Psychological, Sociocultural, and Behavioural Determinants of Obesity-Related Outcomes among Women in Sub-Saharan Africa: A Systematic Review and Meta-analysis

Psychological, Sociocultural, and Behavioural Determinants of Obesity-Related Outcomes among Women in Sub-Saharan Africa: A Systematic Review and Meta-analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review Psychological, Sociocultural, and Behavioural Determinants of Obesity-Related Outcomes among Women in Sub-Saharan Africa: A Systematic Review and Meta-analysis Bruno Basil, Lawrence Ejike Ugwu, Uzoamaka Francisca Ugwuoke, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8555696/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background Obesity among women in Sub-Saharan Africa (SSA) has increased rapidly alongside persistent undernutrition, reflecting a complex double burden of disease modulated by sociocultural change, urbanisation, and shifting gender norms. Although biomedical drivers are well documented, less is known about how psychological, sociocultural, and behavioural determinants jointly influence obesity-related outcomes among women in SSA. Methods This systematic review and meta-analysis was preregistered (PROSPERO CRD42024497617) following PRISMA guidelines. Quantitative observational and experimental studies published between 2000 and 2025 were identified from four major databases. Eligible studies examined associations between psychological, sociocultural, or behavioural determinants and obesity-related outcomes among women in SSA. Outcomes were synthesised across four pathways: (A) overweight/obesity and body image/perception outcomes, (B) eating/disordered eating outcomes, (C) anthropometric or metabolic outcomes, and (D) mental health or functional outcomes. Random-effects meta-analyses were conducted using REML with Hartung–Knapp adjustment. Results Sixty-six studies from 23 countries met inclusion criteria, of which 28 contributed poolable estimates. Overweight or obesity was strongly associated with adverse body image outcomes (OR = 7.17, 95% CI 1.51–34.10; I² = 71%), though prediction intervals were wide, indicating substantial contextual variability. Psychosocial and sociocultural stressors were associated with increased odds of maladaptive eating behaviours (OR = 2.63, 95% CI 1.06–6.51). Determinants predicting anthropometric or metabolic outcomes showed heterogeneous but directionally positive associations (OR = 1.92, 95% CI 1.06–3.46; I² = 92.8%), with behavioural factors demonstrating the greatest consistency (pooled r = 0.21, 95% CI 0.08–0.33). In contrast, no robust association was observed between obesity and mental health or functional outcomes (OR = 1.61, 95% CI 0.60–4.31), consistent with context-specific buffering of psychosocial distress. Conclusions Obesity-related outcomes among women in SSA arise from the combined influence of psychological, sociocultural, and behavioural pathways, with substantial variation across contexts. Although excess adiposity is increasingly linked to body dissatisfaction and maladaptive eating, it remains weakly associated with mental health outcomes, supporting the persistence of culturally specific protective norms. Interventions must therefore move beyond universal models and be grounded in local social meanings of body size and health. Body Mass Index Obesity Women Sub-Saharan Africa Body Image Mental Health Eating Behaviour Social Norms. Full Text Additional Declarations No competing interests reported. Supplementary Files PsychosocialDeterminantsofObesitySupplementaryMaterial.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 24 Jan, 2026 Editor invited by journal 13 Jan, 2026 Editor assigned by journal 09 Jan, 2026 Submission checks completed at journal 09 Jan, 2026 First submitted to journal 08 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8555696","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":575225190,"identity":"ea908fc9-1f5e-492b-814e-62ceeccc12cf","order_by":0,"name":"Bruno 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Meta-analysis","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Body Mass Index, Obesity, Women, Sub-Saharan Africa, Body Image, Mental Health, Eating Behaviour, Social Norms.","lastPublishedDoi":"10.21203/rs.3.rs-8555696/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8555696/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eObesity among women in Sub-Saharan Africa (SSA) has increased rapidly alongside persistent undernutrition, reflecting a complex double burden of disease modulated by sociocultural change, urbanisation, and shifting gender norms. Although biomedical drivers are well documented, less is known about how psychological, sociocultural, and behavioural determinants jointly influence obesity-related outcomes among women in SSA.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis systematic review and meta-analysis was preregistered (PROSPERO CRD42024497617) following PRISMA guidelines. Quantitative observational and experimental studies published between 2000 and 2025 were identified from four major databases. Eligible studies examined associations between psychological, sociocultural, or behavioural determinants and obesity-related outcomes among women in SSA. Outcomes were synthesised across four pathways: (A) overweight/obesity and body image/perception outcomes, (B) eating/disordered eating outcomes, (C) anthropometric or metabolic outcomes, and (D) mental health or functional outcomes. Random-effects meta-analyses were conducted using REML with Hartung–Knapp adjustment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSixty-six studies from 23 countries met inclusion criteria, of which 28 contributed poolable estimates. Overweight or obesity was strongly associated with adverse body image outcomes (OR = 7.17, 95% CI 1.51–34.10; I² = 71%), though prediction intervals were wide, indicating substantial contextual variability. Psychosocial and sociocultural stressors were associated with increased odds of maladaptive eating behaviours (OR = 2.63, 95% CI 1.06–6.51). Determinants predicting anthropometric or metabolic outcomes showed heterogeneous but directionally positive associations (OR = 1.92, 95% CI 1.06–3.46; I² = 92.8%), with behavioural factors demonstrating the greatest consistency (pooled r = 0.21, 95% CI 0.08–0.33). In contrast, no robust association was observed between obesity and mental health or functional outcomes (OR = 1.61, 95% CI 0.60–4.31), consistent with context-specific buffering of psychosocial distress.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eObesity-related outcomes among women in SSA arise from the combined influence of psychological, sociocultural, and behavioural pathways, with substantial variation across contexts. Although excess adiposity is increasingly linked to body dissatisfaction and maladaptive eating, it remains weakly associated with mental health outcomes, supporting the persistence of culturally specific protective norms. Interventions must therefore move beyond universal models and be grounded in local social meanings of body size and health.\u003c/p\u003e","manuscriptTitle":"Psychological, Sociocultural, and Behavioural Determinants of Obesity-Related Outcomes among Women in Sub-Saharan Africa: A Systematic Review and Meta-analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-16 18:36:23","doi":"10.21203/rs.3.rs-8555696/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-01-25T04:19:17+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-13T18:26:58+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-09T09:22:21+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-09T09:19:37+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Women's Health","date":"2026-01-09T01:18:17+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9685c7cf-3f7d-4912-8e76-f8727330cad3","owner":[],"postedDate":"January 16th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-25T04:23:23+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-16 18:36:23","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8555696","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8555696","identity":"rs-8555696","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}