The authors have declared that no competing interests exist.
During the past three decades the prevalence of childhood obesity has steadily increased in the United States. Causes of childhood obesity are complex and include numerous individual and environmental factors. The purpose of this study was to determine parent perceptions on the social-ecological barriers (community, school, and family) to physical activity and healthy eating, perceived specific to their children. Self-reported data gathered from a 50-item questionnaire and six focus groups were conducted with parents (
Global changes in diet and physical activity (PA) patterns are fueling an obesity epidemic as obesity is reaching pandemic proportions throughout the world
In 2007-2008, Hispanic boys, aged 2-19 years, were significantly more likely to be obese than non-Hispanic white boys, and non-Hispanic black girls were significantly more likely to be obese than non-Hispanic white girls
Popular theory suggests that the current epidemic of childhood obesity is caused by existing in a culture that encourages excessive food intake and discourages PA
A host of researchers
The purpose of this study was to use focus group discussions to determine the perceptions of parents participating in the Women, Infants, and Children (WIC) program regarding the social-ecological barriers (community, school, and family) to their children’s engagement in PA and healthy eating. After conducting literature reviews on perceived barriers to healthy eating and PA, the social-ecological model, and the built environment, the primary investigators developed a structured interview guide that was reviewed and validated for content and sensitivity
WIC participants were recruited to attend one of six focus groups offered (five in English, one in Spanish) using study flyers, and word-of-mouth outreach. Three trained moderators (two- English speaking and one- Spanish speaking) led each focus group discussion. Each group included between 4 and 8 participants and lasted between 1.5 and 2 hours total. As incentives, lunch was provided and each participant was given a $20 gift card. Prior to beginning the focus group discussion, each participant was asked to complete a 50-item questionnaire, available in both English and Spanish. A subset of items from that instrument deemed relevant for describing the focus group participants and their family contexts are described in these study results, including: (1) Participant characteristics (gender, age group, race/ethnicity, height and weight); (2) Family composition (number of children living in participants’ homes and other individuals (spouse, relatives, friends, etc.) who live with them; (3) Responsibility for family nutrition (participant reports of who decides what to buy at the store, who shops for the food, and who cooks the food, with response options for all three questions of “you”, “spouse” and “other”). After participants had completed their questionnaires, the focus group discussions commenced. Focus group questions included the following: (1) “What can families do to help prevent weight problems in children?” (2) “Understanding that changing habits is difficult, what do you think makes it hard for families to make changes?” (3) “Can schools help your children make changes? If so, how? If not, why?” (4) “Can the community help your children make changes? If so, how? If not, why?” (5) “If you were the mayor for the day and your job was to reduce childhood obesity in the community, what would you do? What would you change?”
Audiotapes recorded during each session were transcribed verbatim in both English and Spanish languages and the written transcript was reviewed for accuracy. Focus group transcript themes were systematically identified, categorized, and coded by the three lead researchers utilizing the inductive analysis procedures outlined by Patton
Forty-three participants took part in the focus groups. As
Characteristic | N | Percent |
Female | 38 | 88.4% |
Age, years | ||
16-19 | 2 | 4.7 |
20-24 | 6 | 14.0 |
25-29 | 13 | 30.2 |
30-34 | 11 | 25.6 |
35-39 | 2 | 4.7 |
40-44 | 1 | 2.3 |
45 and older | 8 | 18.6 |
Ethnicity | ||
Hispanic/Latino | 28 | 65.1 |
White | 7 | 16.3 |
Multi-racial/ethnic | 4 | 9.3 |
Black or African American | 3 | 7.0 |
Native American or Alaskan Native | 1 | 2.3 |
Number of children in the home | ||
0 | 2 | 4.8 |
1 | 8 | 19.0 |
2 | 16 | 38.1 |
3 | 10 | 23.8 |
4 or more | 6 | 14.3 |
BMI range | ||
Normal, 18.5 – 24.9 kg/m2 | 9 | 22.5 |
Overweight, 25.0 – 29.9 kg/m2 | 10 | 25.0 |
Obese, 30 – 39.0 kg/m2 | 19 | 47.5 |
Severely obese, ≥ 40 kg/m2 | 2 | 5.0 |
An overview of focus group themes, frequencies, and illustrative quotes is shown in
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Perceived barriers to physical activity | Increase the number of recreational programs for kids (42); Reduced fees for pools and parks (30); Improve safety of parks by enforcing regulations mitigating criminal activity in parks (19); Maintain safe roads, bike lanes, and sidewalks providing safe corridors (1) | “Lompoc is for adults, we don’t have a skate rink, so children can play, we barely have anything for children to have fun that is not at home.” “We had a bowling alley but it’s gone.”“It’s very expensive to get your child involved in some kind of a club.” “The aquatic center has such limited time, it is always full.” “It’s the language too. It’s a factor because everyone goes to the recreation center to get information but it’s not in our language. I don’t understand what is on the flyers.” |
Perceived barriers to healthy eating | Healthier foods tend to be priced higher (8); Lack of quality grocery stores in area (4) | “I don’t see many healthy places here, you have to go outside of town to find a Trader Joes TM.” “You can go buy a loaf of bread and the pastas are a lot cheaper than fruits and vegetables.” |
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Perceived barriers to physical activity | Funding commitment for quality physical education is low (5);School playground safety (4);Lack of motivation of school (3);Distance to school is too far to bike or walk (7);Not safe to walk to school (10) | “I ask my daughter about P.E. and she says “she had it on Monday’... and I asked ‘what happened to Wednesday?’ She said, ‘they didn’t have enough money to have a teacher full time.’”“School is very far away.”“I don’t want them to walk because you never know these days, we live close to school but what I hear in the news and read in the newspaper it’s not secure.” “Only after school do they get a guard.”“They fight kids, they assault kids.” |
Perceived barriers to healthy eating | School food quality questioned (33) | “I used to work at the school my son is at and the food is not very healthy… they give them a little pizza.” “The school gives them junk food… I tell my daughter I will pack a lunch and she says ‘NO’… they have Doritos TM and other things.” |
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Perceived barriers to physical activity | Funding commitment for healthy food is low (4);Family economics (10); Denial there is a weight problem in the family (2) | “Because of work I can’t take my child to the recreation center or I can’t afford to put my child in the activities.” “Everything is about money, everything costs money.” “When I was young, I was chubby, and everyone would say “how pretty, how pretty” but they said that because I was chubby.” |
Perceived barriers to healthy eating | Cultural custom to finish food on plate (7); Lack of nutrition education (8 ); Ease of preparing fast food (6); Preference for junk food (5) | “We have a culture that you won’t get up until your plate is empty…the bigger the plate the more food we put on it.” “In our culture it’s a sin to discard food.” “My husband has to have soda in the house.” “I don’t know how to make asparagus and they are full of vitamins, only rich people make them.” “It’s hard to be at work all day and when you come home you are too tired to make dinner. You just put in those Hot Pockets TM.” |
The most common response to what a community could do to prevent future weight problems was to increase accessibility of recreational programming, including increasing the number of – and enrollment caps on – classes, and offering them at times that were more convenient for working families. Participants reported that they were unaware of where and how to find information on what programming is available in their community, as evidenced by the following comment:
Aida ~
Many expressed frustration that the bowling alley had been closed, leaving no family-centered recreational activities in the community. Participants wanted the community to maximize the use of its parks and pool. They were pleased with the swimming pool fee structure when the pool first opened, but had since found it cost-prohibitive for larger families due to a policy change which required that one (paying) adult accompany each (paying) child, thus making the pool too expensive for some large families and impossible for others. Their perception was that the pool existed for the high school sports teams to use and for privately-paid birthday parties that generated money for the facility; serving the families of the Lompoc area was no longer the pool’s primary purpose.
There were many comments regarding the design, maintenance and safety of the parks. Participants felt that certain parks were planned with areas serving younger children oriented too close to the street, presenting a car safety issue:
Nina ~ “JM (Johns-Manville) park, there’s just too many situations because it’s right next to the street… all it takes is one drunk driver.” (Focus group transcript #4)
Other participants mentioned parks that only had equipment geared for older children (basketball, baseball, etc.) and very little equipment for the younger children (ex: few basket swings were available):
Lola ~“I went to Thompson Park with my son the other day, and what I remember about Thompson is that they have the baby swings you can put your baby in and swing. Uh-uh. There was a big bar with five big people swings on it. Are you serious? What a waste.” (Focus group transcript #1)
There were safety and maintenance concerns with glass in the sand, broken or absent water fountains, and unsanitary conditions voiced by many. The following are examples expressing frustration with the parks:
Maria ~ “We have a downtown park, and they have the septic tank people come in and clean it out right by the little kiddy playground which has glass in it, and other stuff that my daughter would put in her mouth. We usually head as far away as we can and try to find some cleaner parks.” (Focus group transcript #3)
Anna ~ “Lompoc really needs to invest in a decent park. The parks aren’t really, really bad, but just yesterday we took our girls to play softball at a park, and there’s no bathroom there. No place to wash your hands. Maybe a port-a-potty wouldn’t be such a big deal to bring out.” (Focus group transcript #3)
Another suggestion as to what the community could do to prevent future weight problems was to address and educate the public on safety issues, enforcing regulations regarding criminal’s proximity to schools and parks, and road safety. Many parents commented on a lack of confidence in their children’s safety when they are not in view, resulting in some resistance to allowing their children to walk to school or participate in other recreational opportunities.
When discussing the barriers the community faced in promoting health, participants mentioned that they felt leadership was failing to enlist community involvement and support. They were impressed with what private local groups like Lompoc/New Heights- Connections, a mental health provider, for transition-age youth, were doing for the benefit of the children in the community. They also mentioned the Big Brothers/Big Sisters program, the YMCA and the Air Force community at Vandenberg Air Force Base as being sources of support for families. While participants knew some services existed (scholarships through the city’s parks and recreation department) they faulted the community organizers with failing to provide a consistent and known means by which to communicate to the public.
Although the Spanish language newspaper, El Sol, was mentioned as an avenue by which community organizers communicate, language was still listed by the Spanish-speaking participants as a barrier to learning about available programming:
Sofia ~
Blanca ~
Ema ~
WIC was complimented as an agency that effectively provided information regarding health; however, it was pointed out that the WIC Program was not available to all segments of the population:
Elina ~ “
Economic barriers in the community were also mentioned. An increase in bus fares caused transportation challenges for families to get to activities. Some distances were perceived as too far to walk or that unmonitored crossings were unsafe for walking or biking. The majority of the participants reported that during tough financial times these factors pose even more difficulty for financially challenged families:
Carisa ~
Many activity program options mentioned by the focus group participants required the child provide their own equipment (which they quickly outgrew) in order to participate, thus adding to the overall cost and making the program unaffordable. When asked how well the community does on helping children and families achieve or maintain a healthy weight, participants overwhelming put the community at below average or failing.
Aside from the community barriers to PA, there were some concerns about the availability, accessibility, and affordability of healthy food in the community (e.g., access to healthy grocery stores, the availability of fresh fruits and vegetables):
Vanesa ~
Overwhelmingly, participants felt schools should provide nutrition education. Specifically, healthier food choices at school breakfasts and lunches were cited as necessities to model healthy eating. It was acknowledged that there are healthy choices available but these food items aren’t fresh:Marie ~
Participants felt more of an effort should be made to make the fresh, healthy food more appealing, perhaps by offering children incentives for eating it. Participants also recommended removing or reducing competitive food offerings. Having poor nutritional quality foods in school was seen as undermining parent’s best efforts to teach children about healthy food selections. As evidenced by the exchange below:
Esma ~
The greatest barrier perceived by the participants to schools promoting healthier eating and PA was a lack of funding and proper allocation of resources. They mentioned teachers’ time constraints for curricula concerning nutrition and physical education. They also believed schools were remiss in not encouraging walking to school and in not improving street crossings as many are considered by the participants to be unsafe. While they acknowledged the constraints on schools, participants did believe more PA time during the school day was possible. They felt that if it were made a priority by the administration, solutions could be found. California’s education system has been hit hard by deep cuts as evidenced by this woman’s comment:
Madalynn ~
Lack of motivation on the school’s part was the next most common barrier mentioned that prevented schools from promoting healthy eating and PA. An elementary teacher was highlighted as setting a positive example by getting “over 100 kids involved” for a track and field program at recess. This school-day program helped all kids, even those who couldn’t stay after school because their parents needed them to come directly home. Over half of the participants assessed the schools in the Lompoc community as average, below average, or failing in their efforts to help kids maintain a healthy weight. However, the parents of very young children (not yet in school) had an overall perception of the schools as “just fine”.
The most commonly reported barrier for families to make positive changes in nutrition and/or PA levels was a lack of support from a spouse or other adult members of the household, some of whom have cultural beliefs and practices that do not support healthy eating:
Cécile ~
Camilla ~
Some participants reported that their spouses were reluctant to make a change in their personal eating behaviors and choices. This not only resulted in poor modeling of healthy eating but also presented a lack of a united front in parenting. This was also true for the grandparents living in the same household. Participants reported that it was common for grandparents to be more indulgent and to go against the wishes of the parents:
Rose Marie ~
Participants also cited single parenthood as a challenge to healthy eating, as single parents’ lower incomes and long working hours made it difficult to prepare more time- consuming and costly healthy meals. Additionally, parents reported that when they felt tired, they were less likely to model PA:
Tia ~
Work responsibilities and financial concerns were generally cited as being significant factors in limiting families’ ability to help their children be active:
Lela ~
Despite the barriers cited above, participants still evaluated their own family as ‘above average’ in how they were doing in regards to weight issues with their children.
Focus group results showed that low-income WIC participants in Lompoc, CA, perceived a number of barriers to healthy eating and PA that existed at the community, school, and family levels. Notably, the community-level barriers focused more extensively on issues related to engaging in PA than healthy eating, and the issues cited are challenges that communities nationwide have been struggling with for years. Mirroring results found back in 1996 in a nationwide telephone sample
The discussion of school-level barriers in addressing childhood obesity revealed that WIC participants generally believed that much more could be done locally in schools to promote healthy behavior. There was strong consistency in the belief that the food provided by their local schools is of poor quality, and many participants felt there were missed opportunities to promote PA, either within the school or by facilitating safer routes for walking or biking to school. Research supports this avenue as a promising direction for obesity prevention in youth. School-based interventions represent an area in which there are many promising efforts, particularly in promoting healthier eating, that have shown that healthier food options in a school are associated with improved eating behaviors among students, such as higher-quality diets
Perhaps the most intriguing results in these focus group findings related to participants’ perceptions of the healthy eating and activity barriers faced within their families. Although participants discussed having limited time and money to support activities for their children, it was in this area – more than in discussions of community- or school-level barriers – where participants focused on issues related to healthy eating. These issues proved to be complex, and the participants themselves provided a somewhat inconsistent portrait of the role they and their families played in their children’s health. For example, most of the participants had reported that they alone were responsible for choosing, buying, and/or cooking the food their family ate.
However, despite having ultimate control over the food that entered and was served in the home, they still felt that other family members often had a significant negative impact on their children’s eating behaviors. These findings underscore the complexity of the interpersonal and cultural dynamics associated with food and mealtimes
Consistent with other research
Clearly these barriers had an impact on participants’ own weight status in addition to that of their children; only 22.5% had a BMI in the “Healthy” range; the rest were overweight to morbidly obese themselves. Moreover, because parent obesity status is a predictor of children’s obesity
Since January 2009, when a version of this report was delivered to the Lompoc Valley Community Health Improvement Project, the Lompoc community environment and policy committee initiated several public health programs via two infrastructure grants providing funds through the year 2015. These new programs included traffic calming measures and police traffic enforcement around schools, having volunteers oversee
Funding made possible by California Polytechnic State University, The College of Science and Math, the Center for