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The Local Food Environment and Body Mass Index among the Urban Poor in Accra, Ghana

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Abstract

Obesity in the sub-Saharan Africa region has been portrayed as a problem of affluence, partly because obesity has been found to be more common in urban areas and among the rich. Recent findings, however, reveal rising prevalence among the poor particularly the urban poor. A growing body of literature mostly in Western countries shows that obesity among the poor is partly the result of an obesogenic-built environment. Such studies are lacking in the African context. This study examines the characteristics of the local food environment in an urban poor setting in Accra, Ghana and further investigates the associated risk of obesity for residents. Data on the local food environment was collected using geographic positioning system (GPS) technology. The body mass indices (BMI) of females (15–49 years) and males (15–59 years) were calculated from measured weight and height. Data on the socio-demographic characteristics and lifestyle behaviors of respondents was also collected through a household survey. Spatial analysis tools were used to examine the characteristics of the local food environment while the influence of the food environment on BMI was examined using a two-level multilevel model. The measures of the food environment constituted the level 2 factors while individual socio-demographic characteristics and lifestyle behaviors constituted the level 1 factors. The local food environment in the study communities is suggestive of an obesogenic food environment characterized by an abundance of out-of-home cooked foods, convenience stores, and limited fruits and vegetables options. The results of the multilevel analysis reveal a 0.2 kg/m2 increase in BMI for every additional convenience store and a 0.1 kg/m2 reduction in BMI for every out-of-home cooked food place available in the study area after controlling for individual socio-demographic characteristics, lifestyle behaviors, and community characteristics. The findings of this study indicate that the local food environment in urban poor Accra is associated with increased risk of obesity through providing access to convenience stores. In order to reduce the risk of obesity in these urban poor communities, there is the need to regulate the availability of and access to convenience stores while also encouraging healthier offerings in convenience stores.

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Notes

  1. Boiled rice stir-fried with vegetables, sausage and eggs

  2. Rice and beans boiled together

  3. Rice cooked in tomato sauce

  4. A pounded starchy staple made from plantain and cassava

  5. Cooked corn and cassava dough

  6. Steamed corn dough

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Acknowledgments

The authors are grateful to the International Development Research Centre (IDRC) for funding support through the African Adaptation Research Centre Initiative grant awarded to the Regional Institute for Population Studies at the University of Ghana (Climate Change Adaptation Research Training Capacity for Development (CCARTCD) Project. Component Number: 106548-001.). We are also grateful to the Carolina Population Center for institutional support. We are especially grateful to Professor Phil Morgan (Director), Professor Carolyn Halpern (Director, Training Program) and Jan Hendrickson-Smith (Associate Director of Training Program) of the Carolina Population Center at the University of North Carolina, Chapel Hill. Many thanks to Philip McDaniels, GIS Librarian at the Davis Library, at The University of North Carolina, Chapel Hill for immense technical support with the spatial data analysis. We would also like to thank Charles Som for technical guidance on the spatial data collection, the team of fieldworkers who helped with data collection, and the respondents who participated in the study.

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Authors and Affiliations

  1. Regional Institute for Population Studies, University of Ghana, P.O. Box LG 96, Legon, Accra, Ghana

    Fidelia A. A. Dake & Samuel N. A. Codjoe

  2. Department of Anthropology and Carolina Population Center, University of North Carolina at Chapel Hill, CB # 8120, 137 East Franklin St., Chapel Hill, NC, 27516, USA

    Amanda L. Thompson

  3. Department of Nutrition and Carolina Population Center, University of North Carolina at Chapel Hill (UNC), CB # 8120, 137 East Franklin St., Chapel Hill, NC, 27516, USA

    Shu Wen Ng

  4. Department of Geography and Resource Development, University of Ghana, P.O. Box LG 59, Legon, Accra, Ghana

    Samuel Agyei-Mensah

Authors
  1. Fidelia A. A. Dake
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  2. Amanda L. Thompson
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  4. Samuel Agyei-Mensah
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  5. Samuel N. A. Codjoe
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Correspondence to Fidelia A. A. Dake.

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Dake, F.A.A., Thompson, A.L., Ng, S.W. et al. The Local Food Environment and Body Mass Index among the Urban Poor in Accra, Ghana. J Urban Health 93, 438–455 (2016). https://doi.org/10.1007/s11524-016-0044-y

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