Abstract
To synthesise evidence on body size preferences for females living in Africa and the factors influencing these. Mixed-methods systematic review including searches on Medline, CINHAL, ASSIA, Web of Science and PsycINFO (PROSPERO CRD42015020509). A sequential-explanatory approach was used to integrate quantitative and qualitative findings. Urban and rural Africa. Studies of both sexes providing data on body size preferences for adolescent girls and women aged ≥10 years. Seventy-three articles from twenty-one countries were included: fifty quantitative, fifteen qualitative and eight mixed methods. Most studies reported a preference for normal or overweight body sizes. Some studies of adolescent girls/young women indicated a preference for underweight. 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. peer pressure, media). 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. 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. Emphasis needs to be placed on education to prevent all forms of malnutrition.
Highlights
In light of the increasing obesity epidemic in African women and the contradictory results reported from the studies discussed earlier(8,30–32), this paper presents the results of a mixed methods systematic review, to assess body size preferences for African women and adolescent girls living in Africa and the factors influencing these preferences
Summary of key findings The evidence we synthesised on body size preferences from seventy three quantitative, qualitative and mixed methods studies in twenty-one African countries suggests that normal or overweight body sizes are mainly preferred for African females
It is generally assumed that larger body sizes are preferred for African females
Summary
Review typology A mixed methods systematic review was chosen as it combines quantitative and qualitative evidence(33) generating a complete, and deeper understanding of women’s body size preferences and the factors influencing these (PROSPERO #: CRD42015020509). Inclusion and exclusion criteria Inclusion criteria were based on the SPIDER tool (Sample, Phenomenon of Interest, Design, Evaluation and Research Type) (Table 1). 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. Studies assessing African males’ preferences for African females’ body size were included. All non-randomised quantitative, qualitative and mixed methods studies were eligible for inclusion
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