TABLE 4.

Common Barriers to Behavior Change

middleics of Interest	Barriers Representative Quotes
Caregivers cook according to family preferences, not health needs	Vegetables, I don’t think we even make them here, no one likes vegetables, and it’s been really difficult to instill the habit of eating vegetables.
For some caregivers, cost is a barrier to following health recommendations	The pediatrician put him on a diet, but then I don’t keep the diet because I don’t have the means to follow it. I try to buy what I can… there are some foods that are expensive; I buy what they tell me for him and then I don’t have enough to buy other things.
Work schedules and multiple caregivers create barriers to control of child feeding	Truthfully, [we eat together] only at dinner, or on the weekends because my husband works, I work, and my children eat with my mother who picks them up for me. My son turned two and we brought him to the doctor; he weighed 29 kg and 190 g so that was when we began to teach him how to eat because my in-laws gave him food and five minutes later they give him food again, and they don’t give him fruit, they give him solid food, so my son eats it, and so it cost me a lot of work to teach him to eat on a schedule again.
Social and familial norms equate proper care with quantity and frequency of meals, and reward the image of the heavy child	He drinks a lot of bottled juices and eats French fries… a lot of sweets. When he’s with his grandmother she is very permissive and buys him everything he asks for; she promotes his bad habits. She tells me “My role is to say yes to him, your role is to educate him; so don’t say anything to me when I am with him.” I breast fed and I felt that my son was healthy while he was breastfeeding but then my mother in law came and gave him juice, and baby food… since my mother-in-law is a little heavy, they told me “chubby children look cuter,” and then my son got to the point where he couldn’t walk… he could walk, but my son was really fat. I tell him, “I’m only going to give you one tortilla” - he sits down to eat really angry, and my husband hears me and scolds me, and he says to me, “why aren’t you giving it to him, he’s growing.”
Physical activity and active play are not a consistent family norms	My children are restless… So what I want sometimes, well, is to have them be a little calm, doing other things….I can’t get my little girl to be calm, not even with the television. So, that’s one of the reasons [she isn’t more physically active], the fact that well I don’t want so much movement in the house.