Food Choice Decision-Making Among School-Going Adolescents Amidst the Nutrition Transition in Urban Accra, Ghana

Like many countries of the world, Ghana is experiencing a nutrition transition and rising non-communicable diseases. Adolescents are susceptible to diet-related health risks as they experience significant physical and psychological changes, which are happening in tandem with food environment changes, including widespread proliferation of large portion and package sizes of energy-dense, nutrient-poor foods. Both local and multinational food and beverage companies have encouraged consumption of their products through various marketing tactics targeted directly to adolescents. Some of these tactics include the use of characters or celebrity endorsement, promotional discounts, and appeal to sociocultural values, including messages about body size preferences. As a result, adolescents may experience conflicting messages from exposure to Western food marketing campaigns promoting abnormally thin bodies by consumption of foods that are known contributors to obesity and chronic diseases. This qualitative study used in-depth interviews to explore perspectives held by 48 public junior high males and female students in six urban districts of the Greater Accra Region of Ghana, with respect to healthy and unhealthy food, portion sizes, body image, and how advertising messages contribute to their food choice decision-making. The first aim sought to understand how adolescents conceptualize healthy and unhealthy foods, food portion sizes and purchasing behaviors. Students had rudimentary knowledge of nutrition, mostly derived from school curricula. However, their food choices were predominantly driven by attitudes and beliefs held by those in their social networks, cost considerations, and health claims on advertisements. Students did not fully understand what portion control and mindful eating was, though they recognized moderation as an important health behavior. The second aim sought to uncover perspectives by these same students regarding body image. Younger students and females felt more body image dissatisfaction and desire to change their current weight status. Body image aspirations were important in food choice decision-making; students alluded to people who they sought to emulate. Students discussed tensions with elders about types and quantities of food to eat and the body sizes that their elders wanted them to be versus what they wanted to look like. The results from this study suggest the need for social network and social marketing interventions that could address healthy eating habits, body dysphoria, as well as deceptive marketing tactics used to promote unhealthy foods for both adolescents and their caregivers