Paediatric obesity is a severe public health problem accompanied by several physical and mental complications, mainly due to an imbalance between energy input and output. Dietary behaviours are influenced by many demographic factors and determinants, such as the place of residence and the level of dietary knowledge of the children and their parents. The aim of the current paper is to assess the levels of dietary knowledge, dietary adherence (in relation to recommendations), and the body mass index (BMI) of Lebanese adolescents in association with demographic variables, their parents’ dietary knowledge and adherence levels, and with other lifestyle behaviours. This cross-sectional study included 1535 Lebanese adolescents aged 15 to 18 years, from 16 public and private high schools located in urban and rural regions, and 317 of their parents. Our results showed that 30.2% of the adolescents were overweight or obese. Participants enrolled in private schools and those living in urban regions had a significantly higher BMI z-score compared to those enrolled in public schools and living in rural regions, respectively. In addition, Lebanese adolescents generally had low levels of dietary knowledge and 32.4% had low levels of dietary adherence. Their dietary adherence was significantly associated with their parents’ dietary adherence. The findings underline the significant role of the parents in shaping their children’s eating behaviours, in addition to the other determinants and factors affecting the diet of Lebanese adolescents. As the prevalence of paediatric overweight and obesity has reached alarming rates, the results of the current study have important implications for both public health policies and obesity prevention interventions in the Middle East and worldwide.

The availability of practical tools to assess dietary knowledge and adherence is essential to evaluate the effectiveness of dietary interventions. The aims of this paper were to develop reliable dietary knowledge and adherence questionnaires, suitable for Lebanese adolescents and their parents, and to estimate the feasibility of conducting studies involving such participants in the school-based setting. Eight Lebanese high schools participated in this study (involving 220 adolescents aged 15–18 years). Self-administered dietary knowledge and adherence questionnaires (the Dietary Knowledge Questionnaire (DKQ) and the Dietary Adherence Questionnaire (DAQ), respectively) were completed by the high school students and their parents. A 24 h recall was additionally administered for the adolescents by a dietitian and a trained interviewer at school, in order to validate the adolescents’ answers in the DAQ. The cognitive interview method was used to qualitatively evaluate the questionnaires. The resulting Cronbach’s alpha ranged from 0.61 to 0.78 for the adolescent questionnaires and from 0.46 to 0.89 for the parental ones. In addition, 23 items (out of 25) of the adolescent DAQ matched with the administered 24 h recall. A significant negative correlation was found between the knowledge score (DKQ) and the unhealthy items of the adolescent DAQ. There was a significant positive correlation between the DKQ of the parents and the knowledge score of their children. This is the first study of dietary questionnaires involving Lebanese high school students from different regions, while also including their parents.

Objective: To evaluate the effectiveness of Sahtak bi Sahnak on dietary knowledge and adherence to dietary guidelines in Lebanese adolescents.Design/setting: A cluster randomised controlled trial was conducted in public and private secondary schools located in urban and rural regions in Lebanon.Participants: Sixteen secondary schools including 1,572 adolescents were randomly assigned to the intervention (n = 739) or control group (n = 833).Intervention: Sahtak bi Sahnak is an educational school-based intervention dedicated to improving dietary adherence to nutritional guidelines, increasing the level of dietary knowledge, and preventing the development of obesity during adolescence. It was systematically designed based on the Intervention Mapping framework. The total length of the intervention was around seven educational sessions, until all of the 11 lessons were covered. Each education session lasted 20–40 min.Main Outcome Measures: Dietary knowledge and adherence levels were measured at baseline and post-intervention using validated questionnaires.Statistical Analysis: Multivariate multilevel regression models were used to examine intervention effects on outcomes, controlled for background characteristics (i.e., age, gender, location, type of school, grade, BMI z-score).Results: The intervention group showed significant improvements in total dietary knowledge (B = 12.74, p < 0.001) and intake of healthy items (B = 1.89, p < 0.001), compared to the control group. Intake of unhealthy items decreased significantly (B = −1.43, p < 0.001), compared to the control group. These results were adjusted for age, gender, type of school, location, BMI z-score, study group, and score at baseline.Conclusion and Implications: Sahtak bi Sahnak is an effective and culturally appropriate school-based intervention for targeting diet among a variety of Lebanese adolescents.

Background: Pediatric obesity is a major public health concern worldwide. Improving dietary and physical activity habits at a young age could prevent many health complications during adulthood and later years.Objective: This paper describes the application of the Intervention Mapping protocol for the systematic development of the Lebanese intervention “Sahtak bi Sahnak” (meaning Your health in your plate) that focuses on preventing pediatric obesity and promoting a healthy lifestyle through a systematically designed and culturally appropriate, school-based program.Method: The development of this intervention is based on the six steps of the Intervention Mapping (IM) protocol. This intervention targets Lebanese adolescents aged 15–18 years enrolled in Lebanese public and private high schools, located in urban and rural areas. Its effectiveness will be tested in a Clustered Randomized Controlled Trial in 16 high schools.Discussion and conclusion: The IM protocol allowed us to develop a theory based, low resource intervention which can be integrated as part of the educational curriculum of public and private high schools in Lebanon. This study provides a detailed example of the application of the IM approach in the Lebanese high school context. Even though it is a time-consuming process, IM serves as a valuable tool in the health promotion field and provides a high level of transparency to improve and replicate the process in the future.

Intervention Mapping (IM) is a theory- and evidence-based framework allowing to develop, implement, and evaluate an intervention in public health. The current paper presents a practical step-by-step guide of the second step of Intervention Mapping, which translates the needs assessment findings into specific objectives aiming at changing health behaviours and/or environmental conditions. This includes: (1) Stating the programme outcomes; (2) Listing the target behaviors and performance objectives; (3) Selecting the sub-determinants; and (4) Producing an overview of intervention targets: the matrix of change objectives. We provide practical guidelines for each of these tasks. In addition, intervention developers may benefit from the listed open tools that may be used in each stage to address the identified needs and achieve meaningful health outcomes.