Obesity in urban civil servants in Ghana: Association with pre-adult wealth and adult socio-economic status

doi:10.1016/j.puhe.2009.02.003

Public Health

Volume 123, Issue 5, May 2009, Pages 365-370

https://doi.org/10.1016/j.puhe.2009.02.003 Get rights and content

Summary

Objective

To investigate the distribution of obesity and its association with pre-adult wealth and adult socio-economic factors in urban Ghanaian civil servants.

Study design

Cross-sectional study of urban civil servants.

Methods

A total of 1015 (615 men and 400 women) civil servants aged 25 years and above employed in seven central government ministries and departments in Accra, Ghana were studied (participation rate 82.7%).

Results

The prevalence of obesity [body mass index (BMI) ≥30.0 kg/m²] was 10% in men and 36% in women. Men of higher pre-adult or current socio-economic position generally had higher mean BMI and waist circumference. In women, however, the mean waist circumference was higher in those of lower socio-economic position (lower education, less pre-adult wealth), but mean BMI did not differ significantly between socio-economic groups. There was a positive graded association between pre-adult and adult levels of wealth (determined by the availability of selected household amenities) and the risk of obesity in men (P-trend = 0.003), but weak suggestions of an inverse association between adult level of wealth and obesity in women under 45 years of age.

Conclusions

The high prevalence of obesity in this population indicates the need for appropriate interventions for its prevention and treatment. Programmes and interventions to control obesity need to address different needs of men and women in the various social strata, and must not be limited to adults.

Introduction

The problems of overweight and obesity [defined as body mass index (BMI) ≥25.0 kg/m² or ≥30.0 kg/m², respectively]¹ have been reported to be socially patterned. An earlier review of published studies reported a strong direct relationship between higher socio-economic status and obesity in developing societies.² However, a more recent review of published studies observed a different pattern and concluded that obesity in the developing world was no longer limited to groups of higher socio-economic status.³ Evidence from the limited information on socio-economic position and obesity in sub-Saharan Africa suggest a generally positive association between obesity and socio-economic position, with the risk of obesity increasing with rising socio-economic position.4, 5, 6, 7 Social class in both childhood and adulthood have been shown to be important determinants of risk factors in later life, contributing to adult health and mortality.8, 9, 10 Population-based data on the socio-economic determinants of obesity in sub-Saharan Africa are sparse, and very few of these studies have considered the association between pre-adult socio-economic position and obesity.

The purpose of this study was to examine the association between adulthood socio-economic position and pre-adulthood wealth and obesity, and to determine whether the socio-economic patterns of obesity differ between men and women.

Section snippets

Methods

A cross-sectional survey of civil servants in Accra, the capital city of Ghana, was conducted between January and September 2006. The Republic of Ghana is centrally located in West Africa, and has a population of 22 million with 43.8% of the population living in urban areas. The gross national income per capita is $590 per year.¹¹ The population of Accra is 3 million and is entirely urban.¹² The Civil Service forms part of the Public Service of Ghana and is an organized body of men and women

Results

The participation rate was 82.7% (1015 participants out of 1227 workers employed in the seven sampled ministries). Men were significantly older [44.6 years, standard deviation (SD) 9.9 years] than women (43.0 years, SD 10.4 years). Table 1 shows the basic characteristics of participants. BMI was lower in men (24.7 kg/m², SD 4.3) than women (28.2 kg/m², SD 5.8, P < 0.001 for difference), but mean waist circumferences were similar (men 89.1 cm, SD 11.9 cm; women 89.5 cm, SD 13.9 cm, P = 0.63 for

Discussion

This study investigated the distribution of BMI, waist circumference and obesity in urban civil servants in Accra, and examined the association between obesity and both pre-adult and adult wealth, and differences between men and women. The prevalence of obesity, particularly in women, was high compared with results from other studies involving populations of African descent.¹⁶ The prevalence of obesity and mean BMI were higher in women than men, but mean waist circumference was similar in men

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The distribution of obesity tends to shift from rich to poor individuals as countries develop, in a process of shifting sociodemographic patterns of obesity that has been called the ‘obesity transition’. This change tends to happen with economic development, but little is known about the specific mechanisms that drive the change. We propose that improvements in childhood circumstances with economic development may be one of the drivers of the obesity transition. We explore whether the social gradient in body weight differs by childhood socioeconomic status (SES), proxied by the respondent’s mother having Grade 12, using South Africa’s nationally representative panel National Income Dynamics Study. In support of our hypothesis, we find that the social gradient in body weight is less positive for adults who had a high childhood SES, and already appears to have reversed among high-SES women who also had a high childhood SES. Upward social mobility over an individual’s life course or across a single generation is associated with higher body weight compared to a stable high SES. But a high SES sustained in childhood and adulthood – or across more than one generation – may decrease adult obesity risk, and result in a reversal of the social gradient in body weight. Random effects within-between models show that the social gradient in body weight and its interaction with childhood SES are driven more by differences in income between individuals than by short-run changes in income within individuals, again suggesting that the obesity transition is driven by long-run changes rather than by very short-run changes. Our results are broadly robust to using several alternative measures of body weight, childhood SES and adult SES. Our results are consistent with the hypothesis that widespread improvements in childhood circumstances and nutrition with economic development may contribute to the shift to later stages of the obesity transition.
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In both measures of adiposity, prevalence rates were found to be significantly higher in female students than in male students. This is consistent with several studies conducted among young adults as well as older adults in Sub-Saharan Africa [6,26,32–35]. Comparative data from other African countries are non-existent; however, the levels of misperception in our sample are lower than those reported among young adults in Pakistan (42.4%) [19], Mexico (37.0%)[12] and South Korean Adolescents (28.1%) [21].
We compared participants’ self-perception of their weight with the World Health Organisation (WHO) definition for BMI categories among undergraduate university students undertaking health related academic programmes in Ghana. Also, we investigated factors associated to the underestimation of weight status in this sample.
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A high prevalence of overweight/obesity and systemic hypertension was found. Hyperglycaemia was more prevalent among overweight/obese participants.
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Prevalence and risk factors of obesity among undergraduate student population in Ghana: an evaluation study of body composition indices
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Original researchObesity in urban civil servants in Ghana: Association with pre-adult wealth and adult socio-economic status

Summary

Objective

Study design

Methods

Results

Conclusions

Introduction

Section snippets

Methods

Results

Discussion

Prev Med

Lancet

Lancet

Obesity: preventing and managing the global epidemic

Socioeconomic status and obesity: a review of the literature

Psychol Bull

Socioeconomic status and obesity in adult populations of developing countries: a review

Bull World Health Organ

Distribution of blood pressure, body mass index and smoking habits in the urban population of Dar es Salaam, Tanzania, and associations with socioeconomic status

Int J Epidemiol

Association between socioeconomic status and adiposity in urban Cameroon

Int J Epidemiol

Obesity and cardio-metabolic risk factors in urban adults of Benin: relationship with socio-economic status, urbanisation, and lifestyle patterns

BMC Public Health

Childhood socioeconomic circumstances and cause-specific mortality in adulthood: systematic review and interpretation

Epidemiol Rev

Is the association between childhood socioeconomic circumstances and cause-specific mortality established? Update of a systematic review

J Epidemiol Community Health

Original research
Obesity in urban civil servants in Ghana: Association with pre-adult wealth and adult socio-economic status