Overweight and obesity epidemic in Ghana-a systematic review and meta-analysis.

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obesity 39 Title: BMC Public HealthOverweight and obesity epidemic in Ghana—a systematic review and meta-analysisRichard Ofori-AsensoAkosua Adom AgyemanAmos
obesity 753 systematically review the literature towards providing an estimate of the prevalence of overweight and obesity among adult Ghanaians.MethodsThis study followed the recommendations outlined in the PRISMA statement.
obesity 1091 Medicus database. This retrieved studies (published up to 31st March 2016) that reported overweight and obesity prevalence among Ghanaians. All online searches were supplemented by reference screening of retrieved
obesity 1521 nearly 43% of Ghanaian adults are either overweight or obese. The national prevalence of overweight and obesity were estimated as 25.4% (95% CI 22.2–28.7%) and 17.1% (95% CI = 14.7–19.5%), respectively. Higher
obesity 1681 17.1% (95% CI = 14.7–19.5%), respectively. Higher prevalence of overweight (27.2% vs 16.7%) and obesity (20.6% vs 8.0%) were estimated for urban than rural dwellers. Prevalence of overweight (27.8% vs 21.8%)
obesity 1797 vs 8.0%) were estimated for urban than rural dwellers. Prevalence of overweight (27.8% vs 21.8%) and obesity (21.9% vs 6.0%) were also significantly higher in women than men. About 45.6% of adult diabetes patients
obesity 2249 the levels of urbanization. Per studies’ publication years, consistent increases in overweight and obesity prevalence were observed in Ghana in the period 1998–2016.ConclusionsThere is a high and rising prevalence
obesity 2384 Ghana in the period 1998–2016.ConclusionsThere is a high and rising prevalence of overweight and obesity among Ghanaian adults. The possible implications on current and future population health, burden of
obesity 3325 in many LMICs, emerging non-communicable diseases (NCDs) relating to diet, lifestyle, and overweight/ obesity have been increasing over the last three decades [[1]]. The influence of the demographic transition,
obesity 4021 energy-rich foods high in fat and sweeteners [[3], [4]]. This alongside increased sedentary lifestyle lead to obesity and related chronic diseases [[5], [6]]. In many developing countries, the rising over-nutrition comes
obesity 4339 complex “multiple burden of malnutrition” [[7]].According to the World Health Organization (WHO), obesity remains “one of today’s most blatantly visible–yet most neglected–public health problems”
obesity 4468 today’s most blatantly visible–yet most neglected–public health problems” [[8]]. Prevalence of obesity across the world has increased more than 200% since 1980 with nearly 2 billion adults estimated to be
obesity 4779 prevalence of under-nutrition has not changed significantly over the last decade [[10]].Overweight and obesity are used to represent abnormal or excessive fat accumulation that has the potential to exert negative
obesity 5079 requirements of the body both for physical activity and for growth [[12]]. The increasing prevalence of obesity is widely attributed to genetic factors, changes in dietary and physical activity patterns and the increasing
obesity 5760 the square of height (metres). Over the years, the BMI has widely been used to assess overweight and obesity in adults [[9]]. Individuals are categorized according to BMI as follows; underweight (BMI <18.5 kg/m2);
obesity 6001 (18.5–24.9 kg/m2); overweight (25.0–29.9 kg/m2) and obese (≥30 kg/m2) [[15], [16]].Underweight, overweight and obesity are known risk factors for NCDs [[17], [18]]. Raised BMI (overweight/obesity) is a major risk factor
obesity 6078 [16]].Underweight, overweight and obesity are known risk factors for NCDs [[17], [18]]. Raised BMI (overweight/ obesity ) is a major risk factor for cardiovascular diseases, diabetes, hypertension, musculoskeletal disorders
obesity 6243 diabetes, hypertension, musculoskeletal disorders and some cancers [[11]–[13]]. The overall impact of obesity /overweight on physical and mental health as well as health-related quality of life is significant [[19]].
obesity 6399 as health-related quality of life is significant [[19]]. In countries where the economic impact of obesity has been studied, its direct (arising from preventive, diagnostic, and treatment services) and indirect
obesity 6685 activity etc.) costs have been estimated to be enormous. In the UK, the direct and indirect costs of obesity have been estimated to be far in excess of 2 billion pounds sterling per year [[20]], while in the US,
obesity 6821 far in excess of 2 billion pounds sterling per year [[20]], while in the US, absenteeism arising from obesity alone has been estimated to cost as much as $4.3 billion annually [[21]].Once conditions of the developed
obesity 6957 cost as much as $4.3 billion annually [[21]].Once conditions of the developed world, overweight and obesity are now prevalent in many low- and middle-income countries [[22], [23]]. In Sub-Saharan Africa, the
obesity 7101 middle-income countries [[22], [23]]. In Sub-Saharan Africa, the rising prevalence of overweight and obesity co-exists with the under-nutrition epidemic [[24], [25]] and the increasing prevalence of NCDs with
obesity 7310 an anticipated largest increase in NCD deaths of 27% in Africa over the next decade [[26]].In Ghana, obesity /overweight have been recognized to be increasing public health problem that could impact significantly
obesity 7560 Ghana Demographic and Health Surveys (GDHS) from 1993 to 2014 reported an increasing prevalence of obesity among Ghanaian women (15–49 years) from 3.4% to 15.3% [[29]–[31]]. The WHO estimates that in 2008,
obesity 7828 prevalence in women (10.9%) than men (4.1%) [[32]]. A meta-analysis including studies from Ghana reported an obesity prevalence of 10% among adults in West Africa, with women being three times more likely to be obese
obesity 8256 search, we identified one systematic review by Commodore-Mensah et al. [[33]], which reported overweight/ obesity prevalence in Ghanaian adults as within the range 20–62%. Aside the wide range presented, this review
obesity 8589 conducted in hospital settings. While the 2013 global burden of disease study also reported overweight and obesity prevalence in Ghanaian adult (>20 years) males (overweight = 15 · 4%; obesity = 2.5%)
obesity 8677 overweight and obesity prevalence in Ghanaian adult (>20 years) males (overweight = 15 · 4%; obesity = 2.5%) and females (overweight = 29.1%, obesity = 9.8%), these estimates were based on
obesity 8734 (>20 years) males (overweight = 15 · 4%; obesity = 2.5%) and females (overweight = 29.1%, obesity = 9.8%), these estimates were based on data selected from only nine survey reports [[26]]. Additionally,
obesity 8951 none of the previously published reviews provide clues as to the temporal changes in overweight and obesity prevalence in Ghana.Our general observation points to a lack of thorough systematic review of the literature
obesity 9121 of thorough systematic review of the literature towards documenting the prevalence of overweight and obesity in Ghana. To support evidence-based policymaking, resource allocation and the design of appropriate
obesity 9282 resource allocation and the design of appropriate public health interventions, accurate overweight and obesity prevalence estimates based on thorough and up-to-date evidence compilation is urgently needed. In this
obesity 9532 to summarize the available information to date towards estimating the prevalence of overweight and obesity among Ghanaian adults. Additionally, we sought to assess the temporal changes in overweight and obesity
obesity 9636 obesity among Ghanaian adults. Additionally, we sought to assess the temporal changes in overweight and obesity prevalence in the country.MethodsThis review adhered to the recommendations outlined in the PRISMA (Preferred
obesity 10057 (AJOL) and the WHO African Index Medicus database to retrieve primary studies reporting overweight and obesity prevalence among Ghanaians. The keywords used in our searches were “obesity OR overweight OR anthropometry
obesity 10135 reporting overweight and obesity prevalence among Ghanaians. The keywords used in our searches were “ obesity OR overweight OR anthropometry OR adiposity” AND “prevalence” AND “Ghana OR Ghanaian”. All
obesity 10632 exclusion of studiesWe included studies published up to 31st March 2016 which reported overweight and obesity prevalence among Ghanaians adults (≥18 years). RO and AAA conducted titles and abstract screening
obesity 11012 allow for aggregation/pooling of data, we only included studies that used BMI to define overweight and obesity prevalence. We classified BMI of 25–29.9 kg/m2 and ≥ 30 kg/m2 to represent overweight and
obesity 11120 prevalence. We classified BMI of 25–29.9 kg/m2 and ≥ 30 kg/m2 to represent overweight and obesity in adults, respectively [[15], [16]]. Studies were included only if BMI was stratified and separate
obesity 11260 [16]]. Studies were included only if BMI was stratified and separate prevalence of overweight and/or obesity were presented. We excluded studies conducted in children as the focus in this review was on adults.
obesity 11417 children as the focus in this review was on adults. Studies presenting self-reported overweight and obesity prevalence were excluded as these have been found to usually underestimate overweight and obesity prevalence
obesity 11515 and obesity prevalence were excluded as these have been found to usually underestimate overweight and obesity prevalence [[35], [36]]. For studies with multiple publications, the version published first or one
obesity 12007 type of setting (e.g. rural), the study population, mean age of participants and the overweight and obesity prevalence rates were collected. Data were independently extracted by RO, AAA and DB and crosschecked.
obesity 23756 from forty-two (42) studies with a combined sample size of 48,811. Among these studies, the reported obesity prevalence was within the range 1.6–63.8%. The pooled national prevalence of obesity (Fig. 5) among
obesity 23843 the reported obesity prevalence was within the range 1.6–63.8%. The pooled national prevalence of obesity (Fig. 5) among Ghanaian adults based on the 42 studies was estimated as 17.1% (95% CI = 14.7–19.5%).
obesity 24052 CI = 14.7–19.5%). I2 was determined as 98.9% (p < 0.001) for the degree of inconsistency. A funnel plot of obesity prevalence rates showed presence of publication bias as depicted by an asymmetrical display of prevalence
obesity 24335 Egger’s test which was significant (p < 0.0001). A leave-one-out analysis revealed that the pooled obesity prevalence estimate was most impacted by Aidoo et al. [[49]] (Fig. 7).Fig. 5Forest plot of studies
obesity 24453 estimate was most impacted by Aidoo et al. [[49]] (Fig. 7).Fig. 5Forest plot of studies reporting obesity prevalence among Ghanaian adultsFig. 6Funnel plot of studies reporting obesity prevalence among Ghanaian
obesity 24532 of studies reporting obesity prevalence among Ghanaian adultsFig. 6Funnel plot of studies reporting obesity prevalence among Ghanaian adultsFig. 7A leave-one-out sensitivity plot of studies reporting obesity
obesity 24632 obesity prevalence among Ghanaian adultsFig. 7A leave-one-out sensitivity plot of studies reporting obesity prevalence among Ghanaian adultsObesity prevalence among males was retrieved from seventeen (17) studies
obesity 24818 from seventeen (17) studies with a total sample population size of 10,550. These 17 studies reported obesity prevalence in the range 0.6–38%. The pooled obesity prevalence estimate for males was estimated as
obesity 24872 population size of 10,550. These 17 studies reported obesity prevalence in the range 0.6–38%. The pooled obesity prevalence estimate for males was estimated as 6.0% (95% CI 4.4–7.6%; I2 = 95.3%; p < 0.001).
obesity 25123 retrieved from twenty-nine (29) studies with a total sample size of 21,079. These 29 studies reported obesity prevalence in the range 2–55%. The pooled obesity prevalence estimate was determined as 21.9% (95%
obesity 25175 sample size of 21,079. These 29 studies reported obesity prevalence in the range 2–55%. The pooled obesity prevalence estimate was determined as 21.9% (95% CI 17.7–26.2%; I2 = 98.74%, p < 0.001). The
obesity 25329 (95% CI 17.7–26.2%; I2 = 98.74%, p < 0.001). The difference (15.9%; 95% CI 15.2–16.6%) in obesity prevalence between males and females was statistically significant (p < 0.0001).Among diabetes patients,
obesity 25450 between males and females was statistically significant (p < 0.0001).Among diabetes patients, the obesity prevalence was estimated using data from 4 studies with a combined sample size of 1663. The pooled obesity
obesity 25557 prevalence was estimated using data from 4 studies with a combined sample size of 1663. The pooled obesity prevalence estimate was determined 15.6% (95% CI 11.2–20.0%; I2 = 83.92%, p < 0.001).Prevalence
obesity 25674 prevalence estimate was determined 15.6% (95% CI 11.2–20.0%; I2 = 83.92%, p < 0.001).Prevalence of obesity in rural settings was estimated using data from 11 studies with a total sample population of 13,913
obesity 25853 sample population of 13,913 and individual prevalence rates ranging from 1.4% to 40.5%. The pooled obesity prevalence estimate for rural dwellers was estimated as 8.0% (95% CI 5.4–10.5%; I2 = 97.9%; p < 0.001).
obesity 25995 dwellers was estimated as 8.0% (95% CI 5.4–10.5%; I2 = 97.9%; p < 0.001). For urban dwellers, obesity prevalence data was retrieved from 33 studies with a total sample population of 25,240. The individual
obesity 26308 (95% CI 16.9–24.3%; I2 = 98.99%, p < 0.001. The difference (12.6%, 95% CI 11.9–13.2%) in obesity prevalence between urban and rural dwellers was found to be statistically significant (p < 0.0001).Obesity
obesity 27051 Central region = 20.9% (95% CI 10.6–31.2; I2 = 93.92% p < 0.001). We were unable to deduce obesity prevalence estimates for the remaining seven regions of Ghana due to limited number of individual prevalence
obesity 27240 number of individual prevalence data from studies (Fig. 8).Fig. 8Regional prevalence of overweight and obesity among adults in GhanaTemporal changes in overweight and obesity prevalence among Ghanaian adultsAs 28%
obesity 27304 8Regional prevalence of overweight and obesity among adults in GhanaTemporal changes in overweight and obesity prevalence among Ghanaian adultsAs 28% (n = 12) of studies did not report the actual period (year/s)
obesity 28486 (95% CI 15.0–21.7%; I2 = 98.56%, p < 0.0001), respectively. Hence the ascending order of obesity prevalence among Ghanaian adults according to studies publication period was 1998–2006 < 2007–2013 < 2014–2016
obesity 28650 publication period was 1998–2006 < 2007–2013 < 2014–2016 (Fig. 9).Fig. 9Overweight and obesity prevalence in Ghana according to studies’ publication yearsDiscussionThis review has documented a
obesity 28800 studies’ publication yearsDiscussionThis review has documented a high prevalence of overweight (25.4%) and obesity (17.1%) among Ghanaian adults. Higher prevalence of overweight and obesity across studies published
obesity 28875 of overweight (25.4%) and obesity (17.1%) among Ghanaian adults. Higher prevalence of overweight and obesity across studies published in the most recent years (2007–2016) as opposed to those published in earlier
obesity 29068 published in earlier years (1998–2006) by inference highlight the growing burden of overweight and obesity in the country. The rising overweight and obesity burden as observed in this review is in line with
obesity 29118 inference highlight the growing burden of overweight and obesity in the country. The rising overweight and obesity burden as observed in this review is in line with observations already communicated by other researchers
obesity 29323 researchers in the country [[28], [87]] and is further supported by the reported consistent increase in obesity /overweight prevalence by the Ghana DHS in the period 1988–2014 [[29]–[31]]. Our results and those
obesity 29485 1988–2014 [[29]–[31]]. Our results and those of others all suggest and corroborate the fact that obesity is no more an issue of only “affluent nations” but becoming an increasing public health problem
obesity 30429 lack of physical activity, which are marked characteristics of advancing nutrition transition, lead to obesity and the development of numerous chronic diseases. This has led to an increase in overweight and obesity
obesity 30533 obesity and the development of numerous chronic diseases. This has led to an increase in overweight and obesity and their-related chronic diseases [[6]].While our analysis points to a growing problem of obesity,
obesity 30632 obesity and their-related chronic diseases [[6]].While our analysis points to a growing problem of obesity , undernutrition still poses significant threat to health and wellbeing of many Ghanaians. In the 2014
obesity 31250 many LMICs, increasing numbers of lower socioeconomic groups struggle with undernutrition, even as obesity and overnutrition increases [[92]].Several theories (such as life-course perspective) have been proposed
obesity 31400 theories (such as life-course perspective) have been proposed to explain this phenomenon of rising obesity among populations with systemic undernutrition challenges [[89]]. Amuna and Zotor [[93]], explain that
obesity 31951 boost the development of thrifty phenotype that may increase risks of chronic conditions including obesity , diabetes and cardiovascular diseases in later life [[94]–[96]]. Additionally, infections contracted
obesity 32128 Additionally, infections contracted at early life years can also increase future risk of NCDs such as obesity [[89], [97]]. This may be an important component particularly in LMICs were infectious diseases remain
obesity 32416 review, we report a 1.3 times higher prevalence of overweight and about 3.7 times higher prevalence of obesity in women as compared to men. This trend is consistent with results from a previous review by Abubakari
obesity 32676 times more likely to be obese than their male counterparts. The higher prevalence of overweight and obesity among women than men in Ghana is also consistent with globally observed gender difference in overweight
obesity 32792 women than men in Ghana is also consistent with globally observed gender difference in overweight and obesity patterns [[9]].Although, physiological pathways such as the differences in body fat distribution and
obesity 33362 of physical activity among Ghanaian women than men. In a study of the predictors of overweight and obesity among a cohort of urban Ghanaian women, just around 21% were found to maintain adequate physical activity
obesity 34342 These socio-cultural construction of ideal body size may be implicated in the rising overweight and obesity burden in the country.Our analysis also brings to bear the impacts of urbanization on the overweight/obesity
obesity 34451 burden in the country.Our analysis also brings to bear the impacts of urbanization on the overweight/ obesity epidemic in Ghana as confirmed by the near 1.6 and 2.6 fold increase in overweight and obesity prevalence,
obesity 34546 overweight/obesity epidemic in Ghana as confirmed by the near 1.6 and 2.6 fold increase in overweight and obesity prevalence, respectively among urban dwellers as compared to their rural counterparts. The differences
obesity 34671 respectively among urban dwellers as compared to their rural counterparts. The differences in overweight/ obesity prevalence in Ashanti, Northern, Central and Greater Accra regions also broadly mimic the extent of
obesity 35219 extent of urbanization may not be the only underlying factor for the regional variation in overweight/ obesity prevalence as cultural/tribal variations have been observed. Amoah [[106]], for instance reported highest
obesity 35348 cultural/tribal variations have been observed. Amoah [[106]], for instance reported highest overweight and obesity prevalence among the Akan and Ga tribes and relatively low rates among Ewes. Similar results were obtained
obesity 35575 al. [[107]] after a secondary analysis of data from the 2008 DHS. The variations in overweight and obesity prevalence among the ethnic groups are thought to broadly reflect differences in social behaviors including
obesity 36791 internet cafes, games consoles for elite and middle class youth) are strongly implicated in Ghana’s obesity and chronic disease epidemics” [[87]]. Alcohol consumption have all been given significant boost and
obesity 37001 evidence suggests that Ghanaians who consume excessive alcohol have higher risks of overweight and obesity [[60], [107]]. Furthermore, as Ofori-Asenso and Garcia [[14]] discussed, the built environment in many
obesity 37421 walking. These poor urban planning if not properly addressed could be a catalyst for further escalation of obesity in the country even as other factors drive an obesogenic environment. The prevalence of overweight/obesity
obesity 37528 in the country even as other factors drive an obesogenic environment. The prevalence of overweight/ obesity in the rural areas reported in this review is also a call for concern and action as this is high compared
obesity 37724 is high compared to what has been reported in the past [[32]]. This highlights that the increasing obesity and overweight prevalence in Ghana may be more widely spread than previously thought. To fully explore
obesity 37884 widely spread than previously thought. To fully explore the contribution of the urban environment to the obesity /overweight burden, further research could focus for instance on assessing how individuals’ risk profiles
obesity 38104 change once they migrate from rural to urban centres and vice versa.While in many high-income countries, obesity tends to be more prevalent in persons with lower socioeconomic status (SES), the reverse has been the
obesity 38355 [[108]]. Studies by Amoah [[106]] and Appiah et al. [[54]] have documented higher prevalence of overweight/ obesity in high-class Ghanaians compared with the low class residents. Additionally, Ghanaians with tertiary
obesity 38524 residents. Additionally, Ghanaians with tertiary education have been found to have the highest prevalence of obesity compared with less literate and illiterate subjects. This may tie in to the perceptions of larger body
obesity 39455 intake, and by extension increased chronic disease risks”.The high and rising burden of overweight and obesity as documented in this study should be a concern to nutritional scientists, health workers and government
obesity 40310 times high when compared to prevalence of about 0.4% in 1956 [[112]]. The impacts of overweight and obesity on individuals’ wellbeing and on productivity means that if the trends observed persists, the consequences
obesity 40614 continually focus on reducing hunger and in many instances neglect the growing problem of overweight/ obesity . De graft Aikins [[113]], attributes this to longstanding misconception that NCDs and risk factors including
obesity 40731 Aikins [[113]], attributes this to longstanding misconception that NCDs and risk factors including obesity do not pose significant health challenges. To address the rising problem of overweight/obesity in Ghana,
obesity 40826 including obesity do not pose significant health challenges. To address the rising problem of overweight/ obesity in Ghana, greater commitment from government will be needed to ensure efficient resource allocation
obesity 41393 [[116]].Strengths and limitationsThis review presents a stronger evidence regarding the prevalence of overweight/ obesity among Ghanaian adults as it is based on larger number of studies than previously published reviews.
obesity 41915 regions. The regional imbalance in data is likely to shift estimates as more evidence on overweight and obesity prevalence in the under-represented regions become available. Secondly, most studies did not report
obesity 42228 status and ethnicity, although, these have all been identified as useful predictors of overweigh and obesity [[117], [118]]. Furthermore, a high level of heterogeneity across studies was observed including the
obesity 42396 across studies was observed including the presence of publication bias. The assessment of overweight/ obesity among diabetes patients were also based on limited studies and dominated by those conducted in urban
obesity 42551 limited studies and dominated by those conducted in urban patients. Our temporal analysis of overweight/ obesity prevalence was also based on studies’ publication years. A more robust approach for this analysis
obesity 43018 conducted is when it is published. In spite of the limitations outlined, the prevalence of overweight and obesity presented in this review should speak to current situation as most studies were recently published,
obesity 43246 studies published within the last 5 years (2011–2016). The prevalence information on overweight and obesity presented should guide and inform policy makers in terms of resource allocation and planning towards
obesity 43388 policy makers in terms of resource allocation and planning towards controlling the rising burden of obesity and overweight in this country.ConclusionsEvidence available supports a high and rising prevalence of
obesity 43513 this country.ConclusionsEvidence available supports a high and rising prevalence of overweight and obesity among Ghanaian adults. This presents a significant public health issue, and the implications on current
obesity 43918 research is needed to provide greater insights into the major drivers underlying the rising overweight and obesity epidemic and also to offer context in terms of documenting the regional difference in prevalence. Urgent

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