Stakeholders' Perspectives on Adolescent Obesity Prevention Amid the Nutrition Transition in Lebanon

Miriam Bou Kheir; Stephen Fallows; Lynne Kennedy

doi:10.29333/ajqr/16537

Miriam Bou Kheir ¹ ^* , Stephen Fallows ², Lynne Kennedy ³

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AM J QUALITATIVE RES, Volume 9, Issue 3, pp. 141-161

https://doi.org/10.29333/ajqr/16537

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Abstract

Adolescent obesity has become a major public health concern globally, particularly in low- and middle-income countries undergoing rapid Nutrition Transitions. Lebanon, a middle-income country in the Eastern Mediterranean Region, has experienced substantial shifts in dietary patterns and physical activity levels in recent decades, contributing to an alarming rise in obesity among youth. This qualitative study aimed to explore the perceptions and experiences of key stakeholders in Lebanon regarding the multilevel determinants of adolescent obesity, as well as the challenges and opportunities for effective prevention strategies in this context. The study explored stakeholders' views on the drivers of adolescent obesity in Lebanon at the individual, interpersonal, community, organizational, and policy levels. The findings underscore the critical need for comprehensive, multilevel, multistakeholder approaches to address the root causes of adolescent obesity in Lebanon. This study provides timely and contextually relevant insights that can inform the development of effective and sustainable strategies to prevent and control adolescent obesity in Lebanon. It also contributes to the growing literature on the challenges and opportunities for tackling the global burden of obesity in the context of rapid Nutrition Transitions in low- and middle-income countries.

Keywords: Stakeholders, Low-Middle Income Countries, Obesity, Policies, Public Health

References

Abarca-Gómez, L., Abdeen, Z. A., Hamid, Z. A., Abu-Rmeileh, N. M., Acosta-Cazares, B., Acuin, C., ... & Ezzati, M. (2017). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128· 9 million children, adolescents, and adults. The Lancet, 390(10113), 2627-2642. https://doi.org/10.1016/S0140-6736(17)32129-3
Abouzeid, M., Habib, R. R., Jabbour, S., Mokdad, A.H., & Nuwayhid, I. (2020). Lebanon's humanitarian crisis escalates after the Beirut blast. The Lancet, 396(10260), 1380-1382.
Baumann, H. (2019). the causes, nature, and effect of the current crisis of Lebanese capitalism.
Nationalism and Ethnic Politics, 25(1), 61- 77.
Bizri, A. R., Khachfe, H. H., Fares, M. Y., & Musharrafieh, U. (2020). COVID-19 pandemic: An insult over injury for Lebanon. Journal of Community Health, 1–7.
Borys, J., Bodo, Y. L., Jebb, S. A., Seidell, J. C., Summerbell, C., Richard, D., . . . Swinburn, B. (2011). EPODE approach for childhood obesity prevention: Methods, progress and international development. Obesity Reviews, 13(4), 299-315.
Bozlak, M.C., Becker, M.A., Herd, M., Teitelman, L., Viola, J., Olson, B.D., & Choucair, B. (2015). An Inter-Governmental Approach to Childhood Obesity in Chicago, Illinois. International Public Health Journal, 7, 7.
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101. https://doi.org/10.1191/1478088706qp063oa
Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and design. Harvard University Press.
Brugha, R., & Varvasovszky, Z. (2000). Stakeholder analysis: a review. Health Policy and Planning, 15(3), 239-246. https://doi.org/10.1093/heapol/15.3.239
Burke, M. A. et al. (2010) From ‘Overweight’ to ‘About Right’: Evidence of a Generational Shift in Body Weight Norms. Obesity, 18 (6), 1226–1234.
Chalak, A., Yehya, N. A., & Zurayk, R. (2019). Investigating the determinants of body mass index and eating practices among university students in Lebanon: A cross-sectional study. Ecology of Food and Nutrition, 58(2), 142-159. https://doi.org/10.1080/03670244.2019.1570176
Chacar, H. R., & Salameh, P. (2011). Public schools adolescents' obesity and growth curves in Lebanon. Lebanese Medical Journal, 59(2), 80–88.
Clarke, J., Lancashire E., Pallan M., & Adab P. (2015). Headteacher perspectives on the role of the primary school in preventing childhood obesity. Appetite, 87377.
Davison, K. K., & Birch, L. L. (2001). Childhood overweight: a contextual model and recommendations for future research. Obesity Reviews, 2(3), 159-171. https://doi.org/10.1046/j.1467-789x.2001.00036.x
Devi, K. (2020). Economic crisis hits Lebanese health care. The Lancet, 395(10224), 548.
Elderkin-Thompson, V., Silver, R. C., & Waitzkin, H. (2001). When nurses double as interpreters: a study of Spanish-speaking patients in a US primary care setting. Social Science & Medicine, 52(9), 1343–1358.
Farhat, A. G., Jaalouk, D., & Francis, S. (2019). Adherence to the Mediterranean dietary pattern and obesity indicators in Lebanese university students. Nutrition & Food Science, 49(5), 888-900. https://doi.org/10.1108/NFS-06-2018-0177
Fraser, L. K., Edwards, K.L., Cade, J.E. & Clarke, G.P. (2011). Fast food, other food choices and body mass index in teenagers in the United Kingdom (ALSPAC): a structural equation modelling approach. International Journal of Obesity, 35 (10), 1325–1330.
Gard, M. (2004). An elephant in the room and a bridge too far, or physical education and the obesity epidemic. In: Evans, J., Davies, B., Wright, J. (eds). Body Knowledge and Control: Studies in the Sociology of Physical Education and Health. London: Routledge.
Guest, G., Bunce, A., & Johnson, L. (2006). How many interviews are enough? An experiment with data saturation and variability. Field Methods, 18(1), 59-82. https://doi.org/10.1177/1525822X05279903
Habib-Mourad, C., Ghandour, L. A., Moore, H. J., Nabhani-Zeidan, M., Adetayo, K., Hwalla, N., & Summerbell, C. (2014). Promoting healthy eating and physical activity among school children: findings from Health-E-PALS, the first pilot intervention from Lebanon. BMC Public Health, 14(1), 940. https://doi.org/10.1186/1471-2458-14-940
Habib-Mourad, C., Ghandour, L. A., Maliha, C., Awada, N., Dagher, M., & Hwalla, N. (2020). Impact of a one-year school-based teacher-implemented nutrition and physical activity intervention: Main findings and future recommendations. BMC Public Health, 20, 1-15. https://doi.org/10.1186/s12889-020-09179-2
Hamadeh, S. & ElZein, H. (2011). Prevalence and Etiology: Middle East and North Africa (MENA) Countries. In: L Moreno, I Pigeot and WA Ahrens (eds) Epidemiology of Obesity in Children and Adolescents – Prevalence and Aetiology. 1st ed. New York: Springer.
Hendy, H. M., & Williams, K. E. (2012). Mother's feeding practices for children 3–10 years of age and their associations with child demographics. Appetite, 58(2), 710- 716.
Huang, T.T. & Glass, T.A. (2008). Transforming research strategies for understanding and preventing obesity. JAMA, 300(15), 1811–1813.
Jones, A. R., Parkinson, K. N., Drewett, R. F., Hyland, R. M., Pearce, M. S., Adamson, A. J., & Gateshead Millennium Study Core Team (2011). Parental perceptions of weight status in children: the Gateshead Millennium Study. International journal of obesity, 35(7), 953–962.
Kallio, H., Pietilä, A. M., Johnson, M., & Kangasniemi, M. (2016). Systematic methodological review: Developing a framework for a qualitative semi‐structured interview guide. Journal of Advanced Nursing, 72(12), 2954-2965. https://doi.org/10.1111/jan.13031
Khoury, P., Azar, E., Hitti, E. (2020). COVID-19 response in Lebanon: Current experience and challenges in a low-resource setting. JAMA, 324(6), 548–549.
Kirk, S. F., Penney, T. L., & Mchugh, T. F. (2010). Characterizing the obesogenic environment: The state of the evidence with directions for future research. Obesity Reviews,11(2), 109-117.
Kuper, A., Reeves, S., & Levinson, W. (2008). An introduction to reading and appraising qualitative research. BMJ, 337.
Library of Congress. (2012). ALA-LC romanization tables: Transliteration schemes for non-Roman scripts. Library of Congress.
Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. Sage.
Lobstein, T., Jackson-Leach, R., Moodie, M. L., Hall, K. D., Gortmaker, S. L., Swinburn, B. A., . . . Mcpherson, K. (2015). Child and adolescent obesity: Part of a bigger picture. The Lancet, 385(9986), 2510-2520.
McLeroy, K. R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An ecological perspective on health promotion programs. Health Education Quarterly, 15(4), 351-377. https://doi.org/10.1177/109019818801500401
Millstone, E., & Lobstein, T. (2007). The PorGrow project: Overall cross-national results, comparisons and implications. Obesity Reviews, 8, 29-36.
Molina, L., & Albir, A. H. (2004). Translation techniques revisited: A dynamic and functionalist approach. Meta: Translators’ Journal, 47(4), 498–512.
Morgan, P. J., & Hansen, V. (2008). Classroom Teachers' Perceptions of the Impact of Barriers to Teaching Physical Education on the Quality of Physical Education Programs. Research Quarterly for Exercise and Sport, 79(4), 506-516.
Musaiger, A., Bader, Z., Al-Roomi, K., & Dsouza, R. (2011). Dietary and lifestyle habits amongst adolescents in Bahrain. Food & Nutrition Research, 55(1), 7122.
Nabhani-Zeidan, M., Naja, F., & Nasreddine, L. (2011). Dietary intake and nutrition-related knowledge in a sample of Lebanese adolescents of contrasting socioeconomic status. Food and Nutrition Bulletin, 32(2), 75-83.
Naja, F., Hwalla, N., Itani, L., Karam, S., Sibai, A. M., & Nasreddine, L. (2015). A Western dietary pattern is associated with overweight and obesity in a national sample of Lebanese adolescents (13–19 years): A cross-sectional study. British Journal of Nutrition, 114(11), 1909-1919. https://doi.org/10.1017/S0007114515003657
Nasreddine, L., Naja, F., Chamieh, M. C., Adra, N., Sibai, A. M., & Hwalla, N. (2012). Trends in overweight and obesity in Lebanon: evidence from two national cross-sectional surveys (1997 and 2009). BMC Public Health, 12(1), 798. https://doi.org/10.1186/1471-2458-12-798
Nasreddine, L., Naja, F., Akl, C., Chamieh, M. C., Karam, S., Sibai, A. M., & Hwalla, N. (2014). Dietary, lifestyle and socio-economic correlates of overweight, obesity and central adiposity in Lebanese children and adolescents. Nutrients, 6(3), 1038-1062. https://doi.org/10.3390/nu6031038
Nasreddine, L., Shatila, H., Itani, L., Hwalla, N., Jomaa, L., & Naja, F. (2017). A traditional dietary pattern is associated with lower odds of overweight and obesity among preschool children in Lebanon: A cross-sectional study. European Journal of Nutrition, 58, 91-102. https://doi.org/10.1007/s00394-017-1574-0
Nasreddine, L. M., Kassis, A. N., Ayoub, J. J., Naja, F. A., & Hwalla, N. C. (2018). Nutritional status and dietary intakes of children amid the nutrition transition: The case of the Eastern Mediterranean Region. Nutrition Research, 57, 12-27.
NCD Risk Factor Collaboration. (2017). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: A pooled analysis of 2416 population-based measurement studies in 128· 9 million children, adolescents, and adults. The Lancet, 390(10113), 2627-2642. https://doi.org/10.1016/S0140-6736(17)32129-3
Nida, E. A. (1964). Towards a science of translating: With special reference to principles and procedures involved in bible translating. New York: Brill.
Nollen, N. L., Befort, C. A., Snow, P., Daley, C., Ellerbeck, E. F., & Ahluwalia, J. S. (2007). The school food environment and adolescent obesity: Qualitative insights from high school principals and food service personnel. International Journal of Behavioral Nutrition and Physical Activity, 4(1), 18.
Oxley, J., Günhan, E., Kaniamattam, M., & Damico, J. (2017). Multilingual issues in qualitative research. Clinical Linguistics & Phonetics, 31(7-9), 612–630.
Patton, M. Q. (2015). Qualitative research and methods: Integrating theory and practice. Sage.
Popkin, B. M., Adair, L. S., & Ng, S. W. (2012). Global nutrition transition and the pandemic of obesity in developing countries. Nutrition Reviews, 70(1), 3-21. https://doi.org/10.1111/j.1753-4887.2011.00456.x
Popkin, B. M., & Gordon-Larsen, P. (2004). The nutrition transition: Worldwide obesity dynamics and their determinants. International Journal of Obesity, 28(3), S2-S9. https://doi.org/10.1038/sj.ijo.0802804
Popkin, B. M. (2015). Nutrition transition and the global diabetes epidemic. Current Diabetes Reports, 15(9), 64. https://doi.org/10.1007/s11892-015-0631-4
Popkin, B. M., Corvalan, C., & Grummer-Strawn, L. M. (2020). Dynamics of the double burden of malnutrition and the changing nutrition reality. The Lancet, 395(10217), 65-74. https://doi.org/10.1016/S0140-6736(19)32497-3
Power, T. G., Bindler, L.C., Goetz, S., & Daratha, K.B. (2010). Obesity prevention in early adolescence: Student, parent, and teacher views. Journal of School Health, 80 (1), 13–19.
Sahoo, K., Sahoo, B., Choudhury, A. K., Sofi, N. Y., Kumar, R., & Bhadoria, A. S. (2015). Childhood obesity: Causes and consequences. Journal of Family Medicine and Primary Care, 4(2), 187. https://doi.org/10.4103/2249-4863.154628
Seidell, J. C., & Halberstadt, J. (2015). The global burden of obesity and the challenges of prevention. Annals of Nutrition and Metabolism, 66(Suppl. 2), 7-12.
Sibai, A. M., Hwalla, N., Adra, N., & Rahal, B. (2003). Prevalence and covariates of obesity in Lebanon: Findings from the first epidemiological study. Obesity Research, 11(11), 1353-1361.
Story, M., Kaphingst, K. M., Robinson-O'Brien, R., & Glanz, K. (2008). Creating healthy food and eating environments: Policy and environmental approaches. Annual Review Public Health, 29, 253-272. https://doi.org/10.1146/annurev.publhealth.29.020907.090926
Stuckler, D., & Nestle, M. (2012). Big food, food systems, and global health. PLoS Med, 9(6), e1001242. https://doi.org/10.1371/journal.pmed.1001242
Swinburn, B. A., Sacks, G., Hall, K. D., McPherson, K., Finegood, D. T., Moodie, M. L., & Gortmaker, S. L. (2011). The global obesity pandemic: Shaped by global drivers and local environments. The Lancet, 378(9793), 804-814. https://doi.org/10.1016/S0140-6736(11)60813-1
Todd, C., Christian, D., Davies, H., Rance, J., Stratton, G., Rapport, F., & Brophy, S. (2015). Headteachers’ prior beliefs on child health and their engagement in school based health interventions: A qualitative study. BMC Research Notes, 8(1).
Turner, K., Foster, C., Allender, S., & Plugge, E. (2015). A systematic review of how researchers characterize the school environment in determining its effect on student obesity. BMC Obesity, 2(1).
Waters, E., Silva-Sanigorski, A. D., Burford, B. J., Brown, T., Campbell, K. J., Gao, Y., . . . Summerbell, C. D. (2011). Interventions for preventing obesity in children. Cochrane Database of Systematic Reviews.
Walton, M., Waiti, J., Signal, L., & Thomson, G. (2010). Identifying barriers to promoting healthy nutrition in New Zealand primary schools. Health Education Journal, 69(1), 84-94.
Wolfson, J., Gollust, S., Niederdeppe, J., & Barry, C. (2015). The role of parents in public views of strategies to address childhood obesity in the United States. The Milbank Quarterly, 93(1), 73-111.
World Bank (2020). Beirut rapid damage and needs assessment (RDNA) — August 2020. https://www.worldbank.org/en/country/lebanon/publication/beirut-rapid-damage- and- needs-assessment-rdna---august-2020
World Health Organization. (2012). Population-based approaches to childhood obesity prevention. World Health Organization.
World Health Organization. (2014). Global status report on noncommunicable diseases 2014. World Health Organization.
World Health Organization. (2021). Obesity and overweight fact sheet. https://www.who.int/en/news-room/fact-sheets/
World Medical Association. (2013). World Medical Association declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA, 310(20), 2191-2194. https://doi.org/10.1001/jama.2013.281053

Citation

Bou Kheir, M., Fallows, S., & Kennedy, L. (2025). Stakeholders' Perspectives on Adolescent Obesity Prevention Amid the Nutrition Transition in Lebanon. American Journal of Qualitative Research, 9(3), 141-161. https://doi.org/10.29333/ajqr/16537

Bou Kheir, M., Fallows, S., and Kennedy, L. (2025). Stakeholders' Perspectives on Adolescent Obesity Prevention Amid the Nutrition Transition in Lebanon. American Journal of Qualitative Research, 9(3), pp. 141-161. https://doi.org/10.29333/ajqr/16537

Bou Kheir M, Fallows S, Kennedy L. Stakeholders' Perspectives on Adolescent Obesity Prevention Amid the Nutrition Transition in Lebanon. AM J QUALITATIVE RES. 2025;9(3), 141-161. https://doi.org/10.29333/ajqr/16537

Bou Kheir, Miriam, Stephen Fallows, and Lynne Kennedy. "Stakeholders' Perspectives on Adolescent Obesity Prevention Amid the Nutrition Transition in Lebanon". American Journal of Qualitative Research 2025 9 no. 3 (2025): 141-161. https://doi.org/10.29333/ajqr/16537

Bou Kheir, Miriam et al. "Stakeholders' Perspectives on Adolescent Obesity Prevention Amid the Nutrition Transition in Lebanon". American Journal of Qualitative Research, vol. 9, no. 3, 2025, pp. 141-161. https://doi.org/10.29333/ajqr/16537

Bou Kheir M, Fallows S, Kennedy L. Stakeholders' Perspectives on Adolescent Obesity Prevention Amid the Nutrition Transition in Lebanon. AM J QUALITATIVE RES. 2025;9(3):141-61. https://doi.org/10.29333/ajqr/16537