Women’s perception of overweight in Accra, Ghana ‘Some amount of weight is good but too much is not good’ Richmond Aryeetey & Gloria Duah University of Ghana School of Public Health, Legon, Accra, Ghana 1.GSS et al The 2008 Ghana Demographic and health Survey. 2.Hill et al, Int. J Gynecol & Obstet 2007: 99 (150–156) References * Globally, overweight and obesity are major public health issues with implications for increased morbidity and mortality. An estimated 30% of Ghanaian women are overweight or obese. 1 In urban areas, estimates average 50% of women. 2 A trend towards increasing overweight is being observed in Ghana. While transitions in food system and lifestyle have been implicated for the observed trend, little is known about women’s beliefs and practices regarding overweight and how these can be incorporated into control strategies. Objective: To describe the beliefs and experiences of urban-dwelling Ghanaian women regarding overweight. Study location: Dome, urban Accra, Ghana Study design: cross-sectional qualitative study. Study participants: overweight/obese women (18y+) seeking preventive child health services in Dome, Accra. Data collection techniques: focus group discussions (n=32), & in-depth interviews (n=10) In addition to notes taken, all interviews and discussions were audio recorded and transcribed for content analysis. Ethical approval: from University of Ghana NMIMR IRB. Background 1 Methods 2 Perceptions of Overweight 3 Varied perceptions including admiration & desire, ambivalence, stigmatization, dread/fear and based on mixture of personal and societal experiences ‘Being big means that you are attractive. But there are different kinds of being big. There is the kind that makes you presentable. There is another kind that makes you look disgusting. And you feel uncomfortable’ (IDI respondent) ‘When there is a quarrel, you can be insulted that your husband does not take good care of you that is why you are looking like a broom stick’. (FGD participant) ‘All the members of my family are overweight. I have had this weight for such a long time that I feel its part of me.’ (IDI respondent) ‘cargo’, ‘obolo’, ‘okesie’ (FGD participant) ‘When I go out and there is laughter, I feel like am the cause of that laughter’ (IDI respondent) ‘Sometimes you even think that will you one day be this big?’ (FGD participant) Conclusion Unsuccessful attempts at weight loss and use of strict weight reduction strategies. ‘My brother’s child has tried so hard, but has not lost weight. She loses it and gains it back. She controls herself but she is still big.’ (FGD participant) ‘ She used to wear a corset when dressing’ (FGD participant) ‘My sister has now reduced. I asked how she did it. She mentioned that she does not eat. She only takes in fruits.’ (FGD participant) ‘Lemon can make her reduce (weight). If the person can drink one glass every morning’ ( FGD participant) ‘A friend said her husband has had a child with a woman who has an appreciable amount of weight. But she is slim. Her husband has stated that if she does not gain weight, he will divorce her’ ( FGD participant) 4 What causes overweight Attribute obesity to both plausible and implausible reasons including: Natural/genetic, pregnancy and childbirth, diet and lifestyle, medical interventions (IV, family planning) and, self-induced (medication). You are born with it..nothing can be done about it’ (FGD participant) ‘ personally, anytime I give birth, I gain weight but when I stop breastfeeding, it reduces a little.’ (IDI respondent) ‘I joined a keep fit club. After the keep fit, I will be drinking beer and some khebab and I realised I was growing fat.’ (IDI respondent) ‘they have no worries, and therefore eat too much’ (IDI respondent) ‘As for that particular friend of mine, it is very important for her (to be fat). She will tell me plainly without any trace of shyness. Her husband wants her that way’ (FGD participant) ‘Some people also gain weight just by drinking iced-water’ (FGD participant) 5 Experiences of overweight 6 “But there are different kinds of ‘being big’. There is the kind that makes you presentable. There is another kind that makes you feel uncomfortable”- (FGD participant) Most of us like to be fat, most people. But not too much’- (FGD participant) While many women would rather not be overweight, being overweight is still considered a desirable social norm. Perception of overweight is influence by both personal and societal expectations Misperceptions regarding determinants of overweight and weight reduction strategies calls for effective behavior change communication in Ghana.