‘Big is beautiful’ – an exploration with urban black community health workers in a South African township

OBJECTIVES: To explore perceptions about factors associated with body weight and body image among black female community health workers (CHWs) living and working in Khayelitsha, Cape Town. DESIGN: A descriptive, cross-sectional study. Setting. Khayelitsha, a black township in Cape Town, South Africa. SUBJECTS: Forty-four black, female, Xhosa-speaking CHWs working in Khayelitsha. Outcome measures. Anthropometric measures (height, weight, and waist circumference) were taken. Body mass index (BMI) was computed as a measure to estimate total body fat. Waist circumference was used as a measure of abdominal obesity. Focus groups were employed to explore beliefs and attitudes about body size. Information from the focus group discussions was used to develop a semi-structured questionnaire for individual interviews, which were conducted to validate the data from the focus groups, and to assess knowledge on causes and risk factors associated with obesity. A body satisfaction question was also included in the questionnaire. Body image was measured using body shape drawings (pictograms). RESULTS: Of the 44 women measured, 2 had normal weight (BMI 18.5 - 24.9 kg/m2), 2 were overweight (BMI 25 - 30 kg/m2), 25 were obese (BMI 30 - 40 kg/m2) and 15 were extremely obese (BMI ≥ ( 40 kg/m2). A moderately overweight shape (BMI 27 kg/m2) was preferred; this was associated with dignity, respect, confidence, beauty, and wealth. Perceived causes of obesity were eating the wrong food, skipping breakfast and worries about debts, husbands/partners and teenage children. Negative aspects of obesity included body aches and tiredness. CONCLUSION: This study emphasises the prevalence of obesity among urban black women in South Africa, particularly among CHWs. Socio-cultural, behavioural and environmental factors seem to influence the development of obesity in this population.