Home environment influences on overweight and obesity among 2-5-year-old preschoolers in Ghana

Although childhood obesity is on the increase in Ghana (as observed all over sub-Saharan Africa), there is little that is known about how the home environment may be contributing to excessive increases in body weight among Ghanaian toddlers. This thesis seeks to address this research gap and contribute to the body of knowledge through its findings. To fill this research gap, this thesis used a mixed method approach involving 4 studies – 1 systematic review, an analysis of nationally representative datasets (drawing data from the multi-indicator cluster survey for Ghana), one primary survey, and one qualitative study. The aim of the systematic review was to summarise the evidence on the home environment and overweight and obesity among preschoolers in sub-Saharan Africa. The review found that household dietary diversity and maternal body mass index (BMI) are the most consistent predictors of childhood overweight/obesity in SSA. The evidence for other aspects of the home environment, i.e., the home physical activity and the home media environments is either lacking or inconsistent. The aim of the secondary data analysis of the MISC datasets was to identify socioeconomic correlates of overweight and obesity in the home environment of Ghanaian preschoolers. The results of that study demonstrated no consistent relationships between the pre-schooler overweight or obesity and household socioeconomic factors. Additionally, there was no association between the home environment and overweight/obesity. Household wealth and education consistently predicted the availability of items in the home environment. The secondary data analysis was followed-up with a cross sectional survey of caregivers of pre-schoolers to examine the relationship between the home food environment (dietary diversity and caregiver food feeding practices), child eating behaviour, and child body weight. The findings from that study demonstrate/suggest that caregiver food restriction is predictive of child weight gain. Child eating behaviour, including an increase in the enjoyment of food and a reduction in satiety responsiveness was associated with excess child body weight. Bidirectional relationships between child eating behaviour and caregiver food feeding practices were also observed. The last study, i.e., the qualitative study, used focus groups and thematic analysis to explore the food feeding habits of caregivers of Ghanaian preschoolers. The results of the focus group revealed that child encouragement, monitoring, modelling, and food restriction were common caregiver food feeding practices in Ghana. Overall, the findings of the mixed methods study suggest that in Ghana, caregiver food feeding practices (especially food restriction) may be contributing to population increases in excessive paediatric body weight. The findings also suggest that the access and availability of items in the home environment alone are inadequate to account for the population increases in paediatric overweight and obesity, and that the social interaction between caregivers and their preschoolers may play a more influential role in paediatric weight gain. However, further research is needed to expand on these findings. Future work may consider examining caregiver food feeding practices in more detail, exploring its bidirectional relationship with pre-schooler eating behaviour using longitudinal or experimental designs in order to confirm causation for excessive pre-schooler weight gain.