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

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.