Preference for a larger body size among African women

Tope Owolabi graduated from the Master of Public Health course at ScHARR in January 2014 with a distinction. Tope decided to do the MPH course to acquire knowledge on how to have an impact on the health of the nation as a whole, especially with regards to providing preventive healthcare. Tope is currently working as a senior house officer in plastic and reconstructive surgery at Charing Cross Hospital, London, with the intention of going into general practice.

The title of Tope's MPH research project was "Preference for a larger body size among African women".

Introduction:  The study of body weight and image perception has become a necessity with the rise in obesity among women globally. Several factors including race, ethnicity and culture have been linked to the diversity in body image perceptions among women and hence a preference for a particular body size. There is a general assumption that African women have a preference for a larger body size. However, there has been no report based on accumulated evidence on an African level in support of or against this assumption. If this assumption holds true, it serves as a factor which can affect planned public health interventions against overweight and obesity.
Objectives: This review sought to assess beliefs about body size in African women, determine if African women prefer to be of larger body size, identify factors responsible for preferences and to assess body size satisfaction.

Methods: Although a narrative literature review, the search for relevant studies was conducted in a systematic way. The following electronic bibliographic databases were searched for studies from 1990 till present: MEDLINE, CINAHL, ASSIA, Web of Knowledge, EMBASE, Psycinfo and Google scholar. Search terms used included all African countries listed separately, women, females, girls, perception, body size, body weight, body image, body satisfaction, body dissatisfaction, body mass index (BMI), obesity and overweight.
Studies included were limited to those published in English Language, conducted in African countries and focused on body size preferences in women and adolescent girls (girls aged between 10 – 19 years). Body size was categorized using BMI and waist to hip ratio (WHR). Studies in which views of both men and women were explored were also included.
The critical appraisal checklist for surveys by the center of evidence based management (CEBM) was used in the quality assessment of this review as most of the studies included were surveys.

Results: A total of eighty nine studies were retrieved with nineteen studies finally included after meeting the inclusion criteria. In this review it was revealed that some of the beliefs about determinants of large body size included purchase and consumption of cheap foods with high fat content due to financial problems or poverty, lack of exercise and genetics. There is a general preference for a larger body size tending towards overweight rather than obese body size. However, it was also revealed that there is a growing rise in a change of preference towards a slimmer body figure especially among the young and urbanized women. Factors influencing preferences include husband’s preference, cultural views where large body size is regarded as a symbol of wealth and health. In addition to these, the HIV epidemic was shown to have had a great impact with regards to perception towards having a slimmer body size. With regards to body size satisfaction, there was some form of dissatisfaction with current body sizes in women across the studies with women idealizing body sizes larger or slimmer than their current sizes, thus no clear trend emerged.

Conclusion: Several factors may play a role in African women’s body size preference including influence of immediate family members, discordance between actual medical body size and perceived body size as well as individual beliefs. Thus, studies focusing on factors that may encourage healthier body sizes among women in several African countries should be attempted as these may provide insight into planning and implementation of programmes or services towards prevention of obesity specifically for each country.