title: Perceived barriers to achieving a healthy weight: a qualitative study using focus groups at public and private schools in Guatemala City.
abstract: Overweight prevalence among Guatemalan girls is higher in public than in private schools. Little is known about adolescent girls' perceptions of the right ways to achieve a healthy weight. This study examines public and private school adolescent girls' perceptions of a "healthy weight," and barriers and facilitators to achieving it.
  
  
  
  We conducted 4 focus groups in public and private schools in Guatemala City with girls from 13 to 15 years old. The discussion guide included open-ended questions and activities aimed at examining perceptions of "healthy weight" and barriers and motivators to achieving it within the school environment. Focus groups were audio-recorded and transcribed. Data analyses followed established methods of content analysis.
  
  
  
  Twenty-eight girls (private school, n = 12; public school, n = 16) of ages ranging from 13.1 to 15.9 years (median, 14, IQR, 13.6-14.9) participated in the study. Girls identified images of thin and fit women as healthy. They cited healthy eating and physical activity as ways to achieve a healthy weight. Within the school environment, barriers to maintaining a healthy weight included a lack of healthy food options and the prioritization of sports for boys over girls. In public schools, facilities were less than optimal; in private schools, girls' access to facilities was limited. Public school girls stated that their uniforms were inappropriate for exercising.
  
  
  
  Our findings support the need to provide more healthy food options in Guatemalan schools. In addition, physical activity for girls should be promoted and facilities made available for their use.
authors.affiliation: Cardiovascular Surgery Unit of Guatemala Research Department, 5a Av. 6-22 zona 11, Guatemala, 01011, Guatemala. luisagmadrigal@gmail.com.|Institute of Nutrition of Central America and Panama, Calzada Roosevelt 6-25 zona 11, Guatemala, 1188, Guatemala. luisagmadrigal@gmail.com.
authors.forename: Luisa
authors.initials: L
authors.lastname: Madrigal
authors.affiliation: Harvard T. H. Chan School of Public Health, Department of Social and Behavioral Sciences, 401 Park Dr. Room 403-E, Boston, MA, 02215, USA.
authors.forename: Inez
authors.initials: I
authors.lastname: Adams
authors.affiliation: Cardiovascular Surgery Unit of Guatemala Research Department, 5a Av. 6-22 zona 11, Guatemala, 01011, Guatemala.
authors.forename: Violeta
authors.initials: V
authors.lastname: Chacon
authors.affiliation: Cardiovascular Surgery Unit of Guatemala Research Department, 5a Av. 6-22 zona 11, Guatemala, 01011, Guatemala.|Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, MO, USA.
authors.forename: Joaquin
authors.initials: J
authors.lastname: Barnoya
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D016497:Adolescent Health Services; D001828:Body Image; D001835:Body Weight; D002947:Cities; D005260:Female; D017144:Focus Groups; D006166:Guatemala / Q000453:epidemiology; D006801:Humans; D009765:Obesity / Q000453:epidemiology* / Q000517:prevention & control / Q000523:psychology; D015995:Prevalence; D012572:School Health Services; D012574:Schools
keywords: Eating; Obesity; Overweight; Physical activity; Weight perception