Knowledge, attitude, and perception (KAP) of obesity among middle-aged overweight and obese adults in the Ho Municipality, Ghana: a cross-sectional study

Abstract Background Obesity is an increasing public health challenge in sub-Saharan Africa, driven by urbanisation, lifestyle transitions, and sociocultural norms that often normalise excess body weight. In Ghana, middle-aged adults represent a critical but under-researched group at high risk of obesity-related non-communicable diseases. This study assessed the knowledge, attitudes, and perceptions (KAP) of obesity among middle-aged obese adults in an urban Ghanaian setting. Methods A community-based cross-sectional study was conducted among 237 overweight and obese adults aged 35–64 years in Ho Municipality, Ghana, recruited through church-based settings using a stratified sampling approach. The participants were recruited from eight churches using stratified sampling. The overweight and obesity status was confirmed using anthropometric measurements. Data were collected using a validated KAP questionnaire informed by the knowledge–attitude–perception framework and Health Belief Model. Descriptive statistics, Pearson’s correlation, and multivariate logistic regression analyses were performed. Results Overall, 61.6% of the participants demonstrated good knowledge of obesity-related risk factors and health consequences; however, key misconceptions persisted, including the belief that skipping meals promotes weight loss (43%). Attitudes and perceptions were generally low, with 53.6% and 63.7% scoring below the mean, respectively. A significant percentage of the respondents were unsure about their weight loss motivation, with 69.2% of them choosing the don’t know category. For example, fewer than 7% of participants reported high confidence in reducing sugar intake, while modestly higher proportions expressed confidence in engaging in physical activity. Knowledge was moderately correlated with attitude ( r = 0.357, p < 0.01), but not with perception. In adjusted analyses, self-employment was associated with lower obesity-related knowledge, whereas female sex independently predicted a more favourable perception of obesity. Conclusions Despite moderate awareness of obesity risks, middle-aged adults in urban Ghana exhibited poor attitudes, suboptimal perceptions, and low self-efficacy for behaviour change. Obesity prevention strategies should extend beyond knowledge-based approaches to incorporate culturally appropriate community-level interventions that address behavioural confidence and structural barriers to healthy lifestyles.