title: Perceptions of body size, obesity threat and the willingness to lose weight among black South African adults: a qualitative study.
abstract: The obesity epidemic is associated with rising rates of cardiovascular disease (CVD) among adults, particularly in countries undergoing rapid urbanisation and nutrition transition. This study explored the perceptions of body size, obesity risk awareness, and the willingness to lose weight among adults in a resource-limited urban community to inform appropriate community-based interventions for the prevention of obesity.
  
  
  
  This is a descriptive qualitative study. Semi-structured focus group discussions were conducted with purposively selected black men and women aged 35-70 years living in an urban South African township. Weight and height measurements were taken, and the participants were classified into optimal weight, overweight and obese groups based on their body mass index (Kg/m(2)). Participants were asked to discuss on perceived obesity threat and risk of cardiovascular disease. Information on body image perceptions and the willingness to lose excess body weight were also discussed. Discussions were conducted in the local language (isiXhosa), transcribed and translated into English. Data was analysed using the thematic analysis approach.
  
  
  
  Participants generally believed that obesity could lead to health conditions such as heart attack, stroke, diabetes, and hypertension. However, severity of obesity was perceived differently in the groups. Men in all groups and women in the obese and optimal weight groups perceived obesity to be a serious threat to their health, whereas the overweight women did not. Obese participants who had experienced chronic disease conditions indicated strong perceptions of risk of obesity and cardiovascular disease. Obese participants, particularly men, expressed willingness to lose weight, compared to the men and women who were overweight. The belief that overweight is 'normal' and not a disease, subjective norms, and inaccessibility to physical activity facilities, negatively influenced participants' readiness to lose weight.
  
  
  
  Low perception of threat of obesity to health particularly among overweight women in this community indicates a considerable challenge to obesity control. Community health education and promotion programmes that increase awareness about the risk associated with overweight, and improve the motivation for physical activity and maintenance of optimal body weight are needed.
authors.affiliation: School of Public Health, University of the Western Cape, Bellville, 7535, South Africa. kufreokop@gmail.com.
authors.forename: Kufre Joseph
authors.initials: KJ
authors.lastname: Okop
authors.affiliation: School of Public Health, University of the Western Cape, Bellville, 7535, South Africa.
authors.forename: Ferdinand C
authors.initials: FC
authors.lastname: Mukumbang
authors.affiliation: School of Public Health, University of the Western Cape, Bellville, 7535, South Africa.
authors.forename: Thubelihle
authors.initials: T
authors.lastname: Mathole
authors.affiliation: Division of Endocrinology and Diabetes, Department of Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Naomi
authors.initials: N
authors.lastname: Levitt
authors.affiliation: School of Public Health, University of the Western Cape, Bellville, 7535, South Africa.
authors.forename: Thandi
authors.initials: T
authors.lastname: Puoane
mesh_terms: D000328:Adult; D000368:Aged; D044383:Black People; D001828:Body Image; D015992:Body Mass Index; D049628:Body Size; D002318:Cardiovascular Diseases / Q000209:etiology; D015444:Exercise; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009765:Obesity / Q000150:complications / Q000208:ethnology / Q000517:prevention & control / Q000523:psychology*; D050177:Overweight; D036301:Qualitative Research; D012016:Reference Values; D012111:Residence Characteristics; D012858:Size Perception; D013019:South Africa; D015431:Weight Loss
keywords: Body image; Intention; Obesity; Overweight; Physical Activity; Risk perception; South Africa; Weight gain; Weight loss; Willingness