Abstract
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.
Highlights
The prevalence of obesity has soared since 1975 (Abarca-Gómez et al, 2017)
Ghana is at an advanced stage of the nutrition transition, experiencing rapid urbanization, and increasing obesity and other diet-related non-communicable disease (NCDs) (Ghana Statistical Service et al, 2015)
Most of the promotional flyers were obtained from Pizza Inn, Chicken Inn, Pizza Hut, and KFC
Summary
The prevalence of obesity has soared since 1975 (Abarca-Gómez et al, 2017). A more recent systematic review by Ofori-Asenso et al (2016) shows consistent increases in overweight and obesity among Ghanaian adults (≥18 years) over the period of 1998 to 2016. 43% of Ghanaian adults are overweight, the prevalence being higher among urban dwellers, women, and residents in the Greater Accra Region. It is argued, rather controversially, that shopping malls and fast food outlets promote unhealthy foods more heavily than healthy ones. We aimed to assess the healthiness of foods on promotional flyers of food outlets located within shopping malls in Ghana’s capital city, Accra
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