South Africa (SA) is undergoing a rapid epidemiological
transition and has the highest prevalence of obesity in sub-
Saharan Africa (SSA), with black women being the most
affected (obesity prevalence 31.8%). Although genetic factors
are important, socio-cultural, environmental and behavioural
factors, as well as the influence of socio-economic status,
more likely explain the high prevalence of obesity in black
SA women. This review examines these determinants in black
SA women, and compares them to their white counterparts,
black SA men, and where appropriate, to women from SSA.
Specifically this review focuses on environmental factors
influencing obesity, the influence of urbanisation, as well
as the interaction with socio-cultural and socio-economic
factors. In addition, the role of maternal and early life factors
and cultural aspects relating to body image are discussed.
This information can be used to guide public health interventions
aimed at reducing obesity in black SA women.