Document Type : Original Article
Authors
Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non‑communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
BACKGROUND: Over the last decades, childhood obesity has become a worldwide epidemic health
problem. Identifying the barriers to a healthy lifestyle among children and adolescents is necessary for
further effective intervention to prevent overweight and obesity. This study aims to assess the barriers
to healthy lifestyle habits, including physical activity (PA), eating, and sleep among adolescents from
the perspective of their parents.
METHODS: In this cross‑sectional study, the parents of obese and overweight middle school students
were enrolled. Data were collected using a questionnaire about barriers of healthy nutrition and PA.
RESULTS: Overall, 172 parents completed the questionnaire. Lack of access to affordable facilities
for PA, lack of access to the appropriate place for PA, and lack of sufficient information on how to
do or increase PA were the main barriers to PA. The barrier factors for healthy eating were media
advertisement of unhealthy foods, lack of motivation to use healthy nutrition, and lack of adequate
information about healthy eating. Regarding poor sleep, lack of knowledge about the benefits of sleep,
prolonged watching television, and late sleep time of family members were reported as the main
barriers. These findings were not statistically different according to the family socioeconomic level.
CONCLUSION: Our findings propose that for improving healthy lifestyle in obese children and
adolescents, access to facilities, and appropriate places for PA should be provided at the community
level. Moreover, training parents and students about healthy lifestyle behaviors is necessary for
families of all socioeconomic levels.
Keywords
1. Rivera‑Vega MY, Flint A, Winger DG, Libman I, Arslanian S.
Obesity and youth diabetes: Distinguishing characteristics
between islet cell antibody positive vs. negative patients over
time. Pediatr Diabetes 2015;16:375‑81.
2. Bacha F, Edmundowicz D, Sutton‑Tyrell K, Lee S, Tfayli H,
Arslanian SA, et al. Coronary artery calcification in obese youth:
What are the phenotypic and metabolic determinants? Diabetes
Care 2014;37:2632‑9.
3. Zabinski MF, Saelens BE, Stein RI, Hayden‑Wade HA, Wilfley DE.
Overweight children’s barriers to and support for physical
activity. Obes Res 2003;11:238‑46.
4. Huybrechts I, De Bourdeaudhuij I, De Henauw S. Environmental
factors: Opportunities and barriers for physical activity, and
healthy eating among children and adolescents. Verh K Acad
Geneeskd Belg 2010;72:277‑93.
5. U.S. Department of Health and Human Services. The Surgeon
General’s Call to Action to Prevent and Decrease Overweight and
Obesity. Rockville, MD, Washington: U.S. Department of Health
and Human Services, Public Health Service, Office of the Surgeon
General, U.S. GPO; 2001.
6. Dunton GF, Schneider M. Perceived barriers to walking for
physical activity. Prev Chronic Dis 2006;3:A116.
7. Sallis JF, Prochaska JJ, Taylor WC. A review of correlates of
physical activity of children and adolescents. Med Sci Sports
Exerc 2000;32:963‑75.
8. NormanGJ, SchmidBA, Sallis JF, Calfas KJ, Patrick K. Psychosocial
and environmental correlates of adolescent sedentary behaviors.
Pediatrics 2005;116:908‑16.
9. Jacobson Vann JC, Finkle J, Ammerman A, Wegner S, Skinner AC,
Benjamin JT, et al. Use of a tool to determine perceived barriers to
children’s healthy eating and physical activity and relationships
to health behaviors. J Pediatr Nurs 2011;26:404‑15.
10. Grow HM, Hsu C, Liu LL, Briner L, Jessen‑Fiddick T, Lozano P,
et al. Understanding family motivations and barriers to
participation in community‑based programs for overweight
youth: One program model does not fit all. J Public Health Manag
Pract 2013;19:E1‑10.
11. JeffersonA. Breaking down barriers –Examining health‑promoting
behavior in the family. Kellogg’s Family Health Study 2005. Nutr
Bull 2006;31:60‑4.
12. Bahreynian M, Motlagh ME, Qorbani M, Heshmat R, Ardalan G,
Kelishadi R, et al. Prevalence of growth disorders in a nationally
representative sample of Iranian adolescents according to
socioeconomic status: The CASPIAN‑III study. Pediatr Neonatol
2015;56:242‑7.
13. Ataie‑Jafari A, Heshmat R, Kelishadi R, Ardalan G,
Mahmoudarabi M, Rezapoor A, et al. Generalized or abdominal
obesity: Which one better identifies cardiometabolic risk factors
among children and adolescents? The CASPIAN III study. J Trop
Pediatr 2014;60:377‑85.
14. Rahmanian M, Kelishadi R, Qorbani M, Motlagh ME, Shafiee G,
Aminaee T, et al. Dual burden of body weight among Iranian
children and adolescents in 2003 and 2010: The CASPIAN‑III
study. Arch Med Sci 2014;10:96‑103.
15. Kelishadi R, Ardalan G, Qorbani M, Ataie‑Jafari A, Bahreynian M,
Taslimi M, et al. Methodology and early findings of the fourth
survey of childhood and adolescence surveillance and prevention
of adult non‑communicable disease in Iran: The CASPIAN‑IV
study. Int J Prev Med 2013;4:1451‑60.
16. Kelishadi R, Motlagh ME, Roomizadeh P, Abtahi SH, Qorbani M,
Taslimi M, et al. First report on path analysis for cardiometabolic
components in a nationally representative sample of pediatric
population in the Middle East and North Africa (MENA): The
CASPIAN‑III study. Ann Nutr Metab 2013;62:257‑65.
17. Mahjoub S, Haji AhmadiM, FaramarziM, Ghorbani H, MoazeziZ.
The prevalence of metabolic syndrome according to the Iranian
committee of obesity and ATP III criteria in Babol, North of Iran.
Caspian J Intern Med 2012;3:410‑6.
18. Kelishadi R, Ardalan G, Gheiratmand R, Majdzadeh R,
Hosseini M, Gouya MM, et al. Thinness, overweight and obesity in
a national sample of Iranian children and adolescents: CASPIAN
study. Child Care Health Dev 2008;34:44‑54.
19. de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C,
Siekmann J, et al. Development of a WHO growth reference for
school‑aged children and adolescents. Bull World Health Organ
2007;85:660‑7.
20. Andajani‑Sutjahjo S, Ball K, Warren N, Inglis V, Crawford D.
Perceived personal, social and environmental barriers to weight
maintenance among young women: A community survey. Int J
Behav Nutr Phys Act 2004;1:15.
21. Musaiger AO, Al‑Mannai M, Tayyem R, Al‑Lalla O, Ali EY,
Kalam F, et al. Perceived barriers to healthy eating and
physical activity among adolescents in seven Arab countries:
A cross‑cultural study. ScientificWorldJournal 2013;2013:232164.
22. McCarron DA, Richartz N, Brigham S, White MK, Klein SP,
Kessel SS, et al. Community‑based priorities for improving
nutrition and physical activity in childhood. Pediatrics
2010;126 Suppl 2:S73‑89.
23. Huybrechts I, De Bourdeaudhuij I, De Henauw S. Environmental
factors: Opportunities and barriers for physical activity, and
healthy eating among children and adolescents. Verh K Acad
Geneeskd Belg 2009;72:277‑93.
24. Kelleher E, Harrington JM, Shiely F, Perry IJ, McHugh SM. Barriers
and facilitators to the implementation of a community‑based,
multidisciplinary, family‑focused childhood weight management
programme in Ireland: A qualitative study. BMJ Open
2017;7:e016459.
25. Ling J, B Robbins L, Hines‑Martin V. Perceived parental
barriers to and strategies for supporting physical activity and
healthy eating among head start children. J Community Health
2016;41:593‑602.
26. Pocock M, Trivedi D, Wills W, Bunn F, Magnusson J. Parental
perceptions regarding healthy behaviours for preventing
overweight and obesity in young children: A systematic review of qualitative studies. Obes Rev 2010;11:338‑53.
27. Sonneville KR, La Pelle N, Taveras EM, Gillman MW, Prosser LA.
Economic and other barriers to adopting recommendations to
prevent childhood obesity: Results of a focus group study with
parents. BMC Pediatr 2009;9:81.
28. Schalkwijk AA, Bot SD, de Vries L, Westerman MJ, Nijpels G,
Elders PJ, et al. Perspectives of obese children and their parents
on lifestyle behavior change: A qualitative study. Int J Behav Nutr
Phys Act 2015;12:102.
29. Lindsay AC, Sussner KM, Kim J, Gortmaker S. The role of parents
in preventing childhood obesity. Future Child 2006;16:169‑86.
30. Jarvis JW, Harrington DW, Manson H. Exploring parent‑reported
barriers to supporting their child’s health behaviors:
A cross‑sectional study. Int J Behav Nutr Phys Act 2017;14:77.
31. Moore MM, Robinson JC, Rachel MM, Boss BJ. Barriers to
physical activity and healthy diet among children ages 6
through 13 in a Mississippi elementary school. J Pediatr Nurs
2014;29:74‑82.
32. Norman Å, Berlin A, Sundblom E, Elinder LS, Nyberg G. Stuck
in a vicious circle of stress. Parental concerns and barriers to
changing children’s dietary and physical activity habits. Appetite
2015;87:137‑42.
33. Vittrup B, McClure D. Barriers to childhood obesity prevention:
Parental knowledge and attitudes. Pediatr Nurs 2018;44:81‑94.
34. Thellman KE, Dmitrieva J, Miller A, Harsh JR, LeBourgeois MK.
Sleep timing is associated with self‑reported dietary patterns in
9‑ to 15‑year‑olds. Sleep Health 2017;3:269‑75.
35. Boerner KE, Coulombe JA, Corkum P. Barriers and facilitators
of evidence‑based practice in pediatric behavioral sleep care:
Qualitative analysis of the perspectives of health professionals.
Behav Sleep Med 2015;13:36‑51.
36. Golley RK, Maher CA, Matricciani L, Olds TS. Sleep duration
or bedtime? Exploring the association between sleep timing
behaviour, diet and BMI in children and adolescents. Int J
Obes (Lond) 2013;37:546‑51.
37. Roenneberg T, Allebrandt KV, Merrow M, Vetter C. Social jetlag
and obesity. Curr Biol 2012;22:939‑43.
38. Anuradha RK, Sathyavathi RB, Reddy TM, Hemalatha R,
Sudhakar G, Geetha P, et al. Effect of social and environmental
determinants on overweight and obesity prevalence among
adolescent school children. Indian J Endocrinol Metab
2015;19:283‑7.
39. Voss LD, Hosking J, Metcalf BS, Jeffery AN, Wilkin TJ. Children
from low‑income families have less access to sports facilities, but
are no less physically active: Cross‑sectional study (EarlyBird 35).
Child Care Health Dev 2008;34:470‑4.
40. Hey DW, Kelly KM, Teaford S, McDermott AY. Barriers to
physical activity and healthy eating in children as perceived by
low‑income parents: A case study. Int J Nutr 2015;1:75.
Obesity and youth diabetes: Distinguishing characteristics
between islet cell antibody positive vs. negative patients over
time. Pediatr Diabetes 2015;16:375‑81.
2. Bacha F, Edmundowicz D, Sutton‑Tyrell K, Lee S, Tfayli H,
Arslanian SA, et al. Coronary artery calcification in obese youth:
What are the phenotypic and metabolic determinants? Diabetes
Care 2014;37:2632‑9.
3. Zabinski MF, Saelens BE, Stein RI, Hayden‑Wade HA, Wilfley DE.
Overweight children’s barriers to and support for physical
activity. Obes Res 2003;11:238‑46.
4. Huybrechts I, De Bourdeaudhuij I, De Henauw S. Environmental
factors: Opportunities and barriers for physical activity, and
healthy eating among children and adolescents. Verh K Acad
Geneeskd Belg 2010;72:277‑93.
5. U.S. Department of Health and Human Services. The Surgeon
General’s Call to Action to Prevent and Decrease Overweight and
Obesity. Rockville, MD, Washington: U.S. Department of Health
and Human Services, Public Health Service, Office of the Surgeon
General, U.S. GPO; 2001.
6. Dunton GF, Schneider M. Perceived barriers to walking for
physical activity. Prev Chronic Dis 2006;3:A116.
7. Sallis JF, Prochaska JJ, Taylor WC. A review of correlates of
physical activity of children and adolescents. Med Sci Sports
Exerc 2000;32:963‑75.
8. NormanGJ, SchmidBA, Sallis JF, Calfas KJ, Patrick K. Psychosocial
and environmental correlates of adolescent sedentary behaviors.
Pediatrics 2005;116:908‑16.
9. Jacobson Vann JC, Finkle J, Ammerman A, Wegner S, Skinner AC,
Benjamin JT, et al. Use of a tool to determine perceived barriers to
children’s healthy eating and physical activity and relationships
to health behaviors. J Pediatr Nurs 2011;26:404‑15.
10. Grow HM, Hsu C, Liu LL, Briner L, Jessen‑Fiddick T, Lozano P,
et al. Understanding family motivations and barriers to
participation in community‑based programs for overweight
youth: One program model does not fit all. J Public Health Manag
Pract 2013;19:E1‑10.
11. JeffersonA. Breaking down barriers –Examining health‑promoting
behavior in the family. Kellogg’s Family Health Study 2005. Nutr
Bull 2006;31:60‑4.
12. Bahreynian M, Motlagh ME, Qorbani M, Heshmat R, Ardalan G,
Kelishadi R, et al. Prevalence of growth disorders in a nationally
representative sample of Iranian adolescents according to
socioeconomic status: The CASPIAN‑III study. Pediatr Neonatol
2015;56:242‑7.
13. Ataie‑Jafari A, Heshmat R, Kelishadi R, Ardalan G,
Mahmoudarabi M, Rezapoor A, et al. Generalized or abdominal
obesity: Which one better identifies cardiometabolic risk factors
among children and adolescents? The CASPIAN III study. J Trop
Pediatr 2014;60:377‑85.
14. Rahmanian M, Kelishadi R, Qorbani M, Motlagh ME, Shafiee G,
Aminaee T, et al. Dual burden of body weight among Iranian
children and adolescents in 2003 and 2010: The CASPIAN‑III
study. Arch Med Sci 2014;10:96‑103.
15. Kelishadi R, Ardalan G, Qorbani M, Ataie‑Jafari A, Bahreynian M,
Taslimi M, et al. Methodology and early findings of the fourth
survey of childhood and adolescence surveillance and prevention
of adult non‑communicable disease in Iran: The CASPIAN‑IV
study. Int J Prev Med 2013;4:1451‑60.
16. Kelishadi R, Motlagh ME, Roomizadeh P, Abtahi SH, Qorbani M,
Taslimi M, et al. First report on path analysis for cardiometabolic
components in a nationally representative sample of pediatric
population in the Middle East and North Africa (MENA): The
CASPIAN‑III study. Ann Nutr Metab 2013;62:257‑65.
17. Mahjoub S, Haji AhmadiM, FaramarziM, Ghorbani H, MoazeziZ.
The prevalence of metabolic syndrome according to the Iranian
committee of obesity and ATP III criteria in Babol, North of Iran.
Caspian J Intern Med 2012;3:410‑6.
18. Kelishadi R, Ardalan G, Gheiratmand R, Majdzadeh R,
Hosseini M, Gouya MM, et al. Thinness, overweight and obesity in
a national sample of Iranian children and adolescents: CASPIAN
study. Child Care Health Dev 2008;34:44‑54.
19. de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C,
Siekmann J, et al. Development of a WHO growth reference for
school‑aged children and adolescents. Bull World Health Organ
2007;85:660‑7.
20. Andajani‑Sutjahjo S, Ball K, Warren N, Inglis V, Crawford D.
Perceived personal, social and environmental barriers to weight
maintenance among young women: A community survey. Int J
Behav Nutr Phys Act 2004;1:15.
21. Musaiger AO, Al‑Mannai M, Tayyem R, Al‑Lalla O, Ali EY,
Kalam F, et al. Perceived barriers to healthy eating and
physical activity among adolescents in seven Arab countries:
A cross‑cultural study. ScientificWorldJournal 2013;2013:232164.
22. McCarron DA, Richartz N, Brigham S, White MK, Klein SP,
Kessel SS, et al. Community‑based priorities for improving
nutrition and physical activity in childhood. Pediatrics
2010;126 Suppl 2:S73‑89.
23. Huybrechts I, De Bourdeaudhuij I, De Henauw S. Environmental
factors: Opportunities and barriers for physical activity, and
healthy eating among children and adolescents. Verh K Acad
Geneeskd Belg 2009;72:277‑93.
24. Kelleher E, Harrington JM, Shiely F, Perry IJ, McHugh SM. Barriers
and facilitators to the implementation of a community‑based,
multidisciplinary, family‑focused childhood weight management
programme in Ireland: A qualitative study. BMJ Open
2017;7:e016459.
25. Ling J, B Robbins L, Hines‑Martin V. Perceived parental
barriers to and strategies for supporting physical activity and
healthy eating among head start children. J Community Health
2016;41:593‑602.
26. Pocock M, Trivedi D, Wills W, Bunn F, Magnusson J. Parental
perceptions regarding healthy behaviours for preventing
overweight and obesity in young children: A systematic review of qualitative studies. Obes Rev 2010;11:338‑53.
27. Sonneville KR, La Pelle N, Taveras EM, Gillman MW, Prosser LA.
Economic and other barriers to adopting recommendations to
prevent childhood obesity: Results of a focus group study with
parents. BMC Pediatr 2009;9:81.
28. Schalkwijk AA, Bot SD, de Vries L, Westerman MJ, Nijpels G,
Elders PJ, et al. Perspectives of obese children and their parents
on lifestyle behavior change: A qualitative study. Int J Behav Nutr
Phys Act 2015;12:102.
29. Lindsay AC, Sussner KM, Kim J, Gortmaker S. The role of parents
in preventing childhood obesity. Future Child 2006;16:169‑86.
30. Jarvis JW, Harrington DW, Manson H. Exploring parent‑reported
barriers to supporting their child’s health behaviors:
A cross‑sectional study. Int J Behav Nutr Phys Act 2017;14:77.
31. Moore MM, Robinson JC, Rachel MM, Boss BJ. Barriers to
physical activity and healthy diet among children ages 6
through 13 in a Mississippi elementary school. J Pediatr Nurs
2014;29:74‑82.
32. Norman Å, Berlin A, Sundblom E, Elinder LS, Nyberg G. Stuck
in a vicious circle of stress. Parental concerns and barriers to
changing children’s dietary and physical activity habits. Appetite
2015;87:137‑42.
33. Vittrup B, McClure D. Barriers to childhood obesity prevention:
Parental knowledge and attitudes. Pediatr Nurs 2018;44:81‑94.
34. Thellman KE, Dmitrieva J, Miller A, Harsh JR, LeBourgeois MK.
Sleep timing is associated with self‑reported dietary patterns in
9‑ to 15‑year‑olds. Sleep Health 2017;3:269‑75.
35. Boerner KE, Coulombe JA, Corkum P. Barriers and facilitators
of evidence‑based practice in pediatric behavioral sleep care:
Qualitative analysis of the perspectives of health professionals.
Behav Sleep Med 2015;13:36‑51.
36. Golley RK, Maher CA, Matricciani L, Olds TS. Sleep duration
or bedtime? Exploring the association between sleep timing
behaviour, diet and BMI in children and adolescents. Int J
Obes (Lond) 2013;37:546‑51.
37. Roenneberg T, Allebrandt KV, Merrow M, Vetter C. Social jetlag
and obesity. Curr Biol 2012;22:939‑43.
38. Anuradha RK, Sathyavathi RB, Reddy TM, Hemalatha R,
Sudhakar G, Geetha P, et al. Effect of social and environmental
determinants on overweight and obesity prevalence among
adolescent school children. Indian J Endocrinol Metab
2015;19:283‑7.
39. Voss LD, Hosking J, Metcalf BS, Jeffery AN, Wilkin TJ. Children
from low‑income families have less access to sports facilities, but
are no less physically active: Cross‑sectional study (EarlyBird 35).
Child Care Health Dev 2008;34:470‑4.
40. Hey DW, Kelly KM, Teaford S, McDermott AY. Barriers to
physical activity and healthy eating in children as perceived by
low‑income parents: A case study. Int J Nutr 2015;1:75.
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