The Influence of Body Size Estimation on Weight Management Behaviours in Accra, Ghana

ABSTRACT

Obesity has been a pertinent issue worldwide as it constitutes one of the major public health challenges. It poses a significant challenge because of the continuous increase in its prevalence and diverse health, social and economic implications. Although the associated consequences are widespread, there is evidence of preference for larger body size in sub-Saharan Africa due to some socio-cultural standards and perceptions about body size. These have implications for weight management, but there are limited studies on weight management, particularly the relationship between body size perception and weight management in sub-Saharan Africa. This study examined the factors influencing the estimation of body size on weight management decisions in an urban poor context in Accra, Ghana. The study involved the collection of primary data and it was a cross-sectional data gathered using quantitative and qualitative research approaches. A total of 395 adults aged 18-70 years were involved in the survey. Logistic regression modelling was employed to examine the influence of body size estimation on weight management behaviours, while controlling for individual, interpersonal and community level factors. Focus group discussions and in-depth interviews were utilised to examine the respondents’ perception of obesity and weight management. A total of 8 focus group discussions and 14 in-depth interviews were held. A thematic network analysis was used for the analysis of the qualitative data with the aid of Atlas ti. The findings indicated that about 57% of the total sample was overweight or obese and 5% was underweight. However, 66.5% of them perceived themselves as overweight or obese and 3% considered themselves as underweight. There was therefore variations in perceived and actual body size: 55.7%  of  the  respondents  accurately  estimated  their  body  size  while  44.3%  inaccurately estimated  their  body  size.  Additionally,  58.5%,  29.6%  and  11.9%  respectively  desired  to maintain their body size, lose and gain weight. To achieve these goals, 60.3% and 39.7% respectively engaged in more healthy and less healthy practices. The results further indicated that body size estimation had no significant influence on weight management behaviours. Factors such as age, marital status,  length of stay in the community, household wealth status, community conduciveness and locality significantly predicted weight management behaviours. Moreover, the respondents were of the view that high cost of fruits and vegetables and the perception that the consumption of fruits and vegetables do not give satisfaction are the main barriers to healthy eating. Laziness and lack of time were mentioned as main factors that inhibit participation in physical activity. Additionally, while stigmatization of slimness and preference for fatness inhibited engagement in weight management, the decision to manage weight, social support from significant others, health professionals, church and media facilitated engagement in weight management. In conclusion, body size estimation has no significant influence on weight management behaviour. However, societal representations about fatness and thinness influenced people’s desire for larger body size and this affected the choice of weight management behaviours. This has programmatic implications in terms of health education strategies and messaging.