditure During Overfeeding. 
Nutrition & Metabolism, 3(1), 25. 
Joosen, A. M. C. P., Bakker, A. H. F., Zorenc, A. H. G., Kersten, S., Schrauwen, P., & 
Westerterp, K. R. (2006). Par Γ Activity In Subcutaneous Abdominal Fat Tissue And 
Fat Mass Gain During Short-Term Overfeeding. International Journal Of Obesity, 
30(2), 302-307. 
Kanter, R., & Caballero, B. (2012). Global gender disparities in obesity: a review. 
Advances in nutrition, 3(4), 491-498. 
Kautiainen, S., Koivusilta, L., Lintonen, T., Virtanen, S. M., & Rimpelä, A. (2005). Use Of 
Information And Communication Technology And The Prevalence Of Overweight 
And Obesity Among Adolescents. International Journal Of Obesity, 29(8), 925-
933. 
Kenkel, D. S. (1991). Health Behavior, Health Knowledge, And Schooling. Journal Of 
Political Economy, 99(2), 287-305. 
Kumah D B, Akuffo K O, Abaka-Cann J E, Affram D E, Osae E A. (2015) Prevalence Of 
Overweight And Obesity Among Students In The Kumasi Metropolis. Journal Of 
Nutrition And Metabolism. 
 66 
University of Ghana http://ugspace.ug.edu.gh
Kvaavik, E., Tell, G. S., & Klepp, K. I. (2003). Predictors and tracking of body mass index 
from adolescence into adulthood: follow-up of 18 to 20 years in the Oslo Youth 
Study. Archives of paediatrics & adolescent medicine, 157(12), 1212-1218. 
Lash, M. M., & Armstrong, A. (2009). Impact Of Obesity On Women's Health. Fertility 
And Sterility, 91(5), 1712-1716. 
Lazarou, C., & Soteriades, E. S. (2010). Children's Physical Activity, Tv Watching, And 
Obesity In Cyprus: The Cykids Study. The European Journal Of Public Health, 
20(1), 70-77. 
Leddy, M. A., Power, M. L., & Schulkin, J. (2008). The Impact Of Maternal Obesity On 
Maternal And Fetal Health. Reviews In Obstetrics And Gynecology, 1(4), 170. 
Leibowitz, K. L., Chang, G. Q., Pamy, P. S., Hill, J. O., Gayles, E. C., & Leibowitz, S. F. 
(2007). Weight Gain Model In Prepubertal Rats: Prediction And Phenotyping Of 
Obesity-Prone Animals At Normal Body Weight. International Journal Of Obesity, 
31(8), 1210-1221. 
Lewis, S., Thomas, S. L., Blood, R. W., Castle, D. J., Hyde, J., & Komesaroff, P. A. (2011). 
How do obese individuals perceive and respond to the different types of obesity 
stigma that they encounter in their daily lives? A qualitative study. Social science & 
medicine, 73(9), 1349-1356. 
Letamo, G. (2011). The prevalence of, and factors associated with, overweight and obesity 
in Botswana. Journal of biosocial science, 43(1), 75-84. 
Martorell, R., Stein, A. D., & Schroeder, D. G. (2001). Early Nutrition And Later Adiposity. 
The Journal Of Nutrition, 131(3), 874s-880s. 
Mclaren, L. (2007). Socioeconomic Status And Obesity. Epidemiologic Reviews, 29(1), 29-
48. 
Memish, Z. A., El Bcheraoui, C., Tuffaha, M., Robinson, M., Daoud, F., Jaber, S., ... & Al 
Rabeeah, A. A. (2014). Peer-Reviewed: Obesity And Associated Factors— 
Kingdom Of Saudi Arabia, 2013. Preventing Chronic Disease, 11. 
Meredith, C. N., & Dwyer, J. T. (1991). Nutrition And Exercise: Effects On Adolescent 
Health. Annual Review Of Public Health, 12(1), 309-333. 
Mighty, H. E., & Fahey, J. O. (2007). Obesity And Pregnancy Complications. Current 
Diabetes Reports, 7(4), 289-294. 
Ministry Of Health (MoH 2007); Regenerative Health; Shifting Emphasis From Cure To 
Prevention, Policy Briefing Paper 002. 
 67 
University of Ghana http://ugspace.ug.edu.gh
Misra, A., & Khurana, L. (2008). Obesity And The Metabolic Syndrome In Developing 
Countries. The Journal Of Clinical Endocrinology & 
Metabolism, 93(11_Supplement_1), S9-S30. 
Mitchell, N. S., Catenacci, V. A., Wyatt, H. R., & Hill, J. O. (2011). Obesity: An Overview 
Of An Epidemic. Psychiatric Clinics, 34(4), 717-732. 
Mogre, V., Gaa, P. K., & Abukari, R. N. S. (2013). Overweight, Obesity, And Thinness And 
Associated Factors Among School-Aged Children (5-14 Years) In Tamale, Northern 
Ghana. Eur Sci J, 9(20), 1857-7881. 
Mogre, V., Nyaba, R., Aleyira, S., & Sam, N. B. (2015). Demographic, dietary and physical 
activity predictors of general and abdominal obesity among university students: a 
cross-sectional study. Springerplus, 4(1), 226. 
Mohammed, H., & Vuvor, F. (2012). Prevalence Of Childhood Overweight/Obesity In 
Basic School In Accra. Ghana Medical Journal, 46(3), 124. 
Morita, Y., Iwamoto, I., Mizuma, N., Kuwahata, T., Matsuo, T., Yoshinaga, M., & Douchi, 
T. (2006). Precedence Of The Shift Of Body‐ Fat Distribution Over The Change In 
Body Composition After Menopause. Journal Of Obstetrics And Gynaecology 
Research, 32(5), 513-516. 
Muhihi, A. J., Njelekela, M. A., Mpembeni, R., Mwiru, R. S., Mligiliche, N., & Mtabaji, J. 
(2012). Obesity, Overweight, And Perceptions About Body Weight Among Middle-
Aged Adults In Dar Es Salaam, Tanzania. Is Obesity, 2012. 
Musa, D. I., Toriola, A. L., Monyeki, M. A., & Lawal, B. (2012). Prevalence Of Childhood  
And Adolescent Overweight And Obesity In Benue State, Nigeria. Tropical 
Medicine & International Health, 17(11), 1369-1375. 
Musaiger, A. O., Al-Roomi, K., & Bader, Z. (2014). Social, dietary and lifestyle factors are 
associated with obesity among Bahraini adolescents. Appetite, 73, 197-204. 
Nathenson, S. L., & Wen, M. (2012). Religiousness, physical activity and obesity among 
older cancer survivors: results from the health and retirement study 2000– 2010. 
The international journal of religion and spirituality in society, 2(3), 129. 
Nelson, M. C., Kocos, R., Lytle, L. A., & Perry, C. L. (2009). Understanding the perceived 
determinants of weight-related behaviours in late adolescence: a qualitative analysis 
among college youth. Journal of nutrition education and behaviour, 41(4), 287-292. 
 68 
University of Ghana http://ugspace.ug.edu.gh
Nelson M. C., Story, M., Larson, N. I., Neumark-Sztainer, D., & Lytle, L.A. (2008). 
Emerging Adulthood and College-aged Youth: An Overlooked age for Weight- 
related Behaviour Change. Obesity, 16(10), 2205-2211. 
Neuman, M., Kawachi, I., Gortmaker, S., & Subramanian, S. V. (2013). Urban-rural 
differences in BMI in low-and middle-income countries: the role of socioeconomic 
status. The American journal of clinical nutrition, 97(2), 428-436. 
Neupane, S., Prakash, K. C., & Doku, D. T. (2015). Overweight and obesity among women: 
analysis of demographic and health survey data from 32 Sub-Saharan African 
Countries. BMC Public Health, 16(1), 30. 
Ng, M., Fleming, T., Robinson, M., Thomson, B., Graetz, N., Margono, C., ... & Abraham, 
J. P. (2014). Global, regional, and national prevalence of overweight and obesity in 
children and adults during 1980–2013: a systematic analysis for the Global Burden 
of Disease Study 2013. The Lancet, 384(9945), 766-781. 
Nishida, C., Uauy, R., Kumanyika, S., & Shetty, P. (2004). The Joint Who/Fao Expert 
Consultation On Diet, Nutrition And The Prevention Of Chronic Diseases: 
Process, Product And Policy Implications. Public Health Nutrition, 7(1a), 245-250. 
Njelekela, M. A., Mpembeni, R., Muhihi, A., Mligiliche, N. L., Spiegelman, D., 
Hertzmark, E., ... & Mtabaji, J. (2009). Gender-Related Differences In The 
Prevalence Of Cardiovascular Disease Risk Factors And Their Correlates In Urban 
Tanzania. Bmc Cardiovascular Disorders, 9(1), 30. 
Nyamdorj, R., Qiao, Q., Söderberg, S., Pitkäniemi, J., Zimmet, P., Shaw, J., ... & Chitson, 
P. (2008). Comparison Of Body Mass Index With Waist Circumference, Waist-To- 
Hip Ratio, And Waist-To-Stature Ratio As A Predictor Of Hypertension Incidence 
In  Mauritius. Journal Of Hypertension, 26(5), 866-870. 
Ofori-Asenso, R., Agyeman, A. A., Laar, A., & Boateng, D. (2016). Overweight And 
Obesity Epidemic In Ghana—A Systematic Review And Meta-Analysis. Bmc 
Public Health, 16(1), 1239. 
Park, M. H., Falconer, C., Viner, R. A., & Kinra, S. (2012). The impact of childhood obesity 
on morbidity and mortality in adulthood: a systematic review. Obesity Reviews, 
13(11), 985-1000. 
Pechey, R., Jebb, S. A., Kelly, M. P., Almiron-Roig, E., Conde, S., Nakamura, R., ... & 
Marteau, T. M. (2013). Socioeconomic Differences In Purchases Of More Vs. Less 
Healthy Foods And Beverages: Analysis Of Over 25,000 British Households In 
2010. Social Science & Medicine, 92, 22-26. 
 69 
University of Ghana http://ugspace.ug.edu.gh
Peltzer, K., & Pengpid, S. (2011). Overweight And Obesity And Associated Factors Among 
School-Aged Adolescents In Ghana And Uganda. International Journal Of 
Environmental Research And Public Health, 8(10), 3859-3870. 
Peltzer, K., & Pengpid, S. (2015). Correlates of healthy fruit and vegetable diet in students 
in low, middle and high-income countries. International journal of public health, 
60(1), 79-90. 
Peltzer, K., & Pengpid, S. (2015). Underestimation of weight and its associated factors in 
overweight and obese university students from 21 low, middle and emerging 
economy countries. Obesity research & clinical practice, 9(3), 234-242. 
Pereko, K. K., Setorglo, J., Owusu, W. B., Tiweh, J. M., & Achampong, E. K. (2013). 
Overnutrition and associated factors among adults aged 20 years and above in 
fishing communities in the urban Cape Coast Metropolis, Ghana. Public health 
nutrition, 16(4), 591-595. 
Poluru, R., & Mukherjee, S. (2010). Concurrent prevalence of underweight and overweight 
among women in India: The case of western states. Journal of Research and 
Practice in Social Sciences, 6, 22-42. 
Poobalan, A. S., Aucott, L. S., Clarke, A., & Smith, W. C. S. (2012). Physical activity 
attitudes, intentions and behaviour among 18–25-year-olds: A mixed-method study. 
BMC public health, 12(1), 1-10. 
Poobalan, A., & Aucott, L. (2016). Obesity among young adults in developing countries: a 
systematic overview. Current obesity reports, 5(1), 2-13. 
Popkin, B. M. (2006). Technology, Transport, Globalization And The Nutrition Transition 
Food Policy. Food Policy, 31(6), 554-569. 
Popkin, B. M. (2006). Global Nutrition Dynamics: The World Is Shifting Rapidly Toward 
A Diet Linked With Noncommunicable Diseases–. The American Journal Of 
Clinical Nutrition, 84(2), 289-298. 
Power, M. L., & Schulkin, J. (2008). Sex Differences In Fat Storage, Fat Metabolism, And 
The Health Risks From Obesity: Possible Evolutionary Origins. British Journal Of 
Nutrition, 99(5), 931-940. 
Pradeepa, R., Anjana, R. M., Joshi, S. R., Bhansali, A., Deepa, M., Joshi, P. P., ... & 
Subashini, R. (2015). Prevalence of generalized & abdominal obesity in urban & 
rural India-the ICMR-INDIAN Study (Phase-I)[ICMR-INDIAB-3]. The Indian 
journal of medical research, 142(2), 139. 
 70 
University of Ghana http://ugspace.ug.edu.gh
Prentice, A. M. (2006). The Emerging Epidemic Of Obesity In Developing Countries. 
International Journal Of Epidemiology, 35(1), 93-99 
Reeves, R. R., Adams, C. E., Dubbert, P. M., Hickson, D. A., & Wyatt, S. B. (2012). Are 
religiosity and spirituality associated with obesity among African Americans in the 
Southeastern United States (the Jackson Heart Study)?. Journal of religion and 
health, 51(1), 32-48. 
Regitz-Zagrosek, V., Lehmkuhl, E., & Mahmoodzadeh, S. (2007). Gender Aspects Of The 
Role Of The Metabolic Syndrome As A Risk Factor For Cardiovascular Disease. 
Gender Medicine, 4, S162-S177. 
Renzaho, A. M. (2004). Fat, rich and beautiful: changing socio-cultural paradigms 
associated with obesity risk, nutritional status and refugee children from sub- 
Saharan Africa. Health & place, 10(1), 105-113. 
Richard, L., Gauvin, L., & Raine, K. (2011). Ecological models revisited: their uses and 
evolution in health promotion over two decades. Annual review of public health, 
32, 307-326. 
Rivas‐ Marino, G., Negin, J., Salinas‐ Rodríguez, A., Manrique‐ Espinoza, B., Sterner, 
K. N., Snodgrass, J., & Kowal, P. (2015). Prevalence of overweight and obesity in 
older Mexican adults and its association with physical activity and related 
factors: An analysis of the study on global ageing and adult health. American Journal 
of Human Biology, 27(3), 326-333. 
Rodgers, A., Ezzati, M., Vander Hoorn, S., Lopez, A. D., Lin, R. B., & Murray, C. J. (2004). 
Distribution Of Major Health Risks: Findings From The Global Burden Of Disease 
Study. Plus Med, 1(1), E27 
Rolland-Cachera, M. F. (1995). Prediction Of Adult Body Composition From Infant And 
Child Measurements (Vol. 100). Cambridge University Press, Cambridge. 
Sallis, J. F., & Owen, N. (1997). Ecological Models. Health Behavior And Health 
Education: Theory, Research, And Practice, 2, 403-424 
Sánchez-Vaznaugh, E. V., Kawachi, I., Subramanian, S. V., Sánchez, B. N., & Acevedo- 
Garcia, D. (2009). Do socioeconomic gradients in body mass index vary by 
race/ethnicity, gender, and birthplace?. American journal of epidemiology, 169(9), 
1102-1112. 
Sartorius, B., Veerman, L. J., Manyema, M., Chola, L., & Hofman, K. (2015). Determinants 
of obesity and associated population attributability, South Africa: 
 71 
University of Ghana http://ugspace.ug.edu.gh
Empirical evidence from a national panel survey, 2008-2012. PloS one, 10(6), 
e0130218. 
Schultz, R. (2012). Prevalences Of Overweight And Obesity Among Children In Remote 
Aboriginal Communities In Central Australia. 
Schutzer, K. A., & Graves, B. S. (2004). Barriers and motivations to exercise in older adults. 
Preventive medicine, 39(5), 1056-1061. 
Scott, A., Ejikeme, C. S., Clottey, E. N., & Thomas, J. G. (2013). Obesity In Sub-Saharan 
Africa: Development Of An Ecological Theoretical Framework. Health Promotion 
International, 28(1), 4-16. 
Singh, A. S., Mulder, C., Twisk, J. W., Van Mechelen, W., & Chinapaw, M. J. (2008). 
Tracking of childhood overweight into adulthood: a systematic review of the 
literature. Obesity Reviews, 9(5), 474-488. 
Steyn, K., & Damasceno, A. (2006). Lifestyle and related risk factors for chronic diseases. 
Disease and mortality in sub-Saharan Africa, 2, 247-65. 
Steyn, N. P., Labadarios, D., Nel, J., Kruger, H. S., & Maunder, E. M. (2011). What Is The  
Nutritional  Status  Of  Children  Of  Obese  Mothers  In  South Africa?. 
Nutrition, 27(9), 904-911. 
Sobal, J., & Hanson, K. (2011). Family meals and body weight in US adults. Public Health 
Nutrition, 14(9), 1555-1562. 
Sobal, J., & Hanson, K. L. (2011). Marital status, marital history, body weight, and obesity. 
Marriage & family review, 47(7), 474-504 
Suter, P. M., & Tremblay, A. (2005). Is Alcohol Consumption A Risk Factor For Weight 
Gain And Obesity?. Critical Reviews In Clinical Laboratory Sciences, 42(3), 197- 
227. 
Swinburn, B. A., Sacks, G., Hall, K. D., Mcpherson, K., Finegood, D. T., Moodie, M. L., & 
Gortmaker, S. L. (2011). The Global Obesity Pandemic: Shaped By Global Drivers 
And Local Environments. The Lancet, 378(9793), 804-814. 
Shayo, G. A., & Mugusi, F. M. (2011). Prevalence of obesity and associated risk factors 
among adults in Kinondoni municipal district, Dar es Salaam Tanzania. BMC public 
health, 11(1), 365. 
Trivedi, T., Liu, J., Probst, J. C., Merchant, A., Jones, S., & Martin, A. B. (2015). Obesity 
and obesity-related behaviours among rural and urban adults in the USA. 
 72 
University of Ghana http://ugspace.ug.edu.gh
Tuoyire, D. A., Kumi-Kyereme, A., & Doku, D. T. (2016). Socio-demographic trends in 
overweight and obesity among parous and nulliparous women in Ghana. BMC 
obesity, 3(1), 44. 
Tzotzas, T., Vlahavas, G., Papadopoulou, S. K., Kapantais, E., Kaklamanou, D., & 
Hassapidou, M. (2010). Marital status and educational level associated with obesity 
in Greek adults: data from the National Epidemiological Survey. BMC public health, 
10(1), 732. 
United Nations General Assembly Resolution, A/Res/62/126 In 2008 
Van Cleave, J., Gortmaker, S. L., & Perrin, J. M. (2010). Dynamics Of Obesity And Chronic 
Health Conditions Among Children And Youth. Jama, 303(7), 623-630. 
Wang, Y., Liang, H., & Chen, X. (2009). Measured Body Mass Index, Body Weight 
Perception, Dissatisfaction, And Control Practices In Urban, Low-Income African 
American Adolescents. Bmc Public Health, 9(1), 183. 
Wang, Y., & Lim, H. (2012). The Global Childhood Obesity Epidemic And The Association 
Between Socio-Economic Status And Childhood Obesity. 
Wardle, J., Haase, A. M., Steptoe, A., Nillapun, M., Jonwutiwes, K., & Bellisie, F. (2004). 
Gender Differences In Food Choice: The Contribution Of Health Beliefs And 
Dieting. Annals Of Behavioral Medicine, 27(2), 107-116. 
Webbink, D., Martin, N. G., & Visscher, P. M. (2010). Does Education Reduce The 
Probability Of Being Overweight? Journal Of Health Economics, 29(1), 29-38. 
Wells, J. C. (2012). Obesity as malnutrition: the role of capitalism in the obesity global 
epidemic. American Journal of Human Biology, 24(3), 261-276. 
Willows, N. D., Hanley, A. J., & Delormier, T. (2012). A Socioecological Framework To 
Understand Weight-Related Issues In Aboriginal Children In Canada. Applied 
Physiology, Nutrition, And Metabolism, 37(1), 1-13. 
World Health Organisation (WHO2000); Obesity Preventing And Managing The Global 
Epidemic Report Of A WHO Consultation On Obesity; WHO Technical Report 
Series. N0 894. Geneva 
World Health Organisation Regional Office For Agriculture (WHO-AFRO 2000); Non- 
Communicable Disease Regional Strategy For 2000-2010. 
World Health Organisation (WHO 2002); World Health Report, Reducing And Promoting 
Healthy Lives. 
 73 
University of Ghana http://ugspace.ug.edu.gh
World Health Organization, (2002). Controlling The Global Obesity Epidemic. World 
Health Organization[Http://Www.WHO.Int/Nutrition/Topics/World Health Report 
2002: Reducing Risks, Promoting Healthy Life. Geneva, Who, 2002. 
World Health Organisation 2003; Global Strategy On Diet, Physical Activity And Health 
World  Health  Organisation  (WHO  2005);  Preventing  Chronic  Disease,  A  Vital 
Investment; WHO Global Report, Geneva 
World Health Organisation (WHO 2006); Obesity and Overweight 
WHO. (2006). WHO Report 2006. 
World Health Organisation. 2006. Obesity and Overweight. 
WHO. (2008). WHO Report 2008. 
World Health Organization (2010). Global Strategy On Diet, Physical Activity, And 
Health: Obesity And Overweight. En/Index.Html 
World Health Organization. Physical Inactivity (2010): A Global Public Health 
Problem. Http://Www.Who.Int/Dietphysicalactivity/Factsheet_Inctivity/En 
WHO. (2010). WHO | World Health Report. WHO. Retrieved July 18, 2014. 
WHO. (2010). WHO | World Health Report. 
World Health Organisation (WHO 2010), Facts And Figures. 
World Health Organisation (WHO 2010); Physical Activity And Older Adults. Adults/En 
World Health Organization, Global Recommendations On Physical Activity For Health 
(WHO, 2011) 
World Health Organisation. 2014a. Obesity And Overweight Fact Sheet No 311. 
World Health Organisation. 2014a. Obesity And Overweight Fact Sheet No 311. 
World Health Organisation. 2014b. What Do We Mean By “Sex” And “Gender”? 
World Health Organisation WHO. (2015) Obesity And Overweight. Who. Fact Sheet 
N°311. Http://Www.Who.Int/Mediacentre/Factsheets/Fs311/En/ 
World Health Organization (WHO) in 2016. Obesity And Overweight. Geneva: World 
Health Organization. 
World Health Organisation (WHO) 2017 Report on Obesity 
World Health Organisation (WHO), 2020. Report on Obesity April 1 
World Health Organisation (WHO) European Report (2013) on Obesity 2020 
WHO (2017) controlling the Global obesity Epidemic 
WHO (2017) Obesity and Overweight 
World Health Organisation, WHO 2020 Report. 
 74 
University of Ghana http://ugspace.ug.edu.gh
Yoon, Y. S., Oh, S. W., & Park, H. S. (2006). Socioeconomic Status In Relation To Obesity 
And Abdominal Obesity In Korean Adults: A Focus On Sex Differences. Obesity, 
14(5), 909-919. 
Ziraba, A. K., Fotso, J. C., & Ochako, R. (2009). Overweight and obesity in urban Africa: 
a problem of the rich or the poor? BMC public health, 9(1), 465. 
 75