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Background It is argued, rather controversially, that shopping malls and fast food outlets promote unhealthy foods more heavily than healthy ones. Promotional flyers are one of many strategies usually deployed to influence purchasing behaviours. We aimed to assess the healthiness of foods on promotional flyers of food outlets located within shopping malls in Ghana’s capital city, Accra. Methods We conducted a content analysis of promotional flyers obtained from all fast food outlets located within Accra-based shopping malls. Food promotions on flyers (n=32) were sampled using a composite week sampling technique. Collected via mystery shopping, all promoted foods were evaluated for healthiness. Healthy foods/food groups were defined as products which help prevent diet-related non-communicable diseases (NCDs). Results All (100%) of the foods (n=79) on the promoted flyers were unhealthy–comprising high sodium/saturated fats (n=36), high sodium exclusively (n=40) and high in added sugar foods (n=3). These unhealthy foods were greatly discounted (average percentage discount was 27.5%). This price benefit (54.0%) and puffery size (34.0%) were the major claims associated with the promoted foods. Conclusions Our data show that food outlets within Accra-based shopping malls promote via flyers unhealthy food items that are greatly discounted. This strategy may influence purchasing behaviour and consumption. The causal relationship between the promotion of unhealthy foods and NCDs deserves evaluation in Ghana.

Healthiness of foods on promotional flyers of fast-food outlets located within Accra-based shopping malls