Adolescents’ eating habits: perspectives of students, parents, and staff in schools: a qualitative study from Rawalpindi, Pakistan | BMC Public Health

The socio-demographic characteristics of the participants are presented in Table 1. The sample included an even gender distribution among students, predominantly female parents, and mostly female teachers, reflecting the caregiving and educational workforce patterns of the study setting.

Thematic analysis yielded five major themes, each encompassing multiple sub-themes, reflecting the complex and multi-layered influences on adolescent eating behaviors. These themes were systematically organized in alignment with the Social Ecological Model, capturing individual, interpersonal, organizational, community, and policy-level determinants. Sub-themes emerged inductively within each level, such as taste preferences, nutritional literacy, emotional eating, and body image concerns at the individual level; and peer pressure, parental food practices, and social media influence at the interpersonal level. Students emphasized taste preferences, peer influence, and body image concerns; parents highlighted time and financial constraints shaping food choices; while teachers pointed to institutional contradictions, particularly the gap between nutrition messages and unhealthy cafeteria options. For clarity and analytical depth, findings are presented according to SEM domains, integrating perspectives from students, parents, and teachers within each level. Although responses were collected separately from these stakeholder groups, their views are presented thematically rather than by group to underscore cross-cutting patterns and contextual contrasts where relevant. This approach allows for a holistic yet nuanced understanding of how multiple, interacting factors shape adolescents’ dietary behaviors within the school setting and broader social environment.

Individual-level influences: Knowledge, attitudes, and behaviors

Taste preferences

Taste emerged as a dominant and unanimous determinant of adolescents’ food choices across all stakeholder groups, often overriding nutritional considerations. One mother shared, “No matter how I cook vegetables, my child still refuses to eat them because they say it doesn’t taste good.” A student candidly admitted, “Healthy food doesn’t taste as good as burgers and fries.” The consistent preference for strong flavors and appealing textures in ultra-processed foods reflects a major challenge to dietary behavior change. These insights underscore the need for school-based interventions that not only educate but also creatively engage adolescents’ palates, making healthy eating both acceptable and enjoyable.

Role of nutritional literacy in shaping adolescent eating habits

Across all stakeholder groups, there was strong consensus that nutritional literacy plays a pivotal role in shaping adolescents’ dietary behaviors, yet widespread misconceptions continue to influence everyday choices. While many adolescents showed basic awareness of healthy eating, their understanding was often fragmented or shaped by misinformation. One student reflected, “I used to skip breakfast, thinking it would help me lose weight, but then I learned how important it is for energy and focus.” Teachers reported similar patterns, with one noting, “Students assume skipping meals or following online diet trends keeps them healthy, but they often don’t realize the long-term impact of poor nutrition.” Parents also acknowledged the need for stronger guidance at home. As one mother shared, “My daughter always preferred packaged snacks because she thought they were more convenient, but once we started talking about nutrition at home, she became more interested in fresh, homemade meals.”

These insights underscore a critical gap in adolescents’ comprehension of nutrition and highlight the urgent need for coordinated, age-appropriate education that reinforces accurate health messages both at school and within the family environment, correcting myths, shifting attitudes, and supporting healthier long-term dietary choices.

Impact of busy schedules adolescent eating habits

While physical activity is widely encouraged and recognized as beneficial, all stakeholder groups acknowledged that many students struggle to align healthy eating with active lifestyles due to time and routine constraints. A parent shared, “After my son started playing football, he began asking for more protein-rich meals instead of just snacking on chips.” However, all stakeholder groups, students, parents, and teachers, consistently identified time constraints as a major barrier to maintaining regular and healthy habits. A student noted, “I often skip breakfast because I’m rushing to school, but then I snack a lot during the day.” Echoing this, a mother remarked, “My daughter is never ready on time in the morning, and that’s why she often leaves without eating anything.” These perspectives highlight a shared recognition that poor time management and hectic routines not only disrupt healthy eating but also undermine physical activity efforts, functioning as a multiplier of risk across both domains of adolescent health.

Cooking skills and dietary independence

Parents and teachers emphasized that adolescents’ limited cooking skills contribute to unhealthy eating habits, as many rely on processed and ready-to-eat foods in the absence of adult supervision. One teacher noted, “Many students rely on instant noodles and packaged snacks because they don’t know how to cook simple, healthy meals.” A mother shared this concern, saying, “I wish my son knew how to cook simple meals, he always reaches for packaged snacks when I’m not home.” However, some students challenged this expectation, viewing meal preparation as a parental responsibility. As one student put it, “It’s not really our job to cook meals, our parents should take care of that.”

This divergence reveals a generational gap in attitudes toward food responsibility and underscores the importance of integrating practical life skills and cooking literacy into adolescent health education, empowering youth to make healthier choices regardless of parental presence or time constraints.

Emotional states and eating behaviors

It was widely acknowledged by students that stress and anxiety significantly influence their eating behaviors, often resulting in emotional eating or appetite suppression. One student shared, “When I’m stressed about exams, I just grab chips and chocolate without even thinking,” highlighting the tendency to seek comfort in high-calorie snacks. In contrast, others reported the opposite effect, with another student stating, “When I’m feeling anxious, I completely lose my appetite, it’s like my stomach just shuts down, and I can’t even think about eating.” These patterns were also recognized by parents, who expressed concern over their children’s stress-related eating habits. One mother noted, “I’ve seen my daughter eat junk food non-stop when she’s upset or under pressure, she won’t listen when I try to stop her.” Another parent shared, “Sometimes my son just skips dinner entirely before exams, I know it’s stress, but I don’t know how to help.”

These accounts stress the need for nutritional interventions that account for the complex interplay between diet, stress, and emotional well-being—promoting healthy eating alongside strategies for stress management and resilience in adolescents.

Body image concerns

Body image emerged as a critical driver of disordered eating behaviors among adolescents, with particular concern expressed for its impact on girls. Students reporting dissatisfaction with their weight often engaged in restrictive practices such as meal skipping and dieting. One student shared, “I sometimes avoid eating lunch at school because I worry about gaining weight.” Both teachers and parents acknowledged the impact of societal appearance norms. A teacher remarked, “The constant promotion of the ideal ‘model figure’ in media and society places a lot of stress on children, especially girls, and leads to restrictive eating, which poses serious health risks.” Reinforcing this, one mother stated, “Obese girls don’t look good—that’s why my daughter tries not to eat too much.”

While all groups acknowledged the influence of body image on adolescent eating habits, their perspectives diverged: students highlighted peer pressure and internal anxiety, teachers pointed to media-driven ideals, and some parents, while concerned, unwittingly perpetuated appearance-based judgments. These findings call for body-positive, gender-sensitive nutrition education that not only counters harmful societal norms but also actively engages families in promoting healthy self-image and eating behaviors.

Interpersonal-level influences: Family, peers, and social circles

Parental food choices

It was a general consensus that adolescents’ dietary habits are largely shaped by the foods their parents purchase and provide at home. One student explained, “I eat whatever my mother prepares and brings home, as she decides what food is better for us”, highlighting the direct influence of parental decisions on their daily meals. Educators also commented on the effect of parental choices on students’ nutritional habits. One teacher observed, “Some students bring nutritious, home-prepared meals, while others arrive with packaged snacks and sugary drinks, reflecting the varying dietary choices made by their parents at home”. However, some parents offered a contrasting perspective, noting that their purchasing decisions are often shaped by their children’s preferences. One mother remarked, “We try to buy healthy food, but we’re constantly pressured by our kids, as they insist on snacks and processed items during grocery shopping.” This divergence suggests that while parental control plays a major role, adolescents also exert influence over household food environments, making collaborative nutrition education efforts essential.

Cultural influences

There was broad agreement among students, parents, and teachers that fast food holds strong appeal for adolescents due to its taste, convenience, and social relevance, often overshadowing traditional home-cooked meals. A parent noted, “At home, we eat traditional meals, but outside, children prefer fast food because they see it as more exciting.” A teacher shared same views, saying, “Even when we discuss the benefits of traditional, home-cooked meals, students still prefer fast food because they associate it with modern lifestyles and social trends.” Students, while recognizing the value of home-cooked food, viewed fast food as integral to their social lives. As one student explained, “When I’m with friends, we usually go for burgers or pizza because it’s quick and popular.”

This contrast highlights a disconnect between adults’ health-oriented perspectives and adolescents’ socially driven eating habits, underscoring the need for nutrition interventions that balance cultural values with adolescents lived social realities.

Time constraints of caregivers

Interview and focus group discussions revealed that household time constraints were a major factor shaping adolescents’ dietary habits. One student shared, “My mom has long working hours, so we often order food instead of cooking at home.” A parent echoed this reality, saying, “After a long day at work, it’s just easier to grab a takeaway than to cook a meal from scratch. I know it’s not the healthiest, but sometimes, it’s the most practical option.” While students and parents often framed these choices as unavoidable, teachers expressed concern over their cumulative impact. One teacher observed, “Many students come to school with packaged snacks and fast-food leftovers because their parents don’t have time to prepare fresh meals. This can affect their health in the long term.”

These perspectives reflect a shared understanding of the challenges busy families face, but also reveal a tension between perceived necessity and its long-term consequences, highlighting the need for practical, family-focused interventions that promote healthy eating within the realities of modern household routines.

Socioeconomic factors

Financial limitations consistently emerged as a key factor influencing food choices across stakeholder groups. Parents highlighted that affordability often drives them toward less nutritious, processed foods. A parent shared, “Healthy food is expensive, so we buy what we can afford—mostly prepackaged or processed options because they are cheaper and last longer.” This economic barrier affects students’ health and academic performance. A teacher noted, “Some students come to school with chips and soda for lunch. It’s clear that cost plays a role in what families can provide, but it affects students’ energy levels and focus in class.” Both groups acknowledged that financial pressures compromise dietary quality, though parents emphasized practicality and necessity, while teachers emphasized the long-term impact on student health and learning outcomes.

Peer pressure

Social norms were consistently identified across stakeholder groups as a powerful influence on adolescents’ eating behaviors. One mother shared, “I try to pack healthy lunches, but my son often trades them for unhealthy snacks his friends are eating.” This reflects the challenge parents face in ensuring their children make nutritious choices when outside the home”. One teacher remarked, “Students mirror their friends’ choices. If most of them prefer sugary snacks, it becomes the norm.” Teens admitted to this fact, in words of a student, “Everyone in my group eats chips and drinks soda during breaks, so it feels awkward to bring something different.” There was strong agreement across parents, teachers, and students that peer influence often overrides individual or parental intentions, reinforcing unhealthy dietary habits within the school environment.

Digital and social media influences

Social media was widely recognized by all stakeholder groups as a major influence on adolescents’ food preferences, primarily through advertisements and influencer-driven content. A student shared, “I see food ads all the time on Instagram; it makes me want to try new snacks.” pointing to the frequent exposure to persuasive, visually appealing content. A teacher remarked, “Students frequently discuss trending foods they see online, prioritizing taste and novelty over nutrition.” Showing concerns on this issue, a mother added, “Social media has made it challenging to encourage healthier eating habits, as social validation often comes from trying popular, widely marketed snacks”.

Interestingly it was noted that students consistently identified TikTok, Instagram, and YouTube as their primary platforms, whereas Facebook and WhatsApp were more commonly used by parents and teachers, revealing a generational gap in digital engagement. While all groups acknowledged the impact of social media on adolescents’ dietary choices, students perceived it as a source of entertainment and social connection, whereas adults viewed it as a barrier to healthy behavior. These findings suggest that tailored interventions must consider platform-specific trends and content types to effectively address the digital influences shaping adolescent nutrition in Pakistan.

Organizational-level influences: Role of school in shaping dietary behaviors

Role of teachers

Teachers were widely recognized as influential figures in shaping students’ health-related attitudes and behaviors. One student noted, “Our PT teacher always tells us to eat healthy and exercise,” emphasizing the value of teacher encouragement in reinforcing positive habits. However, teachers expressed challenges in sustaining student engagement. As one teacher shared, “We had a session on healthy eating last month, but most students didn’t take it seriously.” This concern was echoed by a parent, who observed, “Teachers do talk about healthy eating, but I don’t think students really pay attention unless it’s part of something fun or interactive.“

While there was agreement among all groups that teachers play an important role in health promotion, differences emerged in perceptions of effectiveness. Students appreciated teacher input but often saw it as occasional or peripheral, while educators and parents acknowledged a lack of consistent, structured programming to sustain interest. These insights point to the need for more engaging, curriculum-integrated approaches that empower teachers and maintain students’ attention over time.

Parent-teacher collaboration

Collaboration between schools and families was widely recognized as critical to fostering healthy eating habits. A father stated, “Teachers have a strong influence on what children learn about food. If schools and parents work together, we can ensure kids develop healthier eating habits,” while a teacher mirrored, “When parents reinforce healthy eating messages at home, it makes our job easier and helps students make better food choices both in and outside of school.” A student added, “It’s confusing when teachers say one thing about eating healthy, but at home we don’t follow it.”

All groups agreed on the value of consistency across school and home environments. While adults emphasized coordinated messaging, students stressed the importance of aligned practices, underscoring the need for integrated, family-engaged interventions.

Lack of structured health programs

While schools promote healthy eating, all stakeholders agreed that structured programs for long-term impact are lacking. A teacher explained, “Programs like Healthy Eating Week raise awareness, but their impact remains limited. Even during the week, most students continue consuming junk food.” Another teacher emphasized this concern, stating, “Without a well-integrated curriculum or continuous reinforcement, students struggle to internalize the importance of nutrition, often reverting to unhealthy eating patterns despite awareness efforts.” A Parent also echoed this stating, “….kids need ongoing lessons and practical exposure to healthy eating, both in school and at home.”

There was strong consensus that isolated awareness events are insufficient. Stakeholders called for curriculum-based, continuous efforts that bridge school and home to create lasting change in adolescent dietary behaviors.

School food policies

Limited access to healthy food in school cafeterias was a shared concern among students, parents, and teachers, who viewed it as a barrier to effective nutrition education. stated, “Our school canteen mostly sells snacks, not much healthy food.” Parents echoed concerns about cafeteria offerings. One mother expressed frustration, “It’s difficult to promote healthy eating at home when schools primarily offer unhealthy options.” A teacher acknowledged, “We try to teach students about healthy eating, but when they see only junk food in the cafeteria, it undermines our efforts.”

Stakeholders agreed that inconsistent school food environments dilute nutrition messages, highlighting the need for institutional policy reforms to align cafeteria offerings with health education goals.

Enablers and Barriers of healthy eating, as identified through various themes have been grouped in Table 2.