OBESITY AND SYSTEMIC HYPERTENSION IN ACCRA COMMUNITIES

Thc results show that 22.6% were overweight (BMI 25-29kg/m2) and 17.2% wcre obesc (BMI > 30kg/m'). Overwcigl~t/obcsity incrcascd with age pcakking at age 55-64 ycars and thcn falling. Obesity \vils about twice as conlnlon in womcn than men. Thc prcvalence of hypertension (BP > 140/90 mmHg) was 26.8%. Therc was a positive rclationsliip bctwecn body mass and hypcrtcnsion. In the study population thc prcvalcncc of I~ypcrtension was ~ imi l i~ r in malcs and fc~nnlcs.


INTRODUCTION
Thc World Health Organisation has dcclarcd obesity as a global epidcmicl.In Europe more than Iinlf of thc adult population is overweight or obesc, and in thc United States, the report suggests that approximately onc-third of persons 20 years of agc :~nd above fa11 into this catcgory.Thc prevalence of obesity also has increased in developing countries.physical activity and for growth.The increased ~>revalcncc of obcsity has becn attributed to genetic Ibctors, scdcntary lifestyle and readily available palatable, high-rat foods.
Sometimes cultural bcliers equate success with obcsity.In groups in which grcat emphasis is placed on food, there is a tendency to ovcrcat.In some societies fnt men arc rcspcctcd and fat women considered beauti fill.
I n addition obesity significantly impairs thc quality of life.Many obcsc individuals si1I1'cr pain and have restricted mobility bccausc of mcclianical disabilities.Thcy cxpcricncc low sclr-csteem, depression, emotional distrcss antl other psycl~ological problems because of social prcjutliccs and tliscrimination.
On the other hand, the economic costs associatctl with obcsity are substantial.These includc both tlic dircct cost of hcalth carc, ant1 indirect cost associated wit11 low productivity, causctl by illncss ant1 disability.

Obesity may bc dcfincd as an excess body fat con-
A l l lllctllods of measLlring the rat content in Our cxpcricnce in the hospital and thc eonlrnilnity l i v i n g sLlbjccts are indirect, Body Mass Index SIIOIVS that obesity is common in Ghanaians, ant1

METHODOLOGY
The Population Six communities, urban and semi urban in Accra, were randomly chosen.There was no census of the population take11 but information was relayed to tlie com~nunities of each locality through an identifiable traditional leader, concerning tlie impending exercise.Each day tlie survey field team moved from one location to the other, working between 0900 hours -1500 hours.The blood pressures were taken by State Registered Nurses who had been trained in blood pressure (BP) nieasurenient using standard methods.These nurses nornially take the BP of the 60-80 patients a day, attending the cardiac and hypertension clinic of tlie National Cardiothoracic Centre in Accra.They also took the heights and tlie weights of the subjects.
Hypertension was defined as a BP of more than 1 4 0 / 9 0 m n i ~g ~ or a patient on anti-hypertensive thcrapy.
Overweight was defined as a ~~1 > 2 5 k g / n i ~ with The statistical method used was the z-score for comparing two percentages.Prevalence of hypertension, overweight and obesity x sex.Table 2 There was not n~uch significant difference between males and females with respect to hypertension in the population, p 0 .5 ; Overweight was conimoner in females than niales but tlie difference was not statistically significant.Obesity was thrice as common in females than in niales, the difference was highly significant, p<O.OO 1.

Distribution of population x location x sex
Prevalence of hypertension and overweight was equal in both sexes.However obesity was highly prevalent among females.
Prevalence of overweight and obesity in age groups.Table 3 Overall prevalence of overweight was 22.6% and of obesity 17.2%.
Tlius there is a positive relationship between increasing age and the prevalence of overweight and obesity, though the prevalence of overweight peaked at 45-54 years whilst that ofobesity peaked a decade later only to drop again arter the age of 64 years.

DISCUSSION
Tlie coniniunities were randomly selected without any knowledge as to the behaviour of blood pressure and tlie prevalence rates of hypertension in those coninii~~~ities.It is conceded, however, that without knowledge of the dcnoniinator population, almost certainly, we cannot be.positive about the representativeness of the saniple with respect to the study population as a whole.
Obesity as defined was noted in 17.2% of our study population as compared to 6.2% by Nube et a17 and 5.7% and 7.4% amongst Civil Servants and Mamprobi residents respectivelys.".The Ghanaian rates of obesity of 5.7-1 7.2% compare with 18.5% amongst citizens of the United Kingdom and 24.7% amongst the citizens of the United States of ~m c r i c a ' .
The finding of the higher prevalence rates of overweightlobesity in females Itlore than males, and tlie rising prevalence of body mass in both sexes with age are phenoniena noted of other societies"'" '.

Overweightlobesity and hypertension
That overweiglit/obesity is a risk factor for systemic hypertension is well docuniented in many societies, that wc can only echo the saying attributed to Pickering, one of tlie giants in tlie field of hypertensionology: "The positive correlation (bctween body Inass and blood pressure) has been so often as to leave rooni for no doubt"ls.Indeed this relationship was first noted of Northern Americans by Terry in 1923': Our finding of the positive relationship between body mass and hypertension in the conin~unity has confirnied ad dock's) observation of patients attending the Korle Bu Teaching Hospital.

CONCLUSION
Our study shows that overweight/obesity is comnion in Ghana and that it riscs with increasing agc till the agc of 65 years; and that ovcrweight/obesity tended to be more common in females.
There was a high prevalence of hypertension in both sexes.There was a higher prevalence of liypertension in both sexes in tlie overweight/obcsity than the normal weight persons in a ratio of 2: 1.Thus obesity is a risk factor for liypertension.
body weight in kilograms divided by the square of this is associatcd with othcr risk factors essential to the height in mctrcs) is thc preferred way of calcu-tlic genesis of liypertension.Moreover we Ilovc Iating obesity in clinical l>racticc'.'.notcd ccrtain tolerance and acceptance of obcsity that nlay bc attributed to the cultural and social Obesity occ~lrs wllcn tilc calories illtake exceeds I ' "t er "s.T l i i r ' ~ years Haddock thc cncrgy requirements of thc body both for had noted a high prevalence of obcsity in medical out patients of the Korle Bu Teaching Hospital (KBTH); tlie prevalence of obesity was higher in liypertensives than norniotentives3.Under the ternis of a technical assistance agreement between the Governn~ents of Ghana and Cuba, a Cuban Health Brigade team undertakes clinical assignments in Ghana for periods of 2 years at a time.Each year the team holds a health wcck wlicrc thcsc pliysicians arc located and they pick on a theme for the purpose.During the 2-year duty tour of Octobcr 2000 -Scptenibcr 2002, a hcalth week was held with Hypertension as the theme.The objective of this coni~~~i~nication is to report on tlie study determine the prevalence rates of hypertension and obesity in various comniunities in Greater Accra Region.Previous coni-n~unity studies had been in the Administrative Centre of Accra (Victoriaborg and Christianburg) and a suburb ~a m p r o b i ~. ~.Our study widened the scope of the spread of the population of Accra.

Table 1
Distribution of hypertension aniong categorics of body mass index in both sexes

Table 2
Prevalence of hypertension, overweight and obesity among malcs and females

Table 3
Prevalence of overweight and obesity in age groups males and fcniales together HypertensionTlie prevalence of hypertension defined as a BP more than 140190nin~Ng was noted in 26.8% of subjects of the conin~unities.About that same time, a con~n~unity study of Greater Accra, involving different con~niunities froni the current study, by Anloah, noted a rate of 28% in 4733 silbjects12.Earlier in 1975, Pobee had found anlongst Mamprobi residents a ratc of 25% in his 4703 sub-jectsI3.The prevalence rate of 26.8% in our communities conipare with 26.6% noted in Kpando in the Volta Region and 32% in Zebilla in the Upper East ~egion''.Thus, with tlie caution indicated at the beginning of this disci~ssion in mind, our study confirms tlie high prevalence rates of 11 ypertension already noted in tlie Greater Accra Region.Previous studies reported above were about the Western and Eastern sub districts of Accra and at the very least, we have added other sub districts of Greater Accra Region.