Body size preferences for women and adolescent girls living in Africa: a mixed-methods systematic review

OBJECTIVE

To synthesise evidence on body size preferences for females living in Africa and the factors influencing these.

DESIGN

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.

SETTING

Urban and rural Africa.

PARTICIPANTS

Studies of both sexes providing data on body size preferences for adolescent girls and women aged ≥10 years.

RESULTS

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).

CONCLUSIONS

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.

Statin-use and perceptions of high cholesterol as predictors of healthy lifestyle behaviours in Nigerians

It is unclear how statin-use influences the adoption of healthy lifestyle choices. It is important to understand the nature of this relationship as this could facilitate targeted public health interventions which could help promote a healthy lifestyle, curb the rise of non-communicable diseases, and facilitate overall health. This study aimed to explore whether statin-use influenced the adoption of healthy lifestyle choices by changing the way urban and semi-urban Nigerians thought about their high cholesterol and their future risk of cardiovascular disease. Structured questionnaires were used to compare the lifestyle behaviours, perceptions of high cholesterol and future risk of cardiovascular disease of statin users and non-statin users recruited in urban and a semi-urban Nigeria. In-depth, face-to-face interviews were used to further explore the relationship between statin-use and the adoption of healthy lifestyle choices, and explore the influence of personal and social factors on this relationship. The odds of adopting a low-fat diet increased as perceived statin-effectiveness increased (OR = 2.33, p<0.05), demonstrating a synergistic relationship between statin-use and the adoption of healthy of lifestyle choices. In addition to this synergistic association, at interview, two other relationships were found between statin use and the adoption of healthy lifestyle choices: an antagonistic relationship fuelled by a strong perception of statin effectiveness and a perceived inability to make healthy lifestyle changes, which favoured statin-use, and an antagonistic relationship fuelled by congruous cause-control beliefs and concerns about medication-use which favoured the adoption of healthy lifestyle choices. The odds of adopting a low-fat diet was 5 times greater in urban dwellers than in semi-urban dwellers (p<0.01). Statin-use influenced the adoption of healthy lifestyle choices in three different ways, which require exploration at clinical consultation. Gender, social obligations, and physical environment also influenced statin-use and the adoption of healthy lifestyle choices.

Evaluation of Body Shape, Eating Disorders and Weight Management Related Parameters in Black Female Students of Rural and Urban Origins

This study examined body shape dissatisfaction, eating disorder and weight management-related parameters as well as assimilation of Western cultural norms regarding body shape in black female students of urban and rural origins. Subjects (n=180; 20 ± 4,4 years old) were weighed, their height was measured and they completed the Body Shape Questionnaire, EAT-26, Eating Inventory (restraint scale), Adolescent Self-Concept Scale and a questionnaire concerning weight management behaviours. Main findings include lower prevalences of overestimation of body weight and body shape dissatisfaction, similar prevalences for dieting and the use of Hazardous weight reduction methods, and higher prevalences for overweight, obesity, disordered eating attitudes and behaviours, and dietary restraint among subjects than among similar white groups. Furthermore, those with urban origins were more likely to be restrained eaters, to have attempted weight reduction, to aim for weight loss and to fear weight gain. These data indicate that there are signs of more realism concerning weight status among black female students. However, there are also signs of assimilation of Western cultural norms concerning body shape, eating attitudes and behaviours and weight management. This diversity in the black student population in South Africa needs to be recognized when planning interventions to address eating related problems.

Weight discrepancy and body appreciation of Zimbabwean women in Zimbabwe and Britain

Few studies have investigated a cultural group's corporeal experiences in both its country of origin and a host, Western country using the same methodology. To overcome this dearth in the literature, the present study examined body image among 140 women in Harare, Zimbabwe, and an age-matched sample of 138 Zimbabwean migrants in Britain. Participants completed measures of actual-ideal weight discrepancy, body appreciation, and lifetime exposure to Western and Zimbabwean media. Preliminary analyses showed that there were no significant differences in body mass index between the two groups. Further analyses showed that Zimbabwean women in Britain had significantly greater weight discrepancy and lower body appreciation than their counterparts in Zimbabwe. In addition, weight discrepancy and body appreciation among both samples were significantly associated with exposure to Western media, but not Zimbabwean media. These findings support the contention that transcultural migration may place individuals at risk for symptoms of negative body image.

Objectified body consciousness and mental health in female adolescents: cross-cultural evidence from Georgian and Swiss national samples

PURPOSE

The current study tested both descriptive and explanatory similarities and differences in a latent objectified body consciousness (OBC) construct and its relationship to three mental health indicators among Georgian and Swiss adolescents. Few studies have been conducted on adolescents; similarly, most work has been completed on U.S. college-age women.

METHODS

School-based questionnaire data were collected from a total of 18,239 adolescents in Georgia (n = 9,499) and Switzerland (n = 8,740), following the same protocol. Participants rated three measures of OBC (body shame, body surveillance, and appearance control beliefs) and three mental health indicators (depressive symptoms, somatic complaints, and suicidal ideation). Final study samples included 2,657 (mean age = 16.4 years) and 3,803 female youth (mean age = 17.8 years), respectively. Data analyses included mean level comparisons, confirmatory factor analysis, path analysis, and multigroup invariance tests.

RESULTS

Findings provide support for a latent OBC construct across cultures, with partial evidence of cultural differences (one of two manifest indicators). By contrast, multigroup invariance tests provide consistent evidence of no differences in the relationships between the OBC latent construct and three mental health indicators between Georgian and Swiss samples.

CONCLUSION

Despite mean level differences, findings support a latent OBC construct in both cultures, perhaps slightly more so among Swiss youth. The links between OBC and mental health indicators were also invariant across the two cultures, providing greater support for a global or universal (vs. "cultured") framework of adolescent development related to the constructs and relationships studied.

Influential sources affecting Bangkok adolescent body image perceptions

The study of body image-related problems in non-Western countries is still very limited. Thus, this study aims to identify the main influential sources and show how they affect the body image perceptions of Bangkok adolescents. The researcher recruited 400 Thai male and female adolescents in Bangkok, attending high school to freshmen level, ranging from 16-19 years, to participate in this study. Survey questionnaires were distributed to every student and follow-up interviews conducted with 40 students. The findings showed that there are eight main influential sources respectively ranked from the most influential to the least influential: magazines, television, peer group, familial, fashion trend, the opposite gender, self-realization and health knowledge. Similar to those studies conducted in Western countries, more than half of the total percentage was the influence of mass media and peer groups. Bangkok adolescents also internalized Western ideal beauty through these mass media channels. Alike studies conducted in the West, there was similarities in the process of how these influential sources affect Bangkok adolescent body image perception, with the exception of familial source. In conclusion, taking the approach of identifying the main influential sources and understanding how they affect adolescent body image perceptions can help prevent adolescents from having unhealthy views and taking risky measures toward their bodies. More studies conducted in non-Western countries are needed in order to build a cultural sensitive program, catered to the body image problems occurring in adolescents within that particular society.

Detection of intra- and cross-cultural non-equivalence by simple methods in cross-cultural research: evidence from a study of eating attitudes in Nigeria and Britain

The desiderata for cross-cultural research are reviewed showing how this is dominated by the presumption of transcultural equivalence hidden by the technical problems of translation. This model requires intensive translation work on measures to preserve "equivalence". This work can be prohibitively intensive, might lead to spurious evidence of "equivalence" and has not produced much evidence of equivalence to date. A psychometric axiom--that a measure with low reliability cannot have validity--suggests a pragmatic way to explore these issues and current statistical software and personal computers make this feasible. We recommend that all cross-cultural research should present the internal reliability of the data as this will expose all but one theoretical problem in the detection of "equivalence". We also suggest that non-equivalence may indicate cross-cultural differences in the dimensionality of eating and body image concerns rather than just a problem to be exorcised by more translation work or to be hidden by not reporting reliability. These issues are not specific to work across languages but also apply to comparisons between any social groups within cultures. This is shown using data from questionnaires in their original English with respondents who were fluent in that language.