Body image plays a significant role in healthy weight behaviors, defined as 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. 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. In addition, body dissatisfaction might promote weight gain in slimmer women trying to fit in with cultural norms. Body dissatisfaction (for slimness) may be one of the key drivers of the obesity epidemic in African women and adolescent girls.
This article delves into the complex dynamics of body image among African women, exploring the various factors that shape their perceptions and preferences regarding body size and shape.
Cultural and Evolutionary Influences
A cultural preference for a heavier body size is thought to lead to greater body satisfaction of African women at larger body sizes. For example, Moroccan Sahraouian women actively engage in fattening behaviors 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. Prior to the industrialisation of food production, food shortages were common in all societies; therefore, storing fat improved survival. This preference for a larger body size in women can be explained by evolutionary benefits.
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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.
Notwithstanding, in certain African communities, weight gain during pregnancy is perceived negatively due to the fear of complications during delivery.
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.
Socio-Economic Status and Obesity
The relationship between socio-economic status and body image varies across different income levels in African countries:
- Low-Income Countries: Positive association between SES and obesity.
- Middle-Income Countries: Negative association between SES and obesity in women.
- High-Income Countries: Opposite trend observed compared to low-income countries.
These dynamics highlight the complex interplay between economic factors and body image perceptions.
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Map of African countries.
Influence of Media and Age
Younger females are more likely to want to change their body size to fit emerging societal norms valuing thinness.
What the Science Says about: Social Media and Adolescents’ Body Image and Disordered Eating
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.
Research Methodology
A mixed-methods systematic review was conducted, including searches on Medline, CINHAL, ASSIA, Web of Science and PsycINFO (PROSPERO CRD42015020509). Inclusion criteria were based on the SPIDER tool (Sample, Phenomenon of Interest, Design, Evaluation and Research Type). Studies conducted in any African country among female adolescents (10-19 years) and women (≥18 years) were included. The review focused exclusively on Black African or Arab females.
All studies that assessed preferred body size of African females (adolescent girls and women) using narrative and/or pictorial measures, and those that elicited factors influencing these preferences were included. Furthermore, studies assessing African males’ preferences for African females’ body size were included. The SPIDER tool was used to define search terms and eligibility criteria.
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The search was conducted on ASSIA, CINAHL, Medline, PsycINFO and Web of Science. Initial searches were conducted from 20/04/2015 until 15/05/2015. A supplementary search was then conducted, repeating the search strategies up to 31/08/2019. Duplicates were removed in MS Excel before screening.
All papers were first screened on titles and abstracts and then on full text in MS Excel (OO, EC, RP, MH, CBN). Reasons for exclusion were recorded at full-text stage (i.e. no measure of body size preferences or factors influencing these; data not stratified by gender, ethnic group or country). To ensure consistency in the application of inclusion criteria, two authors (HO and CBN) checked 10 % of all excluded documents screened.
Data extraction of included studies was conducted in MS Excel by OO, EC, RP, MH, HO. Data extracted from studies included general information (study ID, title, authors, date, study location (country, urban v. rural), study aim); study eligibility (participant selection, sample size, participant characteristics); method used to measure body image dimensions; ideal body size; body size self-assessment; body size self-satisfaction and factors influencing body size preferences.
One author (RP) checked the full data extraction file to ensure accuracy and consistency across team members. Where data could not be extracted, authors were contacted to request relevant data, e.g. The ‘Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields’ (QualSyst) was used to critically appraise both the quality of the studies and their reporting.
This tool was chosen because it provided a standard checklist for all study designs. Each study included in the review was rated using a predefined list of criteria (n 14 for quantitative studies, n 10 for qualitative studies). The original tool was modified by replacing the score for each criterion (0, 1, 2) with a qualitative assessment of high quality/green (low risk of bias), medium quality/yellow or low quality/red (high risk of bias) as the Cochrane guidance advises against the use of scores.
Five authors (OO, EC, RP, MH, HO) independently conducted quality appraisal and this was double-checked by RP and EC. A sequential-explanatory approach was used to integrate quantitative and qualitative evidence (Fig. 1). In phase one, quantitative studies were synthesised to define African females’ body size preferences and the factors influencing these.
Phase two involved summarising the evidence from qualitative studies on factors influencing body size preferences, and phase three aimed at integrating findings from both quantitative and qualitative studies. The qualitative data synthesis provided contextual and cultural understanding of the quantitative data.
Flow diagram showing the selection of studies for the systematic mixed-methods review.
Key Findings
Seventy-three articles from twenty-one countries were included: fifty quantitative, fifteen qualitative and eight mixed methods. 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).
Map displaying the African countries included in the review.
Of the seventy-three articles, fifty were quantitative, fifteen were qualitative and eight mixed methods (Table 2). All quantitative studies utilized a cross-sectional design, with the exception of one longitudinal design. A total of 25 512 females and 2090 males aged ≥10 years from 17 African countries were included.
Twenty-three qualitative studies from ten countries were included. Data from 828 participants and twenty households aged 10-70 years were synthesised (sample sizes between 10 and 193). The quality assessment revealed that quantitative and qualitative studies separately scored highly on criteria such as question/objective sufficiently described, evident and appropriate study design and conclusions.
Quantitative studies scored highly on well-defined outcome measures; however, some studies reported poorly on subject selection and characteristics, estimate of variance and control for confounding. The majority of quantitative and mixed methods studies (46/58 (79·3 %)) assessed African women’s body size ideals.
Most studies used body image scales whilst the remaining studies used questionnaires to capture the relationship between specific attributes (e.g. 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.
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.
Body size ideals for African women and adolescent girls.
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.
Body Size Perception and Satisfaction
Few studies explored attributes associated with different body sizes. One study observed differences between urban black and white South African women, especially in middle-aged women, regarding the ‘normal’ and ‘fat’ attributes; and observed that black girls and their mothers were less likely to associate ‘fatness’ with being unhappy in comparison with the white and mixed ancestry group.
Likewise, another study found that more than 80 % of black South African rural women disagreed that ‘fat people eat more than thin people’. Moreover, 25 % of these women associated overweight with a lack of financial problems, and more women with a normal weight associated overweight/obesity with food intake, compared with those overweight and obese.
In a black township of Cape Town, 74 % of black females considered that being fat ‘made you dignified’ and 43 % believed that this weight status led one to ‘feel better about yourself’. Indeed, a woman who was overweight was perceived as ‘well-liked’ (100 %), ‘proud of her movements’ (100 %), ‘healthy’ (100 %) and ‘happy’ (94 %).
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.
Black Women and Body Image
It's no secret that body image issues are a real problem in our society. But what's often overlooked is the fact that these issues disproportionately affect black and other minority populations. Studies have shown that black women, in particular, are more likely to suffer from poor body image and eating disorders. This is likely due to a combination of factors, including racism, colorism, and media portrayal of black women as either hypersexualized or invisible.
It's clear that we need to do more to support black women who are struggling with their body image. 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. The history of black and brown people in America has led to generations of trauma that manifests in the way we see ourselves.
The standard of beauty pushed by the media has had a massive impact on body image issues among BIPOC communities. Many people in these communities may be afraid to speak up about body positivity and body confidence topics that are often challenging to approach. The consequences can include insecurity, stress eating, and body dysmorphia, all of which can lead to medical complications and distress.
It is more important than ever for us to remind ourselves that we are all differently beautiful and our body confidence should not be determined by any “ideal” standard of beauty. We must empower each other to celebrate body diversity, body appreciation, self-love, and body acceptance.
Why Does Your Body Image Differ from the "Standard"?
The truth is that being thin and white is not the only thing that makes us different as black and BIPOC individuals. Body shape is something that can vary drastically between black women. It is something that should be celebrated and embraced, as it reflects the unique beauty of every individual. Black women often come in a variety of sizes, shapes, heights, and body types.
This diversity allows for a more interesting aesthetic, one that challenges the traditional Western standard of beauty. Black women have curves that are not only beautiful but functional. Curves are an important part of our anatomy as they help to support the spine and provide additional stability when we move or lift things. The curves also make us look feminine and give us a certain sensuality that cannot be denied.
Furthermore, research has found that having curves has also been linked with improved mental health and better overall well-being in many cases, making them even more important to celebrate and embrace. Similarly, black women may have differently shaped bodies than those typically seen in mainstream media. They may have wider hips or thicker thighs, bigger arms or smaller waists; whatever their body shape may be, it is still beautiful in its own right and should not be compared to what society says is the “ideal” body type.
Each body type has its unique advantages so it is important to learn how to appreciate one’s own physicality rather than constantly comparing oneself to someone else’s version of beauty.
Skin Tone/Color
Skin tone and color are essential elements of black women's identity and something that should be celebrated. The unique combination of melanin in our skin creates one-of-a-kind shades that are unlike any other on the planet. Our skin has a richness, complexity, and vibrancy that can't be replicated or imitated. It is a deep source of pride for us.
The range of melanin in our skin ranges from dark brown, reddish brown, yellowish brown or gold, pink or peach, and gray or silver to white. In some cases, individuals may also have blue undertones in their skin. This variation makes every black woman unique and beautiful in her own way. Our skin is not just an outward sign of who we are; it plays a critical role in protecting us from UV radiation and other environmental stressors.
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