Background
Theoretical framework
Methods
Study design and setting
Sampling procedure
Data collection
Focus groups
Data coding and analyses
Validity of the study
Ethics statement
Results
Participants groups | Number of participants per group | Number of Sessions | BMI (Range) | Age range (Years) | Weight range (Kg) |
---|---|---|---|---|---|
Men | |||||
Obesea
| 8 | 1 | 36.5–62.9 | 42 to 70 | 77.4–96.6 |
Overweightb
| 10 | 1 | 25.5–31.0 | 36 to 64 | 65.3–89.2 |
Optimal weightc
| 10 &14 | 2 | 18.3–25.0 | 35 to 63 | 45.6–62.3 |
Women | |||||
Obesea d
| 8 & 11 | 2 | 30.8–58.9 | 39 to 68 | 89.5–160.7 |
Overweightb
| 9 | 1 | 25.5–30.0 | 48 to 70 | 85.5–107.8 |
Optimal weightc
| 8 | 1 | 18.0–24.8 | 35 to 60 | 55.8–79.0 |
Total | 78 | 8 |
Themes | Obese | Overweight | Normal |
---|---|---|---|
Causes of overweight | |||
Men | • Unhealthy diet/over-eating • Physical inactivity • Socio-economics status • Genetic make-up | • Unhealthy diet, • Lack of physical exercises • Fatness is culturally desirable | • Poor eating habits (junk food) • Cultural events |
Women | • Over consumption of food • Eating fatty, junk and sugary foods • Inaccessibility to vegetables and fruits • Stress • Obesity comes with age • Cultural influences | • Stress • Over consumption of food • Eating fatty, junk and sugary foods • Lack of vegetables and fruits • Genetic make-up | • Poor eating habits • Unavailability of organic food • Genetic make-up • Cultural influences |
Attitudes towards thinness and overweight | |||
Men | • Thinness attributed to sickness or disease • Overweight is culturally acceptable • Overweight associated with happiness • Excessive body fat is not desirable | • Fatness attributed to laziness, tiredness and drowsiness • Much fat can be ‘unhealthy’ • Overweight is culturally acceptable • Overweight associated with happiness | • Being skinny makes you smart, healthy and good shape • Overweight socially acceptable • Overweight associated with happiness and respect |
Women | • Overweight denotes good health, dignity, happiness and respect • Thinness indicates sickness, stress, unhappiness • Associates being thin to beauty and attractive to men | • Overweight is considered ‘normal’ weight/body size • Overweight associated with happiness; Obesity not a problem if inherited • Thin people are stigmatized | • Fatness means happiness • Too much ‘fatness’ can cause sicknesses |
Body size perceptions | |||
Men | • Unhappy with current weight/size • Uncomfortable with gaining more weight | • Satisfy with body weight • Others desire slim body sizes | • Prefer slim body size • Others desire little increase in weight |
• Larger silhouettes size 7–14 (overweight/obese categories) chosen as ideal normal size for a woman, and smaller silhouettes size 4–9 (normal/overweight) as ideal for a man | |||
• Underestimate body size | • Underestimate body size | • Accurately estimate body size | |
Women | • Perceive current size as ‘normal’ size • Happy with current body weight/size • Grossly obese desired reduced weight—if reported personal gains of weight loss | • Desire larger body size/weight gain • Desire no weight gain—if previously suffered chronic disease. | • Dissatisfy with current body size • Desire to be overweight |
• Women chose silhouettes size 13–15 (obese) as ideal for a woman and less than size 13 (overweight or normal) for a man • Obesity is associated with women; and ‘normal’ weight associated with men | |||
Susceptibility to obesity | |||
Men | Not applicablea
| • Vulnerable if happy and wealthy | • Susceptible to overweight if indulge in overconsumption of food |
Women | Not applicablea
| • Vulnerable to obesity if indulge in unhealthy eating | • Believe of not being susceptible |
Perceived obesity risk and threat of cardiovascular diseases | |||
Men | • Perceived obesity as threat to health • Obesity leads to chronic conditions—high blood pressure, stroke, diabetes, cancer, and arthritis | • Chronic non-communicable disease, physical impairment, and regular pains • Obesity can lead to heart attack, • Being skinny equated to less or no health problems | • At risk of cardiovascular diseases • Obesity is not good at old age • Being fat leads to hypertension, heart attack, too much sleep |
Women | • Obesity is attributed to laziness, sluggishness, stigma, and tiredness, difficulty getting size of clothing to buy • Associate obesity to diabetes and hypertension | • Low perceptions of threat • Excessive weight could cause chronic illnesses, and inactivity | • Attributes diabetes, stroke, hypertension and heart attack to overweight |
Willingness to lose weight | |||
Men | • Indicated intention to lose weight | • Desire for personal weight loss, or maintain current body size | • Currently undertakes job-related physical activities to maintain weight |
Women | • Willing to lose weight in order to reduce health risk | • Intention to gain weight/maintain current weight | • Strong intention to gain more weight |
Perceived causes of overweight
Too much fat is caused by what we eat—like junk food, especially chips and fish, fatty meat, and all those things that are fried. [N-Man]We eat starch and starch—for example we eat rice and potatoes at the same time. These are the things that add fat to our bodies. The other thing is ‘too much oil’—which is not good for our health. [N-Woman]
We have big bones… Overweight is something we inherited; all of us in the family are like this. I do also understand that what we eat also plays a vital role. [O-Woman]Overweight or skinny—we were created by God to be the way we are. I will never be fat because I have taken after my father as you can see that he is not fat. [N-Woman]
According to our values and culture, it is important for a woman to have a large body. It makes you to be respected. [O-Woman]
Attitudes towards thinness and overweight
If you are skinny you are not healthy. When you are thin, people think you have HIV or TB. [N-Man]Being thin is not good. When my child is losing weight, I would ask her about the weight that is dropping. [OO-Woman]Sometimes it could be stress, or worry… Maybe he/she got lots of stress, and too much of stress makes him/her lose weight, and also not eating healthily. [O-Woman]
Being thin is good because when you are too fat you are not healthy. What I would like is to ‘drop’ (i.e. reduce) my weight… The health of a person that is thin is not the same as the one that is fat. A thin person is smart and attractive. [O-Woman]
If a person is fat (overweight) we usually assume she is happy and has (lot of) money. It’s evident that he/she eats nicely, and a lot, and not having problems…[OO-Woman]Being fat is fine, but do not exceed the ‘normal fatness’, because you will be affected by diseases. [N-Woman].
A woman these days for her health’s sake should not be overweight… In the olden days most men used to say that they are dignified when the woman is overweight. That is why we decided to be overweight and ate everything not knowing that we are putting our health in danger. However, I believe things are changing now…” [OO-Woman]
‘We used to follow culture, (and) it was a good thing to be overweight—as it was a sign of respect or happiness’. [N-Man]
Body size perceptions
I am happy with the body I have now…It is lighter than before; (when) I was overweight. [O-Woman]I don’t want it to be fatter than this because now that I have lost some weight, I can feel that my body is light… [OO-Woman]
“This is not my ‘normal’ weight. I would be happy and I will look more attractive, if I can gain more weight. [N-Woman]I’m happy with the body size I have now. I don’t wish to be overweight … [N-Man]
As for me, a large body size is not important. Someone who has a right body size is alright—I mean medium size and not a large size. [O-Woman]“I would like my body to be ‘slimmer’ than what it is now, because I am sick and unhappy”. [O-Man]I would love to gain weight because with the stress (I have), it would be better for me. [O-Woman]
I don’t want to be fatter (than this), because now that I have lost some weight, I can feel that my body is light and those parts that were painful are much better. [O-Woman]
Perceptions of risk and threat of obesity and cardiovascular disease
I don’t think I will ever be fat any more. I was once fat (or obese) then I suffered diabetes. [N-Man]I will not be happy if I can gain weight because I’m diabetic. [OO-Woman]
I would like my body not to be skinny and at the same time not to be overweight (i.e. obese) but be a ‘normal’ weight. Because when you are overweight you can easily have high blood pressure and when you are skinny you can easily be attacked by TB and other diseases. [O-Woman]
You will have many sicknesses when you are overweight (overweight), even those (sicknesses) that you were not suffering from—because of the large body size. [OO-Man]It is people who are fatter than my size that are at risk of disease—because they can have high blood pressure or heart attack. …they are eating what they are not supposed to eat. [OO-Woman]
My relative who is very fat like me had serious health problems—hypertension, and arthritis. [O-Woman]No, I don’t think I will ever be very fat again because I noticed that I became sick when I was ‘overweight’ (referring to obesity). [OO-Woman]When you are fat (obese), it is easy for you to have heart problems, hypertension, stroke and high cholesterol. I am currently sick of hypertension. [OO-Man]I was once fat (obese), then I suffered diabetes. I don’t think I will ever be fat any more. You can see an ‘overweight’ person walking proudly, but (you don’t know) that (her) body is painful (i.e. aching). I do know it from my experience”. [OO-Woman]
Willingness to lose excess body weight
It is good to do some exercises in the morning before you eat. I do run for 30 min or an hour in the morning. … But you need to do that every day so that you can reduce your weight. [OO-Man]I would like to gain more weight… As I have mentioned before, I was weighing 63 kg before I got sick, today I can see that I weigh 49 kg. This weight is not making me happy at all. I would like my weight to be at least 60 Kg. [OO-Woman]It is very important to try and lose weight; do exercise… and check what you eat. Now, I do not sleep immediately after food, I do house chores/work. I have also cut down on my fat meat intake. [O-Woman]I do not want to be overweight (referring to obese) any more. I don’t know how I can get rid of it. [O-Man]
Actions taken to lose weight | |||
---|---|---|---|
Group | Obese | Overweight | Normal |
Men | • Reduce intake of starchy food, and fatty meat • Moderate exercises | • Consider moderate physical exercise, brisk walk • Reduce consumption of unhealthy food | • Involved in active work-related physical activity • Some exercises—walk to shops, bust/train stations |
Women | • Mild physical exercise, street walk and work, house chores • Voiding sleep immediately after meals • Reduce food portion taken | • Walking, smoking, and use of slimming medications • Avoidance of fatty/junk food | • Stop sleeping after meal, • Vigorous exercise/work • Physical exercise |
Both | • Self-weighting at home is uncommon | • Visit clinic for check-up, not in connection with weight check | • No self-weighing at home • Never visit clinic for weight check. |
Exercise at the gym is one way to reduce fat. Smoking and slimming can (also) help you. [OO-Woman]
I also saw that I have lost weight looking from my clothing size. I used to wear size 44, but now I am wearing size 38—I have lost weight. [O-Woman]
But we don’t have enough facilities to train. There are no facilities for you to go and exercise so that you can get rid of all that fat—like the white people do. [O-Man]…some women run in the street as if someone is chasing them. I don’t like to chase the air, though chasing that air, I’m told can help make you fit. [OO-Woman]