Abstract
SummarySouth Africa (SA) is undergoing a rapid epidemiological transition and has the highest prevalence of obesity in sub-Saharan Africa (SSA), with black women being the most affected (obesity prevalence 31.8%). Although genetic factors are important, socio-cultural, environmental and behavioural factors, as well as the influence of socio-economic status, more likely explain the high prevalence of obesity in black SA women. This review examines these determinants in black SA women, and compares them to their white counterparts, black SA men, and where appropriate, to women from SSA. Specifically this review focuses on environmental factors influencing obesity, the influence of urbanisation, as well as the interaction with socio-cultural and socio-economic factors. In addition, the role of maternal and early life factors and cultural aspects relating to body image are discussed. This information can be used to guide public health interventions aimed at reducing obesity in black SA women.
Highlights
South Africa (SA) is undergoing a rapid epidemiological transition and has the highest prevalence of obesity in subSaharan Africa (SSA), with black women being the most affected
Black South Africans have been compromised in terms of education, access to healthcare and earning capacity under apartheid laws. This is still currently reflected in the 2008/2009 South African Living Conditions of Household Survey (LCS),[16] in which it was demonstrated that 25% of black households fell within the lowest quintile of annual household consumption expenditure compared to 0.7% of white households, whereas 81% of white households fell within the highest quintile compared to 8.2% of black households
There is compelling evidence that the prevalence of obesity is increasing in SSA, and that this increase is linked to urbanisation, economic development and concomitant lifestyle risk factors, such as physical inactivity and poor dietary practices
Summary
According to the World Health Organisation (WHO), obesity is a global epidemic that affects 500 million people worldwide, and is predicted to increase to one billion people by 2030.1 The rising prevalence of obesity is associated with an increased risk of non-communicable diseases (NCDs), such as cardiovascular disease, type 2 diabetes and several types of cancer.[2]. Of concern is the large increase in the prevalence of obesity among black SA adolescent girls,[13] who will soon be entering adulthood and will be at increased risk for future NCDs. For the purposes of this review, we attempted to outline the socio-cultural, environmental and behavioural determinants of obesity in black SA women, and compare them to their white counterparts, black SA men, and where appropriate, to women from SSA. It is necessary to consider our definitions of race, ethnicity and culture, and the potential interactions between these constructs, within the
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