project submission(obesity )

8/2/2019 Project Submission(OBESITY )

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KWAME NKRUMAH UNIVERSITY OF SCIENCE AND TECHNOLOGY

COLLEGE OF HEALTH SCIENCES

SCHOOL OF MEDICAL SCIENCE

DEPARTMENT OF COMMUNITY HEALTH

A STUDY ON COMMUNITY PERCEPTION ON OBESITY AND THEIR

KNOWLEDGE OF ITS ASSOCIATED DISEASES IN THE WINNEBA

TOWNSHIPCAPITAL OF AWUTU EFFUTU SENYA DISTRICT,

GHANA.

BY

AFUA OHENEWA ADJEI(Bsc. HUMAN BIOLOGY)

JULY 2008


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DECLARATION

I hereby declare that this thesis is the original work I did with the help of my supervisor except

for

references to other people duly acknowledged and that this work has neither been presented in

whole or in part for the award of a degree of bachelor of medicine and surgery (MBChB).

..

ADJEI AFUA OHENEWA, (BSc Human Biology)

STUDENT

..

DR. ANTHONY K. EDUSEI

ACADEMIC SUPERVISOR

DEPARTMENT OF COMMUNITY HEALTH

DR. E. N. L. BROWNE

HEAD OF DEPARTMENT

DEPARTMENT OF COMMUNITY HEALTH.


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DEDICATION

I dedicate my final year thesis to my parents Prof. and Mrs. Ohene Adjei who have

been an immense support in my medical education and to my husband Kwabena

Kwayisi who has always been there for me.

To you I say a big Thank you.


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ACKNOWLEDGEMENT

I am most grateful to Almighty God, who has brought me this far and whose

abundant grace has made this work possible.

I also wish to thank the Awutu Effutu Senya District Health Directorate and the

Winneba Government District hospital that made my stay in Winneba a memorable

and rewarding experience.

Iam thankful to the Lecturers and other staff of the Community HealthDepartment

with special appreciation to Dr. Anthony K. Edusei, my supervisor for his time and

support for this project.


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TABLE OF CONTENTS PAGE

DECLARATION..i

DEDICATION.............................................................................................................................ii

ACKNOWLEDGEMENT......iii

TABLE OF CONTENTSiv

LIST OF TABLES...v

LIST OF FIGURES....vi

LIST OF ACRONYMS.....vii

ABSTRACT..................................................................................................................................viii

CHAPTER 0NE

1.1. Introduction . ...1

1.2. Problem Statement......3

1.3. Objectives ..................4

1.4. Specific Objectives.....4

1.5. Significance Of Study........................................................................................................41.6. Basic Assumptions......5

1.7. Delimitation............5

1.8. Limitation....5

1.9. Definition Of Terms.... 5

CHAPTER TWO

2.0. Introduction.6

2.1. Risk Factors Responsible For Obesity.8

2.1.1 Gender ....8

2.1.2 Age. .8

2.1.3 Low socioeconomic status.......9

2.1.4 Diet ..9


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2.1.5 Genetics. ..9

2.1.6 Culture 11

2.1.7 Inactivity 11

2.1.8 Alcohol, Smoking, and Medication...12

2.1.9 Lack of knowledge.13

2.2. OVERWEIGHT AND OBESITY: HEALTH CONSEQUENCES .............13

2.2.1 Diabetes ............14

2.2.2 Heart disease .14

2.2.3 Cancer....15

2.2.4 Breathing problems.. ..15

2.2.5 Osteoarthritis..15

2.2.6 Reproductive complications.. .16

2.2.7 Premature death.16

2.2.8 The Cost of Obesity...16

CHAPTER THREESTUDY AREA

3.1 Introduction....17

3.2 Historical Background...18

3.3 Size and Population18

3.4 Terrain and Climate... 19

3.5 Administration...19

3.6 Socio-Economic Activities20

3.7 Health Facilities.20

3.8 Schools.. .20

3.9 Infrastructure .20

3.10 Top Ten Causes of OPD attendance, admissions and deaths21

Chapter Four - METHODOLOGY

4.1 Study Type .22

4.2 Study Population 22

4.3 Sampling Method. ..22


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4.4 Data Collection .... .........22

Chapter FiveRESULT

5.1 Socio- Demographic characteristics..... 24

5.2 Perceptions carried about obesity......26

5.3 Effect of level of education on perceptions about obesity.....28

5.4 Knowledge on diseases associated with obesity........29

Chapter Six - DISCUSSIONS

6.1 Socio-demographic characteristics................32

6.2 Perception about obesity....32

6.3 Perception of obesity by level of education...33

6.4 Knowledge of diseases associated with obesity.....33

Chapter Seven

7.0 Conclusions....35

7.1 Recommendations..35

REFERENCES 36

APPENDIX

APPENDIX 1: INTERVIEW GUIDE39


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LIST OF MAPS AND FIQURES

1. Figure 1 - MAP OF THE AWUTU EFFUTU SENYA DISTRICT2. Table 3.3 - PROJECTED POPULATION FOR THE A.E.S.DISTRICT FOR

YEAR 2007

3. Table 3.10 - TOP TEN OPD CASES IN THE AWUTU EFFUTU SENYA

DISTRICT

4. Table 5.1 - SOCIO DEMOGRAPHIC CHARACTERISTICS OF

RESPONDENTS

5. Table 5.2 - RELATIONSHIP BETWEEN SOCIO-DEMOGRAPHIC

CHARACTERISTICS AND PERCEIVED VIEWS ABOUTOBESITY

6. Bar chart 5.3 - DISTRIBUTION OF PERCEPTION OF OBESITY BY LEVEL OF

EDUCATION

7. Table 5.4.1 - DISTRIBUTION OF RESPONDENTS KNOWLEDGE ABOUT

8. Bar chart 5.4.2 - DISTRIBUTION OF KNOWLEDGE ABOUT OBESITY AND

ASSOCIATION WITH DISEASES BY LEVEL OF EDUCATION

9. Table 5.4.3 - KNOWLEDGE OF SPECIFIC DISEASE ASSOCIATION WITH

OBESITY

10. Table 5.5 - FREQUENCY DISTRIBUTION ON WILLINGNESS TO LOSE

WEIGHT WHEN NECESSARY


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ABSTRACT

COMMUNITY PERCEPTION ON OBESITY AND KNOWLEDGE OF

ASSOCIATED DISEASES IN WINNEBA, GHANA

Obesity is an important public health problem. However, the perception of people in association

with their knowledge about chronic diseases such as hypertension and type 2 diabetes, associated

with it has not been thoroughly explored. Many Ghanaians regard obesity as good living; others

have no idea about the consequences of being obese. Very little epidemiological information is

available in Ghana on the general perception of obesity. The purpose of this study was to

determine the perception of the inhabitants of Winneba in the central region of Ghana where

most inhabitants are regarded as obese, on obesity and their knowledge into its associated

diseases after many years of living in the perception of obesity reflecting increased wealth and

prosperity.

A cross-sectional descriptive study was conducted on a sample of adults aged 20 years and over

who were selected by random cluster sampling. Patients who were not well were excluded from

the study. Data was collected from inhabitants in communities in Winneba, central region Ghana.

In total, 192 (82 males, 110 females) adults participated. Demographic data were obtained by a

questionnaire. Participants were also provided with health related information at the conclusion

of the interview.

There was no significant association on perceptions about obesity with gender, age or

educational level (p< 0.05) of the respondents. More than half (57.8%) of the respondents related

obesity to its ability to make one inactive, and predisposed to various illnesses. The rest were

uncertain on the effect of obesity on health. All who considered obesity good attributed it to

good living or it being a God- given asset. The reasons given to the general views on obesity

were significantly associated with the respondents level of education, as was knowledge on

causes of obesity and obesitys association with diseases. Majority of those who have had

tertiary education (91%) condemned obesity. 33% of the respondents with some basic education

embraced obesity as a good thing. 18% were uncertain about the effects of obesity. About 53 %

of the respondents were aware of the health complications associated with obesity; however

55.8%of these respondents could only associate obesity with only one complication. Findings at


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the end of the study, after respondents were given health related information on obesity, suggest

that 72% of the respondents would reduce their weight if it meant a reduction in risks of obesity-

linked illnesses and complications.

A significant proportion (25%) of the people in Winneba, and probably in other parts of Ghana,

is not totally aware of health complications associated with obesity. A national taskforce to

address the obesity epidemic and to draw up a national policy on effective education on related

non-communicable diseases is urgently recommended.


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1.1INTRODUCTION

Obesity is a common and preventable disease of clinical and public health importance. It is often

a major risk factor for the development of several non-communicable diseases, significant

disability and premature death due to type 2 diabetes mellitus (Type 2 DM) and cardiovasculardiseases (CVD) as well as gall bladder disease, certain cancers (endometrial, breast, prostate,

colon) and non-fatal conditions including gout, respiratory conditions, gastro-oesophageal reflux

disease, osteoarthritis and infertility.(Ofei ,2005)

Obesity also carries serious implications for psychosocial health, mainly due to societal prejudice

against fatness. (Ofei,2005)

The accumulation of adipose tissue in certain areas of the body is a necessary biologicaladaptation which serves an important function of storing energy in the form which is readily

accessible in events of increased metabolic needs. (Tremblay et al , 2000)

Overweight andObesity however result when there is an imbalance between energy intake and

expenditure, with the intake far exceeding expenditure. There is thus an excess of subcutaneous

adipose tissue in proportion to lean body mass. (CDC, 2006)

Weight loss is associated with significant health, social and economic benefits. Effective weight

loss strategies including dietary therapy, physical activity and lifestyle modification have proven

beneficial. Drug therapy is normally reserved for the obese or overweight patients who have

related obesity-related risk factors or diseases. There is presently a global epidemic of obesity in

all age groups and in both developed and developing countries. Its general acceptance by many

societies as a sign of well-being or a symbol of high social status, and the denial by health care

professionals and the public alike that it is a disease in its own right, have contributed to its

improper identification and management and the lack of effective public health strategies tocombat its rise to epidemic proportions. (Ofei, 2005)

It is smarter to raise healthy individuals than to repair damaged adults. There is therefore, the

need to inculcate in the younger generation the right principles to prevent obesity and its

associated diseases. Prevention will always be better than cure.


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Education through population-wide prevention programmes and public awareness, of its harmful

effects may thus play a key role in stemming the obesity epidemic and help promote a healthier

nation. (Ofei, 2005)


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1.2 PROBLEM STATEMENT

The prevalence of obesity is increasing at an alarming rate in many parts of the world. In the

developed world, the prevalence of obesity is similarly high in men and women. However, in

countries with relatively low gross national product, the prevalence is about 1.5 to 2 times higheramong women than men (Biritwum et al,2005). In 1995, there were an estimated 200 million

obese adults worldwide. (Ofei,2005).As of 2000, the number of obese adults had increased to

over 300 million. In developing countries, it is estimated that over 115 million people suffer

from obesity-related problems(WHO, 2003).

The increase in obesity prevalence is problematic as this condition is associated with health

complications such as diabetes and cardiovascular diseases, more particularly when the excess

body fat is stored in the deep abdominal region. (Tremblay et al , 2000)

Psychologically obese individuals have difficulty in movement due to heaviness in their feet.

They are mostly sensitive to ridicule and are easily embarrassed. This can inhibit their ability to

take initiative and pursue ambitions. (Astrup , 2007)

Recent estimates suggest that 2.08.0% of the total sick care costs in the Western countries are

attributable to obesity. Diseases such as hypertension and type 2 diabetes mellitus are becoming

increasingly common diseases in our hospitals. Currently, the main concern of less advanced

countries including Ghana is to alleviate poverty and increase food production (Burlingame,

2002).

A number of research have been done in the area of Obesity among Ghanaians; comparing the

prevalence with respect to age, gender, settlement (rural or urban) and cultural influences.

However little has been done to assess generally how the Ghanaian folks perceive this condition

or more so to ascertain the knowledge about the numerous health risks it comes with in

comparison to their educational level.

It has therefore become necessary for much study to be done concerning the general perception

on obesity and the knowledge into its associated diseases and thus press forward measures to

prevent it from reaching epidemic proportions.


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1.3 GENERAL OBJECTIVES

To assess the perception on obesity and knowledge of its associated diseases among the residents

of Winneba,Ghana.

1.4 SPECIFIC OBJECTIVES

1) To assess the communitys perception on obesity and its social implications

2) To assess the knowledge on obesity associated diseases

3) To determine the relationship between knowledge on obesity associated diseases and

level of education.

1.5 SIGNIFICANCE OF STUDY

Obesity is now a global epidemic, which is gradually creeping up on the African continent. It

may not seem important to us to discuss obesity when there are seemingly more important issues

to tackle such as poverty and under nutrition in our society. To date not much research has been

done involving obesity associated diseases, but with the increasingly number of incidents of

obesity related diseases, for example hypertension, in our hospitals; it is necessary to find out the

perceptions and knowledge concerning obesity and its associated complications so as to develop

the appropriate interventions to address it.

As it is said a stitch in time will save nine.


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1.6 BASIC ASSUMPTIONS

1) It was assumed that all who were interviewed were residents of Winneba and thus a

good representative of the sample of the people in the area.

2) It is also assumed that the people understood the questionnaire and gave honest answers.

1.7 DELIMITATION

1) The study was restricted to ages 2years and above

2) Clinically unwell individuals were excluded.

1.8 LIMITATION

1) Some individuals refused to take part in the study because they explained to be busy

2) Seemingly obese individuals felt uneasy and so declined to take part

3) Only one field worker was available for administration of questionnaires

1.9 DEFINITION OF TERMS

1) BMI = Body Mass Index

= weight (kg) / (height x height) metres2

2) Under weight BMI < 18.50 kg/m2

3) Normal weight BMI = (18.5024 .90) kg/m2

4) Over weight BMI = ( 25.0 0 - 29.90) kg/m2

5) Obesity BMI 30.00 kg/m2

(Source: Myers,2001)


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2.0 LITERATURE REVIEW

Obesity is an excess of subcutaneous fat in proportion to lean body mass. This excess fat

accumulation is associated with increase in the size (hypertrophy) as well as the number

(hyperplasia) of adipose tissue cells. (Stedmans Electronic Medical Dictionary, 2000)

This increase in adiposity may be distributed either around the waist and trunk (abdominal,

central or android obesity) or peripherally around the body (gynoid obesity). Peripheral

distribution carries less risk than when the fat is centrally distributed. Either way ,both have

important health implications (Ofei ,2005).

The body mass index is a simple and the most commonly used method to assess weight for

medical purposes. This tool compares weight against height and measures the weight of the

individual in kilograms divided by the square of the height in metres (kg/m2

) (Ofei ,2005). It is

important to remember that although BMI correlates with the amount of body fat, BMI does not

directly measure body fat. As a result, some people, such as athletes, due to an increase in lean

body mass ( muscle and bones), may have a BMI that identifies them as overweight even though

they do not have excess body fat; BMI however maintains its role as a useful tool in assessing

obesity ( Centres for Disease Control and Prevention(CDC), 2006)

By the current World Health Organisation criteria, a BMI within the range of 18.5 to 25 (kg/m2)

is considered to be healthy weight. One is overweight if the BMI is between 25 and 30 and obese

when 30 or higher. The obese category is sub-divided into obese class I (3034.9kg/m2), obese

class II (3539.9kg/m2) and obese class III (40kg/m2). A BMI greater than 28kg/m2 in adults is

noted to be associated with a three to four-fold greater risk of morbidity due to Type 2 DM and

Cardiovascular Diseases (WHO,2006).

Obesity is fast becoming a global epidemic. As countries transition to westernized lifestyles,

obesity tends to increase. Obesity rates vary from as little as 2 percent in some Asian countries to

as much as 75 percent in some Pacific nations. There are more than 300 million obese persons in

the world, and more than 750 million overweight persons. In the United States, 34 percent of

adults are over-weight and 30.5 percent are obese. This is observed in all states in both sexes,

across age groups and educational levels (Foreyt, 2003).


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It is an irony to note that as developing countries continue their bid to reduce hunger, they are

beginning to face the opposing problem of obesity in the phase modernization and development

with the incidence of obesity fast rising (Burlingame, 2002). According to the World Health

Organization (WHO,2005), more than 75% over the age of 30 in countries as diverse as Turkey,

Mexico, Egypt and South Africa are overweight with similar estimates for men in Argentina,

India china and Greece. A United Nations study in 1999 found that in Brazil and Colombia, the

figure lingers around 40 %, a level comparable to a number of European countries. Even sub-

Saharan Africa, which sees most of the world's hungry inhabitants, is witnessing an increase in

obesity, especially among urban women. In all regions, obesity seems to grow as income

increases (International Obesity Task Force, 2002).

Obesity among Ghanaian adults is fast becoming common, particularly among the elderly,

females and urban dwellers as a study done in 2003 by AlbertGB Amoah shows. The survey

involving two urban and one rural community in the Greater Accra region revealed an overall

prevalence of obesity (BMI 30 kg/m2) of 20.2% and 4.6% for females and males, respectively.

Obesity increased with age, peaking in the 55 to 64-year age group and residents from the high-

class residential area had higher BMI compared to subjects from the lower class suburb with

urban residents having a higher BMI compared to rural subjects. (Amoah, 2003)

From a large body of evidence, the global epidemic of obesity has resulted mainly from societal

factors that promote sedentary lifestyles (WHO,2000). Cultural norms reflect the general image

of prosperity and success associated with weight gain; most would therefore not hesitate to go in

for life styles that promote this perception. (Walker,1998)

Obesity and overweight are chronic conditions which do not occur overnight. There are a variety

of factors that play a role in obesity and many may work simultaneously in an individual.


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2.1 Risk factors responsible for obesity

2.1.1 Gender

Globally females are known to have a higher incidence of obesity as compared to their male

counterparts. Majority of the females in a USA study, considered eating more, childbirth and

reduced activity as some of the possible causes of their obesity. (Mokdad et.al ,1999) In a

research conducted in 2003, it was reported that out of 6300 adults, aged 25 and older from two

urban areas (high-class and low-class suburbs) and one rural community in Accra, the rates of

overweight were markedly higher in females than males (27.1% vs. 17.5%), as were rates of

obesity (20.2% vs. 4.6%). (Amoah, 2003)

Compared to a developed country, the UK government statistics puts around one in four men and

one in three women in the UK as being overweight.According to them, while slightly more

women than men are obese (24 per cent versus 23 per cent); in the last ten years there has been a

greater increase in the number of men who are obese due to low physical activity. The UK

Department of Health predicts that if this trend continues, by 2010, around 6.6 million men will

be obese compared to 6 million women (Astrup, 2007).

2.1.2 Age

Increasing age tends to be associated with inactivity. Besides, the amount of muscle which is

involved with nutrient metabolism decreasing there is also a reduction in calorie needs.

Therefore if one does not decrease the usual amount of calorie intake, it is most likely to result in

weight gain.(Myers, 2001) Statistics in America show that as Americans age, the tendency to be

located in the overweight (BMI - Body Mass Index > 25) and/or obesity (BMI - Body Mass

Index > 30) categories increases. The age group with the highest prevalence of overweight and

obesity among men is 65 to 74 years, and among women, 55 to 64 years (CDC, 2003). In Ghana

the age-standardized prevalence of adult obesity was 13.6%. Obesity increased with age, peaking

in the 55 to 64-year age group in both men and women (Amoah ,2003).


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2.1.3 Low socioeconomic status

There is currently not much data on the prevalence of obesity in most developing countries, on

the other hand; studies conducted by Wamala et.al (1997) showed that low socioeconomic status

was a strong determinant of overweight and obesity especially among women. They usededucation and occupation as a measure of Socio Economic Status and defined overweight as

BMI 28.60kg/m. They reported that both low social position and obesity were related to

reproductive history, that is, higher parity and earlier age at menarche; unhealthy dietary habit,

reduced activity and hostile psychosocial factors including poor quality of life, low self esteem,

and job stress.( Wamala et.a.l, 1997)

2.1.4 Diet

Food intake is one of the major causes of obesity. Regular consumption of high-calorie foods,

such as fast foods, or increasing their portion sizes contributes to weight gain (CDC,2006).

According to American statistics for example, portion sizes continue to increase. Americans

were eating about 200 more calories per day in 2003 than they were in 1993 (Foreyt , 2003).

Epidemiological studies suggest there is a direct relationship between the amount of dietary fat

and degree of obesity (Golay et al, 1997). High carbohydrate diets have the tendency of

converting excess carbohydrate to glycogen and fatty acids and with inactivity get to be stored as

fat (Kumar,1999). However studies byBannini AE et al (2003) could not establish a correlation

between carbohydrate intakes with increase in body mass index. Foods and beverages like soft

drinks and ice creams are high in sugar and calories and also promote weight gain (CDC, 2006).

In general, eating away from home also increases calorie intake. With the current spurt in fast

food chains, heavily fried foods and sugars have become readily available and relatively

affordable with most going in for them in preference for local dishes which tend to be healthier

(Shetty,2002).

2.1.5 Genetics

The genetic role in obesity is one that undoubtedly raises a lot of questions. For the first time in

history, Geneticists from Oxford University and Peninsula Medical School in Exeter have made

a remarkable discovery having linked a specific gene - FTO-to obesity in a study involving


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about 38,759 Britons, Finns and Italians aged 7 and above where they found a strong link

between the FTO variant and body weight. It warned that the people at greatest risk are those

who carry two defective versions of FTO. Those with just one defective inherited gene are 30 %

more likely to be obese and 25 % more likely to develop diabetes than those who have two

normal copies.The study did not help to work out the biological mechanism behind the FTO gene

and weight control, though it is suspected to do with fat regulation. FTO is known to play a role

in the hypothalamus which regulates appetite (Hattersley M. et al, 2007).

The discovery of Leptin in the mid 1990s, a hormone secreted by adipose (fatty) tissue which

informs the brain of the amount of fat stored, has also played a major role in the understanding of

obesitys association with genes. Its absence has been found to provoke severe obesity with

eating disorders and pituitary hormone deficits. Studies with the administration of Leptin

subcutaneous injections to obese children have produced remarkable results of weight loss.

(Farooqi et al., 2002)

There is widespread acceptance that hereditary factors might predispose to human obesity; if

both parents are obese, the chances of being obese are greater due to shared genes and possibly

environmental influence. The comparison of monozygotic and dizygotic twin pairs has

traditionally been one of the most powerful ways of obtaining a reliable estimate of heritability.

In a 100 day, continually supervised in-patient overfeeding study, 12 pairs of male identical

twins were given a 1000 kcal per day more than what was usually taken. The amount of weight

gained during this forced overfeeding varied from 3 to 12 kg. It was noted that 2 brothers were

more likely to similarly respond to overfeeding than when one brother from 2 different set of

twins were compared; suggesting the relation between the bodys genetic makeup and obesity.

(Bouchard et al.,1990)

Significant studies show that genes may affect the amount of body fat you store and where that

fat is distributed and may also play a role in how efficiently the human body converts food intoenergy and also how the body burns calories during exercise. Ones genetic makeup doesn't

guarantee that he will be obese (Astrup. 2007). Environmental factors such as overeating,

irregular meals,lack of daily physical activity would contribute to being overweight. This is why

obesity has tripled since 1980, when only 6 per cent of men and 8 per cent of women were obese

(Astrup, 2007). Lifestyles have changed rapidly, with the ready availability of convenience foods


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and car journeys, replacing walks to work and school. It is lifestyle that determines how the

genes develop (Astrup,2007).

2.1.6 Culture

Cultural norms have always had an effect generally on the perception of obesity. Being big is

considered a sign of affluence, good health and African beauty (Walker,1998). A lean body has

also over some time now, been viewed as having a positive HIV/AIDS status. This

misperception is mostly due to the wasting syndrome that forms part of the clinical presentation

of AIDS. These barriers would thus make it difficult for an obese woman who is not yet

hypertensive or diabetic to lose weight (Nkum, 2007). In a study by researchers from the

University of Maryland,all heavy white females perceived they were heavy, compared to only

40% of heavy black females. Seventy-eight percent of heavy white males considered themselves

heavy versus 36% of heavy black males (Desmond et a., 1989). However, though it is purported

that cultural norms suggest women prefer to be of a larger figure, the survey by Duda et al

(2006), involving 305 Ghanaian women interviewed at Korle-Bu revealed that a high percentage

of the women preferred a smaller figure for a healthier life and reduction in the risk to obesity

associated diseases. The decision to reduce their body weight was not influenced by education,

income, marital status or parity. Could this mean that cultural perceptions are gradually losing

the fight to one for a healthier life? (Duda et al., 2006)

2.1.7 Inactivity

Regular physical activity in addition to what one normally does forms an important part of

weight maintenance. It results in the use up of extra calories and good blood circulation (Foreyt,

2003). Inactivity in any form thus predisposes to weight gain and obesity. It is reported that less

than 32% of American adults do at least thirty minutes of brisk walking or other moderate

activity on most days of the week, and almost half do no leisure-time activity at all. Almost half

of U.S. high school students watch television more than two hours every day. This lack of

physical activity is contributing to the increases in obesity and to other health-related conditions

(Foreyt, 2003). The story may be no different in Ghana. With so much to be shown on television

most recline to seats in front of their sets after the evening meal. In a study in Ghana noted that,


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the average number of days in a week when vigorous activity was performed by an obese person

was 1.1 days compared to 2.5 days for the respondent classified as normal. In the case of

moderate activity, it was performed 2.4 days in a week as against almost 4 days for the normal

individual. The average number of days in which walking was done for at least 10 minutes was

also low for the obese respondent. Thus the obese had less physical activity-days in a week than

the other groups of individuals. (Biritwum et al., 2005)

People with sedentary lifestyles are more likely to gain weight because they do not burn calories

through physical activities (CNN extract- 2007). Traders with stationary stalls, office workers

who work behind desks all day for example, are more susceptible to obesity due to inactivity.

They tend to have higher levels of obesity (15%) than subjects whose jobs involve heavy

physical activity (10%). People who do not engage in leisure-time physical activity are more

obese than those who have three or more sessions of leisure-time physical activity per week

(15.3 vs. 13.5%) (Amoah,2003). Should the obese decide to engage in regular physical activity, it

would also cause an increase in their bodys ability to preferentially metabolize fat as an energy

source thereby contributing to a reduction body weight. (Foreyt, 2003)

2.1.8 Alcohol and Smoking and Medication

Alcohol consumption especially beer has been frequently associated with pot bellies and obesity.

There are facts and studies which support this assumption and others which disprove the

association (Liu et.a., 1994). Nevertheless a considerable number of studies point to the fact that

respondents who consume alcohol have higher proportions of overweight or obesity (Biritwum.,

2005). Pure alcohol contains 7 calories per gram and drinking in excess; causes a change in the

bodys metabolic rate (Camie, 2005). On the other hand, drinking alcohol in moderation of about

a drink or two a few times a week has rather been associated with a low risk of being obese and

it was also noticed in heavy drinkers who may consume in day about four or more drinks a day

to have an increased risk of being obese by 46% (Ahmed et al.,2005). High calorie intake and

low energy burning predisposes one to being overweight and obese (CDC, 2006). Thus alcohol

complimented with over eating and reduced physical activity among others, increase the risk of

obesity and not necessarily as an individual factor (Rohrer, 2005)


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People who smoke commonly gain weight after quitting (CNN extract-,2007). This can be

attributed to the fact that nicotine is able to raise the set point at which the body burns calories

(metabolic rate) thus burning fewer calories. Smoking also affects taste such that food smells and

taste better after quitting resulting in former smokers eating more (CNN extract, 2007). There is

thus increase in food intake, fewer burning of calories and much storage of fat. Thus if one stops

smoking but decisively maintains constant food intake and exercise one would still expect an

increase in body weight usually between 5.00- 10.00% (Myers, 2001).

Uncommonly obesity may be a manifestation of other medical conditions such as

hypothyroidism, Cushing's syndrome and certain hypothalamic disorders. Thus the treatments of

these diseases invariably decrease the BMI (Ofei,2005). Certain medications such

corticosteroids, tricyclic antidepressants, some high blood pressure and antipsychotic

medications can also lead to weight gain (CNN extract- 2007).

2.1.9 Lack of Knowledge

The lack of knowledge about the chronic illnesses commonly associated with obesity also plays a

contributing role in the upsurge of obesity. A study done in Tanzania showed that older subjects

had a higher prevalence of obesity as compared to the young and unlike the old age group (41-50

years), 70% of the youngest subjects were not aware about the harmful effects of obesity. On the

other hand, more than two thirds of all the subjects could not associate excess body weight with

chronic non-communicable diseases such as coronary heart disease, high blood pressure and

breathing problems (Nyaruhucha , 2003).

2.2 Overweight and Obesity: Health Consequences

The primary concern of overweight and obesity is one of health and not appearance (The

Surgeon General, 2007). Being overweight or obese increases the risk of many diseases and the

risk of premature death (Ofei, 2005). These obesity-related diseases are the most common causes

of death before the age of 75 (Astrup , 2007).


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2.2.1 Diabetes

Obesity is a leading cause of type 2 diabetes. Excess fat makes the body resistant to insulin, the

hormone that helps maintain a proper level of a sugar (glucose) in the blood leading to a high

blood sugar and thus type 2 diabetes(CNN extract, 2007). Over 80% of people with diabetes areoverweight or obese. A weight gain of 11 to 18 pounds increases a person's risk of developing

type 2 diabetes to twice that of individuals who have not gained weight (Surgeon General,

2007).

2.2.2 Heart disease

High blood pressure - High blood pressure is twice as common in adults who are obese than in

those who are at a healthy weight (The Surgeon General, 2007).

Fatty tissue builds up as one gains weight and like other parts of the body; this tissue relies on

oxygen and nutrients in your blood to survive. Demand for oxygen and nutrients increase,

likewise the amount of blood circulating through the body. This increases the pressure exerted by

the blood flow on the artery walls. Weight gain also typically increases the level of insulin. The

increase in insulin is associated with retention of sodium and water, which increases blood

volume. In addition, excess weight often is associated with an increase in your heart rate and a

reduction in the capacity of your blood vessels to transport blood. All of these factors increase

blood pressure (CNN extract, 2007).

Abnormal blood fat - A diet high in saturated fats; red meat and fried foods, for example, can

lead to obesity as well as elevated levels of low-density lipoprotein (bad) cholesterol. Obesity

is associated with elevated triglycerides (blood fat) and decreased HDL cholesterol ("good

cholesterol"). Over time, abnormal blood fats can contribute to atherosclerosis, the build up of

fatty deposits in arteries throughout your body. Atherosclerosis increases the risk of coronary

artery disease and stroke (CNN extract, 2007).

Coronary artery disease - Excess fat accumulation results in deposition of these fats in the

coronary vessels. This causes a narrowing to the arteries leading to less blood flow to the heart.

Diminished blood flow to your heart can cause chest pain (angina) and a complete blockage can

lead to a heart attack (CNN extract, 2007).


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Stroke - If a blood clot forms in a narrowed artery (due to atherosclerosis) in the brain, it can

block blood flow to that area of the brain. The result is a stroke. Being obese thus raises your risk

of a stroke (CNN extract, 2007).

2.2.3 Cancer

Many types of cancer are associated with being overweight. These include cancers of the breast,

endometrium, gall bladder, colon, rectum, oesophagus, kidney, and prostate (CNN extract,

2007).

Women gaining more than 20 pounds from age 18 to midlife double their risk of postmenopausal

breast cancer, compared to women whose weight remains stable (The Surgeon General, 2007).

2.2.4 Breathing Problems

Sleep apnoea (interrupted breathing while sleeping) is more common in obese persons which

contributes to a large neck and narrowed airways. This condition causes the upper airway to be

blocked during sleep, which results in frequent awakening at night, heavy snoring and

subsequent drowsiness during the day (CNN extract, 2007).

Obesity is also associated with a higher prevalence of asthma (The Surgeon General, 2007).

2.2.5 Osteoarthritis

These joint disorders most often affects the knees, hips and lower back. Excess weight puts extra

pressure on these joints and wears away the cartilage that protects them, resulting in joint pain

and stiffness (CNN extract, 2007). For every 2-pound increase in weight, the risk of developing

arthritis is increased by 9 to 13% according to the United States department of health and human

services. Symptoms of arthritis can therefore improve with weight loss (The Surgeon General,2007).


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2.2.6 Reproductive Complications

Increased body mass may be associated with fertility problems for both men and womenand in

premenopausal women, irregular menstrual cycles (CNN extract, 2007).

There is a general weight gain during pregnancy with about 12kg increase in body weight. This

is mostly lost after delivery. Overweight and obese women with the added weight are however at

an increased risk of developing complications. There may be an increased risk of death in both

the baby and the mother and the maternal high blood pressure may increase 10 times more

(preeclampsia). There is also the likelihood for these obese women to develop gestational

diabetes and problems with labour and delivery. The infants born are more likely to have high

birth weights and this increases the rate for a caesarean section delivery. Obesity during

pregnancy is associated with an increased risk of birth defects, particularly spina bifida, brain

damage and seizures which result from low blood sugar (The Surgeon General, 2007).

2.2.7 Premature death

The risk of death rises with increasing weight. As shown by United States statistics, even

moderate weight excess (10 to 20 pounds for a person of average height) increases the risk of

death, particularly among adults aged 30 to 64 years. An estimated 300,000 deaths per year may

be attributable to obesity with individuals who are obese (BMI > 30) having a 50 to 100%

increased risk of premature death from all causes, compared to individuals with a healthy weight

(The Surgeon General, 2007).

2.2.8 The Cost of Obesity

The direct cost of diagnosing treating and managing obesity and its associated diseases with

national systems has been only assessed in a few countries.( IOTF,2001) A study in America

estimated the health care cost of overweight and obesity to be $120 billion. This included doctor

visits and medication, wages lost by people too ill to work and the value of future earnings cut

short by premature death. (Foreyt, 2003)

The possible impact of obesity on the health care resources in less developed health care systems

of the developing world is likely to be more severe. (Foreyt, 2003)


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3.0 STUDY AREA

3.1 Introduction

The Awutu Effutu Senya District where Winneba is located, is situated between latitudes 520

north and longitudes 025, west and 037west on the eastern part of the central region, Ghana.

It is widened and sandwiched by Greater Accra region and the following Districts, Ga rural, Agona

and Gomoa. It is bordered on the North by Agona district, North East by the West Akyim District

to the South by the Gulf of Guinea, on the East by the Ga District and on the West by the Gomoa

District.

The District covers an area of 417.3 square kilometres with a total population of 196588 according

to the projected population for 2007 representing 12.4 of the total population of the central region.

Fig 1. MAP OF AWUTU EFFUT

SENYA DISTRICT


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3.2 Historical Background

Winneba which is the district capital is about 66 km west of Accra, Ghanas capital, on the Accra

Takoradi road. Medium sized and traditionally known as Simpa, Winneba is the principal

town of the Effutu State founded around 1530 AD. According to history, the name Winneba

originated from sailors who plied along the Atlantic Coast and who were often aided along the

bay by a favourable wind. From their constant use of the words windy bay the name Winneba

was coined. It has a population size of 51161, 26% of the total population as projected for

2007and is the second largest subdistrict.

The indigenous dialect of Winneba is Effutu but Fante is also widely spoken. As a coastal town

the principal occupation of the people is fishing. In the colonial day, Winneba was the second

seat of administration in the Central Province of the Gold Coast, now Ghana. Winneba has a

proud history, culture and fascinating environment. A former commercial hub the town providesa serene and congenial atmosphere for all manner of businesses. (ghanadistricts.com.gh, 2007)

3.3 Size And Population

PROJECTED POPULATION FOR THE A.E.S. DISTRICT FOR YEAR 2007

SUB

DISTRICTS

TOTAL

POPULATION


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3.4 Terrain and Climate

The topography of the District is characterized by isolated undulated highlands and lowlands.

The lowlands are found along the coastline-Senya and Winneba areas with isolated hills. The

nature of topography is directly related to the soil nature with the lowlands having clay soils and

parts of loamy soil.

The district experiences two rainfall patterns: the major rainy season (April to July) and minor

rainy season (September to November). There is normally a five month dry season starting from

November to March followed by seven month rainy season from April to October. The rainfall

figures of the district are quite low (40cm50cm) along the coastal but are higher in the

hinterlands with the mean annual rainfall ranging between 50cm and 70 cm. The mean annual

minimum and maximum temperature of 22C and 28C coupled with the rainfall pattern favour

cultivation of many crops such as cassava, plantain, maize, yam, palm trees and cocoaparticularly in the semi-deciduous forest areas. The high temperatures and dry conditions along

the coast also favour salt winning from the lagoons. (ghanadistricts.com.gh, 2007)

3.5 Administration

The Awutu-Senya District Assembly is the highest administrative and political authority in the

District with the mandate to initiate development and co-ordinate all development efforts aimed

at sustainable development at the local level.

The District Administration, which is headed by the District Co-ordinating Director, has an

oversight responsibility in the general administration. There is also the general assembly with

one third being appointed by the ruling government. The Assembly is empowered to make and

enforce by-laws.

The AES District has seven sub-committees, established to function as the operating arms of the

executive committee and assist in the planning and implementation of specific activities of the

Assembly. Eleven decentralised departments and other administrative sub-structures such as the

urban/town/area councils and unit committees have been represented to provide specialised and

technical services to the assembly. (ghanadistricts.com.gh, 2007)


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3.6 Socio-Economic Activities

Majority of the people living in the district have chosen farming, fishing and petty trading as

their main occupation. The farmers produce staple crops such as maize, yam, cassava and

plantain. Some of the farmers also produce exportable cocoa, the economic backbone of the

country and pineapples. Winneba is one of the major fishing communities. The main fish catches

include herrings, shrimps, tuna, lobster and octopus. Fish production is mainly from marine

source. The system of fishing is mainly by motorized canoe, which engages about 6,000

fishermen. (ghanadistricts.com.gh, 2007)

3.7 Health Facilities

The District has seven health facilities operating within its jurisdiction. These are the Winneba

Government Hospital, Awutu-Bereku Clinic, Awutu-Bawjiase Health Centre, Awutu-Bontrase

Health Centre, Awutu- Okwampa Health Centre, SenyaBekeku Health Centre, Kasoa Health

Centre and Tawiakwaa Health Centre.

In addition nine private hospitals and clinics are also operating in the area.

(ghanadistricts.com.gh, 2007)

3.8 Schools

The district has a total of 286 schools (public and private) of various types. These include 101

pre-schools (Nursery /Kindergarten) of both public and private ownership, primary schools, 60

Junior Secondary Schools (JSS), and one senior secondary school in Winneba, another in Senya

and Obrachire Secondary Technical at Bereku. Winneba also boasts of The National Sports

College situated within the University of Education which is also in Winneba.

(ghanadistricts.com.gh, 2007)

3.9 Infrastructure

The Awutu Effutu Senya district has one commercial bank and three rural banks, as well as someinsurance companies. The district capital, Winneba, and other towns like Kasoa, Bawjiase, have

access to Ghana Telecom fixed land line service whilst the networks of three cellular phone

services providers cover the district. The University of Education, Winneba, provides internet

services which enable some business centers in the district to offer ICT services to the general

public.


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Almost all of the over 29 FM radio stations in the capital of the country Four television stations

operating from Accra have networks covering the district. (ghanadistricts.com.gh, 2007)

3.10 Top Ten Causes of OPD attendance

Disease 2007

Malaria 28,814

Upper respiratory tract infection 7,353

Skin diseases 4,143

Other diarrhoeal diseases 2,257

Gastrointestinal diseases 1,506

Diseases of oral cavity 1,462

Acute eye infection 1,358

Gynaecological diseases 1,284

Hypertension 1,154

Bites and minor trauma 1,063

SOURCE: Winneba Government Hospital - 2007


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4.0 METHODOLOGY

This study was a cross-sectional descriptive survey to test the hypothesis that the people of

Winneba have the right perception about obesity (BMI > 30) and its associated diseases. The

study was done in the months April and May 2007 in the Winneba Township. Data was collected

from 192 adults (82 males, 110 females) aged 20 years and above with the administration of

questionnaires. In the questionnaire, enquiries were made on age, sex, occupation, marital status,

educational level, a self perception regarding obesity, and the individuals knowledge on obesity.

Exercise habits, family or peer pressure to change their weight and individuals knowledge on

chronic non-communicable diseases was also gathered. The choice of diseases was limited to

Hypertension, Diabetes mellitus, Stroke which are more known in the community and for easy

interpretation in vernacular (Twi). The questionnaires were pre-tested on ten people randomly

selected and each interviewed after the purpose of the study was explained to them. This was to

enable any corrections to be made and necessary re-wording to be done to ensure clarity of

questions. The questionnaire was of closed ended type except for a few open- ended type

questions, which were designed to allow respondents to express their ideas on certain issues.

A sample size of 381 was calculated using EPI INFO version 3.3.2 assuming 50% of the

population had knowledge about obesity at a 95% level of significance. This was however, not

achievable due to limitations already stated in section 1.8 and thus a convenience sample size of

192 was selected as a fair representation of adults in Winneba. The town was divided into six

communities using the main road leading from the main market to the District Health Service

office. Each community was visited in turn. In each community, 32 respondents were

interviewed with the 1st house being chosen randomly in the centre of the community. Adults

above the age of 20 years in each household were selected by simple random sampling and were

interviewed regarding their views on obesity and their in-depth knowledge into obesity

associated diseases. The administration of the questionnaire took 4 weeks with an average of 20

minutes spent on one person. Participation was voluntary and verbal consent sought from the

interviewees before the beginning of each questionnaire. Respondents were also provided with

health related information at the conclusion of the interview.


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Variables collected from the survey enabled linkage of the perception of the people on obesity to

obesity-predisposing factors and to some of the diseases that have obesity as a risk factor

(diabetes and cardiovascular diseases).

The data collated was analyzed and presented on frequency tables and graphs to enhance easy

interpretation and analyzed using the statistical package SPSS 11.0 for Windows. The results are

expressed as means or percentages with 95% levels of significance.


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5.0 RESULTS

5.1 Socio- Demographic characteristics

A total of 192 adults within the age group 20-69 years participated in the study. The mean agewas 40.3years with median age, 34.3years. According to the table, a lower percentage, 8.3% was

recorded for people aged 60 and above. More than 50% (57.3%) of the subjects were females

and the remaining males (46.7%). Majority (60.4%) of those interviewed were married. Almost

half (49.0%) of those interviewed also had some form of education up to the basic level (up to

the primary school). This was followed by those with an education up to the secondary level with

28.6% and less than 20% (18.2%) had an education up to the tertiary level. A few (4.2%) of the

respondents did not have any form of formal education. More than half of those interviewed

(57.8%) are engaged in petty trading (especially fish mongering and small provisions

stores).Office workers formed 13.0% whilst 9.4% of the respondents were unemployed.

Table 5.1 below gives the Socio-Demographics of the respondents.


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Table 5.1- Socio- demographic Characteristics of Respondents

Characteristics Frequency Percent (%)

Age(yrs.)

Total

20 - 29 years 30- 39 years

40 - 49 years

50 - 59 years

60 years +

5147

41

37

16

192

26.624.5

21.4

19.3

8.3

100.0

Sex

Total

male

female82

110192

42.7

57.3

100.0

Education level

Total

Basic

Secondary

Tertiary

No formal

education

94

55

35

8

192

49.0

28.6

18.2

4.2

100.0

Marital status

Total

Single

Married

Divorced

61

116

15

192

31.8

60.4

7.8

100.0

Occupation

Total

Trading

Office workers

Teaching

Student

Unemployed

111

25

18

19

18

192

57.8

13.0

9.4

10.4

9.4

100.0

(Source: Field Survey 2008)


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5.2 Perceptions carried about Obesity

All the people who said obesity was good considered to it as a gift from God and a sign of good

living. For those who condemned obesity 57.8% 0f 192 people, 53.6% gave the reason of it

being prone to various illnesses while 46.4% said it was bad because it made one inactive and

apathetic. Of the 22% of the study population who were not sure as to whether obesity was good

or bad, 43.6%, 33.3% and 23.1% gave proneness to illness, God-given, and inactiveness,

respectively, as their reason for it being good or bad. However, they could not be too certain.

A test of association between views on obesity and characteristics of the respondents indicated

that there is no association with Marital status and Occupation. However, there is an association

between the perceived views on obesity and Gender (p=0.004), Age (p=0.001) and Educational

status (p = 0.001). This is shown in Table 5.2 below.


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Table 5.2

Relationship between Socio-demographic characteristics and perceived

views about obesity

good Bad Not sure p-value

% (#) % %Gender% 0.004

Male 20.7 69.5 9.8

Female 21.8 50.0 28.2

Age group% 0.001

2029 35.3 51.0 13.7

3039 14.9 83.0 2.1

4049 12.2 53.7 34.1

5059 13.5 56.8 29.7Over 60 37.5 25.0 37.5

Marital status% 0.133

Married 19.8 56.9 23.3

Single

Divorced

27.9

6.7

60.7

60.0

11.5

33.3

Educational status% 0.001

No formal education 25.0 37.5 37.5

Basic level 33.0 48.9 18.1

Secondary level 14.5 56.4 29.1

Tertiary 0.0 91.4 8.6

Occupation %

Trading 23.3 40.5 36.2 0.145

Office workers 19.2 45.3 35.5

Teaching 8.2 63.2 28.6

Student 18.7 62.4 18.9

Unemployed 30.6 33.4 36.0



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5.3 Effect of level of education on perception about obesity

Bar chart 5.3Distribution of perception of obesity by level of education

tertairy Percent

secondary Percent

basic Percent

no formal education

100

80

60

40

20

0

obesity is

good

bad

not sure9

29

18

38

91

56

49

38

15

33

25


Obesity is seen as bad across all the educational levels. People with education up to the tertiary

level recorded the highest percentage (91% of 35 people) of those condemning obesity. None

said it was good in this group. Respondents falling into the category of those with some basic

education, who form the majority of the study population, had almost half of them (49%)

condemning obesity. 33% said it was a good thing to be obese, 18% were, however not sure.

Results also indicated that the reasons given to the general views on obesity( as to it being

good or bad or not being sure) were significantly associated with the respondents level of

education, as was the knowledge on the causes of obesity and obesitys association with diseases.

Level of education (%)


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5.4 Knowledge on diseases associated with obesity

Table 5.4.1 Distribution of Respondents knowledge about Obesity and association with

Diseases

Response to association

between obesity and

diseasesFrequency Percent (%)

Yes

No

Not sure

Total

103

44

45

192

53.6

22.9

23.4

100.0


The majority (53.6%) are aware that obesity is associated with diseases. About 23.4% could not

say if obesity was associated with diseases or not as compared to 22.9% who were more certain

that obesity was notassociated with diseases.


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Bar chart 5.4.2 Distribution of knowledge about obesity and association with

diseases by level of education

tertairy Percent

secondary Percent

basic Percent

no formal education

100

80

60

40

20

0

is obesity associate

yes

no

not sure6

33

26

1316

33

50

94

51

4138


In the bar chart, majority responded positively to the association of obesity with diseases apart

from respondents with no formal education. Those with tertiary education recorded the highest

positive response (94.3%) with none at all responding no to the question.

Level of Education (%)


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Table 5.4.3 Knowledge of specific disease association with obesity by Respondents

Respondents knowledge on

specific diseases Frequency Percent (%)

Hypertension or Diabetes

Mellitus or Stroke 107 55.7

Hypertension and Diabetes

Mellitus or

Hypertension and Stroke or

Diabetes Mellitus and Stroke 26 13.6

Hypertension and Stroke and

Diabetes Mellitus 1 0.5

Others 10 5.2

Not sure 48 25

Total 192 100


Of the 192 people interviewed, a quarter (25%) could not link any disease to obesity. Most

(69.8%) could associate at least one disease with obesity. More than half (55.7%) linked only

one disease to Obesity. Hypertension was the most widely known. Whilst 13.6% of the

respondents could link two diseases to obesity, only one person mentioned hypertension, stroke

and diabetes mellitus, as among the numerous obesity associated diseases. A few (5.2%) of the

respondents linked other diseases such as Malaria, Fibroid, Joint pains, Epilepsy to obesity.

Table 5.5 Frequency Distribution on willingness to lose weight when necessary (N=192)


After a briefing on health consequences of obesity, Majority (72.5%) of the people interviewed

would want to lose weight for a healthier life, as seen from the table.

Response to willingness to

lose weight Frequency Percent (%)

Yes

No

Total

139

53

192

72.5

29.5

100


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6.0. Discussion

Much research has been done concerning the epidemiology and prevalence of obesity in Ghana

among the Akans, Ewes and the Gas. On the other hand not much data are available concerning

the perception of obesity among Ghanaians in the 21st

century. This study differs from previousresearch in that it was conducted mainly to assess the general perception of obesity among the

people of Winneba- an Akan subgroup and to further assess their general knowledge on obesity

associated diseases.

6.1 Socio-Demographic Characteristics

Winneba is a community known mainly for its farming activities (crop and fishing). It may be

surprising to note that most were traders. This can be explained considering the fact that at the

time of data collection which was during the day, most of these farmers had gone to the farms.

The people with more stationary jobs, the traders, office workers, teachers and even the

unemployed at home who are normally associated with obesity, were thus more readily

accessible for the interviews. This study thus had a good representation of the group more prone

to obesity; whose response to the questionnaires would give a better representation of the

perception on obesity and its associated diseases.

More females were questioned (57.3%) as compared with males (42.7%). This ratio is quite

similar to that of the projected population for 2007 (47% males, 53% females).It also appearsthat marital status may be a factor in the prevalence rates of obesity whereby the married tend to

be more prone to obesity than their single, divorced or widowed colleagues partly as a result of

the view held by most married people that obesity is a sign of peace of mind.(Ramsey- 2003).

This study however failed to show any association on the views on obesity and marital status.

6.2 Perception about Obesity

Cross-cultural differences exist worldwide concerning the perception on obesity. Many,

especially women do not associate heavy weight with potential health problems (Davidson MSN

-2006). The review by Davidson MSN -2006showed that African-Americans regarded obesity

and overweight status more positively, relating extra weight with attractiveness, sexual

desirability, strength, goodness, self-esteem and social acceptability. This is also particularly

among the black race, Hispanics and in the Pacifics and Middle East- (CDC- 2003)


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Winneba is a town with rich culture and heritage. Its inhabitants belong to the Akan ethic group

which records the highest prevalence of obesity in Ghana. (Amoah A.G -2003)

This study however showed that majority (57.8%) were worried about obesity and its tendency

to make one inactive, its predisposition to various illnesses and the psychosocial aspect of low

self esteem. This demonstrates that most of the people are not significantly affected by the

supposedly positive perceptions of obesity.

6.3 Perception of Obesity by Level of Education

The study also shows that majority (91%) of the people with tertiary education condemned

obesity. None said it was good. A far lesser frequency was recorded for those with basic

education. The result obtained is thus in agreement with the CDC-2003 studies which indicated

that though the prevalence of obesity increases across all education levels, it tends to skew higher

for persons with less education. This means that though people with lesser education tend to be

more obese, they rather have a low perception about obesity. In a similar study involving

maternal perception of overweight children, Baughcum (2000), reported that mothers with lower

levels of education had little or no perception of obesity. The finding showed that after receiving

education, 94.3 percent of mothers had became aware of the obese condition of their children,

and therefore found it necessary to prevent and to treat the obesity.

6.4 Knowledge on Diseases associated with obesity

It was noticed in this study that the number of people who were not sure about their answers with

respect to questions on obesity and its association with diseases (23.4%) was quite high. If this

number of people were added to those not totally concerned about obesity (22.9%), it

significantly raises the number of people with inadequate knowledge about the adverse effects of

obesity on society to more than 40% (46.3%, 89people,).

The result from this study again shows that 25% of the people could not associate any disease to

obesity. Majority of the remaining people could however associate obesity to only one disease as

compared to 0.4% with knowledge about 3 or more diseases. It is interesting to note that people

who linked obesity to only one disease would generally not view obesity as a health problem that

needs to be tackled.The lack of knowledge about these non communicable chronic illnesses


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commonly associated with obesity plays a contributing role in the upsurge of obesity in our

society.

After a 5 minutes briefing on the health consequences of obesity findings indicated that majority

(72%) of the respondents would want to lose weight if it meant healthier and longer life.

Comparing this response to the previous level of concern about obesity at the beginning of the

interview (58.3%), it shows that community education on obesity as a health issue would be

beneficial. It is also noted that a significant number of younger people were more likely than

those aged 60 years and older to change their current body image to reduce the risk of

hypertension, diabetes, myocardial infarction, stroke and poor vision. This may reflect an attitude

of the older generation, that it may be too late to improve their health or the young hoping to

maintain good health and thus willing to make sacrifices to do so (Duda R. et al -2006).


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7.0 Conclusions

With increasing westernization, the dietary habits of numerous people all over the world have

been influenced with the readily available, supposedly cheap fast foods, which are so high in fat

and of poor quality. This has in adversely increased the prevalence of obesity globally and evenin the third world countries where poverty is endemic. This fact could not be significantly

gathered from this study. However, the information gathered from this study indicates that

majority of the people in the winneba township and probably in many other places in Ghana have

a negative perception about obesity and a significant proportion (25%) of them are not totally

aware of health complications associated with obesity.

Hypertension, Heart diseases, Diabetes mellitus, Stroke and other obesity associated diseases are

slowly becoming prevalent in our part of the region. On the other hand, only about 55.8% in

Winneba where hypertension is quite prevalent could associate any of these diseases with

obesity.

The minimally educated in the Winneba community recorded the highest percentage (38%) of

those perceiving obesity as a good health status. On the other hand, about 94% of the people with

tertiary education condemned obesity. This shows the significant role education has to play in

forming the right perception on any societal issue and for that matter on obesity. This is also

shown by the response to lose weight for a healthier longer life after a five minute briefing on the

health implications of obesity.

7.1 Recommendation

There is need for more public awareness on the effect of obesity on people's health through

information, education and communication. It would be of great importance if such interventions

were introduced at early age of life, for example by inclusion in school curricula.

An educational program that explains the association between obesity and heart disease and

diabetes would be of benefit to all age groups.


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APPENDIX

KWAME NKRUMAH UNIVERSITY OF SCIENCE AND TECHNOLOGY.

SCHOOL OF MEDICAL SCIENCES , KUMASI GHANA

QUESTIONNAIRE

INTRODUCTIONThis questionnaire is to assist in evaluating the general perception on obesity and the knowledgeof the diseases associated with it among the town folks of winneba the capital of the Auto EffeteSenya district.

SOCIO- DEMOGRAPHICS

AGE .. SEX MALE FEMALE

OCCUPATION.

HIGHEST LEVEL OF EDUCATION

MARITAL STATUS SINGLE MARRIED DIVORCED

PERCEPTION ON OBESITY

IS BEING OBESE GOOD BAD? NOT SURE

REASONS/ BELIEFS.

DO YOU THINK YOU ARE FAT? YES NO NOT SURE

WHAT MAKES ONE FAT?

EATING TOO MUCH LACK OF EXERCISE FAMILIAL

OTHER ...

WHAT MAKES ONE LOOSE WEIGHT? DIETING EXERCISING

OTHER.........................................................................................

WHAT DO YOU USUALLY DO AS A FORM OF EXERCISE?..

HOW OFTEN?DAILY WEEKLY OFTEN SOMETIMES NEVER


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KNOWLEDGE ON OBESITY- ASSOCIATED DISEASES

DOES BEING OBESE MAKE YOU PRONE TO DISEASES? YES NO NOT SURE

IF YES TICK IF RELEVANT

HYPERTENSION DIABETES MELLITUS STROKE

OTHER

WHAT CAN BE DONE TO PREVENT THESE DISEASES

.

DO YOU HAVE ANY OF THESE DISEASES?

YES NO NOT BEEN TOLD

IS THERE ANY FAMILY HISTORY / OR IS THERE ANY ONE IN YOUR FAMILY WITHANY OF THESE CONDITIONS

YES NO NOT SURE

ARE YOU WILING TO LOOSE WEIGHT IF YOU HAD TO? YES NO


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project submission(obesity )

Documents