CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 9/10, October/November 2013
AFRICA
369
Review Articles
Socio-cultural, environmental and behavioural
determinants of obesity in black South African women
LISA K MICKLESFIELD, ESTELLE V LAMBERT, DAVID JOHN HUME, SARAH CHANTLER, PAULA R
PIENAAR, KASHA DICKIE, THANDI PUOANE, JULIA H GOEDECKE
Abstract
South 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 behaviour-
al 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 interven-
tions aimed at reducing obesity in black SA women.
Keywords:
South Africa, obesity, food security, diet, physical
activity, body image, socio-economic status
Submitted 12/6/13, accepted 12/9/13
Published online 19/9/13
Cardiovasc J Afr
2013;
24
: 369–375
DOI: 10.5830/CVJA-2013-069
Prevalence of obesity
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
Until recently, Africa has been spared from this epidemic as
it grappled with under-nutrition, as well as infectious diseases
such as HIV and tuberculosis. However, over the last century the
continent has seen a rapid rise in the prevalence of overweight
and obesity, and their associated co-morbidities.
3-5
This dual
burden of disease in Africa is particularly devastating as it is
compounded by the metabolic consequences of the roll out of
anti-retroviral medications in certain countries.
6,7
Within sub-Saharan Africa (SSA), the prevalence of obesity
differs widely from as low as 1% in Ethiopia
8
to as high as 27%
in South Africa (SA).
9
Only three other countries in SSA report
a national obesity prevalence of over 20%, including Mauritania
(23.3%),
10
Swaziland (23.1%)
11
and Gabon (21.5%).
10
In SA, statistics from the 1998 National Demographic and
Health survey (SADHS) reported an obesity prevalence of
30% in all women over the age of 15 years, which is more than
three times higher than the prevalence in men (7.5%).
12
Those
most affected were black women, with a prevalence of 31.8%,
compared to 6% in black men, 22.7% in white women, 21.1% in
Indian women and 26.3% in women of mixed ancestry.
The most recent SADHS undertaken in 2003
9
reported that the
prevalence of obesity remains high in black women (28.5%). 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 therefore 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. The literature included in this review was selected
from the available literature to highlight the magnitude and
complexity of the determinants of obesity in this population
(Fig. 1).
Definitions of race, ethnicity and culture
To contextualise this review, it is necessary to consider our
definitions of race, ethnicity and culture, and the potential
interactions between these constructs, particularly within the
MRC/Wits Developmental Pathways for Health Research
Unit, Department of Paediatrics, Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, South Africa
LISA K MICKLESFIELD, PhD,
UCT/MRC Research Unit for Exercise Science and Sports
Medicine, Department of Human Biology, UCT School of
Health Sciences, University of Cape Town, South Africa
LISA K MICKLESFIELD, PhD
ESTELLE V LAMBERT, PhD
DAVID JOHN HUME, BSc (Med) (Hons)
SARAH CHANTLER, BSc (Med) (Hons)
PAULA R PIENAAR, BSc (Med) (Hons)
KASHA DICKIE, MSc (Med)
JULIA H GOEDECKE
School of Public Health, University of the Western Cape,
South Africa
THANDI PUOANE, PhD
South African Medical Research Council, Parow, South Africa
JULIA H GOEDECKE, PhD
