{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T19:07:48Z","timestamp":1787771268118,"version":"build-2784847793"},"reference-count":46,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,5,10]],"date-time":"2022-05-10T00:00:00Z","timestamp":1652140800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Childhood obesity is a serious issue in the Kingdom of Saudi Arabia, but there is no known community intervention. The aim of the study was to use a participatory approach to obtain the perspectives of students, school staff and Ministry of Education (MoE) representatives and parents on important and feasible intervention opportunities for school-based obesity prevention for adolescent girls.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>The study was conducted in two intermediate schools for girls (13\u201315 years old) in Jeddah that were purposefully identified with the support of the MoE. Group concept mapping, a mixed method approach, was conducted with 19 adults which included staff from the MoE and schools, school canteen suppliers and mothers. Adults generated statements in response to two prompts (P); P1 \u201c<jats:italic>The factors influencing adolescent obesity in Saudi are...\u201d<\/jats:italic> and P2 \u201c<jats:italic>The content of school-based programmes should focus on....\u201d<\/jats:italic> Photovoice-enhanced concept mapping was used with students (<jats:italic>n<\/jats:italic> = 15 students) to capture adolescent perspectives on what influences their dietary and physical activity habits. Students generated statements' using their own photographs. Stakeholders, both adult and students, sorted the statements into themes and rated each statement for relative importance and feasibility. Multidimensional scaling and hierarchical cluster analyses were used to produce concept maps with the input from students and adults.<\/jats:p><\/jats:sec><jats:sec><jats:title>Result<\/jats:title><jats:p>Adults generated 35 statements in response to P1 and identified five themes that influenced adolescent obesity including \u201cHome Environment,\u201d \u201cLifestyle,\u201d \u201cSchool Environment,\u201d \u201cCommunity,\u201d \u201cBiology.\u201d They generated 42 statements in relation to P2 and identified four themes including \u201cMinistry of Education Support,\u201d \u201cSchool Environment,\u201d \u201cPublic health programmes\u201d and \u201cWider environmental influences.\u201d Students generated 42 statements from 39 pictures. They identified five themes that influenced their dietary and physical activity habits\u2014\u201cRole of Government,\u201d \u201cSchool Environment,\u201d \u201cHome Environment,\u201d \u201cRetail Environment\u201d and \u201cCultural Practices.\u201d Both groups identified several common important and feasible actions with a strong emphasis on improving the school environment, in particular food provision, with MoE support. Exemplar corresponding statements from adults were \u201c<jats:italic>Offer healthy foods in the canteen,\u201d \u201cRemove chocolates and sweets\u201d<\/jats:italic> and \u201c<jats:italic>Educate children about healthy foods\u201d<\/jats:italic> and from students were \u201c<jats:italic>Offer fruit and vegetables in the canteen,\u201d \u201cRemove chocolates from the canteen,\u201d \u201cHealthy meals should not expensive.\u201d<\/jats:italic> Lack of correspondence related to students' emphasis on access to both healthy foods and physical activity in schools and the wider environment (e.g. retail environments), while adults emphasized school-based education and food provision. After further consultations, both stakeholder groups agreed on improving access to healthy foods in the canteen.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Students and school and MoE staff jointly agreed that a canteen-based intervention was important and feasible to improve dietary habits and thus help to prevent obesity among adolescent girls. This was the first time a participatory approach was used with students for intervention development in Saudi Arabia. A co-development approach may have value to improve their school food environments.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2022.863765","type":"journal-article","created":{"date-parts":[[2022,5,10]],"date-time":"2022-05-10T13:28:21Z","timestamp":1652189301000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":18,"title":["Adolescent Obesity Prevention in Saudi Arabia: Co-identifying Actionable Priorities for Interventions"],"prefix":"10.3389","volume":"10","author":[{"given":"Manal","family":"Almughamisi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Majella","family":"O'Keeffe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seeromanie","family":"Harding","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,5,10]]},"reference":[{"key":"B1","volume-title":"The Co-development of a School-Based Nutrition Intervention to Prevent Childhood Obesity in Jeddah, Saudi Arabia","author":"Almughamisi","year":"2021"},{"key":"B2","doi-asserted-by":"publisher","first-page":"407237","DOI":"10.1155\/2011\/407237","article-title":"Overweight and obesity in eastern mediterranean region: prevalence and possible causes","volume":"2011","author":"Musaiger","year":"2011","journal-title":"J Obes."},{"key":"B3","doi-asserted-by":"publisher","first-page":"e1002968","DOI":"10.1371\/journal.pmed.1002968","article-title":"The overweight and obesity transition from the wealthy to the poor in low-and middle-income countries: a survey of household data from 103 countries","volume":"16","author":"Templin","year":"2019","journal-title":"PLoS Med."},{"key":"B4","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1093\/tropej\/fmm089","article-title":"Obesity and related behaviors among adolescent school boys in Abha City, Southwestern Saudi Arabia","volume":"54","author":"Mahfouz","year":"2007","journal-title":"J Trop Pediatr."},{"key":"B5","doi-asserted-by":"publisher","first-page":"110","DOI":"10.4274\/Jcrpe.898","article-title":"The effect of parental socioeconomic class on children's body mass indices","volume":"5","author":"Al Alwan","year":"2013","journal-title":"J Clin Res Pediatr Endocrinol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"3435","DOI":"10.1017\/S1368980020000245","article-title":"Response of the public and restaurant owners to the mandatory menu energy-labelling implementation in restaurants in Saudi Arabia","volume":"23","author":"Alkhaldy","year":"2020","journal-title":"Public Health Nutr."},{"key":"B7","doi-asserted-by":"publisher","first-page":"347","DOI":"10.3390\/ijerph17010347","article-title":"School-based intervention programs for preventing obesity and promoting physical activity and fitness: a systematic review","volume":"17","author":"Yuksel","year":"2020","journal-title":"Int J Environ Res Public Health."},{"key":"B8","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1108\/13620430310465471","article-title":"Saudisation and employment in Saudi Arabia","volume":"8","author":"Madhi","year":"2003","journal-title":"Career Dev Int."},{"key":"B9","unstructured":"GDP Growth (Annual %) - Saudi Arabia2019"},{"key":"B10","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1111\/j.1753-4887.2011.00456.x","article-title":"Global nutrition transition and the pandemic of obesity in developing countries","volume":"70","author":"Popkin","year":"2012","journal-title":"Nutr Rev."},{"key":"B11","unstructured":"Noncommunicable Diseases Country Profiles 20142014"},{"key":"B12","doi-asserted-by":"publisher","first-page":"763","DOI":"10.26719\/2016.22.10.763","article-title":"Dietary transition and obesity in selected Arabic-speaking countries: a review of the current evidence","volume":"22","author":"Aboul Enein","year":"2016","journal-title":"East Mediterr Health J."},{"key":"B13","unstructured":""},{"key":"B14","doi-asserted-by":"publisher","first-page":"E174","DOI":"10.5888\/pcd11.140236","article-title":"Peer reviewed: obesity and associated; factors\u2014Kingdom of Saudi Arabia, 2013","volume":"11","author":"Memish","year":"2014","journal-title":"Prev Chronic Dis."},{"key":"B15","doi-asserted-by":"publisher","first-page":"4756260","DOI":"10.1155\/2019\/4756260","article-title":"Health promotion and obesity in the Arab Gulf states: challenges and good practices","volume":"2019","author":"Samara","year":"2019","journal-title":"J Obes."},{"key":"B16","unstructured":"MiddletonG\n            EvansAB\n            KeeganR\n            BishopD\n            EvansD\n          New York, NYNOVA Science PublishersThe Importance of Parents and Teachers as Stakeholders in School-Based Healthy Eating Programs. 2014. 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