A Qualitative Research Synthesis of Contextual Factors Contributing To Female Overweight and Obesity over the Life Course in Sub-Saharan Africa

Adult women are disproportionately burdened by overweight and obesity in Sub-Saharan African (SSA) countries and there is limited understanding of the sociocultural context of this problem. In this qualitative research synthesis, we aimed to surface contextual influences that potentially predispose adult women and adolescent girls to overweight and obesity. PubMed, CINAHL, PsychInfo, PROQUEST, EMBASE, Web of Science were searched to locate qualitative research articles conducted in sub-Saharan African countries beginning in year 2000. After assessment for eligibility and critical appraisal, 16 studies were included in the synthesis. Textual data and quotes was synthesized using the methods proposed by the Joan Briggs Institute and a thematic analysis framework. The synthesized studies were conducted in South Africa, Ghana, Kenya and Botswana. The three overarching themes across these studies were body size and shape ideals, barriers to healthy eating, and barriers to physical activity with cultural and social factors as cross-cutting influences within the major themes. Culturally, the ideal African woman was expected to be overweight or obese, and voluptuous and this was associated with their identity. While overweight and obesity was not acceptable among adolescent girls, they also desired to be voluptuous. Healthy food choices among women and girls were hampered by several factors including affordability and peer pressure. Both adult women and girls experienced ageism and institutional discrimination as barriers to physical activity. This is the first qualitative research synthesis to amplify the voices of women and girls in SSA countries highlighting the challenges they face in maintaining a healthy weight. Sociocultural, institutional and peer-related factors were powerful forces shaping body size preferences, food choices and participation in physical activity. Our study findings provide insights for the design of contextually appropriate interventions and lay the foundation for further research studies