The Impact of Adolescent Friendships on Unhealthy Eating Behaviors of Overweight and Obese Adolescents: A Qualitative Study

Background: Childhood obesity has reached epidemic proportions and become one the most important public health issues globally. One of the significant determinants of childhood obesity-related behaviors such as poor dietary habits relates to role of friends and peers. This study aimed to explore the role of interaction within the social network of friends on unhealthy eating behaviors of overweight and obese adolescents. Materials and Methods: This qualitative study was conducted between 2016 and 2017 in Mashhad and Isfahan, two large cities of Iran. Ten parents and 52 overweight and obese adolescents were selected through purposeful sampling. To obtain perceptions and experiences regarding the role of adolescent friendships on unhealthy eating behaviors, in-depth semi-structured interviews and focus group discussions were conducted. Data were analyzed based on conventional content analysis. Results: Six themes which contributed to following unhealthy dietary habits when adolescents are in the friend networks were identified: "Eating in the peer networks as a usual way for social interaction", "Peers' pressure to have unhealthy dietary habits", "High availability and accessibility to unhealthy foods", "Lack of nutritional knowledge", "Neglectful parenting style", and "Passive interaction in the friendship networks". Conclusion: Our findings indicate that peer support along with appropriate parenting style are necessary to affect adolescent eating behaviors when they are in the friend social networks, but are not sufficient per se. Being a confident, decisive and self-determined adolescent and owing a high level of behavioral confidence and self-esteem might reduce the impact of friends for adhering to unhealthy dietary habits in youth.