Qualitative Study to Determine Stressors Influencing Dietary and Physical Activity Behaviors of Overweight and Obese Adolescents in Iran

Abstract

Introduction: Childhood obesity has become a global endemic public health problem. Emotional
distress has been proposed to be a strong mediator of unhealthy lifestyle behaviors among youth.
The aim of this study was to explore the sources and role of stress on developing unhealthy
lifestyle practices pertaining to diet and physical activity among overweight and obese adolescents.

Methods: This qualitative study was conducted in 2016–2017 in two large cities of Iran, Mashhad
and Isfahan. Fifty‑two overweight and obese adolescents were selected through purposeful sampling.
In‑depth semi‑structured interviews and focus group discussions were conducted to obtain perceptions
and experiences regarding underlying factors of obesity and the sources and role of stress in inducing
unhealthy lifestyle. Ten parents were also interviewed. Data were analyzed using conventional
content analysis with MAXQDA software. Study rigor was verified using criteria proposed by
Lincoln and Guba.

Results: After analyzing the data, two main categories which triggered emotional
overeating and physical inactivity among adolescents were: “school originated stress” and “family
originated stress.” Three subcategories of school originated stress were “Too much homework,”
“Frequent exams” and “Priority for studying at both school and home” and family originated
stress subcategories were “Parental destructive conflicts,” “Divorce” and “Socio‑familial issues.”

Conclusions: Our findings highlighted the sources and role of stress in emerging unhealthy lifestyle
practices including emotional overeating and physical inactivity among adolescents which could lead
to weight gain. Therefore, to improve lifestyle behaviors of students and prevent childhood obesity,
addressing school, and family stressors is a crucial subject.

Keywords: Adolescent, emotional eating, obesity, physical activity, qualitative research