Barriers and Enablers That Influence Overweight/Obesity/Obesogenic Behavior in Adolescents From Lower-Middle Income Countries: A Systematic Review

Abstract

Background: Overweight/obesity during adolescence in lower-middle income countries has become a public health problem with consequences in adulthood. Inadequate dietary habits, poor diet quality, sedentary behavior, and parental obesity have been reported. Objective: To describe management of obesity-like food habits and behavior of adolescents from lower-middle income countries with respect to what keeps them using this diet (barriers) and what helps them avoid it (enablers). Methods: Systematic review of the literature related to obesity and food intake of adolescents conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Results: We classified 11 eligible studies describing the barriers to and enablers of the management of obesity-like food intake and obesity lifestyle. The dual burdens of malnutrition and increased urbanization have been observed. There is preference for processed food, dietary habits, and obesity-like food intake and sedentary behavior. Barriers to managing body weight gain included mostly consumption of fast-food and snack food, less vegetable and fruit intake, skipping meals, and sedentary behavior. Enablers of managing body weight gain included changes in nutritional habits, perception of the consumption of healthy food, physical activity, and engagement in programs to change lifestyle. Conclusion: The globalization of the fast food industry has provided an obesogenic environmental stimulus for adolescents in lower-middle income countries.

Factors influencing obesogenic behaviours of adolescent girls and women in low‐ and middle‐income countries: A qualitative evidence synthesis

“…Despite the apparent rise of overweight and obesity in LMICs, most research on obesogenic behaviours has been conducted in high-income countries (HICs). Furthermore, previous systematic reviews focused only on Africa, [26][27][28] on diets of adolescents in LMICs, 1 on young children, 29,30 and on adolescents 31,32 or on considerations for interventions to prevent overweight and obesity. 21,33 Little of this evidence stems from qualitative research, [26][27][28] as this prior research primarily was aimed at quantifying the influence of different drivers.…”

Evidence for factors associated with diet and physical activity in African and Caribbean countries

“…Thirteen reviews considered diet, 17 , 23 , 25 , 29 – 32 , 34 – 38 , 40 four considered physical activity, 16 , 18 – 20 and eight considered both. 21 , 22 , 24 , 26 – 28 , 33 , 39 Eighteen reviews summarized quantitative evidence only, 16 , 18 – 21 , 24 – 30 , 32 – 34 , 38 – 40 including four that conducted meta-analyses, 18 , 21 , 29 , 38 and one that used modelling techniques. 32 Four reviews incorporated both quantitative and qualitative evidence, 22 , 31 , 35 , 37 including one that used a meta-ethnographic approach.…”

“… 21 In the remaining 12 reviews, 29 – 40 only 25–50% of studies came from Africa or the Caribbean – they tended to focus on low- and middle-income countries. A small number of countries were over-represented in the primary evidence: Kenya, 17 , 19 , 20 , 24 , 29 , 30 , 33 – 35 , 37 Nigeria 16 , 18 – 20 , 24 , 33 – 35 , 37 , 39 and South Africa, 19 , 20 , 22 , 23 , 26 – 28 , 30 , 32 , 37 featured in 10 reviews each and Jamaica featured in all three reviews that included Caribbean countries. 21 , 29 , 30 …”

Nutritious or Delicious?

“…These findings align with other literature, which suggests that each of those factors contribute to food preferences and health behavior. For example, adolescents (ages 10-19) show higher rates of unhealthy eating behaviors, eating fewer vegetables, frequent snacking, and show preferences for salty, sweetened, highcarbohydrate, and processed foods (see [13] for a review). Evidence from Nascimento-Ferreira et al, [41] suggests that young adults may be interested in maintaining good health, but do not adequately understand the factors that lead to healthy food choices.…”