Obesity was rising as Ghana embraced fast food. Then came KFC
ACCRA, GHANA – After finishing high school a decade ago, Mr Daniel Awaitey enrolled in computer courses, dropped out to work in a hotel, then settled into a well-paying job in the booming oil sector.
He has an apartment, a car, a smartphone and a long-distance girlfriend he met on a dating website. So he had reasons and the means to celebrate his 27th birthday in late July. His boss and co-workers joined him for an evening of laughter and selfies, lingering over dinner at his favorite restaurant: KFC.
Mr Awaitey learned about the fried chicken chain on Facebook. The "finger lickin' good" slogan caught his attention, and it has lived up to expectations. "The food is just ..." he said, raising his fingertips to his mouth and smacking his lips. "When you taste it you feel good."
Ghana, a coastal African country of more than 28 million still etched with pockets of extreme poverty, has enjoyed unprecedented prosperity in the past decade, buoyed by offshore oil. Although the economy slowed abruptly not long ago, it is rebounding, and the signs of new fortune are evident: millions moving to cities for jobs, shopping malls popping up, and fast food roaring in to greet people hungry for a contemporary lifestyle.
Chief among the corporate players is KFC, and its parent company, Yum Brands, which have muscled northward from South Africa where KFC has about 850 outlets and a powerful brand name throughout sub-Saharan Africa: to Angola, Tanzania, Nigeria, Uganda, Kenya, Ghana and beyond. The company brings the flavors that have made it popular in the West, seasoned with an intangible: the symbolic association of fast food with rich nations.
But KFC's expansion here comes as obesity and related health problems have been surging. Public health officials see fried chicken, french fries and pizza as spurring and intensifying a global obesity epidemic that has hit hard in Ghana one of 73 countries where obesity has at least doubled since 1980.
In that period, Ghana's obesity rates have surged more than 650 per cent, from less than 2 per cent of the population to 13.6 per cent, according to the Institute for Health Metrics and Evaluation, an independent research center at the University of Washington.
The causes of obesity are widely acknowledged as complex involving changing lifestyles, genetics and, in particular, consumption of processed foods high in salt, sugar and fat.
KFC's presence in Ghana is relatively modest but rapidly growing, and it underscores the way fast food can shape palates, habits and waistlines.
Research shows that people who eat more fast food are more likely to gain weight and become obese, and nutrition experts here express deep concern at the prospect of an increasingly heavy and diabetic population, without the medical resources to address a looming health crisis that some say could rival AIDS.
"You are what you eat," said Charles Agyemang, a Ghanaian who is an associate professor at the University of Amsterdam, where he studies obesity and chronic disease. KFC alone, he said, is only one factor in the country's obesity epidemic, but it represents the embrace of western foods. In Ghana, he said, "eating local foods in some places is frowned upon. People see the European type as civilized."
"This is having a major impact on obesity and heart disease."
KFC executives see a major opportunity here to be part of people's regular routines, a goal they are advancing through a creative marketing campaign and use of social media. When asked if it is unhealthy for people to eat fried chicken often, Kimberly Morgan, a KFC spokeswoman in Plano, Texas, said, "At KFC, we're proud of our world famous, freshly in-store prepared fried chicken and believe it can be enjoyed as a part of a balanced diet and healthy lifestyle."
Company representatives said KFC takes health seriously in the region, noting its sponsorship of a youth cricket league in South Africa. The company, they said, has worked to make its menu healthier and more diverse.
"That's why we provide consumers choice," said Mr Andrew Havinga, who runs the supply chain for KFC's Africa division. "We do believe in a healthy, balanced lifestyle."
For now, though, KFC customers in Ghana have fewer healthy options than in Western countries. Grilled chicken, salads and sides like green beans and corn, standard at KFCs in the United States, are not available here. Having said that, KFC hoped to offer Ghanaians more options eventually. "That's part of our journey," he said.
KFC emphasizes its focus on sanitation and cleanliness. Ghanaian customers interviewed spoke appreciatively of the tidy containers used for takeout and the hairnets worn by workers.
"We wouldn't go into a market unless we are comfortable that we can deliver the same food safety standards that we deliver around the world and people see that," said Mr Greg Creed, chief executive of Yum Brands, said in an interview last year on CNN. "They actually trust us that it's so much safer to eat at a KFC in Ghana than it is to eat obviously, you know, pretty much anywhere else."
Some nutrition experts bristle at the implication.
"To say it's the safest food is a bit like saying my hand grenade is the safest hand grenade," said Mike Gibney, an emeritus professor of food and health at University College Dublin. "Ghanaians would be better off eating less KFC. But that is the way of the world, I'm afraid."
In Ghana, a place that suffered severe food shortages as recently as the early 1980s, attempts at curbing obesity have butted up against long-held societal views: Girth can be a welcome sight here. To many, weight gain is an acceptable side effect of a shift from hunger to joyful consumption.
"People march their sons and daughters to buy KFC and buy pizza and the like to show them what we can afford," said Dr Matilda Laar, who lectures about family and consumer sciences at the University of Ghana. KFC is not just food, she said. "It's social status."
Mr Awaitey, who celebrated his 27th birthday at a KFC, was raised eating local dishes like soup and banku, a mix of fermented corn and cassava dough. He has increasingly made KFC part of his routine.
Some nights on his way home from work, he turns off a sewer-lined street jammed with cars and crisscrossed by men hawking sunglasses and women selling doughnuts from baskets they carry on their heads and steps into a world transformed: a tidy, air-conditioned KFC where Bruno Mars blares. He orders dinner with a Coke, sitting in a translucent red plastic chair at a white table beneath giant faux Polaroids of children blowing bubbles in a park and a couple strolling on a beach.
"When I grew up I did not have the benefits I'm enjoying today," Mr Awaitey said. "This didn't even exist."
Skin in the Game
In late July, Ashok Mohinani, whose company owns all the KFC franchises in Ghana, dabbed away a smear on a plate-glass window in the dining room of a KFC on the outskirts of Accra as customers trickled in after the doors opened at 10 a.m. It was the newest KFC in the nation, the 13th so far, and Mohinani was eager to see how it would be received.
The executive director of Mohinani Group, he came to restaurants late, after years in other industries, notably plastics. In 2011, he saw potential in fast food. Incomes were rising as Ghana's oil business took off and other commodities soared; that year the country achieved "lower middle-income" status, according to the World Bank. Its economy had grown 7 per cent a year since 2005.
In Accra, the country's densely populated capital, it was plain that diets were changing. Mohinani had watched street fare evolve from stews and porridges to fried rice and knockoff Cheetos. Vendors now stocked glass cabinets with fried chicken, which in the past families served only on holidays.
The first fast-food restaurants to move in were local chains that served fried chicken and mimicked Western brands. Mohinani was convinced a foreign chain would succeed.
"The obvious brand," he said, "was KFC."
KFC opened in South Africa in the early 1970s. It is now so popular that its executives say they impress dinner-party guests by name-dropping the company where they work.
In 2012, Mohinani opened a KFC franchise that included the first drive-through restaurant in the nation. People streamed in on foot, just to check it out.
"It was beautiful," he said.
Now, he said, the goal is to move KFC from a special treat to routine. Toward that end, he has opened restaurants alongside gas stations. "We want this to evolve into the idea of getting it to be a daily brand."
It is a goal pursued by fast-food companies around the world. From 2011 to 2016, fast-food sales grew 21.5 per cent in the United States, according to Euromonitor, a market-research firm, while they swelled 30 per cent worldwide. The industry has had remarkable success in finding new mouths to feed, with 254 per cent growth in Argentina, 83 per cent in Vietnam and 64 per cent in Egypt.
From around the globe come snapshots of fast-food's spread. Carl's Jr. opened Cambodia's first drive-through fast-food restaurant in 2016, bringing Phnom Penh staples like the Western Bacon Cheeseburger; McDonald's, with 600 Russian outlets, recently opened in Siberia and the Urals; India, which, according to Euromonitor, saw fast-food sales rise 113.6 between 2011 and 2016, now has more than 1,100 Domino's Pizza outlets and is home to an experiment * a "Dessert Pizza," topped with brownies, cookies, coconut nougat, cheesecake and fudge sauce.
While McDonald's remains the emblem of fast food worldwide, Yum Brands is second and grew 22.9 per cent from 2011 to 2016, considerably more than the burger giant's 12.2 per cent growth, according to Euromonitor. Yum, which includes Taco Bell and Pizza Hut, has nearly 44,000 restaurants worldwide, about 17,000 of them in emerging markets as of 2016, the company said. KFC and its franchisees operate nearly 21,000 KFC restaurants in 129 countries and territories around the globe.
Crucial to its effort, the company said, is finding franchisees like Mohinani, who have "skin in the game" as Creed, the Yum Brands chief executive, said on CNN. The company can rely on their knowledge of the local market and commitment to the investment.
Also crucial: mixing local culture with flavors company executives repeatedly called "aspirational." In Ghana, KFC's menu includes chicken and fries along with a version of jollof rice, a locally beloved spicy dish made with peppers and onions.
"People come to us for the exotic, international American brand, and we don't want to water that down," Mohinani said. "If we made the menu entirely local we'd lose the aspiration."
Affordability is another key ingredient. For KFC, costs here are hard to contain: The company imports chickens from Brazil, in part because local farms do not yet meet KFC's standards for safety and other issues; stores need generators in case of power outages; clean water is specially pumped in. Affordability got tougher since 2014 as global oil prices sank, straining the Ghanaian economy. Nevertheless, to lure more customers, Mohinani has cut menu prices a risky move that he said had paid off with more repeat and regular visitors.
KFC has also begun a marketing campaign called "Streetwise" a series of ads and meals it introduced in South Africa and elsewhere intended to appeal to a first generation of middle-class consumers looking for new experiences. In Ghana, the campaign aims at "hustlers and influencers," as executives called them, who rose from the streets and climbed the social ladder.
Ads debuted in May for the Streetwise 2 two pieces of chicken, fries and a Coke with popular local singer Ko-Jo Cue holding a sign that says, "It's thanks to the streets that I became a winner."
"I get a Streetwise 2," it continues, "and fuel my ambition."
The health effects of fast food are challenging to study, particularly in the United States. That is because burgers, fries, fried chicken, pizzas and milkshakes are served all over the place, not just in traditional fast-food joints, making it hard to establish the specific influence of fast food on obesity.
But developing countries are newer to fast food. One large-scale study, done in Singapore as it grew economically and attracted Western fast-food chains, offers evidence that the arrival of McDonald's, KFC and Pizza Hut, among others, posed a serious health risk.
The study, funded by the National Institutes of Health and published in 2012 in the journal Circulation, followed tens of thousands of Chinese Singaporeans, ages 45-74, from the mid-1990s to 2009. Those who ate Western fast food two or more times a week were 27 percent more likely to get Type 2 diabetes, and 56 percent more likely to die from heart disease, than subjects who did not regularly eat such food. And the more times they ate fast food, the higher the risk of death from heart disease.
Studies like these can be challenging to interpret, nutrition experts said, because people who eat fast food can have poor dietary habits, but this study sought to isolate fast food by factoring out many other issues, like sleep, exercise and even consumption of local fried foods. It also caught Singapore as its economy matured and fast food came to town.
"It's a parable, or microcosm, of what's occurring in other parts of the globe," said assistant professor Andrew Odegaard, a co-author on the study.
In Ghana, data suggest that the change in diet to heavier fare * including fast food but also processed foods has led to soaring health risks.
The death rate associated with high body mass index more than doubled in Ghana from roughly 14 per 100,000 in 1990 to 40 per 100,000, according to the Institute for Health Metrics and Evaluation and is fast approaching the global average of 54 deaths per 100,000.
The data also suggest that the changing diet has led to health risks in Ghana that are getting worse at a rate faster than in the United States. From 1990 to 2015, deaths related to high body mass increased 179 per cent in Ghana, compared with an increase of 20 per cent in the United States.
Further complicating the situation in Ghana, medication for high blood pressure is expensive and patients often ration it to save money. National health insurance lags in its coverage of other diet-related diseases such as diabetes; it does not cover devices to monitor blood sugar or some of the medicine to treat the side effects of diabetes.
The nation's health system lacks a sufficient number of specialists, counselors and dietitians, let alone doctors.
Dr Laar, the lecturer from the University of Ghana, said the lack of proper care meant that some people would live with metabolic syndrome until they dropped.
"It's common that you'll see someone just pass out and die," she said.
One smoldering July day, mourners gathered in Accra to pay tribute to someone who did just that Ms Vivian Acheampong, 56, who had collapsed at home while hanging laundry on the clothesline and died two days later in a hospital. They fondly remembered her as they milled around and talked about what they believed had killed her.
The doctors had told them that one major factor was inattention to her high blood pressure: She had not listened to their advice to change her eating habits, and she could not afford all the medicine prescribed to control her condition. Relatives were convinced that her love of fried, fatty food had led her to become obese and played a role in her death.
"Every time it was oil, oil, oil," said her son, Mr Alfred Osei Tutu.
Under a tent decorated with red and black bunting, her relatives and friends heaped their plates with the very foods they said they had warned her against: fried chicken, fried fish, fried rice and fried okra. These offerings have become common at funerals and represent a clear change in tradition: soup and vegetables were once served to mourners.
Ms Acheampong's son said she had only dabbled in fast food and had never eaten at KFC. But she had developed a taste for such fare, usually cooked at home, after she moved from her native village to the capital 15 years ago for a better job. An old photo propped up at the funeral showed her as a slender young woman with hollowed cheeks. In the city, the family's diet shifted from stews and fufu, a starch made with cassava, to fried foods.
She fit squarely in a demographic most affected by rising obesity here: women living in cities. A study published last year in the journal BMC Medicine found that obesity among urban female adults in Ghana was 34 per cent, compared with 8.3 per cent for women in rural areas; among urban men, the rate was 7 per cent, compared with 1.3 per cent in rural areas.
"You have more money, you have more food," her son said matter-of-factly.
Birthdays and Takeout
KFC's busiest store in Ghana is its flagship, on Oxford Street in the Osu neighborhood. The nation's first KFC, it is a three-story, glassy corner building on a busy retail strip across from two banks and a jewelry shop.
This summer, it drew from all walks: uniformed kids celebrating the last day of school; students from nearby universities using free Wi-Fi at corner tables; government workers ordering lunch to go; members of an artists' collective meeting over dinner to talk about a poetry slam; a dad treating his teenage son and friends to takeout chicken.
On a weekend, the place turned raucous. A group of women dressed in tight, sparkly gowns guzzled Champagne from the bottle one evening around a table littered with french fries, fried chicken and a birthday cake, taking turns smearing frosting across the face of the birthday girl. Children joined their parents, downing Coke and buckets of chicken.
Fariha Yussif brought her boyfriend to the restaurant to celebrate his 24th birthday. They stood in a doorway and took photos as friends popped into the frame.
"I like the lights here," said Yussif, 21, pointing to the low-hanging red lamps. "I like how they arrange the tables and chairs. It's like I'm in Germany or Canada. Everything is very nice."
In late July, the restaurant was low on chicken, a two-day supply hiccup that dogged all of the country's KFCs. Some customers were outraged, prompting workers to ration supplies. Loretta Anaglate, 21, photographed the chicken in her boxed meal that was supposed to contain two pieces but was actually only 1 1/2 pieces.
She was not holding a grudge. Ms Anaglate, who has been eating KFC since her 16th birthday, lives in a university dormitory a 10-minute walk from a KFC. She estimates she eats there three times a week.
"It's a lie," her friend, Loretta Adjei, interjected. "She eats here every day."
The two young women who favor chicken, soda and a popular milkshakelike drink called Krushers love the brand so much they worked for a day last year as "promo girls," handing out flyers for a new KFC.
The company has met the youth market in Ghana where it spends time on the internet. KFC has a Facebook page and Twitter feed tailored for Ghana and ran an Instagram-based promotion that placed customers' pictures on chicken buckets. Young people fill the company's Facebook page with their own comments and photos.
There do not seem to be a lot of complaints about a menu with items that, in a single meal, can challenge the daily allowance of salt, fat and sugar. According to KFC's online nutrition calculator for Africa, the lunch box meal alone exceeds the daily recommended levels of salt and sugar, and includes trans fatty acids.
"I don't see it as unhealthy," said Ms Adjei, "I'm still fit and thin."
Local health experts said most Ghanaians do not pay attention to nutrition data. Indeed, the kind of public and political pressure that has prompted KFC to make changes in the West has not been felt much here.
The chickens are cooked in hot tubs of palm oil a substance the company stopped using in the United States and Britain because, among other reasons, it is high in saturated fats. Customers in most of KFC's African markets must go online to find calorie counts, which are not on menu boards like in the United States. The company says there is neither government nor consumer clamor to add them.
"The consumer mindset is not asking that question generally," said Doug Smart, managing director of KFC Africa.
Concern but Little Action
Deep inside the presidential palace in Accra, called Flagstaff House, President Nana Akufo-Addo sat in his softly lit, spacious office, decorated with patterned marble floors and ornate, cream-colored couches. A wide-screen TV was tuned to local news. He has recently shed his sharp suits, favoring comfortable print shirts made in Ghana like the bright orange one with colorful swirls he wore on a recent evening.
In office since January, the president ticked off his achievements: plans to chip away at the nation's debt load, to increase tax revenue, to cut waste, to beat back corruption and to spur the economy. He is in the midst of fulfilling a campaign promise to build a factory in each of the nation's 216 districts. He has begun cracking down on illegal gold mining, which is robbing the country of revenue from one of its key natural resources.
Of course, he said, he is worried about skyrocketing obesity and related diseases. Like many of his countrymen, the round-faced president is overweight. He said he's also concerned about the increase in fast-food restaurants that fuel the trends but said: "I'm strongly averse to banning things."
It is a quandary faced in numerous nations, from India and Brazil to China and Egypt: how to invite economic growth and move beyond scarcity without being overtaken by two of modernity's chief markers, processed and fast food. So far, not a single nation has been able to reverse the growth of obesity, and only a handful have succeeded in enforcing marketing reforms to limit consumer exposure.
President of Ghana Akufo-Addo said he hoped to address the problem by expanding national health insurance. That, though, he said, is "a work in progress," given the expense. So, for now, without specifics, he echoed leaders from other nations (and food companies themselves): "There must be heightened public awareness of what's good and bad in terms of eating habits."
Some activists have tried to prompt more action. Dr Laar has been pushing for labels that display nutritional content and restrictions on imports of processed food. And she wants more regulations for fast-food restaurants, "before it gets out of hand."
"We already have a problem," she said, "and now there is an influx of fast-food companies trying to penetrate the market. We need to make sure the government is regulating how they're trying to do that."
She added: "We shouldn't underestimate the impact they can have now, and in the future if they spread to rural areas."
She was aghast to learn KFC had plans to open four restaurants in towns in rural areas in the next year.
"We must," she said, "come up with more stringent laws."
The presidential palace is not far from the country's most popular KFC, just a short trip after crossing Liberation Road. The day before the president outlined his priorities, a part-time pastor, Mr Joshua Edwards, stopped at the KFC to buy chicken for five boys living in an orphanage. "It's just a wonderful taste for them," he said.
The pastor's round belly strained his shirt buttons and hung far over the red stool where he waited for his order. "My health is my life, so I have to be cautious about my life," he said. "God needs my body to do things to his glory."
Still, Edwards said he came to KFC almost every day, beckoned by a giant red billboard outside the store with a huge photo of crispy fried chicken and shimmering golden fries.
"You become addicted to the spices," he said. "That's why everybody wants to have it."
"They don't force us to eat here," he added, "But it's as if we've become mentally enslaved. It tantalizes us by even saying it, pulling you to where you don't want to be." THE NEW YORK TIMES