Body size preferences for women and adolescent girls living in Africa: a mixed-methods systematic review

Abstract

Objective: To synthesise evidence on body size preferences for females living in Africa and the factors influencing these. Design: Mixed-methods systematic review including searches on Medline, CINHAL, ASSIA, Web of Science and PsycINFO (PROSPERO CRD42015020509). A sequential-explanatory approach was used to integrate quantitative and qualitative findings. Setting: Urban and rural Africa. Participants: Studies of both sexes providing data on body size preferences for adolescent girls and women aged ≥10 years. Results: 73 articles from 21 countries were included: 50 quantitative, 15 qualitative and eight mixed methods. Most studies reported a preference for normal or overweight body sizes. Some studies of adolescent girls/young women indicated a preference for underweight. Factors influencing preferences for large(r) body sizes included: socio-demographic (e.g. education, rural residency), health-related (e.g. current Body Mass Index, pubertal status), psycho-social (e.g. avoiding HIV stigma) and socio-cultural factors (e.g. spouse’s preference, social standing, cultural norms). Factors influencing preferences for slim(mer) body sizes included: socio-demographic (e.g. higher socioeconomic status, urban residency, younger age), health-related (e.g. health knowledge, being nulliparous), psycho-social (e.g. appearance, body size perception as overweight/obese), and socio-cultural factors (e.g. peer pressure, media). Conclusions: A preference for overweight (not obese) body sizes among some African females means that interventions need to account for the array of factors that maintain these preferences. The widespread preference for normal weight is positive in public health terms, but the valorisation of underweight in adolescent girls/young women may lead to an increase in body dissatisfaction. Emphasis needs to be placed on education to prevent all forms of malnutrition.

Assessing the readiness of small cities in Ghana to tackle overweight and obesity

“…A thin body stature was described as primarily desirable among the young. A related systematic review similarly reports that acculturative stress to look slimmer was only reported by younger women and adolescents (Pradeilles et al, 2021).…”

“…Furthermore, in Ghana people face a number of other competing nutrition and health challenges such as malaria, HIV/ AIDS, diarrheal diseases, and stunting in children. And some studies have demonstrated an acceptance of overweight -though not extreme overweight -for women in Ghana (Aryeetey, 2016;Tuoyire et al, 2018), and Africa more broadly (Pradeilles et al, 2021). Furthermore, gendered barriers to maintaining a healthy weight include time and cultural barriers to physical activity and cultural norms related to women's weight especially before and after childbirth (De-Graft Aikins, 2011;Elvis et al, 2018).…”

No overall impact on rate of weight gain with integrase inhibitor‐containing regimens in antiretroviral‐naïve adults

“…One hypothesis to explain the variability of effect could be that INSTIs sensitize PLWH to gaining weight, the melanocortin-4 receptor pathway being one proposed mechanism [9]. However, absolute gains are probably influenced by lifestyle [10], cultural attitudes to weight [11], the individual's perception of their weight [12], and host genetics/microbiome [13]. This may explain why weight gain is not a universal phenomenon for all individuals on ART and for all regimens [14].…”

Direct and Indirect Determinants of Body Mass Index in Both Major Ethnic Groups Experiencing the Nutritional Transition in Cameroon

“…Both physical and sociocultural environments can favor obesity. A greater access to processed energy-dense foods and motorized transports favors obesogenic dietary practices and sedentary behaviors [7,8], while the traditional social valorization of stoutness and idleness, as symbols of prosperity and peacefulness, leads to obesogenic fattening practices in urban environments [9]. However, the respective and combined contributions of these socioecological determinants remain insufficiently explored, and few studies include all of them in the same multivariable analyses [10].…”

“…There has been an increase in the number of studies analyzing these "determinants of determinants"-through body weight perception, dietary intake, and physical activity. Many of these studies were recently synthesized in several systematic reviews focusing on African women's health [9,20,21].…”