What are the key behavioral drivers contributing to childhood obesity in Arab communities?

How have behavioral interventions (“nudges”) been used globally to address childhood obesity?

What lessons can be adapted to the Arab context to influence healthier choices among children and families?

This research employed a scoping review approach to systematically map the available literature on behavioral strategies addressing childhood obesity, with a focus on nudging interventions within Arab communities and similar contexts. A scoping review was selected due to the exploratory nature of the topic, the diversity of intervention types, and the limited prior synthesis of behavioral insights strategies within Arab contexts. Scoping reviews are a method of knowledge synthesis that identify trends and gaps within an existent knowledge base, or scope of knowledge, for the purpose of informing research, policy, and practice. We used Arksey and O’Malley’s scoping review methodology to examine the literature.

The literature search was conducted up to June 2025 to identify relevant studies, policies, and initiatives related to behavioral strategies addressing childhood obesity. A comprehensive search strategy was developed using the following databases: PubMed, Scopus, and Google Scholar. Additionally, relevant grey literature and policy documents were retrieved from authoritative organizations such as the World Health Organization (WHO), regional health bodies, and government ministries from Arab countries.

The following keywords and Boolean operators were used in various combinations: “childhood obesity,” “pediatric obesity,” “child overweight,” “public health interventions,” “behavioral insights,” “behavioral economics,” “nudge,” “nudging,” “choice architecture,” “action plans,” “obesity programs,” “evaluation,” “effectiveness,” “nutrition,” “diet,” “eating habits,” “healthy eating,” “Arab,” “Middle East,” “MENA,” “Gulf States,” “Saudi Arabia,” “UAE,” “Qatar,” “Kuwait,” “Jordan,” “Egypt,” “Lebanon,” “Morocco,” and “Oman.”

The search strategy combined key concepts using Boolean operators, incorporating synonyms and related terms to ensure breadth and precision. An example of the Boolean search string used was: (“childhood obesity” OR “pediatric obesity” OR “child overweight”) AND (“nudge” OR “nudging” OR “behavioral insights” OR “behavioral economics” OR “choice architecture”) AND (“nutrition” OR “diet” OR “eating habits” OR “healthy eating”) AND (“Arab” OR “Middle East” OR “MENA” OR “Gulf States” OR “Saudi Arabia” OR “UAE” OR “Qatar” OR “Kuwait” OR “Jordan” OR “Egypt” OR “Lebanon” OR “Morocco” OR “Oman”).

The systematic screening process followed these stages:

Stage 1: Initial Screening (Identification).

All retrieved records underwent initial title and abstract screening to assess basic relevance to childhood obesity and behavioral interventions. Records were excluded if they clearly did not meet the inclusion criteria based on population, intervention type, or study focus.

Stage 2: Full-Text Review.

Potentially relevant studies identified in Stage 1 underwent full-text review for detailed assessment against inclusion and exclusion criteria. Particular attention was paid to the presence of behavioral components, cultural relevance, and applicability to Arab contexts, and duplicates were removed.

Stage 3: Additional Sources.

Reference lists of included studies were manually searched for additional relevant publications. Expert recommendations and policy documents from Arab health ministries were also included where they met the inclusion criteria.

Stage 4: Quality Assessment.

While formal quality assessment tools were not applied, given the scoping review nature, Sources were evaluated for authoritativeness, particularly for grey literature and policy documents. Peer-reviewed publications were prioritized, with grey literature included only from recognized health organizations, government bodies, and established research institutions.

A data-charting framework was developed to systematically extract variables relevant to behavioral policy design. Extracted fields included:

Due to heterogeneity in policy interventions and evidence sources, a narrative synthesis approach was applied. Data were organised thematically by policy type (e.g., school guidelines, taxation, labelling policies, digital nudges) and mapped against behavioral frameworks, including:

Cross-country patterns, strengths, and gaps were compared to identify regional trends and implementation challenges.

Richard H. Thaler and Cass R. Sunstein introduced the concept of Libertarian Paternalism, which acts as the basis for Nudges, a specific behavioral intervention tool. The essence of the concept underlying this method is captured in the subsequent definition: “Any aspect of the choice architecture that alters people’s behavior predictably without forbidding any options or significantly changing their economic incentives.” [(8), p. 6].

Behavioral economics is an interdisciplinary field that encompasses findings from research on human behavior across disciplines such as economics, psychology, sociology, and neuroscience, offering valuable insights into how individuals make choices (behave) based on their inherent traits, life experiences, and contextual factors (7). It involves analyzing patterns of purchasing/consumption of goods (e.g., energy-dense food) in relation to constraints such as availability and price of a good and of competing goods (e.g., nutritious foods) or activities (e.g., physical activity). This field is based on the premise that individuals do not always make fully rational decisions, unlike assumptions of classical economic theory that rely on “cold” calculation of utilities, potentially improving the predictive validity (translational value) of empirical studies (9).

A nudge is a programmed change in the person’s environment to promote behavior that serves the individual’s best interest, often without their conscious awareness (10). A nudge has three primary characteristics: (1) it does not mandate individuals to adopt a specific behavior, (2) it maintains the freedom of choice, and (3) it does not provide substantial financial incentives (11).

Within this framework, nudge-driven policy formulation signifies a type of intervention that enhances the freedom of selection, enabling individuals to adjust their actions and make choices that advantage them. This differs from legal and economic methods, which enforce increased restrictions on the freedom to make decisions. For instance, laws like prohibiting snack items in educational institutions, banning trans fats and tobacco, or taxing unhealthy choices (such as taxes on sugar, fat, and salt). These policies require substantial regulatory oversight and include legal repercussions for noncompliance (12). Various public health domains are increasingly turning to nudging, including nutrition, where the approach can influence food choices. In general, Nudges are low-cost interventions; however, there might be indirect costs from their implementation (13). A major benefit of behavioral nudging strategies is their inexpensive execution and broad applicability across multiple societal levels, including households, educational institutions, governmental bodies, and companies. Conversely, legal and economic strategies frequently necessitate prolonged legislative procedures, rigorous enforcement systems, and increased operational expenses. Though nudges serve as effective policy instruments, they are definitely not silver bullets. Policymakers ought to view nudges as essential components in their array of policy instruments and apply them in conjunction with conventional tools like informational, financial, and regulatory strategies (Figure 1).

The primary factors contributing to childhood obesity are largely similar between developed and developing countries. However, unhealthy dietary practices and decreased physical activity remain prominent challenges globally. A sedentary lifestyle driven by excessive engagement in indoor leisure activities, such as television watching, internet use, and computer gaming, plays a significant role in childhood obesity.

Several external factors further exacerbate the lack of physical activity, including limited access to open spaces and playgrounds in schools and communities. A study by Paniccià, Acito, and Grappasonni (14) emphasized that interaction with green areas, whether outdoor parks or indoor plants, is associated with reduced stress, lower hypertension and inflammation, and improved physical activity levels. Moreover, the increasing prevalence of screen time among children has raised concerns about its impact on their physical activity and overall health, as extended use of digital devices often replaces outdoor play and exercise (15). In addition, increasing academic pressures often reduce the emphasis on sports and physical education, while unsafe neighbourhoods discourage outdoor play and walking. Furthermore, some overweight children avoid participating in physical education classes or informal activities due to fear of bullying by peers (16). Collectively, these factors create an environment that fosters inactivity and contributes to rising childhood obesity rates (17).

The process of Westernization in Arabic-speaking countries has led to numerous Western influences, particularly the increased availability of foods that are high in fats, sugar, and carbohydrates (6). Furthermore, unrestricted access to energy-dense, fast foods in school cafeterias, vending machines, and nearby outlets significantly contributes to excessive caloric consumption among schoolchildren. This issue is often exacerbated by limited knowledge about proper dietary components among students. Additionally, the practice of overfeeding low-birth-weight infants to promote catch-up growth, if prolonged, can increase the risk of obesity later in life (17).

Supportive people can significantly impact behavior change, either facilitating or obstructing it, while social circles can affect weight loss outcomes. For children, Parental engagement is an essential element of successful obesity treatment programs (18). However, this engagement is often limited when parents fail to recognize or acknowledge their child’s overweight status. Research has indicated that most parents do not correctly understand their child’s weight status (19).

Parental practices also contribute to children’s obesity. Overprotective behaviors, forced feeding, combined with traditional misconceptions about health and nutrition, as well as limited nutritional knowledge among parents and caregivers, contribute to childhood obesity. Additionally, the educational background of parents significantly influences their children’s diet. For example, a study in Italy employing the KIDMED index found that greater parental education, not income or housing situation, was notably associated with better adherence to the Mediterranean Diet (20).

Beyond the family, Peers’ influence can act as a vital source of encouragement for children and teenagers trying to lose weight. Evidence of how peers and friends affect the health behaviors of children and adolescents found that engaging peer networks in prevention and intervention initiatives effectively changes health behaviors (18).

Cultural factors may exacerbate the obesity issue. For instance, in Saudi Arabia and Kuwait, social gatherings often involve increased food consumption, with traditional meals typically consisting of rice (high in carbohydrates) and meat (high in fat), which are shared among large groups.

Ramadan and Religious Observances: The Islamic holy month of Ramadan presents unique challenges and opportunities for nutrition interventions. Fasting patterns significantly alter daily eating habits, with concentrated food consumption occurring during Iftar (evening meal breaking the fast) and Suhur (pre-dawn meal). Post-Iftar behaviors often involve increased social eating and consumption of traditional sweets and fried foods. Tailored interventions during Ramadan can include pre-Ramadan habit formation campaigns, balanced Iftar meal promotion, and health messaging embedded within religious contexts that emphasize moderation and balance—core Islamic principles of well-being.

Maternal vs. Paternal Influence: In Arab families, mothers typically bear primary responsibility for meal planning and preparation, while fathers often make decisions regarding household food budgeting. As a result, Interventions must address both decision-making levels, with messaging targeted appropriately to each gender’s sphere of influence. Moreover, Children in Saudi Arabia whose fathers were overweight or obese were nearly twice as likely to be overweight or obese themselves compared to those whose fathers had a normal weight (21).

Cultural Body Image Expectations: Boys and girls face different cultural pressures regarding body size and eating behaviors. Traditional preferences for larger body sizes in some Arab cultures, particularly for young children, may conflict with obesity prevention messages. Moreover, research exploring the relationship between gender and body image has shown that males tend to report greater satisfaction with their bodies compared to females, despite generally having a larger body size. Therefore, gender-specific interventions should address these cultural norms while promoting health rather than appearance-focused goals (22).

Nudges can be utilized across multiple health policy areas and organizational functions, such as preventive healthcare, health and non-health service delivery, long-term care/dementia prevention, community-based care frameworks, and technological advancements. The World Health Organization (WHO) projected that by funding the most efficient and practical measures to prevent and manage NCDs in low- and middle-income nations, a seven-fold return might be realized by 2030 (11).

Family-based behavioral weight loss programs (FBT) targeting childhood obesity frequently incorporate incentive systems centred around positive reinforcement. Insights from behavioral choice theory and behavioral economics have informed the development of obesity treatments and how to tackle this issue. For Example:

In many cultures, obesity is often stigmatized as a personal flaw, despite advances in understanding its complex causes, including genetic, cultural, and environmental factors. This bias is also evident in the medical community, where a blaming approach can harm the therapeutic relationship and create barriers to behavioral change, such as low self-esteem and hopelessness. Families affected by obesity are often sensitive to the topic, making it crucial to avoid blame and instead focus on addressing modifiable environmental risk factors (17).

Despite significant efforts to promote healthy eating and increased physical activity, notable improvements in these behaviors or obesity outcomes remain limited. The reason lies in the gap between evidence-based obesity guidelines and their translation into behaviorally informed, patient-centred recommendations. To combat the obesogenic environment and reduce the global prevalence of childhood obesity, a multifaceted policy approach is essential. Policies guided by ‘behavioral insights’ (BIs) have shown promise in enhancing children’s dietary habits. While, behavioral economics provides a framework for how we counsel patients through small changes (23).

When applying nudges, considering social and cultural contexts is essential. Reports indicate that both the acceptance of nudges by individuals and the effectiveness of nudges varied across different countries and regions. This indicates that the applicability of the nudge method requires additional examination, and policymakers need to interpret the outcomes of nudges from various social or cultural backgrounds with caution (11).

To contextualize global behavioral strategies within Arab settings, we reviewed ongoing interventions across Arabic-speaking countries and categorized them by behavioral strategy, implementation challenges, and alignment with COM-B frameworks. Table 1 presents a summary of this mapping exercise, highlighting where behavioral components have been effectively used or underutilized. (Table 1) It outlines key initiatives aimed at promoting healthier lifestyles, such as mandatory guidelines for school meals, nutritional awareness campaigns, front-of-pack labelling, and taxation on unhealthy foods. A range of intervention strategies & nudges were employed across the Arabic countries, with some studies detailing multiple, combined behavior change strategies (including nudges), others incorporating few strategies.

Arab governments have introduced initiatives to promote healthier food options in schools: Mandatory Guidelines for School Meals: Countries like the UAE and Saudi Arabia regulate school cafeterias to provide balanced meals, reduce sugary snacks, certain food items (e.g., alcohol, carbonated drinks, pork, and allergens) are prohibited and promote water consumption. According to the School Healthy Eating and Food Safety Policy in UAE, Schools must foster a nutritious food environment that promotes a nutritious eating atmosphere filled with healthy foods for every individual in the school (32). Schools must guarantee that the meals provided are healthy, focusing on lowering excessive amounts of sugar, salt, and fats. Sustainable and secure food methods are crucial, spanning from production to consumption. Furthermore, the MASAR project, in the UAE, is implementing a set of interventions is being implemented to reduce childhood obesity in schools by raising health awareness among students and their families, improving school food quality, and providing opportunities for safe physical activity. Additionally, the project offers behavioral intervention programs to students and their parents who are experiencing weight issues (33). According to Dubai’s 2024 Food and Nutrition Guidelines are transforming meals and nutrition in educational institutions from nurseries to universities. The revised guidelines emphasize healthier food choices, sustainability (such as plant-based dishes and environmentally friendly packaging), and involving students with technology through initiatives like the “Food Heroes Plate” and “SCAN the Block” for food education. Schools also implement “healthy eating points” to encourage nutritious choices (15).

In 2004, the Ministry of Health and Education in Saudi Arabia established the “Regulations of Health Conditions for School Canteens,” which has been compulsory for implementation since 2014. The guidelines feature a compilation of canteen food items that are either permitted or prohibited (34). In Kuwait, authorities introduced a new policy for school cafeterias with the goal of encouraging healthy eating practices and lowering student obesity (35).

Nutritional Labelling: The GCC countries have adopted front-of-pack labelling (traffic light systems) to provide consumers with clear information about sugar, salt, and fat content.

In Morocco, to lower the sugar content of processed food products the country has implemented a sugar tax and the Nutri-Score front-of-pack labelling scheme (33). As per this GCC-wide standard, prepackaged Food product labels must be in Arabic or contain a translation of the label in Arabic. Producers and retailers are required to offer a list of the nutrient content for pre-packaged food items, even in the lack of a health or nutrition assertion (36–38).

In Dubai, the Food and Nutrition Guidelines for 2024 require all meals provided in educational settings, including buffet and grab-and-go selections, to have food labelling. The regulations indicate that labels should contain nutritional details according to the serving size, which represents the actual portion eaten by students, instead of per 100 grams. Moreover, allergen details, including prevalent allergens like nuts, dairy, gluten, and more, should be prominently shown to protect students with food sensitivities (39). These labels should be available in both Arabic and English to guarantee clarity and accessibility for all parties involved, such as students, parents, and school personnel (15, 40). The SEHHI Healthy Menus initiative displays the SEHHI logo on healthy menus in restaurants and food establishments. Foods featuring the SEHHI logo contain less fat, reduced sugar and salt levels, and increased fiber. The initiative is part of the broader SEHHI programme that is led by the Abu Dhabi Public Health Centre (36).

A review indicated that legislative measures to control food marketing aimed at children are quite scarce in the Middle East region (41). Advertising regulations pose a number of challenges, including restricting marketing to children (particularly in relation to cross-border marketing, digital marketing, and monitoring of marketing) (33). In countries like Lebanon and Jordan, advertising unhealthy foods during children’s TV programming or on social media is restricted, although enforcement varies. In Kuwait, many recommendations have been adopted to limit the inappropriate marketing of complementary foods up to 36 months. The legislation prohibits the promotion of complementary foods for infants younger than 6 months, as well as the promotion of complementary foods on packaging for complementary foods (42).

The Farm-To-School Program (F2SP) is a competitive grant initiative aimed at participants of the National School Lunch Program and School Breakfast Program, focusing on enhancing the amount and regularity of locally sourced fruits and vegetables provided to students throughout the academic year. The World Food Programme (WFP) is at the forefront of humanitarian initiatives. Egypt and Morocco have both gained advantages from their assistance and have observed enhancements in the number of children receiving lunches at school. Egypt has established a continuous centralized school nutrition initiative in collaboration with the World Food Programme (43).

Sugary Drink Taxes: Saudi Arabia, the UAE, and Oman have implemented excise taxes on sugary beverages, with rates up to 50–100%, aimed at reducing consumption. Implementing a sugar tax on sugary drinks has led to large reductions in the consumption of sugar from sugary drinks in the UK, primarily through manufacturers’ reformulation of sugary drinks without affecting sales (16). Sugar taxes were first implemented in GCC countries in 2017. Saudi Arabia and the UAE currently charge 50 to 100% on most sweetened drinks. Sugar taxes, however, have a limited reach and scope in the region. Moreover, governments can use the revenues from these taxes to support health and fitness programs (44).

Qatar’s Your Health First (YHF) is a national, multi-faceted health campaign designed to change unhealthy behaviors into healthy ones. By educating the population about health, obesity and diabetes. The campaign collaborated with the Ministry of Education and Higher Education for the second consecutive year to make sure children returned to school aware of the significance of health. The camping provided children with school bags, lunchboxes, water bottles, and activity books in preparation for their first day returning to school after the extended summer break (45). The Ministry of Health and the Ministry of Education have initiated a public health awareness campaign for childhood obesity in Saudi Arabia called the “RASHAKA Initiative.” This program seeks to encourage healthy habits in students by enhancing eating practices, boosting exercise levels, and educating them about the dangers of obesity (46).

In Qatar, a study evaluated a three-year integrated intervention (Agder) targeting overweight and obese school children aged 9–12. In the first year, 941 children from four intervention schools were screened, and 430 (45.7%) were found to be overweight/obese. One hundred children with BMI ≥ 95th percentile completed a two-phase program: (1) an 11-day intensive weight-loss camp combining physical activity, dietary control, lifestyle education, and behavioral nudges; followed by (2) 10 weeks of after-school clubs focused on weight maintenance, motivation, and parent engagement. The camp led to a significant 12.5% reduction in BMI SDS (p < 0.001) for all participants, with girls showing slightly greater improvements than boys (46) (Table 2).

Dubai 2024 Food and Nutrition Guidelines incorporate technology to enhance the engagement of nutrition education. The “Food Heroes Plate” aids students in grasping balanced meal sizes, while online resources allow parents to monitor school meals, enhancing communication between home and school. Moreover, food labeling is essential in directing healthier food selections (15).

While the existing policy landscape in the Arab region reveals a growing commitment to addressing childhood obesity, these interventions often lack a cohesive behavioral foundation and struggle with sustained impact. Most programs remain education-heavy, increasing knowledge but failing to shift daily habits or automatic behaviors. Even intensive interventions, such as the Qatar weight-loss camp, show short-term improvements but struggle with long-term maintenance, largely because children return to environments that lack supportive and reinforced habits.

Policies are an integral part of health promotion, and certain policies related to school environments, food labelling, and others are crucial in addressing childhood obesity (5). When seeking to reduce childhood obesity, national governments have often adopted similar top-down initiatives such as Higher taxes on sweet beverages, National dietary and physical activity guidelines, School food regulations, and Restrictions on marketing (47). There are a number of possible explanations for government action not yet achieving a reduction in childhood obesity in most countries (47). Arab countries lack important local policies in schools, such as healthy food and drinks in school canteens, regular screenings for overweight and obesity, and extracurricular activities (5). One of the major gaps in policy is weak Policy Enforcement; policies to promote the implementation of simplified nutrition information are limited in the MENA region (48).

The majority of initiatives in Arab nations have centred around schools or campaigns, mainly targeting children and teenagers. Nonetheless, children’s eating habits are greatly influenced by family interactions and household settings. There is a significant absence of nudging techniques targeting parents and caregivers, who play essential roles in decisions regarding grocery purchases, meal cooking, and screen usage. Interventions offering gentle prompts for parents, like serving size labels on food packages, fridge magnets featuring dietary visuals, or text messages reminding caregivers to add fruit to lunchboxes, are still uncommon. Additional family-focused strategies are essential to cultivate healthier food environments at home and support initiatives in schools. To create a family-oriented incentive system, parents and children collaborate to identify suitable and attractive rewards for achieving goals. Optimal incentives are those that enhance social support and strengthen the importance of specific activities, like a family biking trip or a stroll with friends.

There is limited contextualization of behavioral interventions, reducing their acceptability and sustainability in Arab cultural settings. Many strategies are borrowed from Western contexts without adapting them to local food preferences, religious norms (e.g., fasting periods), or societal structures. These gaps underscore the need for a comprehensive, culturally grounded behavioral framework.

While digital engagement is high across Arab countries, mobile apps and social media are underutilized as tools for nudging healthy behavior in children and families. Digital tools present a vast, underutilized opportunity for scaling nudges across the MENA region, especially among tech-savvy youth. Apps and platforms could be used to send real-time reminders, gamify healthy behaviors, or customize meal suggestions. For example, apps that nudge users to drink water before meals, reward daily step goals, or highlight the healthiest nearby food options are widely used in high-income settings but are almost absent in regional public health strategies. Governments and local innovators can collaborate to develop culturally appropriate, behaviorally designed digital solutions that are accessible across income levels.

The majority of initiatives in the Arab region depend on education and regulation instead of utilizing behavioral insights such as nudges or incentives. Behavioral science shows that defaults, pre-chosen options requiring no active decision-making, are among the most effective nudges for encouraging healthier choices. Within Arab nations, however, default mechanisms remain significantly underused. For instance, school cafeterias and food venues could automatically provide healthy meals (such as fruits, vegetables, and water) unless students opt to refuse. Nevertheless, most school food policies focus on restrictions or rules rather than fostering environments where choosing healthy foods is the simplest choice. Enhancing the use of defaults, such as placing healthy options at eye level, incorporating pre-packaged fruit in meal sets, or designating healthier combinations as the norm in digital food ordering platforms, can subtly shift consumption patterns while preserving the freedom to choose.

Campaigns that employ compelling visuals, emotionally resonant messages, and trustworthy spokespeople typically perform better than those that focus only on providing information. When children and families come across campaigns associating health behaviors with compelling visuals (such as sugar turning into fat in the bloodstream), captivating stories, or endorsement from well-regarded figures like local influencers, clergy, or renowned athletes, the message is likely to enhance motivation and memory retention. In many Arab countries, these approaches have only recently begun to be integrated into health promotion strategies. Integrating these behavioral tactics into public educational initiatives—especially through social media channels—can greatly enhance message retention and behavior adoption.

Although behavioral nudges are essential, they need to be integrated into supportive structural environments. In low- and middle-income areas throughout the MENA region, cost is a significant limitation. Nutritious choices frequently come at a premium compared to processed options, and despite being aware, families might still opt for less healthy food because of expenses. Taxes on sugary beverages have advanced in curbing unhealthy intake, but beneficial incentives like subsidies for fruits, vegetables, and whole grains are less frequent and less focused. Pricing strategies informed by behavior (e.g., loyalty rewards for nutritious purchases, cash-back offers, mobile discounts) can close this affordability gap and encourage sustainable decisions. In low-income countries such as Yemen and Sudan, healthy food options remain unaffordable and inaccessible for large portions of children.

Despite the adoption of various health campaigns and policy reforms in the region, rigorous behavioral evaluations are lacking. Most monitoring focuses on health outcomes (e.g., BMI, diabetes risk) rather than the specific behavioral changes leading to them (e.g., sugar reduction per week, snack replacement habits, label-reading frequency). Without clear behavioral metrics, it is difficult to assess the real efficacy of nudges or modify them based on real-world results. Building local research capacity to design randomized controlled trials, A/B testing of messages, and pre-post behavioral assessments is critical for scaling evidence-based interventions.

This gap analysis underscores the need for Arab countries to transition from traditional health promotion methods toward systematically embedding behavioral science principles into policy design and implementation. Closing these gaps will require stronger enforcement, cross-sectoral coordination, digital innovation, and a deeper understanding of local behavioral drivers. To bridge this gap, there is a need to move beyond traditional approaches and structural policies toward strategies informed by behavioral science. The following section explores global and regional evidence on the effectiveness of such behavioral interventions. By analyzing successful case studies and identifying context-specific barriers and facilitators, we aim to extract actionable insights that can inform a more robust and adaptive policy approach in Arab countries.

Behavioral strategies are increasingly being used in health promotion due to their potential to subtly guide people toward better choices without coercion. In the context of childhood obesity in Arab communities, these strategies can complement existing policies by closing the gap between awareness and action.

Addressing childhood obesity in Arab communities requires more than isolated interventions; it demands a comprehensive, multi-level approach that considers the interplay of individual behavior, social environments, and cultural norms. Behavioral strategies, particularly nudges, offer a subtle yet powerful mechanism to guide healthier choices without coercion. By targeting parents, schools, and children, policies can influence decision-making at every stage of a child’s daily life, from household food purchases to school meals and personal eating habits.

The Three-Level Behavioral Nudge Framework presented here integrates evidence from regional studies, global behavioral science, and practical case studies from the Arab world. It identifies common barriers at each level and proposes contextually adapted counter-strategies, ensuring interventions are both effective and culturally sensitive. By mapping barriers, COM-B domains, and nudge types, this framework provides actionable guidance for policymakers, educators, and community stakeholders aiming to create supportive environments for healthy behavior.

Parents: As the heads of households, parents control household spending and make key decisions about food purchases. Their choices are pivotal in determining their children’s access to nutritious food and shaping their dietary habits.

Building on the evidence-based policy framework outlined above and strengthening the effectiveness of childhood obesity interventions in the region, this paper proposes the Arab Context Nudge Model, a culturally grounded behavioral framework that integrates the COM-B system with cultural components. The proposed Arab Context Nudge Model (ACNM) serves as a culturally grounded behavioral framework designed to systematically enhance childhood obesity interventions in the Arab region.

1. Purpose and Rationale

Structurally, the ACNM integrates three key layers: Layer 1: The COM-B Core (Capability, Opportunity, Motivation) identifies the fundamental behavioral mechanisms; Layer 2: Arab Cultural Determinants specifies region-specific factors like Family Hierarchy, Hospitality Culture, and Religious Values that modify the COM-B drivers; and Layer 3: Context-Specific Nudge Points defines the realistic settings—Home, Schools, and Community/Digital spaces, where culturally tailored nudges can be applied. By explicitly linking behavioral science with local norms and environments, the ACNM provides policymakers with a structured blueprint to design interventions that are culturally relevant, behaviorally informed, and scalable across diverse Arab countries. (Figure 3).

The Arab Context Nudge Model (ACNM)

A three-layer model integrating:

Layer 1: COM-B Core (Behavioral Mechanisms)

Layer 2: Arab Cultural Determinants

These shape how children and families make food decisions:

Layer 3: Nudge Points

Where nudges can be applied realistically:

Designing nudges within public health policy, including childhood obesity interventions, requires careful ethical examination. While the principle of “libertarian paternalism” underpins nudging, guiding behavior without restricting choice, it has faced criticism for its potential misuse. Policymakers could leverage behavioral insights in ways that benefit certain stakeholders rather than the majority, creating what is referred to as “sludge.” Sludge uses cognitive biases and choice architecture similarly to nudges, but instead of facilitating healthier decisions, it introduces friction, complicating informed choice and potentially undermining public welfare. For example, a school policy might encourage children to “choose healthier snacks” but only provide expensive packaged “healthy” products in the cafeteria, rather than affordable fresh fruits or culturally familiar options. In this case, the policy could unintentionally benefit certain vendors or brands without genuinely improving children’s nutrition or promoting equitable access to healthy foods. To ensure that nudges promote ethical and equitable outcomes, both policymakers and communities must actively monitor, evaluate, and safeguard interventions so that nudges genuinely enhance the health and well-being of children and families, respecting autonomy while fostering positive behavior change (11).

This scoping review presents various methodological limitations that need to be recognized. Initially, the focus on English-language publications might have created a language bias, possibly omitting pertinent studies released in Arabic or other languages. Secondly, publication bias might exist since studies showcasing positive results are more prone to being published and available. Third, even though the review included grey literature, it is possible that some relevant policy documents or program reports from Arab nations were not included. Fourth, the review depends solely on secondary data; no primary data were gathered from children, families, or healthcare providers in the area. Ultimately, the evaluation of the cultural relevance of interventions and behavioral insights relied on the authors’ interpretation instead of established cultural adaptation or validation procedures.

These constraints highlight the importance of future studies to enhance proof and relevance in the Arab setting. Empirical research examining nudges, the feasibility of interventions, and their effectiveness in home, school, and community environments is crucial. Moreover, consulting with local health experts, educators, and policymakers can enhance the design of interventions that are culturally sensitive. Future research must assess long-term behavioral effects and incorporate participatory methods that engage families and children in collaboratively designing interventions. In spite of these constraints, this review offers a foundational synthesis that aids in the creation of the Arab Context Nudge Model (ACNM) and directs evidence-driven, culturally appropriate childhood obesity prevention strategies in the area.