Adolescents' perspectives on socio-cultural influences on overweight and obesity in African countries: a systematic scoping review of qualitative studies.

INTRODUCTION: Adolescent obesity is a global public health concern, with increasing prevalence rates in many African countries. Studies have highlighted diverse social and cultural influences on weight, but there is uncertainty about how adolescents in Africa perceive and experience these influences. This review aims to describe adolescents' perspectives on how cultural beliefs and norms, peers, family, and media influence weight-related behaviours, body weight, and experiences of weight stigma in African countries.

METHODS: We systematically searched Scopus, PubMed, Embase, Web of Science, CINAHL, PsycINFO and SocINDEX for qualitative studies on socio-cultural determinants of adolescents' overweight and obesity in African countries. Study quality was assessed using the Critical Appraisal Skills Programme (CASP) for qualitative research. Using a narrative synthesis approach guided by socio-cultural theory, we summarised and interpreted findings across studies to describe adolescents' perspectives on how cultural beliefs, peers, family, and media influence weight and experiences of weight stigma.

RESULTS: Of 1,410 articles identified, 17 met the inclusion criteria from eight African countries. Eight studies were conducted in South Africa, while the remaining studies were conducted in Benin, Botswana, Cameroon, Ethiopia, Gambia, Kenya, and Uganda, with no eligible studies identified from Northern or Central Africa. Synthesis of these studies revealed that adolescents perceived peers and parents/families as important influences on their food choices, in the direction of unhealthy options, and on their physical activity levels. Adolescents also described media as shaping these behaviours and perceptions of body image. Several studies reported that overweight or obesity was associated with wealth and health, while thinness was associated with disease or illness. Weight stigma was reported among adolescents irrespective of their weight status.

CONCLUSION: Adolescents from eight African countries perceived peers, family members, and media as important socio-cultural influences on their weight-related behaviours, perceptions of body weight, and experiences of weight stigma. Interventions to prevent and manage adolescent obesity may be more effective and better received if these perceived socio-cultural influences are integrated into the design.