Perceived barriers to achieving a healthy weight: a qualitative study using focus groups at public and private schools in Guatemala City

Abstract

BackgroundOverweight prevalence among Guatemalan girls is higher in public than in private schools. Little is known about adolescent girls’ perceptions of the right ways to achieve a healthy weight. This study examines public and private school adolescent girls’ perceptions of a “healthy weight,” and barriers and facilitators to achieving it.MethodsWe conducted 4 focus groups in public and private schools in Guatemala City with girls from 13 to 15 years old. The discussion guide included open-ended questions and activities aimed at examining perceptions of “healthy weight” and barriers and motivators to achieving it within the school environment. Focus groups were audio-recorded and transcribed. Data analyses followed established methods of content analysis.ResultsTwenty-eight girls (private school, n = 12; public school, n = 16) of ages ranging from 13.1 to 15.9 years (median, 14, IQR, 13.6–14.9) participated in the study. Girls identified images of thin and fit women as healthy. They cited healthy eating and physical activity as ways to achieve a healthy weight. Within the school environment, barriers to maintaining a healthy weight included a lack of healthy food options and the prioritization of sports for boys over girls. In public schools, facilities were less than optimal; in private schools, girls’ access to facilities was limited. Public school girls stated that their uniforms were inappropriate for exercising.ConclusionOur findings support the need to provide more healthy food options in Guatemalan schools. In addition, physical activity for girls should be promoted and facilities made available for their use.

Impact of school and work status on diet and physical activity in rural Guatemalan adolescent girls: a qualitative study

“…5,6,15,16 However, most of this work has been conducted in large metropolitan settings (including in Guatemala) and much less is known about the choices of adolescent girls from outside these areas. 18,20 In addition, comparative work on the choices of out-of-school girls has not been conducted, despite the importance of this issue in LMICs, where many adolescents are not enrolled in school due to multiple reasons, including work and pregnancy. Our qualitative interviews with adolescent girls either in or out of school and working from a midsized, predominantly indigenous Maya town address these issues.…”

“…These findings are similar to urban Guatemalan schools and described how, in that setting, energy-dense snacks and sugarsweetened beverages available at kiosks around schools comprise a large proportion of the school food environment. [18][19][20]32 Even though out-of-school and working adolescents seem to have less eating habit disruption, they struggled to find time for physical activity and therefore had a much more sedentary lifestyle than their counterparts enrolled in school. They identified home and work responsibilities, significant life changes (e.g., pregnancy) triggering transition out of school, and access to opportunities afforded by the school environment as limiting factors to exercise.…”

“…For example, junk food vendors in close proximity to schools are important drivers of adolescent diet quality in Brazil 17 and Guatemala. 18,19 In addition, family or community gender norms as well as differential opportunities doi: 10.1111/nyas.14183 for girls to participate in sports both in community and school venues are important determinants of physical activities disparities in Guatemala, 20 Nigeria, 21 India, 22 and Costa Rica. 23 Similarly, differential responsibility for domestic chores has been reported that adversely affect lifestyle habits for girls in several settings.…”

“…23 Similarly, differential responsibility for domestic chores has been reported that adversely affect lifestyle habits for girls in several settings. 15,20,24 One final issue pertinent to the study of adolescent's diet and activity (particularly adolescent girls) is that there have been very few studies in LMICs in indigenous populations or among those living outside major urban centers. In these populations, a considerable percentage of adolescents may be obligated to combine school with work or not attend school for work or other reasons.…”

“…Therefore, understanding the impact of out-of-school (e.g., due to work and motherhood) status on adolescent behaviors in an LMIC setting is an important research priority. In Guatemala, around half of adolescents and young adults (aged [15][16][17][18][19][20][21][22][23][24] are out of school. Girls are more likely to be out of school (55%) than are boys (49%).…”