Barriers and enablers to obesity prevention in female-only high schools in Riyadh: a qualitative study exploring healthy eating, physical activity and school-based interventions using the COM-B model

TL;DR

This study explores barriers and enablers to obesity prevention in female-only high schools in Riyadh, focusing on healthy eating, physical activity, and school-based interventions.

Contribution

The study is the first qualitative investigation of obesity prevention in Saudi female-only schools using the COM-B model and socio-ecological framework.

Findings

Barriers include lack of trained staff, hot weather, and curriculum limitations.

Low student motivation was a dominant barrier identified by both students and staff.

Enablers include physical education curriculum and health-related motivators like improved body image.

Abstract

In the Kingdom of Saudi Arabia (KSA), adolescent health is suboptimal. Findings reported that 79% of youths aged 15–29 were physically inactive with 30% living with overweight or obesity. Poor dietary habits further complicate the obesity epidemic. Schools are promoted as key settings for obesity prevention, yet little is known about female-only high schools. This study explored barriers and enablers to healthy eating (HE), physical activity (PA), and obesity prevention school-based interventions (SBIs) through conducting focus group discussions (FGDs) with students and staff.

Nine FGDs were conducted across three female public high schools in Riyadh from varying deprivation levels; six with 37 students (aged 16–17) and three with 19 staff members. A semi-structured topic guide, informed by the COM-B model, explored capabilities, opportunities, and motivations related to obesity prevention. Framework analysis identified key barriers and enablers to HE, PA, and SBIs implementation.

Barriers emerged across all COM-B constructs. Capability-related barriers included lack of trained staff. Opportunity-related barriers were most prominent, including hot weather, curriculum limitations, and built school environment. Staff and students collectively agreed that low student motivation was a key barrier. School staff highlighted structural enablers such as the physical education curriculum, while students identified individual-level motivators including willpower, improved mood, health, and body image. No mutual enablers were identified across staff and student groups.

Female-only high schools in KSA face major barriers to obesity prevention SBIs, with low student motivation emerging as a dominant barrier across staff and student groups. Addressing these barriers through context-specific, multi-level approaches integrating staff and student perspectives is critical for effective SBIs.

The online version contains supplementary material available at 10.1186/s12889-026-26568-1.

What is already known on this topic:

Childhood obesity rates in KSA are among the highest globally and driven by poor dietary habits, physical inactivity, socio-cultural and environmental factors.Schools are considered a key setting for health promotion.Obesity prevention initiatives within the context of female-only schools in KSA remains underexplored with most evidence originating from Western or mixed-gender settings.Female-only schools in KSA operate within unique cultural and environmental conditions (such as gender segregation and limited physical activity opportunities for females). This creates a need to further explore how to effectively design and implement SBIs in this unique context.

Childhood obesity rates in KSA are among the highest globally and driven by poor dietary habits, physical inactivity, socio-cultural and environmental factors.

Schools are considered a key setting for health promotion.

Obesity prevention initiatives within the context of female-only schools in KSA remains underexplored with most evidence originating from Western or mixed-gender settings.

Female-only schools in KSA operate within unique cultural and environmental conditions (such as gender segregation and limited physical activity opportunities for females).

This creates a need to further explore how to effectively design and implement SBIs in this unique context.

What this study adds:

This is the first qualitative study to investigate barriers and enablers to healthy eating, physical activity and school-based obesity prevention interventions implementation among both female high school students and staff in Riyadh.By employing the COM-B model, the socio-ecological model and using framework analysis, the study offers a structured and behaviourally informed perspective.This study identifies structural and motivational barriers, such as the built school environment, lack of trained staff, curriculum limitations, and lack of student motivation for healthy eating and physical activity.It also identifies a range of behaviourally-informed enablers across COM (capability, opportunity and motivation) such as staff cooperation, peer support, the introduction of a physical education curriculum, body image, and health-related motivators. These findings provide context-specific understanding of obesity prevention SBIs in Saudi schools.

This is the first qualitative study to investigate barriers and enablers to healthy eating, physical activity and school-based obesity prevention interventions implementation among both female high school students and staff in Riyadh.

By employing the COM-B model, the socio-ecological model and using framework analysis, the study offers a structured and behaviourally informed perspective.

This study identifies structural and motivational barriers, such as the built school environment, lack of trained staff, curriculum limitations, and lack of student motivation for healthy eating and physical activity.

It also identifies a range of behaviourally-informed enablers across COM (capability, opportunity and motivation) such as staff cooperation, peer support, the introduction of a physical education curriculum, body image, and health-related motivators.

These findings provide context-specific understanding of obesity prevention SBIs in Saudi schools.

How this study might affect research, practice, or policy:

This study highlights the need for culturally appropriate and context-specific obesity prevention SBIs, that address the individual, interpersonal, institutional, community, and public policy levels.It supports staff training, improvement of the built school environment, and practical PA in schools.The study informs future SBIs research in KSA and Gulf Cooperation Council countries with similar contexts.

This study highlights the need for culturally appropriate and context-specific obesity prevention SBIs, that address the individual, interpersonal, institutional, community, and public policy levels.

It supports staff training, improvement of the built school environment, and practical PA in schools.

The study informs future SBIs research in KSA and Gulf Cooperation Council countries with similar contexts.

The online version contains supplementary material available at 10.1186/s12889-026-26568-1.

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