Perceived barriers to achieving a healthy weight: a qualitative study using focus groups at public and private schools in Guatemala City

Background: 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. Methods: 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. Results: 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. Conclusion: 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.