Addressing childhood obesity in Iran: exploring a multifaceted conceptual model in a low/middle income country...

Despite significant global efforts to control childhood obesity (CO), its prevalence continues to rise, particularly in low- and middle-income countries. This study aims to identify the determinants of CO in Iran.

This qualitative study employed a purposive snowball sampling method to interview 30 stakeholders from various specialities and disciplines. They included scientists, government and industry authorities, representatives from international organizations, and members of civil society. The data analysis was conducted using MAXQDA 2020, employing inductive content analysis. The credibility and dependability of the data were ensured by using Lincoln and Guba's criteria. We used the consolidating criteria for reporting qualitative studies.

The main determinants of childhood obesity control in Iran can be categorized into three levels: local, national, and international. At the local level, home and school environments are influential in shaping unhealthy lifestyles and energy imbalances. The national determinants are the triad of governance, dominant social structure, and national policies/regulations. Governance factors such as inappropriate policy-making processes, Low responsiveness and accountability, and Low collaboration and parallel working between stakeholders; impact childhood obesity control. Dominant social structures including cultural norms, urban design, air pollution, social transitions, and inequalities also contribute to the issue. National policies and regulations exhibit shortcomings in fiscal and food promotion aspects. At the international level, the World Health Organization's approach to Ending Childhood Obesity (ECHO), trade policies, political sanctions, climate change, and the COVID-19 pandemic have significant implications for childhood obesity control.

This study provides valuable insights into the determinants of childhood obesity (CO) in Iran. It can inform evidence-based policymaking not only in Iran but also in other countries with similar socio-economic statuses.