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.

Keywords: Body mass index; Demographic and health survey; Ghana; Obesity/overweight; Urban-rural.

© 2025. The Author(s).

背景： 非洲城市人口中超重和肥胖的发病率高于农村地区，然而关于男性中这些差异的具体证据仍然有限。本研究考察了加纳20至49岁男性中超重/肥胖的城市与农村差异及其相关因素。

方法： 我们分析了来自2022年加纳人口和健康调查的数据，总样本量为4,797名20至49岁的男性，并具有有效的BMI测量数据。超重/肥胖被定义为BMI ≥ 25 kg/m²。数据分析使用Stata版本17.0进行。多变量非线性分解模型评估了社会人口特征对城市与农村地区超重/肥胖差异的贡献。

结果： 城市男性中超重/肥胖的患病率显著高于农村男性（分别为27.48%和12.03%）。社会人口特征的不同解释了观察到的城市与农村差异中的87%，其中财富指数的不同解释了一半以上（超过77%）的城市与农村超重/肥胖差异。与超重/肥胖相关的因素包括年龄、财富指数、婚姻状况以及饮酒，而吸烟则具有保护作用。在城市男性中，30-49岁年龄段的超重/肥胖几率较高：30-34岁（调整后的优势比AOR = 2.56；95% CI: 1.37-4.79），35-39岁（AOR = 2.86；95% CI: 1.54-5.30），40-44岁（AOR = 2.80；95% CI: 1.56-5.03），以及45-49岁（AOR = 4.47；95% CI: 2.20-9.07）。财富是各环境中强有力的预测因子；城市中最富裕五分位的男性超重/肥胖的优势比为17.37（95% CI: 5.41-55.83），相比之下农村男性的该值为5.35（95% CI: 2.76-10.34）。饮酒在城市男性中与超重/肥胖显著相关（AOR = 1.49；95% CI: 1.09-2.04），而吸烟则显示了农村男性的保护作用（AOR = 0.33；95% CI: 0.13-0.86）。

结论： 本研究表明，男性中超重/肥胖的城市与农村差异主要是由财富指数的差异驱动。在设计旨在减少男性的超重和肥胖干预措施时应考虑社会经济差异。尤其是在城市环境中促进健康饮食和体育活动的策略对于解决这些差异至关重要。

关键词： 身体质量指数；人口与健康调查；加纳；肥胖/超重；城乡。