Eating behaviors, attitudes, and beliefs that contribute to overweight and obesity among women in Lilongwe City, Malawi: a qualitative study

Abstract

Background Obesity is increasingly a public health concern in low- and middle-income countries, including Malawi where 36% of women have body mass index in overweight/obese categories in urban areas. Eating behaviors, attitudes, and beliefs are associated with body size, but have not been studied in-depth in sub-Saharan African countries. This study therefore, explored eating behaviors, attitudes, and beliefs of women in Lilongwe, Malawi. Methods This was a descriptive ancillary qualitative study utilising in-depth interviews with 27 women (13 in normal weight range and 14 in overweight/obesity ranges) puporsively selected in Lilongwe City, Malawi from October to November 2017. The concept of data saturation guided data collection, and it was reached with the 27 interviewed participants when there was no new information coming from the participants. All interviews were conducted in the local language, transcribed verbatim, and translated into English. The transcripts were analysed manually using thematic content analysis. Results Majority of participants perceived overweight as an indication of good health such that with food affordability, women deliberately gain weight to demonstrate their good health. Most normal weight respondents said they ate less food than they wanted to because of financial constraints. Most women in overweight/obese ranges in our sample reported that they eat large portions and eat frequently due to the desire to portray a good image of their marital life since there is a societal expectation that when a woman is married, her weight should increase to show that the marriage is successful. The perceived contributors to weight gain include eating behaviors, feelings about weight gain, and gender roles and social expectations to gain weight. Conclusion Beliefs and attitudes related to eating behaviors may have contributed to women being in overweight range and should be considered in designing obesity prevention interventions targeting women in Malawi.

Knowledge, perceptions and practices towards diabetes risk in sub-Saharan Africa: a mixed-methods scoping review

“… A high body weight was associated with: financial stability ‘a sign of good living’ in urban Ghana (39) , urban Cameroon (40) and urban South Africa (38,63) ; being ‘well-off’ in rural and urban Uganda (91) ; and ‘ having a lot of money’ in urban South Africa (41) and urban Cameroon (64) . A high body weight attracted respect: ‘administrative belly’, ‘executive belly’, ‘commanding belly’ in Cameroon (40,64) , and ‘a very important person’ in Uganda (91) . A high body weight in women was associated with good care from husbands in Malawi (100) , Cameroon (40,64) and South Africa (95,109,136) . For example, a Cameroonian woman recounted: ‘ For a woman, being overweight suggests that her husband takes good care of her’ (64) . A high body weight was considered attractive in women: ‘true buttocks’ in Cameroon (40) ; ‘revealing the female figure’ (37) , ‘big hips’ (38) and ‘fresh and round’ (24) in South Africa; ‘presentable’ in Ghana (39) ; ‘nice and beautiful’ in Malawi (100) ; ‘beautiful and attractive’ in South Africa (63) . High body weight was viewed as part of African culture in South Africa (37,41,111) and Ghana (79) . For example, an obese South African woman mentioned that: ‘According to our values and culture, it is important for a woman to have a large body’ (41) . Nudges by spouses, family and peers to gain weight in Ghana (39,79) : ‘my husband wants a fat person so he wants me to gain some more weight’ (39) . Association of weight loss with ill health, especially HIV/AIDS in South Africa (24,38,63,92,111,135) and Uganda (91) .…”

“…A high body weight in women was associated with good care from husbands in Malawi (100) , Cameroon (40,64) and South Africa (95,109,136) . For example, a Cameroonian woman recounted: ‘ For a woman, being overweight suggests that her husband takes good care of her’ (64) .…”

“…Perceptions p : A Nigerian study found that perception of being obese was associated with likelihood to attempt weight loss (62) . X: In contrast, a Malawian qualitative study among urban women found those with a normal weight were involved in weight control, while those who were overweight or obese were not controlling their weight (100) . p : Discontent and concerns about body appearance (weight and size) were associated with lower physical activity engagement in Botswana (116) .…”

“…• A high body weight attracted respect: 'administrative belly', 'executive belly', 'commanding belly' in Cameroon (40,64) , and 'a very important person' in Uganda (91) . • A high body weight in women was associated with good care from husbands in Malawi (100) , Cameroon (40,64) and South Africa (95,109,136) . For example, a Cameroonian woman recounted: 'For a woman, being overweight suggests that her husband takes good care of her' (64) .…”

“…For example, a Cameroonian woman recounted: 'For a woman, being overweight suggests that her husband takes good care of her' (64) . • A high body weight was considered attractive in women: 'true buttocks' in Cameroon (40) ; 'revealing the female figure' (37) , 'big hips' (38) and 'fresh and round' (24) in South Africa; 'presentable' in Ghana (39) ; 'nice and beautiful' in Malawi (100) ; 'beautiful and attractive' in South Africa (63) . • High body weight was viewed as part of African culture in South Africa (37,41,111) and Ghana (79) .…”