Table 3 Barriers to childhood obesity prevention policies in Iran

Individual (children, adolescents and parents (n = 11 )

Lack of sufficient knowledge and risk perception in children and adolescents

8.33

Lack of active transport by parents

8.33

Lack of sufficient knowledge in children

8.24

Lack of Self-regulation and self-control when eating in children

8.14

Misunderstanding of weight status by parents ^a

7.29

Parents' financial problems

6.8

Misunderstanding of weight status by children ^b

6.47

Parent’s reluctance to become involved in COP activities and poor utilization of maternal and child health services by parents ^c

6.16

High family income

5.87

Eating disorders (eg, bulimia nervosa) in children and adolescents

5.36

lack of time and high academic pressures in children and adolescents

3.83

Mean points

Executive (n = 12)

Lack of proper monitoring and control of policies announced for implementation

7.2

Insufficient cooperation of stakeholders

7

Lack of skills in communicating with school health educators or health care providers with children, adolescents and parents

6.92

Insufficient knowledge of school health educators and health care providers

6.78

Lack of communication skills in school health educators with children and adolescents

6.77

Lack of commitment of schools in implementing intervention programs

6.71

Lack of sufficient time and opportunity for executives to implement policies properly

6.39

Insufficient cooperation of school health educators with other health care providers

6.35

Lack of clarity of strategies and policy guidelines communicated for implementation

6.29

Lack of peace of mind of executive staff (for example, school officials and health care providers) to carry out interventions

5.79

High workload of teachers or health care providers

5.69

Frequent changes in the workplace of teachers and health workers

5.54

Mean points

Structural (n=22)

Unsafe and unsuitable physical activity environments for children and adolescents (on the streets, parks and sports clubs)

8.27

Lack of proper transportation plans

High access of children and adolescents to unhealthy food

Lack of equipment and facilities ^d

8.11

Obegenic environments in family, schools and community

8

Cultural problems of sports for girls such as cycling and ....

7.95

Existence of incorrect and unscientific information of childhood obesity in society

7.95

Insufficient commitment at management and executive levels

7.79

Widespread advertising of fast food (poor- nutrient and high-energy foods)

7.77

Infrastructure problems near schools, such as the abundance of fast food stores near schools

7.74

Lack of data on the effectiveness of childhood obesity policies

7.62

Lack of mandatory weight control for all school students

7.43

Restrictive policies ^e

7.39

Allocation of subsidies or lack of taxes for unhealthy food

7.17

Lack of space for preventive interventions such as exercise

7.1

Problems with agenda setting) Prioritize politics(

7

Inadequate time to provide preventive services to children, adolescents and parents ^f

6.77

Top-down process planning and implementation approach

6.67

Lack of manpower

6.65

Emergence of other unforeseen immediate priorities other than obesity in the community and school

6.5

Legal barriers (such as administrative bureaucracies) to intervention programs

6.5

Inconsistent policies in preschools and schools ^g

6.3

Mean points