Perceptions relating to body size, weight loss and weight-loss interventions in black South African women: a qualitative study

Abstract

Objective: A higher tolerance for a larger body size has been associated with obesity in black South African (SA) women. The aim of the present study was to explore perceptions regarding body size and weight loss in a sample of black women from a low-income community in Cape Town, SA. Design: Qualitative pilot study including five focus groups. Data were analysed using thematic analysis. Setting: Khayelitsha, Cape Town, SA. Subjects: Twenty-one black SA women. Results: The majority of participants had positive perceptions of overweight/ obesity, which were influenced by community and cultural perceptions, but some inconsistencies were observed as overweight/obesity was also associated with ill health. Participants identified many benefits to weight loss, but due to the association with sickness, they were concerned about being stigmatised in their community. Although participants had knowledge about healthy eating, the main barrier to eating healthily included the perceived higher cost of healthier food and food insecurity. All participants saw exercise as a strategy to lose weight and improve health, and were interested in participating in a community-based exercise intervention, but negative community perceptions and conflicting views regarding who should lead the intervention were identified as barriers. Conclusions: These findings highlight the complexities surrounding participants' perceptions regarding body size, weight loss and weight-loss interventions, and emphasise low socio-economic status as a barrier to change. The study also highlights the strong influence of cultural ideals and community perceptions on personal perceptions. These findings underscore the necessity for culturally appropriate weight-loss interventions in low-income, transitioning communities.

HIV‐positive Malawian women with young children prefer overweight body sizes and link underweight body size with inability to exclusively breastfeed

“…Women also said that they viewed a morbidly obese silhouette as healthy because the figure looked at peace and without worries, suggesting a possible psychological benefit. Studies across sub‐Saharan Africa have noted the perception that a large female body size is associated with health, beauty, dignity, wealth, respect, happiness, proud parents‐in‐law, and contented husbands (Draper et al, ; Holdsworth et al, ; Matoti‐Mvalo & Puoane, ; Mchiza, Goedecke, & Lambert, ; Mvo et al, ; Puoane et al, ).…”

“…Despite increases in overweight among women of reproductive age in low‐ and middle‐income countries (Jaacks, Slining, & Popkin, ), research on maternal body size perceptions and infant feeding practices in sub‐Saharan Africa has focused on undernutrition and women's belief that they cannot produce enough milk to exclusively breastfeed if they lack adequate food security (Buskens, Jaffe, & Mkhatshwa, ; Webb‐Girard et al, ; Young et al, ). In many parts of Africa, a thin body size is stigmatized because it is associated with illness, especially HIV/AIDS, whereas an overweight body size is preferred because it is perceived to be associated with desirable personality traits, beauty, wealth, and health (Devanathan, Esterhuizen, & Govender, ; Draper, Davidowitz, & Goedecke, ; Holdsworth, Gartner, Landais, Maire, & Delpeuch, ; Matoti‐Mvalo & Puoane, ; Pedro et al, ; Puoane et al, ).…”

Sociodemographic, socioeconomic, clinical and behavioural predictors of body mass index vary by sex in rural South African adults-findings from the AWI-Gen study

“…In contrast, in high income countries, obesity appears to be more prevalent in poorer, less-educated individuals [36,37]. This may be due to several factors including the ability of wealthier individuals to afford larger quantities of food and perceptions in some communities in emerging economies that obesity is a desirable characteristic and indicative of personal wealth [38,39]. …”

Addressing the problem of obesity and associated cardiometabolic risk in black South African women – time for action!

“…), which are typically performed at a higher intensity than transport- or work-related activities, might be suggested as alternative interventions to increase cardiorespiratory fitness. However, barriers to leisure activities, including lack of time and facilities, safety issues and negative community perceptions regarding weight loss [15] need to be addressed before interventions can be implemented.…”