There is growing concern about the rising global prevalence of overweight and obesity, as well as their associated adverse health implications [1,2,3]. One feature of this global problem is the fast pace at which developing countries are being affected compared to the developed countries. For example, while the number of people affected by overweight or obesity increased 1.7 times between 1980 and 2008 in developed countries, those affected in developing countries more than tripled from around 250 million people to 904 million over the same period [4].
As in many developing countries, the prevalence of overweight and obesity in Ghana has consistently increased over the last few decades, disproportionately affecting women than men. For instance, the Ghana Demographic and Health Survey (GDHS) estimated the prevalence of overweight or obesity among women (40%) aged 15–49 years to be more than twice that of men (16%) [5]. Specifically, the prevalence among women was estimated to have increased by 27% between 1993 and 2014 [5]. Further, the prevalence of overweight or obesity in Ghana affects more urban than rural residents, and increases with household wealth and level of education [5].
Although overweight and obesity result from energy imbalance (consuming more calories than are equivalently expended in physical activity), studies have found a variety of factors to be associated with the phenomenon. Various associations, in terms of magnitude and direction have been reported between overweight and obesity, and a number of factors including age [6, 7], gender [8, 9], socioeconomic status [10, 11], marital status [12, 13], education [14, 15], occupation [6, 15], ethnicity [6, 14], genetics [16], dietary [17, 18] and physical activity patterns [19]. For instance, contrary to developed countries, the wealthier, more educated and urban populations are more at risk of overweight and obesity in developing countries [10, 11, 20]. Prior studies [6, 21, 22] in Ghana have found overweight and obesity to be positively associated with age, household wealth, education, being married, and parity among others.
Engaging in sedentary behaviours, such as television (TV) viewing has been implicated among the multiplicity of the factors underlying the increasing prevalence of overweight and obesity observed in many populations around the world [23, 24]. A number of theoretical propositions about the possible mechanisms through which TV viewing affects overweight and obesity have been advanced. It is hypothesized that, TV viewing displaces participation in high-intensity discretionary physical activity, reduces resting energy expenditure compared to other activities, and increases sleep deprivation [19, 25]. Nonetheless, studies exploring this hypothesis have found a weak relationship between TV viewing and physical activity [19, 25].
An alternatively hypothesis posited is that TV viewing leads to an increase in overall energy intake either indirectly through exposure to advertising and consequent intake of foods commonly advertised on TV, or directly through the consumption of high calorie foods and beverages while viewing TV [17, 18]. Indeed studies involving both children and adults have found a positive association between TV viewing and intake of high calorie foods such as soda, pizza, and high-energy snacks [17, 18, 23]. In an experimental study involving children, Blass et al. [26] found children’s energy intake to be higher when viewing TV than in control conditions when the TV is switched off.
Beyond exploring the possible mechanisms between TV viewing and physical activity or calorie intake, positive associations between TV viewing and obesity and/or related indicators have consistently been observed across space and time. Studies in the United States (US) have found that men and women viewing the most TV have an increased risk of obesity compared with those viewing the least TV [27,28,29]. In Australia, women who viewed TV for more than three hours a day were found to have a higher prevalence of severe abdominal obesity; while men who viewed TV for the same amount of time had a higher prevalence of moderate abdominal obesity [23]. More recently, a worldwide cross-sectional study across low, middle, and high income countries involving 207,672 adolescents from 37 countries and 77,003 children from 18 countries found increased TV viewing hours to be positively associated with body mass index (BMI) [30].
Although the public health importance of the association between TV viewing and obesity or related outcomes have been demonstrated in both cross-sectional and prospective studies involving children, adolescent and adult samples in other regions of the world, similar studies are rare within the African region. Nonetheless, while examining the relationship between ownership of different types of household assets and BMI among Ghanaian women, Dake and Fuseini [31] tangentially observed that women who reported viewing TV almost every day were likely to have obesity compared to those who did not. Taking cue from Dake and Fuseini [31], this study explored the association between TV exposure and overweight/obesity in Ghana with the view to contributing to the discourse on TV viewing and obesity, particularly in the African region.
In Ghana, TV ownership has been increasing since the inception of Television broadcasting in 1965. The sixth Ghana Living Standard Survey (GLSS) [32] estimated TV ownership to have increased between 1998/99 and 2012/13 from 40 to 75% and from 12 to 34% in urban and rural households, respectively. Indeed, hardly would one pass by a street, shop, bar, restaurant, bus station or even an office in most cities, towns and villages in Ghana without seeing a TV streaming. The screening of foreign telenovelas (soap operas) during primetime has become a means for competing stations to attract large audience, particularly women [33]. Telenovelas seem to have gone “viral” to the extent that TV stations screen them almost simultaneously with people – mostly women – seated and viewing for considerable hours each day. Some TV stations translate telenovelas into the local language (Twi) which makes it the more attractive for those who would otherwise have been deterred by language barriers.
With TV viewing considerably a part of life in Ghana today, this study explored the relationship between TV viewing and overweight/obesity among Ghanaian women using data from the 2014 GDHS. The study focused on women mainly because of the disproportionately high and rapid rates of overweight/obesity among Ghanaian women, compared to men [5]. In addition, Ghanaian women have also been found to report low levels of vigorous physical activity, which could increase their risk of developing overweight/obesity [34, 35]. This study would be useful in broadening our understanding of some of the drivers of obesity in Ghana or Africa, as well as at-risk groups for designing interventions.
