| الوصف: |
Background: In Lebanon, the population is experiencing nutrition transition and a high prevalence of obesity. Studies have shown that the Lebanese people are shifting their dietary behaviours from the traditional Lebanese diet, a variation of the Mediterranean diet, towards a westernised diet and are being physically inactive. To achieve a population behaviour change and address the obesity epidemic, the root causes of these behaviours and food choices should be explored and addressed. This approach requires joint efforts from different sectors such as the government, healthcare, and civil society to develop action plans and enact policies. In Lebanon, the factors that influence eating behaviours and physical activity are still not explored, national level policies are still lacking, and researchers have called for an urgent need to implement policies to halt the rise of obesity prevalence. Aims and objectives: The general aim of this thesis is to explore the perceived factors that influence adults' eating behaviours and physical activity using the socio-ecological model as the conceptual framework. In addition, this PhD research explores the relevant contribution and the position of different stakeholders towards obesity prevention in Lebanon. Finally, this thesis draws on lessons learned from countries worldwide that help in developing guidelines for obesity prevention in Lebanon. Methods: Two studies were conducted for this PhD research. In the first study, the Photovoice method was used to engage Lebanese adults from the North Governorate to explore different factors that influence their eating behaviours and physical activity and to identify their perceptions towards the actions needed to address obesity. The second study involved a series of one-to-one face-to-face semi-structured interviews which were conducted with key stakeholders from different public and private sectors (government, civil society, education, and healthcare). These interviews aimed to explore the key stakeholders' perceptions towards obesity and its causes, their relevant contribution towards obesity prevention, their priority of action to address obesity, and finally the barriers to effective action to reduce obesity in Lebanon. Results: The findings of the two qualitative studies show that obesity is commonly perceived as a body image issue rather than a health issue. Some of the main factors that were perceived to influence Lebanese adults' eating behaviours and physical activity were: females' (wives' and mothers') employment, social gatherings, and social norms (e.g. food and meal sharing), safety concerns, the availability of countless unhealthy food options that are relatively cheaper than healthy food, the lack of a physical environment that encourages physical activity, and food marketing and advertisements. The results of the stakeholder's interviews show that the key stakeholders are aware of the nutrition transition and some of the underlying environmental factors that caused these behaviour changes. Yet, most of the key stakeholders framed obesity in an "individualistic approach" by focusing on unhealthy dietary behaviours, the physical inactivity and placed the responsibility on individuals for their lifestyle. Due to their approach, most of them focused their actions on raising awareness such as the role of education. Some of the barriers to effective policy action to address obesity in Lebanon are the political instability, lack of public demand for action, and lack of coordinated multi-sectoral actions. Implications: The recognition of obesity as a disease as well as strengthening the public, stakeholders', and policymakers' support towards obesity prevention strategies are essential to overcome the "policy inertia" in Lebanon. The key areas that need to be addressed for obesity prevention are raising awareness on obesity health consequences, increasing access to healthy food in public and private settings, limiting unhealthy food advertisements, and fiscal measures such as taxing unhealthy food and subsidising healthy food. To facilitate the implementation of policies that aim to prevent obesity, a systematic plan of action should be developed. To engage stakeholders from different sectors and establish a national multi-sectoral collaboration, national strategies and policies that follow a Health in all Policies Approach (HiPA) are recommended. This requires strong leadership from the government. Conclusions: There is an urgent need to shift the actions beyond targeting the individual by implementing public policies to address the obesogenic environment in Lebanon. Recommendations for research, policy actions, and practice are provided to guide the action towards establishing an appropriate public policy that recognises the need to adopt a socioecological model of implementation. |
