(P14-019-23) A Comparative Study of Shared Plate Eating and Obesity Prevalence in Urban and Rural Households in Ghana Using a Wearable Camera

Objectives: Low- and middle-income countries (LMICs) continue to experience the double burden of malnutrition, i.e., both under and over-nutrition co-existing at the household and population levels. At the household level, shared plate eating (SPE) – a cultural eating dynamic in many LMICs where food is shared and consumed from the same bowl/plate – remains a defining feature of food consumption. Traditional dietary assessment methods were designed to assess individual dietary intake and are challenging to use in settings where SPE is widely practiced. Newer methods such as wearable cameras may help to address this problem by allowing observation of family eating dynamics that traditional methods would otherwise miss. We examined the association between SPE and obesity prevalence in urban and rural households using a wearable camera, hypothesizing that households engaging in SPE more often would have a lower overweight/obesity prevalence compared to households engaging in SPE less often because of likely disproportionate intakes.

Methods: We used purposive convenience sampling to recruit 30 households each from a rural and an urban community in Ghana. A wearable camera – the Automatic Ingestion Monitor-2 (AIM-2) – was worn by the father, mother, and an index child (adolescent and/or child under 5 years) for dietary intake assessment over 3 days (2 weekdays and 1 weekend day). Custom AIM annotation software enabled the examination of eating dynamics including SPE. BMI was calculated from measured weight and height.

Results: Most rural households (29/30) compared to about a third of urban households (11/30) engaged in SPE. Obesity prevalence was higher in urban compared to rural households. We observed significant differences in obesity prevalence between urban compared to rural mothers (46.7 vs 23.3%, p=0.033), and urban compared to rural fathers (13.3 vs 0%, p=0.023). Varied dynamics were observed for SPE- couples eating together, couples eating with children, mother eating with her children, children eating together, etc.

Conclusions: Wearable cameras can potentially address many of the challenges associated with traditional dietary assessment methods, particularly in LMICs plagued by the double burden of malnutrition.

Funding Sources: The Bill and Melinda Gates Foundation (Contract ID: OPP1171395)
Georgia Agriculture Experimental Station Grant (Hatch: GEO00820)