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Hindawi Publishing Corporation
e Scientic World Journal
Volume , Article ID , pages
http://dx.doi.org/.//
Research Article
Perceived Barriers to Healthy Eating and Physical
Activity among Adolescents in Seven Arab Countries:
A Cross-Cultural Study
Abdulrahman O. Musaiger,1Mariam Al-Mannai,2Reema Tayyem,3Osama Al-Lalla,4
Essa Y. A. Ali,5Faiza Kalam,6Mofida M. Benhamed,7Sabri Saghir,8Ismail Halahleh,9
Zahra Djoudi,10 and Manel Chirane10
1ArabCentreforNutrition,P.O.Box26923,Manama,Bahrain
2Department of Mathematics, College of Science, Sakhir, Bahrain
3Department of Clinical Nutrition and Dietetics, Faculty of Allied Health Science, e Hashemite University, Zarqa, Jordan
4Department of Nutrition and Health, Ministry of Education, Dubai, UAE
5Elia Nutrition and Health Centre, Kuwait, Kuwait
6Dietetic Clinic, Damascus, Syria
7Department of Food Science, Faculty of Agriculture, University of Tripoli, Tripoli, Libya
8Faculty of Agriculture, Hebron University, Hebron, Palestine
9Nutrition Department, Makassed Hospital, Jerusalem, Palestine
10NutriDar, Algiers, Algeria
Correspondence should be addressed to Abdulrahman O. Musaiger; amusaiger@gmail.com
Received August ; Accepted September
Academic Editors: N. Sarraf Zadegan and J. Telfair
Copyright © Abdulrahman O. Musaiger et al. is is an open access article distributed under the Creative Commons
Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is
properly cited.
Objective. To highlight the perceived personal, social, and environmental barriers to healthy eating and physical activity among
Arab adolescents. Method. A multistage stratied sampling method was used to select students aged – years ( males
and females) from public schools. Seven Arab counties were included in the study, namely, Algeria, Jordan, Kuwait, Libya,
Palestine, Syria, and the United Arab Emirates. Self-reported questionnaire was used to list the barriers to healthy eating and
physical activity facing these adolescents. Results. It was found that lack of information on healthy eating, lack of motivation
to eat a healthy diet, and not having time to prepare or eat healthy food were the main barriers to healthy eating among both
genders. For physical activity, the main barriers selected were lack of motivation to do physical activity, less support from teachers,
and lack of time to do physical activity. In general, females faced more barriers to physical activity than males in all countries
included. ere were signicant dierences between males and females within each country and among countries for most barriers.
Conclusion. Intervention programmes to combat obesity and other chronic noncommunicable diseases in the Arab world should
include solutions to overcome the barriers to weight maintenance, particularly the sociocultural barriers to practising physical
activity.
1. Introduction
Over the last decade, the unhealthy lifestyle and poor
dietary habits have been of great concern to the local health
authorities in most Arab countries. is is mainly due to
the fact that these factors are among the leading causes of
obesity and chronic noncommunicable diseases []. Statistics
from the World Health Organization indicate that more
than % of morbidity, disability, and mortality in these
countries are caused by chronic noncommunicable diseases,
especially cardiovascular disease, diabetes, and cancer [].
Obesity has reached an epidemic rate in Arab countries
e Scientic World Journal
for both children and adults. Among adolescents aged –
years, the proportions that were overweight and obese
in seven Arab countries ranged from % to % []. is
current epidemic of childhood obesity is largely due to
an environment that promotes excessive food consumption
and encourages sedentary behaviours []. erefore, weight
maintenance such as promoting healthy eating and physical
activity among adolescents contributes to improving the
health status of children and most probably prevents obesity
and many chronic diseases in adulthood [].
Several studies in the Arab world have reported that the
dietary habits of the people have become more westernized
[–]. e diet of Arab adolescents is per se characterized
by a low intake of fruit, vegetables, and milk and a high
intake of sugar-sweetened beverages, fast foods, and sweets
[–].istypeofdietisstronglyassociatedwiththe
incidence of obesity and other chronic diseases []. Among
Syrian adolescents, for example, the percentage of the daily
energy intake contributed by sweets and sugary beverages
was signicantly higher in obese than nonobese adolescents;
whereas the energy intake from milk, other dairy products,
and fruit was found to be signicantly higher in nonobese
than obese subjects []. e estimated daily intake of fruit
and vegetables among young Arabs aged – years was
reported to be and grams for males and females,
respectively. Increasing the daily intake of fruit and vegetables
to up to grams, the baseline choice, could reduce the
risk of some chronic diseases such as ischaemic heart disease,
ischemic strokes, and some types of cancer []. Furthermore,
more than % of Arab adolescents skipped breakfast []. It
was evident that skipping breakfast is associated with high
risk of obesity [] and poor cardiometabolic health status
[].
Moreover, the lifestyle of Arab adolescents has changed
to be more sedentary, with long durations spent on viewing
television, playing video games, and using the internet, as
well as lack of physical activity [–]. e majority of Arab
adolescents do not meet the recommended guidelines for
daily physical activity. It has been reported that more than
% of girls and % of boys aged – years in seven
Arab countries (Djibouti, Egypt, Jordan, Libya Morocco,
Oman, and the United Arab Emirates) did not engage in a
sucient amount of daily physical activity (obtaining at least
minutes of physical activity per day) [].
Giving the high rate of obesity among adolescents in the
Arab world, in addition to an environment that encourages
an unhealthy lifestyle and culture of eating, the need to
study the barriers to a healthy lifestyle is essential. However,
studies on obstacles to the adoption of healthy eating and a
healthy lifestyle in Arab adolescents are extremely lacking.
Data from western countries has indicated that there are
various social, personal, cultural, and environmental barriers
tohealthyeating[,] and physical activity [,]among
teens. Understanding barriers to a healthy lifestyle among
adolescents is important in any intervention to promote the
nutritional and health status of the community. us, the
objective of this study is to provide a better understanding
of the barriers to healthy eating and physical activity among
adolescents in seven Arab countries.
2. Methods
2.1. Sampling and Participants. is study is part of the
ARAB-EAT project, which aims to investigate prevalence of
obesity, eating attitudes, and barriers to healthy eating and
physical activity among adolescents in seven Arab countries:
Algeria, Jordan, Kuwait, Libya, Palestine, Syria, and the
United Arab Emirates (UAE). Students aged – years from
public schools were the target group in this study. Data were
obtained from one of the major cities in each country. e
sample was calculated with a % margin of error and with
% condence intervals.
e students were selected using a multistage stratied
sampling method. To ensure the representation of various
social classes, each city was rst divided into administrative
regions, which varied from two to ve regions, depending
onthecountry.eschoolsweredividedintoboysand
girls secondary schools, and only government schools were
included. Private schools were excluded because of a lack of
statisticsontheseschoolsinmostoftheincludedcountries
and diculty in obtaining permission from some of the
schools. e schools were then selected proportionally by
a simple random method from each administrative region.
e classes were selected for each secondary level (Levels
to)ineachschoolusingasimplerandommethod.e
total sample of students selected from each country varied,
depending on the number of students in each class and
number of selected schools.
To ensure the accuracy and consistency of the sampling
procedure,theanswerofthequestionnaire,andthecollection
of data, a standardized protocol was prepared and distributed
to all participating centres in the seven countries. Each centre
was responsible for training its research team, as well as
obtaining ethical approval from the government authorities
concerned, mainly from the Ministries of Education. e
total sample obtained from schools in the seven countries was
( males and females). Due to the diculty
in obtaining permission from one administrative region in
Algiers, the capital of Algeria, the sample size represented
two rather than three administrative regions in Algiers. is
may have aected the ndings concerning Algeria. Data were
collected between March and January .
2.2. Questionnaire. Statements relating to barriers to healthy
eating and physical activity were obtained from a previously
published study, which used a validated self-reported ques-
tionnaireonyoungwomen[]. e statements were rst
translated into Arabic. Slight modications were then carried
outtoadaptthestatementstotheArabiccultureaswellasto
the target group of this study (adolescents). For example, the
words “partners” and “children” were deleted, and the words
“parents” and “teachers” were added. For the environmental
barriers to physical activity, four new statements were added
to the original statements and one irrelevant statement was
deleted. ese four statements were related to the cultural,
climate and economic barriers to physical activity in the Arab
community. A statement which related to jobs was deleted
from the section on the social and environmental barriers to
healthy eating, as it was not applicable. e nal version of
e Scientic World Journal
T : Reliability of Arabic version of questionnaire as compared
with original English version, using Cronbach’s alpha coecients.
Barriers statements
Cronbach’s alpha
coecients
Arabic
version
English
version
Barriers to physical activity
Personal barriers ( statements) . .
Social support barriers ( statements) . .
Environmental barriers ( statements) . .
Barriers to healthy eating
Personal barriers ( statements) . .
Social and environmental barriers
( statements) . .
the questionnaire consisted of and statements that were
relatedtobarrierstohealthyeatingandtophysicalactivity,
respectively. e barriers were divided into personal, social,
and environmental barriers. Response options for all the
barriers statements were not a barrier,asomewhat important
barrier,andavery important barrier.
e Arabic version of the questionnaire was then tested
on Kuwaiti adolescents. e ndings revealed that the
questionnaire was well understood by the participants, and
no signicant modications were made. To test the relia-
bility of the questionnaire, Cronbach’s alpha coecient was
calculated for each group of statements and compared with
the original statements. It was found that Cronbach’s alpha
coecients for the statements related to barriers to physical
activity ranged from . to ., while those related to
barriers to healthy eating were between . and .,
indicating moderate internal reliability, which is very close to
the original version (Tab l e ).
2.3. Data Analysis. DatawererstenteredinanExcelleand
then sent to the central processing station (Bahrain), along
with the questionnaire, for the data to be checked and the
statistical analysis to be carried out. SPSS statistical package
version was used in the analysis of the data. Chi-square
test was used to examine the association between males and
females in healthy eating and physical activity barriers.
3. Results
Tables and present the proportions of adolescents report-
ing each of the perceived barriers to healthy eating in the
seven Arab countries for males and females, respectively.
With the exception of Palestinian males, “do not have enough
information about a healthy diet” seems to be one of the main
barriers among both males and females in all the countries
includedinthestudy.Combiningtheresponsecategoriesof
somewhat important barrier and important barrier,%to
% of males and % to % of females reported this barrier.
“Not having motivation to eat healthy diet” came next as
a barrier to healthy eating among both males and females,
except for males in Libya and Palestine. e proportion
of those who reported this barrier as somewhat important
or important ranged from % to % in males and %
to % in females. Another barrier which was relatively
highly reported was “do not have access to healthy foods,”
whereabout%to%ofmalesand%to%of
females reported that this barrier was somewhat important or
important.
As for social barriers to healthy eating, “not having timeto
prepare or eat healthy foods because of school commitment”
was the most important barrier reported by both genders in
all countries, with this being reported by a higher percentage
of females than males. Algerian males (%) and females
(.%) were more likely to report this barrier as important,
compared with their counterparts in other countries (the
range was from .% to .% of males and from % to
.% in females in other countries). In general, there were
signicant dierences between males and females in these
seven countries (𝑃 < 0.05) for all barriers to healthy eating.
Perceived barriers to physical activity reported by male
and female adolescents are presented in Tables and ,
respectively. Interestingly, all the personal barriers were not
important among males in Algeria, Jordan, Libya, Syria,
and UAE, but they were somewhat important or important
among males in Kuwait and Palestine. e picture was not
thesameforfemales,whereaboutmorethan%ofthe
females perceived the two barriers as somewhat important or
important (“donothavemotivationtodophysicalactivity,
exercise, or sport” and “Do not have skills to do physical
activity, exercise, or sport”). However, “not enjoying physical
activity, exercise, or sport” was perceived to be not important
by %–% of the females. Excluding males in Kuwait,
the barrier “no parents’ support to be physically active”
was reported to be not important by %–% of males
and %–% of females. e barrier of “not having the
time to be physically active” was perceived to be somewhat
important or important by the males in all countries, except
in Jordan where the proportion was signicantly lower (%
compared to more than % in other countries). However,
this barrier seems to be more strongly perceived by all
females (%–% reported that this barrier was important
or somewhat important). In general, cultural factors were
found to be important or somewhat important barriers among
females but not among males. e dierences between males
and between females in the seven countries regarding the
majority of barriers to physical activity were signicant (𝑃<
0.05).
e signicance of dierences between males and females
in each country for perceived barriers to healthy eating and
physical activity is presented in Tables and ,respectively.
e dierence between males and females concerning “do
not have enough information about a healthy diet” was
found to be highly statistically signicant in Jordan, Kuwait,
Libya, Palestine, and UAE (𝑃values ranged from . to
.). However, there was great variation between males and
females from country to country for the rest of the barriers.
As for physical activity barriers, the dierences between
males and females were signicant for most barriers. Almost
allpersonalbarrierstophysicalactivityinallcountries
were highly signicant for males and females, whereas the
e Scientic World Journal
T : Perceived barriers to healthy eating among adolescents of seven Arab countries (male) (%).
Barriers Algeria Jordan Kuwait Libya Palestine Syria UAE
Imp. Som. Not. Imp. Som. Not. Imp. Som. Not. Imp. Som. Not. Imp. Som. Not. Imp. Som. Not. Imp. Som. Not.
(A) Personal and environmental barriers to healthy eating
() Do not have enough information about a
healthy diet . . . . . . . . . . . . . . . . . . . . .
() Do not have motivation to eat a healthy diet . . . . . . . . . . . . . . . . . . . . .
()Donotenjoyeatinghealthyfoods . . . . . . . . . . . . . . . . . . . . .
() Do not have skills to plan and shop for
preparing or cooking healthy foods . . . . . . . . . . . . . . . . . . . . .
() Do not have access to healthy foods . . . . . . . . . . . . . . . . . . . . .
() Not able to buy healthy foods that are
inexpensive . . . . . . . . . . . . . . . . . . . . .
(B) Social barriers to healthy eating
() No parents’ support to eat a healthy diet . . . . . . . . . . . . . . . . . . . . .
() No friends’ support to eat a healthy diet . . . . . . . . . . . . . . . . . . . . .
() No teachers’ support to eat a healthy diet . . . . . . . . . . . . . . . . . . . . .
() Not having time to prepare or eat healthy
foods because of school commitment . . . . . . . . . . . . . . . . . . . . .
Imp.: important barrier (%), Som.: somewhat important (%), and Not.: not a barrier (%).
e Scientic World Journal
T : Perceived barriers to healthy eating among adolescents of seven Arab countries (female) (%).
Barriers Algeria Jordan Kuwait Libya Palestine Syria UAE
Imp. Som. Not. Imp. Som. Not. Imp. Som. Not. Imp. Som. Not. Imp. Som. Not. Imp. Som. Not. Imp. Som. Not.
(A) Personal and environmental barriers to healthy eating
() Do not have enough information about a
healthy diet . . . . . . . . . . . . . . . . . . . . .
() Do not have motivation to eat a healthy diet . . . . . . . . . . . . . . . . . . . . .
()Donotenjoyeatinghealthyfoods . . . . . . . . . . . . . . . . . . . . .
() Do not have skills to plan and shop for
preparing or cooking healthy foods . . . . . . . . . . . . . . . . . . . . .
() Do not have access to healthy foods . . . . . . . . . . . . . . . . . . . . .
() Not able to buy healthy foods that are
inexpensive . . . . . . . . . . . . . . . . . . . . .
(B) Social barriers to healthy eating
() No parents’ support to eat a healthy diet . . . . . . . . . . . . . . . . . . . . .
() No friends’ support to eat a healthy diet . . . . . . . . . . . . . . . . . . . . .
() No teachers’ support to eat a healthy diet . . . . . . . . . . . . . . . . . . . . .
() Not having time to prepare or eat healthy
foods because of school commitment . . . . . . . . . . . . . . . . . . . . .
Imp.: important barrier (%), Som.: somewhat important (%), and Not.: not a barrier (%).
e Scientic World Journal
T : Perceived barriers to physical activity among adolescents of seven Arab countries (male) (%).
Barriers Algeria Jordan Kuwait Libya Palestine Syria UAE
Imp. Som. Not. Imp. Som. Not. Imp. Som. Not. Imp. Som. Not. Imp. Som. Not. Imp. Som. Not. Imp. Som. Not.
(A) Personal barriers to physical activity
() Do not have motivation to do physical activity,
exercise, or sport . . . . . . . . . . . . . . . . . . . . .
() Not enjoying physical activity, exercise, or
sport . . . . . . . . . . . . . . . . . . . . .
()Donothavetheskillstodophysicalactivity,
exercise, or sport . . . . . . . . . . . . . . . . . . . . .
(B) Social support barriers to physical activity
() No parents’ support to be physically active . . . . . . . . . . . . . . . . . . . . .
() No friends’ support to be physically active . . . . . . . . . . . . . . . . . . . . .
() No teachers’ support to be physically active . . . . . . . . . . . . . . . . . . . . .
(C) Environmental barriers to physical activity
() Do not have enough information about how to
increase physical activity . . . . . . . . . . . . . . . . . . . . .
() Not having access to places to do physical
activity, exercise, and sport . . . . . . . . . . . . . . . . . . . . .
() Not being able to nd physical activity
facilities that are inexpensive . . . . . . . . . . . . . . . . . . . . .
()Nothavingthetimetobephysicallyactive . . . . . . . . . . . . . . . . . . . . .
() Feeling shy when practising exercise outdoors . . . . . . . . . . . . . . . . . . . . .
() e climate is not suitable for practising
exercise . . . . . . . . . . . . . . . . . . . . .
() Not being able to practise physical activity due
to cultural factors . . . . . . . . . . . . . . . . . . . . .
() Do not have enough money to enrol on
physical activity club . . . . . . . . . . . . . . . . . . . . .
Imp.: important barrier (%), Som.: somewhat important (%), and Not.: not a barrier (%).
e Scientic World Journal
T : Perceived barriers to physical activity among adolescents of seven Arab countries (female) (%).
Barriers Algeria Jordan Kuwait Libya Palestine Syria UAE
Imp. Som. Not. Imp. Som. Not. Imp. Som. Not. Imp. Som. Not. Imp. Som. Not. Imp. Som. Not. Imp. Som. Not.
(A) Personal barriers to physical activity
() Do not have motivation to do physical activity,
exercise, or sport . . . . . . . . . . . . . . . . . . . . .
() Not enjoying physical activity, exercise, or
sport . . . . . . . . . . . . . . . . . . . . .
()Donothavetheskillstodophysicalactivity,
exercise, or sport . . . . . . . . . . . . . . . . . . . . .
(B) Social support barriers to physical activity
() No parents’ support to be physically active . . . . . . . . . . . . . . . . . . . . .
() No friends’ support to be physically active . . . . . . . . . . . . . . . . . . . . .
() No teachers’ support to be physically active . . . . . . . . . . . . . . . . . . . . .
(C) Environmental barriers to physical activity
() Do not have enough information about how to
increase physical activity . . . . . . . . . . . . . . . . . . . . .
() Not having access to places to do physical
activity, exercise, and sport . . . . . . . . . . . . . . . . . . . . .
() Not being able to nd physical activity
facilities that are inexpensive . . . . . . . . . . . . . . . . . . . . .
()Nothavingthetimetobephysicallyactive . . . . . . . . . . . . . . . . . . . . .
()Feelingshywhenpractisingexerciseoutdoor . . . . . . . . . . . . . . . . . . . . .
() e climate is not suitable for practising
exercise . . . . . . . . . . . . . . . . . . . . .
() Not being able to practise physical activity due
to cultural factors . . . . . . . . . . . . . . . . . . . . .
() Do not have enough money to enrol on
physical activity club . . . . . . . . . . . . . . . . . . . . .
Imp.: important barrier (%), Som.: somewhat important (%), and Not.: not a barrier (%).
e Scientic World Journal
T : Signicant dierences (𝑃value) between males and females for perceived barriers to physical activity among Arab adolescents (using
chi-square test).
Barriers Algeria Jordan Kuwait Libya Palestine Syria UAE
(A) Personal barriers to physical activity
() Do not have motivation to do physical activity, exercise, or sport . . . . . . .
() Not enjoying physical activity, exercise, or sport . . . . . . .
() Do not have the skills to do physical activity, exercise, or sport . . . . . . .
(B)Socialsupportbarrierstophysicalactivity
() No parents’ support to be physically active . . . . . . .
() No friends’ support to be physically active . . . . . . .
() No teacher’ support to be physically active . . . . . . .
(C) Environmental barriers to physical activity
() Do not have enough information about how to increase physical activity . . . . . . .
() Not having access to places to do physical activity, exercise, or sport . . . . . . .
() Not being able to nd physical activity facilities that are inexpensive . . . . . . .
() Not having the time to be physically active . . . . . . .
() Feeling shy when practising exercise outdoor . . . . . . .
() e climate is not suitable for practising exercise . . . . . . .
() Not being able to practise physical activity due to cultural factors . . . . . . .
() Do not have enough money to enrol on physical activity club . . . . . . .
T : Signicant dierences (Pvalue) between males and females for perceived barriers to healthy eating among Arab adolescents (using
chi-square test).
Barriers Algeria Jordan Kuwait Libya Palestine Syria UAE
(A) Personal and environmental barriers to healthy eating
() Do not have enough information about a healthy diet . . . . . . .
() Do not have motivation to eat healthy diet . . . . . . .
()Donotenjoyeatinghealthyfoods . . . . . . .
() Do not have skills to plan and shop for preparing and cooking
healthy foods . . . . . . .
() Do not have access to healthy foods . . . . . . .
() Not able to buy healthy foods that are inexpensive . . . . . . .
(B) Social barriers to healthy eating
() No parents’ support to eat healthy diet . . . . . . .
() No friends’ support to eat healthy diet . . . . . . .
() No teachers’ support to eat healthy diet . . . . . . .
() Not having time to prepare or eat healthy foods because of school
commitment . . . . . . .
dierences varied between countries with respect to social
support barriers and environmental barriers.
4. Discussion
is study indicates that there are several personal, social,
and environmental barriers to healthy eating and physical
activity among adolescents in Arab countries, and there
are signicant dierences in these barriers between males
and females in each country and among countries. Lack
of information on healthy eating, lack of motivation to eat
healthy diets, and not having time to prepare or eat healthy
foods due to school commitments were found to be the main
barriers to healthy eating. However, lack of motivation to
do physical activity, insucient support from teachers, and
lack of time to do physical activity were the main barriers
to physical activity, especially among females. Parents and
friends support for eating a healthy diet or to do physical
activity were somewhat positive, while the support of teachers
was indicated as negative, which suggests the role these
people have in overcoming barriers to weight maintenance.
e Scientic World Journal
ManystudiesintheArabworldhavereportedthatthe
dietary habits of adolescents are unhealthy and that it is
therefore important to promote healthy eating as well as
ahealthylifestyle[–].However,basedonthecurrent
study, a deciency of information related to healthy nutrition
was reported as being one of the predominant obstacles to
eating a healthy diet. is barrier has also been stated by
adolescents in western countries [,]. is may indicate
that there are insucient nutrition education programmes,
especially through the mass media and schools. Although
studies on the eect of nutrition education programmes on
food habits in the Arab world are scanty, some evidence has
shown that these programmes have little impact on changing
nutritional behaviours. is is probably due to the inadequate
information provided, the lack of specialized people in
nutrition education, and the inability of these programmes
to attract the attention of the public []. Furthermore, it
was found that much of the nutrition information in the
school curricula in Arab countries is outdated and does
not cover many local dietary habits that are associated with
existing diet-related diseases in Arab states []. e ird
Arab Conference on Nutrition, which was held in the United
Arab Emirates in , made several recommendations for
promoting healthy nutrition in the Arab world. ese recom-
mendations included the need for the review and evaluation
of the current curricula in both government and private
schools in order to update the information related to nutrition
andtolinkthisinformationtothelocalandArabsituation
[].
Poor availability of healthy diets in schools and food
outlets and preferences for fast foods and easy access to them
may reduce the motivation of adolescents to eat healthy foods
[,]. e lack of personal motivation to eat a healthy diet
has also been shown to be a barrier to adolescents in some
western countries []. Motivation to practise healthy eating
by school children is usually inuenced by parents, peers,
teachers, and the mass media [,]. Food choices and
availability at home are mostly inuenced by parents []. e
current study has shown that parents are not an important
barrier to healthy eating; however, the lack of knowledge
of sound nutrition among parents as well as their work
schedule may continue to reduce the level of supervision and
guidance of children’s food habits []. At the adolescence
stage, peers have a high impact on nutritional behaviour [];
nevertheless, friends were not reported to be a barrier to
healthyeatinginthisstudy.Shepherdetal.[]reportedthat
healthy food intake is mainly associated with parents and
the home environment, while fast food intake is associated
with friendship and socioeconomic status. Teachers seem to
be an important barrier in countries included in this study.
is nding is in agreement with other studies in western
countries [,]. Teachers who model unhealthy eating
habits have been found to be a barrier to healthy eating
[]. Nutrition knowledge and the attitudes of teachers are
of great concern in the promotion of healthy dietary habits
among students []. Some studies have shown that school
teachers lack nutrition information [] and that they have
an unhealthy lifestyle [].
Physical inactivity, either among children or adults, is
one of the fastest growing risk factors associated with several
chronic diseases in the Arab states []. It is apparent from this
study that Arab adolescents face more barriers to the practice
of physical activity than they do to eating a healthy diet, and
the dierences between males and females for most physical
activity barriers are highly signicant. In general, personal
and social barriers were found to be higher among females
than males. Many barriers to physical activity among Arab
adolescents have also been reported in western countries, and
to a lesser extent among females in western countries than
among females in Arab countries [,,]. As with healthy
eating barriers, support from parents, friends, and teachers
for the practice of physical activity should be taken into
consideration when tackling physical activity barriers. It has
been shown that adolescents with little support from friends
for physical activity and with physically inactive parents tend
to be physically inactive [], while adolescents who believe
that their friends regard them as athletically competent have
been found to exhibit a more positive feeling towards physical
activity [].
Several factors are associated with barriers to physical
activity. Among US adolescents, Kahn et al. []foundthat
the most important variables associated with the practice of
physical activity in both genders were age, BMI, psychosocial
factors, parental attitudes about physical activity, parental
physical activity, parental attitudes towards body shape,
perceived peer views of body shape, and environmental bar-
riers. However, due to the sociocultural dierences between
western and Arab countries, not all these factors may be
applicable to the Arab culture. Studies of factors associated
withthepracticeofphysicalactivityintheArabworldare
very limited. e nutrition transition during the past decades
in most Arab countries has led to a more sedentary lifestyle,
especially with advances in technology and transportation.
e appeal of television, electronic games, and computers has
increased the sedentary time of children [].
e highly signicant dierences between males and
femalesinphysicalactivitybarriersinthisstudycouldbe
attributed to sociocultural factors. In general, women in
most Arab states are facing more barriers to the practice of
physical activity than men. ere are greater freedom and
more places for men to practise physical activity and other
recreational activities than for women. Furthermore, due to
religious and social norms, most women in the Arab region
cannot practise exercise outdoors and with sports dress, as
many families do not allow their girls to practise exercise
outdoors for religious and safety reasons. Also, many families
do not permit their girls to practise physical activity wearing
sports dress, but with traditional dress, which is not physically
comfortable for taking exercise; this in turn discourages them
from exercising outdoors []. In Bahrain, it was reported
that % of women believed that there is sex discrimination
in the lack of opportunities for women to take part in physical
activity, as most exercise and sports facilities are provided
for men. Approximately % of these women perceived that
the negative attitudes of the community and family members
towards women who practise exercise are preventing them
from exercising [].
e Scientic World Journal
e variation in barriers to healthy eating and to physical
activity among adolescents in the seven Arab countries may
be due to the dierences in socioeconomic and cultural
factors, as well as the prevalence of obesity in these countries.
Some countries with high economic status such as Kuwait
and UAE have experienced nutrition transition earlier than
other countries, which leads to rapid change in dietary habits
and lifestyle. Consequently, the prevalence of obesity and
sedentary behaviours is relatively high, which in turn aects
the barriers to a healthy lifestyle in adolescents. However,
the sociocultural dierences should be considered, as these
factors are not equal in these countries. is is beyond the
scope of this paper.
isstudyhassomelimitationsthatareworthmen-
tioning. First, the sample did not include private schools,
which means that the sample did not represent all secondary
school students in the studied Arab countries. Second, the
questionnaire should have asked for more information on
sociocultural barriers, especially those related to physical
activity. ird, the questionnaire may need further validation.
Despite these limitations, this study is the rst attempt to
investigate barriers to healthy eating and physical activity
in a relatively large sample of adolescents in various Arab
countries and provide baseline data for any further studies
of this aspect.
In conclusion, the current environment in Arab countries
is characterized by the high availability of unhealthy foods
coupled with a lifestyle requiring a low level of physical activ-
ity. is environment is promoting a high energy intake and
low energy expenditure. erefore, to combat the epidemic
of obesity and other chronic diseases, we must rst correct
the environment. e results of this study highlighted some
of the barriers that are associated with negative nutrition
and unhealthy lifestyles in Arab adolescents. A strategy to
overcome barriers to healthy eating and physical activity
in Arab schoolchildren should take into consideration the
support from parents, peers, and teachers, time management,
self-motivation, increased nutrition awareness, sociocultural
variables, and the provision of facilities for adolescents to
practise physical activity in and out schools. Increasing the
availability of healthy foods in school canteens and providing
an environment that encourages physical activity are also
essential elements for supporting a healthy lifestyle among
adolescents. We hope that this study opens the door for
further in-depth studies related to factors that inhibit people
in the Arab world from eating healthy foods and taking part
in physical activity.
References
[] A. O. Musaiger and H. M. Al-Hazzaa, “Prevalence and risk
factors associated with nutrition-related noncommunicable
diseases in the Eastern Mediterranean region,” International
Journal of General Medicine,vol.,pp.–,.
[] World Health Organization, Global Status Report on Non-
Communicable Diseases 2010, World Health Organization,
Geneva, Switzerland, .
[] A. O. Musaiger, M. Al-Mannai, R. Tayyem et al., “Prevalence
of overweight and obesity among adolescents in seven Arab
countries: a cross-cultural study,” Journal of Obesity,vol.,
Article ID , pages, .
[] J.O.HillandJ.C.Peters,“Environmentalcontributionstothe
obesity epidemic,” Science,vol.,no.,pp.–,
.
[] J. Shepherd, A. Harden, R. Rees et al., “Young people and
healthy eating: a systematic review of research on barriers and
facilitators,” Health Education Research,vol.,no.,pp.–
, .
[] A. O. Musaiger, “Diet and prevention of coronary heart disease
in the Arab Middle East countries,” Medical Principles and
Practice, vol. , no. , supplement, pp. –, .
[] S.W.Ng,S.Zaghloul,H.Alietal.,“Nutritiontransitioninthe
United Arab Emirates,” European Journal of Clinical Nutrition,
vol. , no. , pp. –, .
[] A. Mehio Sibai, L. Nasreddine, A. H. Mokdad, N. Adra, M.
Tabet, and N. Hwalla, “Nutrition transition and cardiovascular
disease risk factors in middle East and North Africa countries:
reviewing the evidence,” Annals of Nutrition and Metabolism,
vol. , no. -, pp. –, .
[] A.R.Al-Hai,M.A.Al-Fayez,B.L.Al-Atharietal.,“Relative
contribution of physical activity, sedentary behaviors, and
dietary habits to the prevalence of obesity among Kuwaiti
adolescents,” Food and Nutrition Bulletin,vol.,no.,pp.–,
.
[] H. N. Bashour, “Survey of dietary habits of in-school adoles-
cents in Damascus, Syrian Arab Republic,” Eastern Mediter-
ranean Health Journal,vol.,no.,pp.–,.
[] H. Al Sabbah, C. Vereecken, P. Kolsteren, Z. Abdeen, and
L. Maes, “Food habits and physical activity patterns among
Palestinian adolescents: ndings from the national study of
Palestinian schoolchildren (HBSC-WBG),” Public Health
Nutrition, vol. , no. , pp. –, .
[] L. Nasreddine, A. Mehio-Sibai, M. Mrayati, N. Adra, and N.
Hwalla, “Adolescent obesity in Syria: prevalence and associated
factors,” Child,vol.,no.,pp.–,.
[] K. Lock, J. Pomerleau, L. Causer, D. R. Altmann, and M. McKee,
“e global burden of disease attributable to low consumption
of fruit and vegetables: implications for the global strategy on
diet,” Bulletin of the World Health Organization,vol.,no.,
pp. –, .
[] A. O. Musaiger, Overweight and Obesity in the Arab Countries:
e Need for Action, Arab Centre for Nutrition, Bahrain, .
[] M. Maddah, “Risk factors for overweight in urban and rural
school girls in Iran: skipping breakfast and early menarche,”
International Journal of Cardiology,vol.,no.,pp.–,
.
[] K. J. Smith, S. L. Gall, S. A. McNaughton, L. Blizzard, T. Dwyer,
and A. J. Venn, “Skipping breakfast: longitudinal associations
with cardiometabolic risk factors in the childhood determinants
of adult health study,” American Journal of Clinical Nutrition,
vol. , no. , pp. –, .
[] R. Guthold, M. J. Cowan, C. S. Autenrieth, L. Kann, and L.
M.Riley,“Physicalactivityandsedentarybehavioramong
schoolchildren: a -country comparison,” Journal of Pediatrics,
vol. , no. , pp. –, .
[] M. Bruening, M. Y. Kubik, D. Kenyon, C. Davey, and M.
Story, “Perceived barriers mediate the association between self-
ecacy and fruit and vegetable consumption among students
attending alternative high schools,” Journal of the American
Dietetic Association,vol.,no.,pp.–,.
e Scientic World Journal
[] S. Jenkins and S. D. Horner, “Barriers that inuence eating
behaviors in adolescents,” Journal of Pediatric Nursing,vol.,
no. , pp. –, .
[] N. E. Findholt, Y. L. Michael, L. J. Jeroe, and V. W. Brogoitti,
“Environmental inuences on children’s physical activity and
eating habits in a rural Oregon County,” American Journal of
Health Promotion,vol.,no.,pp.e–e,.
[] J. L. Tergerson and K. A. King, “Do perceived cues, benets,
andbarrierstophysicalactivitydierbetweenmaleandfemale
adolescents?” JournalofSchoolHealth,vol.,no.,pp.–
, .
[] S.Andajani-Sutjahjo,K.Ball,N.Warren,V.Inglis,andD.Craw-
ford, “Perceived personal, social and environmental barriers to
weight maintenance among young women: a community sur-
vey,” International Journal of Behavioral Nutrition and Physical
Activity,vol.,article,.
[] K. Skinner, R. M. Hanning, and L. J. S. Tsuji, “Barriers and
supports for healthy eating and physical activity for First
Nation youths in northern Canada,” International Journal of
Circumpolar Health,vol.,no.,pp.–,.
[] O. O. Biloukha and V. Utermohlen, “Healthy eating in Ukraine:
attitudes, barriers and information sources,” Public Health
Nutrition,vol.,no.,pp.–,.
[] A. O. Musaiger, A. S. Hassan, and O. Obeid, “e paradox of
nutrition-related diseases in the Arab countries: the need for
action,” International Journal of Environmental Research and
Public Health,vol.,no.,pp.–,.
[] A. O. Musaiger and S. Miladi, e State of Food and Nutrition in
the Near East, FAO/Regional Oce, Cairo, Egypt, .
[] “e state of food and nutrition in the Arab countries,” in
Proceedings of the 3rd Arab Conference on Nutrition,A.O.
Musaiger, Ed., Arab Centre for Nutrition, Muharaq, Bahrain,
.
[] C. Stevenson, G. Doherty, J. Barnett, O. T. Muldoon, and
K. Trew, “Adolescents’ views of food and eating: identifying
barriers to healthy eating,” Journal of Adolescence,vol.,no.
, pp. –, .
[] D. Benton, “Role of parents in the determination of the
food preferences of children and the development of obesity,”
International Journalof Obesity,vol.,no.,pp.–,.
[] L. L. Birch and K. K. Davison, “Family environmental factors
inuencing the developing behavioral controls of food intake
and childhood overweight,” Pediatric Clinics of North America,
vol.,no.,pp.–,.
[] N. Pearson, K. Ball, and D. Crawford, “Parental inuences
on adolescent fruit consumption: the role of adolescent self-
ecacy,” Health Education Research,vol.,no.,pp.–,
.
[] J. K. Croll, D. Neumark-Sztainer, and M. Story, “Healthy
eating:whatdoesitmeantoadolescents?”Journal of Nutrition
Education and Behavior,vol.,no.,pp.–,.
[] M. B´
elanger, M. Casey, M. Cormier et al., “Maintenance and
decline of physical activity during adolescence: insights from
a qualitative study,” e International Journal of Behavioral
Nutrition and Physical Activity, vol. , pp. –, .
[] Y.-H. Chen, C.-Y. Yeh, Y.-M. Lai, M.-L. Shyu, K.-C. Huang, and
H.-Y. Chiou, “Signicant eects of implementation of health-
promoting schools on schoolteachers nutrition knowledge and
dietary intake in Taiwan,” Public Health Nutrition,vol.,no.,
pp. –, .
[] B. M. Margetts, J. A. Martinez, A. Saba, L. Holm, and M.
Kearney, “Denitions of “healthy” eating: a pan-EU survey of
consumer attitudes to food, nutrition and health,” European
Journal of Clinical Nutrition, vol. , no. , pp. S–S, .
[] S. Sharma, K. S. Dortch, and C. Byrd-Williams, “Nutrition-
related knowledge, attitudes, and dietary behaviors among head
start teachers in Texas: a cross-sectional study,” Journal of the
Academy of Nutrition and Dietetics, vol. , no. , pp. –,
.
[] R. Quattrin, E. Saveri, L. Calligaris, and S. Brusaferro, “Italian
public school: a survey to estimate teachers’ knowledge and
perception on prevention and management of nutrition related
pathologies,” Igiene e Sanita Pubblica,vol.,no.,pp.–,
.
[] M. Rossiter, T. Glanville, J. Taylor, and I. Blum, “School food
practices of prospective teachers: research article,” Journal of
School Health,vol.,no.,pp.–,.
[] J. A. O’Dea, “Why do kids eat healthful food? Perceived benets
ofandbarrierstohealthfuleatingandphysicalactivityamong
children and adolescents,” Journal of the American Dietetic
Association,vol.,no.,pp.–,.
[] F.C.Bull,M.Pratt,R.J.Shephard,andB.Lankenau,“Imple-
menting national population-based action on physical activity–
challenges for action and opportunities for international col-
laboration,” Promotion & Education,vol.,no.,pp.–,
.
[]C.D.Patnode,L.A.Lytle,D.J.Erickson,J.R.Sirard,
D. Barr-Anderson, and M. Story, “e relative inuence of
demographic, individual, social, and environmental factors on
physical activity among boys and girls,” International Journal of
Behavioral Nutrition and Physical Activity,vol.,article,.
[] M. A. Chase and G. M. Dummer, “e role of sports as a social
status determinant for children,” Research Quarterly for Exercise
and Sport, vol. , no. , pp. –, .
[] J. A. Kahn, B. Huang, M. W. Gillman et al., “Patterns and
determinants of physical activity in U.S. adolescents,” Journal
of Adolescent Health,vol.,no.,pp.–,.
[] A. O. Musaiger, “Overweight and obesity in eastern mediter-
ranean region: prevalence and possible causes,” Journal of
Obesity, vol. , Article ID , pages, .
[] A. O. Musaiger and M. S. Al-Ansari, “Barriers to practicing
physical activity in the Arab countries,” in Nutrition and
Physical Activity in the Arab Countries of the Near East,A.
O. Musaiger and S. Miladi, Eds., FAO Regional Oce, Cairo,
Egypt, .
