Barriers to childhood obesity prevention in the school food environment: a qualitative study from Indonesia

BACKGROUND: Schools play a crucial role in shaping children's growth and development. In Indonesia, however, school food environments face major challenges in promoting nutrition and healthy lifestyles. These environments are increasingly dominated by unhealthy ultra-processed products (UPPs), limited nutritious options and inadequate opportunities for physical activity-key contributors to rising childhood obesity rates. METHODS: We explored the drivers of childhood obesity and barriers to prevention in selected school food environments using qualitative data from in-depth interviews and focus group discussions with 165 purposefully selected participants across four study areas, field observations and a desk review of relevant regulations. Data were analysed through an iterative content analysis approach, using a predefined variable indicator matrix outlining key study themes. RESULTS: Findings show frequent consumption of unhealthy snacks and sweetened drinks in and around schools, driven by a lack of food environment regulations. Barriers to healthier diets include children's food preferences, limited parental time and the widespread availability of UPPs. While school-based physical activity was generally adequate, sedentary behaviours at home were common. Key gaps include limited teacher capacity, inadequate health education materials and weak data sharing and referral mechanisms for obesity between schools and community health services. CONCLUSION: Strengthening school food environments regulations in Indonesia is urgently needed. Priorities include developing national canteen guidelines, restricting the sale and marketing of UPPs and high-fat, salt and sugar foods, adopting interpretative front-of-pack labelling schemes and promoting equitable physical activity opportunities. Improving knowledge, capacity and coordination among schools, parents and health workers is also critical.