The concept of body positivity, which promotes acceptance and appreciation of all body types, intersects with diverse cultural norms and health realities across the African continent. Understanding these nuances is crucial for developing effective public health interventions and fostering positive body image among African women and adolescent girls.
Body size preference plays a significant role in healthy weight behaviors, reflecting an individual’s perception of how acceptable their body is to themselves and society. This includes body image dissatisfaction that may contribute to attempting to achieve an ideal body image leading to a desire for weight loss or weight gain.
Body Size Preferences: A Shifting Landscape
Current literature suggests that there are underlying social and cultural factors related to body image, such as a preference for larger body sizes, contributing to the increasing prevalence of obesity in African females. The prevalence of overweight including obesity has increased rapidly amongst women in African countries, from 33·0 % in 2000 to 42·9 % in 2016.
Factors influencing preferences for large(r) body sizes included: socio-demographic (e.g. education, rural residency), health-related (e.g. current BMI, 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.
A mixed-methods systematic review of seventy-three articles from twenty-one countries revealed diverse body size preferences. Most studies reported a preference for normal or overweight body sizes, while some studies of adolescent girls/young women indicated a preference for underweight.
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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.
Cultural and Evolutionary Roots
A cultural preference for a heavier body size is thought to lead to greater body satisfaction of African women at larger body sizes. Body dissatisfaction (for slimness) may be one of the key drivers of the obesity epidemic in African women and adolescent girls. In addition, body dissatisfaction might promote weight gain in slimmer women trying to fit in with cultural norms. For example, Moroccan Sahraouian women actively engage in fattening behaviours to attain the desirable body size within their community.
Fatness is a sign of femininity, fertility and being a nurturing mother. Women’s primary role in these societies is associated with motherhood, therefore, ‘being fat’ elevates females’ status by embodying their suitability for this role.
This preference for a larger body size in women can be explained by evolutionary benefits. Prior to the industrialisation of food production, food shortages were common in all societies; therefore, storing fat improved survival. This was particularly important for women of childbearing age, meaning fatter women would be more successful in pregnancy and childbearing.
The belief that fatness represents an advantage for pregnancy and childbearing might persevere in some African societies due to the persistence of undernutrition secondary to poverty, particularly in rural areas, potentially making fatness desirable, by setting one apart from the community and embodying excess in resource poor settings.
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This is supported by the positive association between socio-economic status (SES) and obesity in low-income African countries, whereas in high-income countries (HICs) the opposite is observed. In African middle-income countries, the association between SES and obesity is negative for women.
The Influence of Western Media and Urbanization
Younger females are more likely to want to change their body size to fit emerging societal norms valuing thinness. In addition to cultural factors contributing to body size preference, studies from HICs have reported that being overweight, media exposure and psychological factors contribute to higher body dissatisfaction.
Therefore, access to ‘Western’ media in Africa might increase the value of slimmer bodies, particularly amongst younger African females. Adolescence signifies the onset of puberty, which increases awareness of body image directly and indirectly via a greater importance placed on peer perceptions.
Indeed, studies have reported an increased ‘drive for thinness’ in Black South African adolescents when compared with their White South African counterparts. This contradicts studies of fattening practices in African women.
Regional Variations and Study Findings
Seventy three articles were included (Fig. (57)). Studies were conducted in 21/54 African countries and clustered particularly within three regions: Southern Africa, West Africa and East Africa, with a predominance in South Africa (Fig. 3).
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Fig. Map displaying the African countries included in the review
Of the seventy-three articles, fifty were quantitative, fifteen were qualitative and eight mixed methods. A total of 25 512 females and 2090 males aged ≥10 years from 17 African countries were included.
For studies using body image scales and for which a BMI category could be extracted, we found that, overall, participants in most studies preferred normal weight to overweight (Fig. 4). We observed a positive relationship between age category and ideal body size, with valorisation of underweight in some adolescent females and valorisation of overweight in middle-aged women.
Fig. Body size ideals for African women and adolescent girls
Self-Perception and Satisfaction
In total, 19/58 (32·7 %) studies included information on body size self-assessment. Using body image scales, one study found that 34·6 % of Kenyan women living in urban Nairobi underestimated their body weight; with 28·8 % of women who underestimated their weight classified as obese, a pattern also observed in Cameroonian urban women.
The same was also observed with overweight/obesity in Nigerian students and South African black urban women, as well as in black schoolgirls, Algerian Saharawi refugees, urban Tunisian, Moroccan and Malawian women. Using questionnaire items in rural Morocco, almost all (99·2 %) women who were overweight/obese underestimated their body weight status, which increased with age. Similarly, 89 % of middle-aged South African black women living in Cape Town were happy with their weight, whereas most of them were overweight or obese.
Likewise, approximately two-thirds of Black women with overweight/obesity in Cape Town did not perceive themselves as such. Using body image scales, most adolescent Egyptian schoolgirls estimated their body weight accurately along the spectrum of BMI categories.
Of the studies that assessed satisfaction using scales (n 24), seventeen found a positive Feel minus Ideal Discrepancy (FID) (i.e. current > ideal), meaning that women and/or adolescent girls wanted to lose weight. A further five studies found a negative FID (i.e. current < ideal), meaning that women and or/adolescent girls wanted to gain weight and two found mixed results.
Of the studies that assessed satisfaction using questionnaires (n 30), ten found that women who were overweight or obese were satisfied with their current body size.
Cross-National Comparisons
Very few cross-national studies on body image focus on Black African women. Kenyan and Nigerian women showed differences across multiple body image measures. Nigerian women showed thinner body ideals compared to Kenyan women and also endorsed higher skin color satisfaction, racialized body dissatisfaction, and internalized Eurocentric beauty idealization. Kenyan women showed higher levels of objectified body consciousness.
An indirect effect of nationality was observed with internalized Eurocentric beauty ideals mediating differences in racialized body dissatisfaction and objectified body shame.
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The Influence of Migration
Among African residents, the body preferences depend on the country of residence and their socio-cultural status. Ethnic groups living in great isolation or with low incomes still have an ancestral idea of beauty, preferring a shapely body. However ethnic groups living in urban areas are moving toward Westernization of beauty ideals, preferring underweight or normal weight bodies.
This review highlights that both residents and migrants are at high risk of nutritional disorders due to the adoption of Western beauty ideals. The results suggest that body dissatisfaction and BMI are increasing from Southern Africa to Europe according to a geographical gradient.
Conclusion
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.
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