Body size preferences and food choice among mothers and children in Malawi.

Valerie L Flax,John C Phuka,Lindsay M Jaacks,Chrissie Thakwalakwa

doi:10.1111/mcn.13024

Abstract

Overweight in mothers and children in sub‐Saharan Africa is rapidly increasing and may be related to body size perceptions and preferences. We enrolled 268 mother–child (6–59 months) pairs in central Malawi; 71% of mothers and 56% of children were overweight/obese, and the remainder were normal weight. Interviewers used seven body silhouette drawings and a questionnaire with open‐ and closed‐ended questions to measure mothers' perceptions of current, preferred and healthy maternal and child body sizes and their relation to food choices. Overweight/obese and normal weight mothers' correct identification of their current weight status (72% vs. 64%), preference for overweight/obese body size (68% both) and selection of an overweight/obese silhouette as healthy (94% vs. 96%) did not differ by weight status. Fewer overweight/obese than normal weight mothers' preferred body silhouette was larger than their current silhouette (74% vs. 29%, p < .001). More mothers of overweight than normal weight children correctly identified the child's current weight status (55% vs. 42%, p < .05) and preferred an overweight/obese body size for the child (70% vs. 58%, p < .01), and both groups selected overweight/obese silhouettes as healthy for children. More than half of mothers in both groups wanted their child to be larger than the current size. Mothers said that increasing consumption of fruits, vegetables, meat, milk, grains, fizzy drinks and fatty foods could facilitate weight gain, but many cannot afford to purchase some of these foods. Their desired strategies for increasing weight indicate that body size preferences may drive food choice but could be limited by affordability.

Highlights

Two billion adults and 38 million children under 5 years of age are overweight or have obesity (Development Initiatives, 2018)
We calculated the difference between the selected current and preferred body silhouette numbers for mothers and children to quantify how many preferred a smaller, the same or a larger body size and conducted chi-squared tests comparing the difference by mother and child weight status
With overweight and obesity increasing in Malawi (NSO Malawi & ICF, 2017; NSO Malawi & ICF Macro, 2011), understanding mothers' perceptions of their own and their child's current, preferred and healthy body sizes, as well as how body size preferences relate to food choice, is important for achieving the Malawi Ministry of Health's goal to reduce the prevalence of overweight and obesity by 5% (Government of Malawi, 2018)

Summary

Introduction

Two billion adults and 38 million children under 5 years of age are overweight or have obesity (Development Initiatives, 2018). In sub-Saharan Africa, large body sizes are preferred, especially for women, because they are linked with good health, beauty, fertility and wealth (Appiah, Otoo, & Steiner-Asiedu, 2016; Devanathan, Esterhuizen, & Govender, 2013; Draper, Davidowitz, & Goedecke, 2016; Holdsworth et al, 2004; Matoti-Mvalo & Puoane, 2011; Muhihi et al, 2012; Tateyama et al, 2019). This preference is further fuelled where HIV is prevalent because being thin is considered a sign of HIV (Croffut et al, 2018; Muhihi et al, 2012; Tateyama et al, 2019)

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Results

Conclusion