Knowing the Risks Isn’t Enough: Ghana Study Reveals Obesity Knowledge Gap in Urban Adults

Knowing that obesity raises the risk of diabetes, heart disease, and joint damage does not automatically translate into the confidence or motivation to change behaviour. That is the central, uncomfortable finding of a new community-based study from Ho Municipality in Ghana’s Volta Region, where researchers surveyed 237 middle-aged adults living with overweight or obesity and found that moderate awareness of obesity’s dangers coexists with strikingly poor attitudes, weak risk perception, and low self-efficacy for weight management. The work, published in Discover Social Science and Health, offers one of the most detailed behavioural portraits yet of a population that sits squarely in the path of sub-Saharan Africa’s escalating obesity epidemic.

The research team, led by Jonathan Annan-Asare of Kwame Nkrumah University of Science and Technology and the University of Health and Allied Sciences, recruited participants aged 35 to 64 through eight churches drawn from different denominations and geographic zones across the municipality. Faith-based institutions were chosen deliberately: church attendance is high among middle-aged Ghanaians, and congregations have proven effective platforms for health screening and community surveys. Using stratified and systematic random sampling, the researchers enrolled adults whose overweight or obese status was confirmed on the spot with calibrated digital scales and stadiometers, applying World Health Organization body mass index cutoffs of 25 to 29.9 kilograms per square metre for overweight and 30 or above for obesity.

Participants completed an interviewer-administered questionnaire adapted from a validated knowledge-attitude-perception instrument, structured around the KAP framework and the Health Belief Model. The 41-item tool probed three distinct domains: factual knowledge of obesity’s definition, causes, and consequences; behavioural orientation and confidence regarding weight management; and subjective perceptions encompassing body image, health risk appraisal, and sociocultural interpretations of body size. Internal consistency was respectable, with a Cronbach’s alpha of 0.78. The researchers then used descriptive statistics, Pearson’s correlations, and multivariable logistic regression to map how the three domains related to each other and to sociodemographic characteristics such as sex, education, employment, and marital status.

The knowledge results were a study in contrasts. Overall, 61.6 percent of participants scored above the sample mean, classified as having good knowledge. Most recognised that obesity is linked to cardiovascular disease (70.9 percent), osteoarthritis (68.8 percent), and diabetes (58.6 percent), and majorities correctly fingered fried foods, sugar-sweetened beverages, excess sugar, and refined foods as drivers of weight gain. Yet only 40.1 percent could identify body mass index as the standard measure of obesity, and a mere 35.9 percent acknowledged stress as a risk factor, suggesting that the psychological pathways to weight gain remain poorly appreciated. More troubling were the misconceptions about what actually works: 43 percent believed that fasting or skipping meals promotes weight loss, 78.5 percent considered anti-obesity medications the preferred route to slimming, and a quarter endorsed meal replacements or supplements as healthy strategies.

Attitude scores told a bleaker story. More than half of participants (53.6 percent) fell below the mean, and the dominant pattern was not opposition to healthy living but profound uncertainty and low confidence. Nearly 70 percent answered “don’t know” when asked about their motivation to lose weight, 68.8 percent were unsure whether regular breakfast consumption belongs in a healthy lifestyle, and 52.3 percent could not say whether small, frequent meals support weight reduction. Self-efficacy was especially fragile: 62.4 percent reported being unconfident about cutting sugar, 62 percent doubted their ability to sustain structured exercise such as jogging, cycling, or swimming, and 67.5 percent said they were not at all confident about walking to nearby destinations. Meanwhile, almost half (47.7 percent) claimed satisfaction with their current activity level, a disconnect the authors interpret as a possible reflection of social norms and environmental constraints in an urbanising setting.

Perception data revealed perhaps the study’s most striking mismatch. Nearly two-thirds of participants (63.7 percent) scored poorly, with 37.6 percent uncertain whether they were actually overweight or obese and 45.1 percent unsure whether their current weight harmed their health. Yet the same respondents reported intense body-image distress: 73 percent avoided running for fear of their flesh wobbling, 71.3 percent had felt so bad about their shape that they cried, 64.6 percent were dissatisfied with the size of their thighs, hips, or bottom, and over half reported frequent rumination about their shape when bored, feeling they ought to diet, or fearing they would become fatter. In other words, many participants could see and feel their bodies clearly but could not connect what they saw to biomedical risk, a pattern consistent with well-documented underrecognition of weight status and with cultural norms in parts of Africa that associate larger body size with affluence, attractiveness, and well-being.

The statistical architecture of the study sharpened these observations. Knowledge correlated moderately with attitude (r = 0.357, p < 0.01), hinting that factual understanding nudges behavioural orientation, but knowledge showed no significant relationship with perception (r = -0.059), and attitude was likewise uncorrelated with perception. In adjusted regression models, most sociodemographic associations dissolved. Tertiary education roughly tripled the odds of good knowledge in crude analysis, but the effect attenuated after adjustment (adjusted odds ratio 2.08, 95 percent confidence interval 0.96 to 4.54). Self-employment, however, remained a robust independent predictor of poorer knowledge (AOR 0.35, 95 percent CI 0.16 to 0.76), a finding the authors link to workplace exposure, economic stability, and access to health information. For attitudes, no variable survived adjustment, suggesting that crude associations with sex, ethnicity, marriage, and education were confounded by overlapping factors. For perception, female sex stood alone: women were more than twice as likely as men to show good perception (AOR 2.22, 95 percent CI 1.12 to 4.35), echoing international evidence that women experience greater body dissatisfaction and weight-related psychosocial burden.

The context makes these findings urgent. Globally, obesity prevalence has nearly tripled since 1975, and roughly one billion people now live with the condition. Sub-Saharan Africa is undergoing a rapid epidemiological transition driven by urbanisation, the shift toward energy-dense processed foods, sedentary occupations, and psychosocial stress. Projections suggest that if current trends persist, obesity prevalence in the region, including Ghana, could more than double by mid-century, straining health systems already contending with infectious disease. Ghana’s 2022 Demographic and Health Survey found that more than half of women aged 20 to 49 are overweight or obese, and the Volta Region slightly exceeds the national average for women, with Ho Municipality showing a similar upward trajectory. Middle-aged adults are particularly vulnerable because of cumulative dietary exposure, age-related metabolic change, and entrenched lifestyle patterns.

The study’s authors argue that the results expose the limits of knowledge-only public health campaigns. If six in ten people already know the risks but fewer than seven percent feel confident cutting sugar, then leaflets and lectures are unlikely to move the needle. Instead, they call for culturally appropriate, community-level interventions that build behavioural skills and self-efficacy, address structural barriers such as food environments and walkability, and incorporate psychosocial components tackling body image, weight stigma, and risk denial. Faith-based settings, already proven venues for hypertension and diabetes screening in Ghana, could serve as delivery platforms for such programmes, meeting people where they already gather.

The researchers are candid about limitations. The cross-sectional design precludes causal inference, church-based recruitment limits generalisability to non-religious populations, and interviewer administration may have invited socially desirable answers. Dichotomising scores at the sample mean is somewhat arbitrary, conceptual overlap between attitude and perception may blur the constructs, and the analysis did not account for clustering within churches. Even so, the study fills a genuine gap: most Ghanaian obesity research has focused on prevalence and clinical outcomes rather than the behavioural and perceptual dimensions of living with excess weight. Its message resonates far beyond Ho. Wherever obesity is rising, the distance between knowing and doing appears to be the critical frontier, and closing it will require interventions that treat confidence, culture, and context as seriously as calories.

Subject of Research: Knowledge, attitudes, and perceptions of obesity among middle-aged overweight and obese adults in urban Ghana

Article Title: Knowledge, attitude, and perception (KAP) of obesity among middle-aged overweight and obese adults in the Ho Municipality, Ghana: a cross-sectional study

Article References: Annan-Asare, J., Apprey, C., Tandoh, M. A., Twum-Dei, B., Immurana, M., & Danzerl, N. O. P. (2026). Knowledge, attitude, and perception (KAP) of obesity among middle-aged overweight and obese adults in the Ho Municipality, Ghana: a cross-sectional study. Discover Social Science and Health, 6(1), Article 107. https://doi.org/10.1007/s44155-026-00439-x

Image Credits: AI Generated

DOI: 10.1007/s44155-026-00439-x

Keywords: obesity, Ghana, knowledge-attitude-perception, public health, non-communicable diseases, body image, self-efficacy, cross-sectional study, urban health, weight management, sub-Saharan Africa, Health Belief Model