Perceptions of overweight African women about acceptable body size of women and children.

PURPOSE Malnutrition, presenting as obesity in women and under-nutrition in children, is a prevalent problem in the squatter communities of Cape Town. Food habits are determined by a complex matrix of economic, social and cultural factors which need to be understood by health professionals prior to the implementation of strategies to improve the nutritional status of this community. This qualitative study is designed to explore the perceptions of overweight black women in Cape Town, with underweight infants, about the culturally acceptable body size for women and children. METHOD Qualitative in-depth interviews were conducted with 10 overweight black women who were resident in the metropolitan area of Khayelitsha in Cape Town. A snowballing technique was utilised to select the key informants, all of whom were mothers of underweight infants. The interviews were conducted in Xhosa and recorded, with the permission of participants, onto tape. They were then transcribed and translated into English. The transcripts were coded and analysed by two researchers who worked independently to ensure content validity. RESULTS The informants came from disadvantaged communities in which food was highly valued as a result of the fact that food security was not assured. The concept of an individual voluntarily regulating the intake of nutrients when food did become available, appeared unacceptable to the informants. It was not clear from the interviews how the participants perceived their normal or "desired" body weight. Increased body mass was regarded as a token of well-being in that marital harmony was perceived to be reflected in increased body weight. Overweight children were regarded as reflecting health as it was associated with sufficient food supply and intake. CONCLUSIONS Although women expressed the desire to loose some excess weight for practical reasons, there was no negative social pressure to motivate this. The attitudes recorded from this qualitative research project suggest cultural perceptions of excess body weight that will complicate the design of effective health promotion strategies to normalise and maintain ideal body weight in this group of African women.