Abstract
BACKGROUND: Overweight and obesity are more prevalent among urban than rural populations in Africa, yet evidence on these disparities specifically among men remains limited. This study examined the urban-rural disparities and associated factors in overweight/obesity among Ghanaian men aged 20-49. METHODS: We analysed data from the 2022 Ghana Demographic and Health Survey, with a total sample of 4,797 men aged 20-49 with valid BMI measurements. Overweight/obesity was defined as a BMI ≥ 25 kg/m². Data were analysed using Stata version 17.0. A multivariate nonlinear decomposition model assessed the contributions of sociodemographic characteristics to urban-rural disparities in overweight/obesity. RESULTS: The prevalence of overweight/obesity was significantly higher among urban men (27.48%) than rural men (12.03%). Differences in sociodemographic characteristics explained 87% of the observed urban-rural disparities, with differences in wealth index explaining over half (77%) of the urban-rural differences in overweight/obesity. Factors associated with overweight/obesity included age, wealth index, marital status, and alcohol use, while smoking was protective. Among urban men, the odds of overweight/obesity were higher in those aged 30-34 years (AOR = 2.56; 95% CI: 1.37-4.79), 35-39 years (AOR = 2.86; 95% CI: 1.54-5.30), 40-44 years (AOR = 2.80; 95% CI: 1.56-5.03), and 45-49 years (AOR = 4.47; 95% CI: 2.20-9.07). Wealth was a strong predictor across settings; urban men in the richest quintile had an AOR of 17.37 (95% CI: 5.41-55.83), compared to 5.35 (95% CI: 2.76-10.34) among rural men. Alcohol use was significantly associated with overweight/obesity among urban men (AOR = 1.49; 95% CI: 1.09-2.04), while smoking showed a protective association in rural men (AOR = 0.33; 95% CI: 0.13-0.86). CONCLUSION: This study shows that urban-rural disparities in overweight/obesity among men are largely driven by differences in wealth index. Socioeconomic differences should be considered when designing interventions to reduce overweight and obesity among men. Targeted strategies promoting healthy eating and physical activity, particularly among men in urban settings, are essential to address these disparities.