Body image perception of African immigrants in Europe

15 Pages·2016·0.58 MB·English

by  Stefania Toselli

Tosellietal.GlobalizationandHealth (2016) 12:48
DOI10.1186/s12992-016-0184-6
REVIEW Open Access
Body image perception of African
immigrants in Europe
Stefania Toselli1, Natascia Rinaldo2* and Emanuela Gualdi-Russo2
Abstract
Nutritional disorders are now spreading worldwide both in developed and developing countries. Bodyimage ideals
and dissatisfaction have been linked to a number ofpoorhealth outcomes,including nutritional disorders. While
previous studies have offered insight into weight status and body image perception of immigrants inNorth
America, very few studies have analysed these aspects in migrants from Africa to Europe. Our review examines
theeffects of the migration process on beauty ideals and body dissatisfaction inAfrican immigrants inEurope
compared to residents in their own countries. The PubMed, PsycINFO and Google Scholar databases were searched
for studies published from January 2000 till November 2015. Of the730 titles identified, 26 met the inclusion criteria
and were included inthepresent review. Among African residents, thebody preferences depend onthe country
ofresidenceand their socio-cultural status. Ethnicgroups living ingreatisolation or with low incomes still have an
ancestral idea of beauty, preferring a shapely body. However ethnic groups living in urban areas are moving toward
Westernization ofbeautyideals, preferring underweight or normal weight bodies. This review highlights that both
residents and migrants are athigh risk of nutritional disorders due to the adoption of Western beauty ideals. The
results suggestthatbody dissatisfaction and BMI are increasing from Southern Africa to Europe according to a
geographical gradient (described for femalesby Spearman’scoefficient and linear regression, respectively).We
emphasize theneed for monitoring oftheweight and psychological status of immigrants and the development
ofspecific preventive strategies in European countries.
Keywords: Body image perception, Dissatisfaction, BMI, Migration,Europe,Health
Background of a misperception, thin people might overestimate their
A wide body of research has described the relationships weight and, conversely, many overweight/obese people
between health and weight status in different populations are unaware that their body weight is too high. In such
and environmentalcontexts. The categorization of weight cases,aswell asincase ofdissatisfaction with one’sbody
statusbyBMI isa simple way toestimate underweight or image, there is often an association with weight-related
overweight for a given height for general assessment of behaviors[2,4].
health status in a population. The increasing incidence of The relationship between weight status and body self-
overweight and obesity worldwide is now reachingalarm- perception is also influenced by others factors such as
ing proportions. As an effect of the nutritional transition, cultural and social factors [5–8]. Previous studies in
these diseases concern both developed and developing Western countries have reported lower accurate percep-
countries. Hence the latter are facing a dual burden of tions of overweight in low socio-economic status (SES)
malnutrition, with a high prevalence of both underweight groups and this misperception contributesto thepersist-
andoverweight/obesity[1–3]. ence of unhealthy lifestyle [9, 10]. This aspect is particu-
Body image perception is one of the psycho-social fac- larly burdensome in immigrants who, misperceiving
tors that can affect the weight status. As a consequence their overweight/obesity, do not attempt to lose weight,
leading toan increase of these nutritional disorders. Fur-
thermore,people from low-to-medium-income countries
*Correspondence:[email protected]
2DepartmentofBiomedicalandSpecialtySurgicalSciences,Universityof who have migrated to high-income countries seem to be
Ferrara,Ferrara,Italy more susceptible to overweight and obesity than their
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Tosellietal.GlobalizationandHealth (2016) 12:48 Page2of15
local counterparts [11]. In addition, overweight and Methods
obesity among immigrants appear to increase signifi- An extensive search for publications regarding body
cantly with time after migration, with rates approaching image perception and body size preferences in different
or overtaking those of the host population [12]. The ethnic groups from Africa, both in their countries of
process of “acculturation” leads to great changes in the origin and after their migration to Europe, was carried
“hosted” group, influencing diet and favouring the adop- out with Web-based search engines (PubMed and Psy-
tion ofobesogenic behaviours[13,14]. cINFO). Further searches were carried out in the search
However, this process is not uniform across all immi- engine Google Scholar. In particular, experimental or re-
grant groups and depends on ethnicity, gender, age at view articles published from January 2000 to November
the time ofmigration and period of residency in the new 2015 were screened by one author (NR) on the basis of
country [15, 16]. Since socio-cultural factors influence titles and abstracts. The inclusion of the full-text studies
the standards of desirable body weight within cultures, was then decided by all authors. A combination of
body image perception and body shape preferences are the following key words was used for literature identi-
culturally determined [5]. Furthermore, the ideals of fication: “immigration”, “immigrants”, “migrants”, “ref-
beauty may change as a result of immigration, leading ugees”, “ethnic minorities”, “body size preferences”,
immigrant people, especially women, to pursue ideals “body dissatisfaction”, “body image dissatisfaction”,
of thinness. Thus, in immigrants in which the beauty “body image”, “weight”, “weight perception”, “Europe”,
ideals determine an increased level of dissatisfaction, “Africans”, “North Africa”, “Central Africa”, “Southern
the risk for the development of nutritional disorders Africa”.
increases. In addition, the reference lists of all the selected arti-
As is the case of immigrants, the comparison of body cles were examined to find other non-indexed papers. In
image perception andbodyshape preference across pop- the selection, we took into consideration only cross-
ulations living in developing countries is complicated by sectional studies with samples of healthy subjects aged
the variety of environmental and cultural conditions. 15 years or more; longitudinal studies, case reports or
However, the diffusion and subsequent adoption of studiesofsubjectsinchildhoodorwithconcomitantdis-
Western ideals of thinness also in these countries can eases (i.e. diabetes) were excluded. In total, 730 records
affect changing body ideals of populations and thus their were found, both through database and references
lifestyle, diet and physical activity patterns. This is related searching, and 582 records were screened after dupli-
to ‘modernization’, media influence and recent rapid cates removal. A number of 36 full-text articles were
transitions of the economy and urbanization [17–19]. assessed for eligibility. After the omission of four studies
Nevertheless, it is not so clear if the recent prefer- on samples of too young or unhealthy subjects, three
ence for slimmer body size is only due to the studies without body image outcomes and other three
Westernization process. It is also probably related to studies not focused on African migrants in Europe or on
the idea that “plumpness” is revered only when it is a African residents, we included in this review 26 full-text
rare condition in a context of food scarcity, while it papers (Fig. 1). A summary sheet was developed for
loses desirability when overweight and obesity become extracting data including qualitative or quantitative
more prevalent [17]. methodologies to assess body image perception; sample
Body size and body image perception have mainly size; age, gender and nationality of participants; host
been investigated among immigrant groups in the USA country; body mass index (BMI); prevalence of over-
[11] and there are few data regarding migrants from weight and obesity (according to WHO cut-off points);
Africa toEurope. actual and ideal figures, level of dissatisfaction. As there
In this review we evaluate body dissatisfaction and are few articles available in the literature on this topic,
weight discrepancy among African immigrants in Europe we considered all of them, irrespective of sample size,
compared topeople still livinginAfrica, tracing a pattern foragenerallisting.
ofgeographicalvariationwherepossible. Most of the considered studies classified subjects into
Furthermore, specific aims included: to compare body weight categories by BMI. In some cases, height and
image perception in different population samples from weight were self-reported by the participants. There was
the same country; to compare body image perception wide variability among studies regarding the methods
between women and men; to consider how weight status used for the evaluation of body image perception (sil-
interactswith body image perception.The changing self- houettes developed by different authors; self-reported
perception among immigrants entails new challenges in questionnaires). In some studies, the Feel minus Ideal
Europe for the development of appropriate strategies Difference index (FID) [20] representing the discrepancy
aimed at ethnic groups more at risk for nutritional between the actual figure and the ideal figure, was re-
disorders. ported as the level of body image dissatisfaction, while
Tosellietal.GlobalizationandHealth (2016) 12:48 Page3of15
n
catio Records identsiefaierdch tihnrgough database Addthitriooungalh r oetchoerrd ss oiudrecnetsified
ntifi (n =714) (n =16)
e
d
I
Records after duplicates removed
(n =582)
g
n
ni
e
e
r
Sc Recordsscreened Non-relevant studies excluded
(n =582) (n =546)
y
gibilit Full-tefxotr aerltiigcilbeisl iatyssessed Full-text articles excluded (n =10)
Eli (n =36)
d
de Studies included in review
clu (n =26)
n
I
Fig.1Flowchartofstudiesforreview
in other studies the percentage of satisfaction, or of dis- in Europe (EU) or still in their own countries (Table 1).
satisfaction(desiretolose/gainweight), wasindicated. Six of them were carried out on body image and body
An evidence synthesis was carried out by weighted size ideals of Africans who had migrated to EU: three on
means and pooled standard deviation (SD) of FID and North African (NA) immigrants in the Netherlands [18,
BMI for African residents and immigrants in Europe to 22, 23], one on NA immigrants in Italy [24] and two on
checkfor anytrend.Onlyaggregationsofdatafromstud- Southern African (SA) immigrants in the UK [25, 26].
ies reporting both BMI and FID for samples≥50 subjects For the comparison with their peers still resident in
were considered for this purpose. According to the inclu- Africa, we utilized studies on Moroccans, Tunisians,
sion criteria, only female samples were considered. Linear Egyptians [17, 22–24, 27–33] and people living in
regression analysis and Spearman R coefficient were car- Zimbabwe and South Africa [2, 25, 26, 33–38]. Unfortu-
riedouttoestimatethegeographicalpatternsonthebasis nately,nostudywasfoundonCentralAfrican(CA)immi-
of the weighted means of BMI and FID, respectively. For grantsinEU.However,forcompletenessandcomparative
calculation purposes, the geographical areas were identi- purposes, we report data for residents in this area [4, 33,
fied by numbers 1 (Southern Africa),2 (Central Africa), 3 39–43] in order to have a full picture of body image per-
(North Africa) and 4 (African immigrants to Europe). ceptionanddissatisfactionthroughoutAfrica.
Comparisons of mean BMI values between independent
sampleswerecarriedoutbyStudent’st-test. StudiesonNorthAfricans
Theresultswerestatisticallysignificantwhenpwas<0.05. Nicolau et al. [22] focused on body size preference and
The statistical analysis was carried out using STATISTICA body size perception of Moroccan immigrants in the
forWindows,Version11.0(StatSoftItaliasrl,Padua,Italy). Netherlands (Amsterdam), reporting that most Moroccan
This review was carried out in accordance with the women wished to be thinner than they were (Table 1).
PRISMAguidelines [21]. The majority of Moroccan men were unaware of being
overweight. Another two studies [18, 23] found that
Results both female Moroccan immigrants in the Netherlands
Descriptionofincludedstudies and residents in Morocco expressed a preference for
Twenty-six studies were included in this review on the thin and normal body size. Many of them wished to
basis ofavailable data onsamples ofAfrican originliving lose weight.
Table1Studiesonbodyimageperception,bodysizeidealandweightdissatisfactioninAfricanimmigrantsandresidents T
o
s
Reference(year) Countryof Eventualhost Gender:number Age BMI Actualbody Idealbodyimage Dissatisfaction Methods elli
origin/ethnic country ofsubjects (years) imageand andFID e
t
sample self-perception a
l.
NORTHAFRICA Glo
b
Nicolauetal. Morocco Amsterdam, Male:56 18–30Mean: BMI:23.4±2.8 4.1±0.8 Self:4.2±0.5 Wanttobe 7silhouettesdeveloped aliz
(2008)[22] The 21.6±3.4 Ow:19.6% Ownsex:4.4±0.7, thinner:21.8% byColllins[49] a
Netherlands Ob:3.6% Oppositesex:4.2±1.1 tio
n
Female:104 18–30Mean: BMI:23.1±4.1 4.6±1.0 Self:3.9±0.7 Wanttobe 7silhouettesdeveloped an
d
23.4±4.2 Ow:24.8% Ownsex:4.1±0.6, thinner:57.6% byColllins[49] H
Ob:11.5% Oppositesex:4.2±0.6 ea
N(2i0c0o9la)u[2e3t];al. Morocco TAhmesterdam, Female:22 3240–.559Mean: Pfrroemfer2retdos4il.hTohueetmteosst Adelsoirteotfowloosmeen 7bysiClhoollulientste[4s9d]eveloped (20lth
1
Nicolauetal. Netherlands/ attractiveisnumber4. weight 6
(2012)[18] Second ) 1
2
generation :4
8
immigrants
Nicolauetal. Morocco Female:31 16–48Mean: Preferencesare Alotofwomen 7silhouettesdeveloped
(2009)[23] (AlHoceima, 25.7 betweensilhouettes desiretolose byColllins[49]
Rifregion) 2to4.Themost weight
attractiveisnumber4
Gualdi-Russo NorthAfrica Italy Female:105 Mean: BMI:28.4±4.8 5.9±2.1 3.9±1.6 FID:+1.99±2.31 9silhouettesdeveloped
etal.Inpress (Morocco, 36.3±7.8 byThompsonand
[24] Tunisiaand Grey[50]
Egypt)
Gualdi-Russo Morocco Female:124 Mean: BMI:26.4±5.2 5.9±2.0 4.4±1.4 FID:+1.50±1.83 9silhouettesdeveloped
etal.Inpress (Casablanca) 39.5±13.1 byThompsonand
[24] Grey[50]
Gualdi-Russo Tunisia(Tunis) Female:104 Mean: BMI:25.5±5.5 5.2±2.4 3.8±1.6 FID:+1.40±2.41 9silhouettesdeveloped
etal.Inpress 28.7±11.5 byThompsonand
[24] Grey[50]
Lahmametal. Morocco(High Male:165 ≥20 BMI:22.9±3.2 Falseperception: Gainweight: Self-administered
(2008)[30] Atlas)/ Uw:6.7% 48.5%,uw:46.7%, 40.0% questionnaire
Amazigh Nw:69.01% ow:1.8% Sat:59.4%
people Ow:21.8% Rightperception: Loseweight:
Ob:2.4% 51.5% 0.6%
Female:271 ≥20 BMI:25.0±4.2 Falseperception: Gainweight: Self-administered
Uw:3.7% 75.2%,uw:74.5% 53.1% questionnaire
Nw:50.2% ow:0.8%. Sat:45.8%
Ow:32.8% Rightperception: Loseweight:
Ob:13.3% 24.7% 1.1%
Rguibietal. Morocco Female:249 ≥15 BMI:26.1±5.6 Idealbodysize: Gainweight: 9silhouettesdeveloped
(2004)[27]; (Laayoun)/ Uw:2.7% 4.88±0.86Healthy 16.9% byLeandrisetal.[51] P
Rguibietal. Sahraoui Nw:47.1% bodysize:4.33±0.82 Sat:79.9% andself-administered ag
(2006)[28] women Ow:28.3% Loseweight: questionnaire e
4
Ob:21.9% 3.2% o
f
Ow-Ob:50.2% 1
5
Table1Studiesonbodyimageperception,bodysizeidealandweightdissatisfactioninAfricanimmigrantsandresidents(Continued) T
o
s
e
Jafrietal. Morocco Female:425 ≥18 BMI:29.9 Rightperception: Gainweight: Self-administered lli
(2013)[29] (Casablanca) Ow:36.2% 47%. 16.7% questionnaire et
Ob:47.4% Ow-ob al.
underestimate: G
lo
36.1% b
a
Ansarietal. Egypt(Assiut) Male:1504 Mean: Uw:7% Self-perception: Sat:64%dis:46%; BodyShapeQuestionnaire liza
(2013)[31]; 19.3±1.6 Nw:68% Uw:17% noBIC:74.4%, byCooperetal.[52]; tio
n
Ansarietal. Ow:19% Nw:60% mildBIC:17.3%, BIC:BodyImage a
(2014)[32] Ob:6% Ow:23% moderate/ Concern[52] nd
markedBIC:8.3% H
e
a
Female:1663 Mean: Uw:6% Self-perception: Sat:45%,dis:55%; BodyShapeQuestionnaire lth
18.6±1.2 Nw:62% Uw:11% noBIC:60%, byCooperetal.[52]; (2
Ow:25% Nw:56% mildBIC:24.2% BIC:BodyImage 0
1
Ob:7% Ow:14% mBICo:d1e5r.a8te%/marked Concern[52] 6) 12
:4
Tlilietal. Tunisia(Tunis) Female:203 18–52 BMI:26.1±5.6; Dis:62.1% 6photographicsilhouettes 8
(2008)[17] Uw:2.7% Loseweight: developedbyBush
Nw:47.1% 47.3% etal.[44]
Ow:28.3% Gainweight:
Ob:21.9% 14.8%
Ow-Ob:50.2% Ow-obwantto
loseweight:77.9%
Jaegeretal. Tunisia(Tunis) Maleand 19–23 BMI:22±3 3.6 2.8 FID:+0.8 10silhouettes
(2002)[33] Female:52 Mean: (self-administered
21.4±1.1 questionnaire)
CENTRALAFRICA
Benkeseretal. Ghana(Accra Female:2814 Mean: BMI:28.34±6.69 5.05±1.45 4.84±1.45 8silhouettesdeveloped
(2012)[39] Metropolitan 46.28±18.21 byStunkardetal.[53]
Area)
Frederick Ghana Male:22 Mean:24.5±8.0 Femaleidealbody: ContourDrawingRating
(2008)[4] (HO,rural) 4.4±1.4 Scale(ModifiedVersion;
9women'ssilhouettes
developedbyThompson
andGrey[50])
Female:26 Mean: 5.1±2.2 4.6±1.4 FID:+0.5±1.7 ContourDrawingRating
30.6±12.23 Scale(ModifiedVersion;
9women'ssilhouettes
developedbyThompson
andGrey[50])
P
a
g
e
5
o
f
1
5
Table1Studiesonbodyimageperception,bodysizeidealandweightdissatisfactioninAfricanimmigrantsandresidents(Continued) T
o
s
e
Siervoetal. Gambia Female:50 Mean: BMI:20.6±4.1 4.4±2.3 4.7±1.4 FID:−0.38±2.5 BodyImageAssessment lli
(2006)[40] (Bakau- 18.6±3.4 forObesity(18silhouettes et
Kanifing developedbyWilliamson al.
Municipal etal.[54]);8silhouettes G
lo
Area) developedbyStunkard b
a
[53] liz
a
Female:50 Mean:42.5±5.2 BMI:30.3±5.2 7.8±3.0 5.0±2.6 FID:+2.8±3.0 BodyImageAssessment tio
n
forObesity(18silhouettes a
developedbyWilliamson nd
etal.[54]);8silhouettes H
e
developedbyStunkard a
[53] lth
(2
Male:50 Mean:19.3±2.6 BMI:19.0±2.2 3.7±1.5 4.9±1.6 FID:−1.2±1.9 BodyImageAssessment 0
1
fdoervOelboepseitdyb(1y8Wsiillhliaomuestotnes 6) 12
etal.[54]);8silhouettes :48
developedbyStunkard
[53]
Male:50 Mean:42.0±5.3 BMI:22.3±3.9 5.4±2.6 5.5±2.1 FID:−0.08±1.8 BodyImageAssessment
forObesity(18silhouettes
developedbyWilliamson
etal.[54]);8silhouettes
developedbyStunkard
[53]
Holdsworthetal. Senegal Female:301 20–50 BMI:25.4±5.6 2.90 2.40 6photographicsilhouettes
(2004)[41] (Dakar) developedbyBush
etal.[44]
Okoroetal. Nigeria Male:220 Mean:42.6±17.2 BMI:21.7±3.7 4.30±0.99 4.72±1.06 9silhouettesdeveloped
(2014)[42] (Yoruba) byBeckeretal.[55]
Female:304 Mean:44.9±16.7 BMI:24.6±5.5 4.33±1.17 4.41±1.22 9silhouettesdeveloped
byBeckeretal.[55]
Jaegeretal. Gabon Maleand 19–23 BMI:20.8±2.8 4.4 4.2 FID:+0.2 10silhouettes
(2002)[33] (Libreville) Female:100 Mean:19.5±1.3 (self-administered
questionnaire)
Jaegeretal. Ghana Maleand 19–23 BMI:22.4±4.6 3.9 4.2 FID:−0.3 10silhouettes
(2002)[33] (Techiman) Female:58 Mean:19.3±1.3 (self-administered
questionnaire)
P
a
g
e
6
o
f
1
5
Table1Studiesonbodyimageperception,bodysizeidealandweightdissatisfactioninAfricanimmigrantsandresidents(Continued) T
o
s
e
Ettarhetal. Kenya Male:2669 ≥18 Uw:9.8% Self-perception: Idealbodysize: 18silhouettesdeveloped lli
(2013)[43] (Korogocho Mean:42 Nw:72.9% Uw:13.2% Uw:6.1%, byWilliamsonetal. et
andViwandani Ow:15.0% Nw:52.7% Nw:41.3% (1989)[54] al.
slumsof Ob:2.3% Ow:20.8% Ow:32.0% G
lo
Nairobi) Ob:13.4% Ob:20.6% b
a
Female:2265 ≥18 Uw:5.1% Self-perception: Idealbodysize: 18silhouettesdeveloped liza
Mean:42 Nw:51.5% Uw:14.2% Uw:7.1% byWilliamsonetal. tio
n
Ow:27.9% Nw:50.5% Nw:53.4% (1989)[54] a
Ob:15.5% Ow:22.2% Ow:24.8% nd
Ob:13.2% Ob:14.8% H
e
a
SOUTHERN lth
AFRICA (2
0
Swamietal. Zimbabwe UK(London) Female:138 18–49Mean: BMI:24.9±4.62 5.89±1.95 Self:4.39±1.35 BAS:+1.64±0.95; PhotographicFigure 16
(2012)[25] 26.6±6.7 Typicalfemale: FID:1.50±1.06 RatingScale ) 1
2
4.31±1.47 (10photographic :4
Mostattractive: silhouettes;Swami 8
3.66±1.19 etal.[56];
BAS:BodyAppreciation
Scale[57];
BMI(self-reported)
Swamietal. Zimbabwe Female:140 18–46Mean: BMI:24.81±4.61 4.54±1.91 Self:4.99±1.10 BAS:1.19±0.93; PhotographicFigure
(2012)[25] (Harare) 25.3±6.87 Typicalfemale: FID:−0.45±0.31 RatingScale
4.71±1.16 (10photographic
Mostattractive: silhouettes;Swami
5.17±1.07 etal.[56];
BAS:BodyAppreciation
Scale[57];
BMI(self-reported)
Tovéeetal. SouthAfrica UK Male:25; Mean:26.6±6.87 Femaleideal 50high-resolution
(2006)[26] (Mshwati Female:27 BMI:23.99 photographicimages
Mpolveni)/ (self-administered
Zulus questionnaire)
Tovéeetal. Britonsof UK/Second Male:34; Mean:24.4±4.53 Femaleideal 50high-resolution
(2006)[26] African generation Female:32 BMI:20.68 photographicimages
descent immigrants (self-administered
questionnaire)
Tovéeetal. SouthAfrica Male:19; Mean:25.6±4.47 Femaleideal 50high-resolution
(2006)[26] (Mshwati Female:16 BMI:26.52 photographicimages
Mpolveni)/ (self-administered
Zulus questionnaire)
McHizaetal. SouthAfrica Female:44 Mean:38.5±9.0 BMI:32.1±7.1 5.5±1.9 4.4±1.2 FID:1.1±+2.0 8silhouettesdeveloped
(2011)[34] (CapeTown, byStunkardetal.[53]
P
urbanarea) a
g
e
Swamietal. SouthAfrica Male:52; Mean:38.4±11.1 BMI:23.3±3.8 FemaleActual:4.5 FemaleIdeal:3.2 9silhouettesdeveloped 7
(2010)[2] (CapeTown, Female:48 byThompsonandGrey of
urbanarea) [50];BMI(self-reported) 15
Table1Studiesonbodyimageperception,bodysizeidealandweightdissatisfactioninAfricanimmigrantsandresidents(Continued) T
o
s
e
Swamietal. SouthAfrica Male:45; Mean:38.4±11.1 BMI:40.1±10.4 FemaleActual:6.0 FemaleIdeal:5.6 9silhouettesdeveloped lli
(2010)[2] (KwaZulu- Female:60 byThompsonandGrey et
Natal, [50];BMI(self-reported) al.
ruralarea) G
lo
b
Jaegeretal. SouthAfrica Maleand 19–23 BMI:23.9±4.3 4.3 2.6 FID:+1.7 10silhouettes a
(2002)[33] (CapeTown)/ Female:21 Mean:19.3±0.9 (self-administered liza
blackorigin questionnaire) tio
n
Peltezeretal. SouthAfrica Male:100 ≥18 BMI:21.1 BASS:3.95±0.70 TheMultidimensional an
d
(2012)[35] Body-SelfRelations
H
Questionnaire[58]; e
a
BASS:Body-Areas lth
SatisfactionScale. (2
0
Female:189 ≥18 BMI:23 BASS:3.91±0.73 TheMultidimensional 16
Body-SelfRelations ) 1
2
Questionnaire[58]; :4
BASS:Body-Areas 8
SatisfactionScale.
Puoaneetal. SouthAfrica Female:44 28–60 BMI:40.0±8.1 Self-perception: PreferredBMI:27 8silhouettesdeveloped
(2005)[36] (Khayelitsha, Mean:43.2±7.2 Uw:0% Uw:7% byStunkardetal.[53]
CapeTown)/ Nw:4.7% Nw:48%
blackorigin Ow:4.7% Ow/Ob:45%
Ob:90.7%
Faberetal. SouthAfrica Female:187 25–55 Uw:0%Nw: Sat:37%Dis:11% Self-administered
(2005)[37] (KwaZulu 28.9%Ow: Loseweight:8% questionnaire
Natal, 41.2% Ow-obwantto
ruralarea)/ Ob:29.9% loseweight:25%%
blackorigin
Senekaletal. SouthAfrica Female:180 Mean:20±4.4 BMI:22.6±3.8 Self-perception: BodyShape
(2001)[38] (ruraland Uw:25.7% Uw:6.1% Questionnaireby
urban Nw:52.5% Nw:67.0% Cooperetal.[52]
area)/black Ow:16.8% Ow:26.3%
origin Ob:5.0% Ob:0.6%
P
a
g
e
8
o
f
1
5
Tosellietal.GlobalizationandHealth (2016) 12:48 Page9of15
Research on NA immigrant women in Italy compared idealsinAfrica,weincludedfivestudiesonCAresidents
to Moroccan and Tunisian residents in their countries from different countries in Table 1. Three of them con-
[24] suggested that there were great similarities in the sidered Ghanaian women, reporting their preference for
ideal figure among NA immigrant women and Tunisian a slightly overweight or normal weight body shape and
residents while Moroccan residents tended to prefer a rather low level of FID [4, 33, 39]. The studies of
heavier ideal figure. Body image dissatisfaction was Frederick [4] and Benkeser et al. [39] found that, unlike
slightly (albeit not significantly) higher in NA immigrants normal weight Ghanaian men and women studied by
(FID: 1.99±2.31) than in NA residents (Moroccans FID: Jaeger et al. [33], there was a misperception of their
1.50±1.83;TunisiansFID:1.40±2.41). weight status since, despite their obesity status (accord-
As regards NA residents, misperception of body ing to BMI), they saw themselves as overweight [4, 39].
weight [30] and a preference for fat body size [27, 28] Siervo etal. [40] reported that Gambian men and women
were reported in three studies on Moroccan populations hadapreferenceforoverweightbodyshapes.Inparticular,
(Table 1). In particular, despite their high percentage of the oldest group of men and women wanted to be fatter.
normalweightandoverweight,Amazighmenandwomen Higher body dissatisfaction emerged only in the oldest
fromtheHighMoroccanAtlasunderestimatedtheirbody group of females, since they were aware of being obese
mass and wished to gain weight [30]. Moroccan Saharoui and wanted to be slightly slimmer. Senegalese women
women [27, 28] were generally satisfied with their body generally had a good perception of their body [41],show-
weight (almost 80 % satisfaction) in spite of the high ingonlyslightbodydissatisfactionbecausetheiridealwas
prevalence of overweight and obesity, with a small per- a little slimmer than their actual figure (slightly over-
centageofthemwishingtogainweightandanevenlower weight). Both male and female residents in Nigeria and
percentage wishing to lose weight. Moroccan women Gabon had, on average, low levels of FID and a normal
living in Casablanca [29] had a high percentage of over- BMI. They had good perception of their body and a pref-
weight and obesity, but most of them were not aware of erencefornormalbodysize[33,42].Moreover,themajor-
their body size: about half of the normal weight women ityofNairobislumresidentswereinnormalweightwitha
considered themselves too thin, while most of the over- tendency for men to overestimate their body size and for
weight and obese women considered themselves “normal women to underestimate it. Unlike men, women had low
weight”. Another study taking in consideration Moroccan levels of dissatisfactionwitha preferencefor normalbody
women living in Casablanca [24] reported that they were size[43].
aware of their body size but they are dissatisfied because In general, CA residents showed a preference for
they wanted to be thinner. Also Egyptian university stu- normal or slightly overweight body size, with a rather
dents were dissatisfied with their body weight, especially lowlevelofdissatisfaction with theirbody.
women [31, 32], which is consistent with the results ob-
tained by Gualdi et al. [24] and by Nicolau et al. [23] on StudiesonSouthernAfricans
NAresidents.InTunisia,Tlilietal.[17]reportedthatover Two studies of SA migrants in EU reported the results
halfofthewomeninaperi-urbanareaofTunisweredis- for Zulus and Zimbabweans who had migrated to the
satisfiedwiththeirbodyweight,withmostofthemprefer- UK [25, 26]. Both groups of immigrants wanted to lose
ring a lighter ideal body size and a smaller proportion weight and had general preferences for normal weight
wanting a heavier one. Moreover, the majority of over- body size. The female Zimbabwean immigrants in the
weight and obese women preferred a slimmer silhouette. UK [25] had a more negative body image perception
A normal body size was generally seen in the most posi- than their peers in Zimbabwe and their level of dissatis-
tive light, although some positive attributes were associ- faction was very high. They reported a greater weight
ated with overweight. An association between BMI or discrepancy because they saw themselves as larger than
body size preferences and age or level of education was they were to a greater degree than the Zimbabwean resi-
found in this study [17]. Consistently with these results, dents and they wanted a thinner body size. Instead the
the young Tunisian men and women examined by Jaeger Zimbabwean women living in Zimbabwe still held to an
et al. [33] and Tunisian women examined by Gualdi- ancestral idea of beauty, preferring a heavier body [25].
Russo et al. [24] were aware of their body size (normal In Tovée’s study [26], there were substantial differences
weight or slightly overweight), but they wished to be in the perceptionof female attractivenessin the different
thinner. groups of immigrants examined. The peak of attractive-
ness for Zulus resident in South Africa shifted to a
StudiesonCentralAfricans higher BMI, while for Zulus who moved to Britain
As already mentioned, no studies were found regarding (Female ideal BMI: 23.99) it seemed to be intermediate
CA immigrants in EU. However, in order to have a between those of their peers living in South Africa and
complete picture of body image perception and beauty BritonsofAfricandescent.
Tosellietal.GlobalizationandHealth (2016) 12:48 Page10of15
Five studies reported results for SA residents in urban status [44]. A recent study of South Africans [45] re-
(CapeTown) and rural (KwaZulu-Natal) areas [2, 33, 34, vealed that overweight women underestimate their
36, 37]. Both rural and urban groups wished to lose size and have an inappropriate perception of the risk
weight but the greatest body discrepancy was among the of the obesity. However, it was suggested that the
urban residents, who preferred normal weight figures in degree of preference for plumpness in non-Western
contrast to the rural inhabitants who preferred an societies has been exaggerated by Western studies
overweight body shape. Additionally, other two studies and that the fearoffatness is morelikelyto be expressed
[35–38] found the presence of body dissatisfaction in those who have had a greater exposure to Western
among South African residents in urban and rural areas, culture[46].
with normal weight men and women slightly overesti- During the complex immigration process, everything
mating theirbodyweight. that surrounds the person changes, including the diet,
social and family relationships, climate and culture [47].
Summaryandgeneralgeographicalpattern Factors such as acculturation, enculturation and socio-
In order to clarify the complex picture emerging from economic status (SES) have a strong effect on many pa-
the literature, this paragraph provides a summary rameters,includingweight statusandperceptionof body
(Table 2) of the main results examined in detail above. It size.
is organized around the main aims of this study focusing Thedata analysis inthe presentreview revealed awide
on weight status and body image perception in African variability of body weight/image perception in Africa:
residents and immigrants, compared to European popu- African residents generally showed a preference for
lations,whenpossible. heavier body size than their immigrant peers, but differ-
To acquire a synthetic overview of body imagepercep- ences in preferences were evident in relation to the area
tion in people with an African origin, we considered of residence, ethnicity, and social and cultural factors
resident and immigrant African samples, combining the even in the same population (i.e. Moroccans). Similarly,
data from several studies for the following geographical in a longitudinal study on changes in body composition
areas: Southern Africa, Central Africa, North Africa, EU of black urbanised South African women [48], the pres-
(immigrants from Africa). This analysis was possible ence oftwo different groups ofoverweight/obese women
only for females (Southern Africa: 140 Zimbabwes from was highlighted: one group, more aligned with Western
Swamietal.,2012[25];CentralAfrica:twoGambiansam- values, wished to be thinner and the other one, more
ples differently aged, 50 subjects each, from Siervo et al. aligned with the African values, was content with its
[40]; North Africa: 124 Moroccans and 104 Tunisians body size.
from Gualdi-Russo et al. [24]; EU: 138 Zimbabwe Some of the considered ethnic groups desired a
immigrantstoUKfromSwamietal.[25]and105NAim- thinner body image while others held to the idea that
migrants to Italy from Gualdi-Russo et al. [24]. Figure 2 higher body weight is a positive factor. This puts the
shows the linear relationship between BMI and the latter groups at higher risk of obesity and the main-
geographical areas (statistically significant). The FID also tenance of it over time. A high level of body size
increased significantly with the geographical gradient dissatisfaction can lead to eating disorders and poor
(SpearmanR=1).ThemeanincreaseinBMIwas0.53kg/ eating habits.
m2perunitincreaseingeographicalarea(Fig.2). Hence this review shows that there is a different
AdifferenttrendemergedforNorthAfricaandSouthern awareness of weight among the examined groups,
Africa (Fig. 3) when immigrants were compared with with different consequences for health and well-
residents in the country of origin: SA immigrant women being.
had higher values of FID than SA residents, but similar We found in the analysis of general geographical pat-
BMIvalues;NAimmigrantwomenhadsignificantlyhigher tern that the body image dissatisfaction (FID) increased
values of BMI (p<0.05) than NA residents, but similar with the increase in BMI from south to north, reaching
valuesofFID. thehighestvaluesinAfricanimmigrantsinEU,who also
had the highest values of BMI (on average, above the
Discussion cut-off of overweight). These results indicate different
In many non-Western and low-income countries, body beauty ideals of African populations and thus different
fat is seen as an indicator of health and prosperity since degrees of satisfaction in the perception of their body
only high-status individuals have the possibility to put image from Southern Africa to North Africa and, to a
on body weight because of the scarcity of food. Con- greaterdegree,with the migrationto Europe.In addition
versely in many industrialized countries with a food to differences in ideals, there were changes in weight
abundance, fatness is associated with poverty and poor status, which increased from Southern Africa to North
health [17] while slimness is a sign of high economic Africa andtoEU.