Ahmed, S., Mohammed, R. (2026). Assessment of Awareness, Attitudes, and Self-Management Behaviors Toward Obesity Among Adults in Northern Iraq: A Cross-Sectional Study. , 1(1), -. doi: 10.64554/njphn.2026.192138
Sirwan Khallid Ahmed; Ribwar Arsalan Mohammed. "Assessment of Awareness, Attitudes, and Self-Management Behaviors Toward Obesity Among Adults in Northern Iraq: A Cross-Sectional Study". , 1, 1, 2026, -. doi: 10.64554/njphn.2026.192138
Ahmed, S., Mohammed, R. (2026). 'Assessment of Awareness, Attitudes, and Self-Management Behaviors Toward Obesity Among Adults in Northern Iraq: A Cross-Sectional Study', , 1(1), pp. -. doi: 10.64554/njphn.2026.192138
Ahmed, S., Mohammed, R. Assessment of Awareness, Attitudes, and Self-Management Behaviors Toward Obesity Among Adults in Northern Iraq: A Cross-Sectional Study. , 2026; 1(1): -. doi: 10.64554/njphn.2026.192138

Assessment of Awareness, Attitudes, and Self-Management Behaviors Toward Obesity Among Adults in Northern Iraq: A Cross-Sectional Study

Ninevah Journal of Public Health & Nursing
Volume 1, Issue 1, August 2026
Document Type: Original Article
DOI: 10.64554/njphn.2026.192138
Authors
Sirwan Khallid Ahmed* ; Ribwar Arsalan Mohammed
College of Nursing, University of Raparin, Rania, Kurdistan Region, 46012, Iraq
Abstract
Background
Obesity is a major global public health concern associated with increased risks of metabolic, cardiovascular, respiratory, musculoskeletal, and psychological disorders. Despite its growing prevalence in Iraq, evidence regarding public awareness, attitudes, and self-management behaviors toward obesity remains limited. This study assessed obesity-related awareness, attitudes, and self-management behaviors among adults in northern Iraq and identified their associated sociodemographic factors.
Methods
A community-based cross-sectional study was conducted between 27 November 2024 and 10 January 2025 among 582 adults residing in Rania City, Kurdistan Region, Iraq. Participants were recruited using convenience sampling. Data were collected using a structured, content-validated, and pilot-tested questionnaire consisting of sociodemographic characteristics and 27 items assessing obesity awareness, attitudes, and self-management behaviors. Body mass index (BMI) was calculated from self-reported height and weight. Data were analyzed using descriptive statistics, chi-square tests, multivariable ordinal and binary logistic regression, and Spearman's rank correlation in SPSS version 27, with statistical significance set at p ≤ 0.05.
Results
The mean age of participants was 28.42 ± 9.32 years, and the mean BMI was 25.23 ± 3.99 kg/m²; 53.6% were female. Based on BMI, 42.6% had normal weight, 38.8% were overweight, 12.9% were obese, and 5.7% were underweight. Awareness was low in 31.4%, moderate in 40.4%, and high in 28.2% of participants. Positive attitudes toward obesity prevention were observed in 91.8%, whereas high self-management behaviors were reported by only 16.7%. Older age, male sex, higher educational attainment, marital status, and government employment independently predicted greater awareness. More positive attitudes were associated with younger age, sub-urban residence, normal or overweight BMI, student or government employment, and absence of a family history of obesity. Attendance at an obesity-related educational course was the strongest predictor of better self-management (AOR = 0.323, 95% CI: 0.189–0.559, p < 0.001). Awareness demonstrated a moderate positive correlation with self-management (ρ = 0.389, p < 0.001).
Conclusion
Adults in northern Iraq demonstrated generally positive attitudes toward obesity but only moderate awareness and limited self-management practices, indicating a substantial gap between knowledge and healthy behaviors. Public health interventions focusing on obesity education, behavioral modification, and practical self-management strategies should particularly target younger adults and individuals with lower educational attainment to improve obesity prevention and control.
Keywords
Obesity; Awareness; Attitudes; Self-management; Body mass index; Adults; Cross-sectional study; Iraq
Full Text

Introduction

Obesity has become one of the most pressing public health challenges of the twenty-first century, with its prevalence increasing at an alarming rate worldwide. According to the World Health Organization (WHO), more than 2.5 billion adults were overweight in 2022, including over 890 million who were living with obesity, and these numbers continue to rise across both developed and developing countries [1]. Obesity is a complex, chronic disease characterized by excessive body fat accumulation that adversely affects health and is commonly defined as a body mass index (BMI) of ≥30 kg/m², while overweight is defined as a BMI between 25.0 and 29.9 kg/m² [2]. The growing burden of obesity represents a major challenge for healthcare systems because of its association with increased morbidity, mortality, and healthcare expenditure [3].

Obesity is a multifactorial condition influenced by genetic susceptibility, unhealthy dietary habits, physical inactivity, socioeconomic status, environmental factors, and behavioral characteristics [4,5]. Rapid urbanization, increased consumption of energy-dense foods, sedentary lifestyles, and technological advances have substantially contributed to the rising prevalence of obesity worldwide [6]. Beyond its physical causes, psychological factors, inadequate health literacy, and cultural beliefs also influence individuals' weight-related behaviors and their willingness to adopt healthier lifestyles [7].

The health consequences of obesity are extensive. Excess body weight significantly increases the risk of developing type 2 diabetes mellitus, hypertension, dyslipidemia, coronary artery disease, stroke, obstructive sleep apnea, osteoarthritis, chronic kidney disease, and several types of cancer [8–10]. In addition, obesity is associated with depression, anxiety, reduced quality of life, and premature mortality [11]. The economic burden is equally substantial, with obesity contributing to increased healthcare utilization, reduced work productivity, and higher national healthcare expenditures [12].

The Middle East has experienced one of the fastest increases in obesity prevalence globally. Recent evidence indicates that approximately one-third of adults in the region are overweight and more than one-fifth are obese [13]. Iraq is among the countries with the highest obesity burden in the region, largely driven by nutritional transition, reduced physical activity, and rapid urbanization [14,15]. These trends highlight the urgent need for effective prevention strategies that are tailored to the cultural and socioeconomic characteristics of the Iraqi population.

Improving obesity outcomes requires more than medical treatment alone. Public awareness of obesity risk factors, positive attitudes toward healthy lifestyle behaviors, and effective self-management practices are fundamental components of successful obesity prevention and long-term weight management [16]. Awareness enables individuals to recognize obesity as a chronic disease and understand its associated health risks, while positive attitudes facilitate motivation to adopt healthier behaviors. Self-management behaviors—including healthy dietary choices, regular physical activity, weight monitoring, and seeking professional advice—are essential for preventing excessive weight gain and maintaining long-term health [17].

Previous studies have reported varying levels of obesity-related knowledge, attitudes, and practices across different populations. While relatively high awareness has been observed among healthcare professionals and university students, studies conducted among the general population have consistently identified important gaps in obesity knowledge and healthy lifestyle practices [18–21]. Furthermore, positive attitudes toward obesity prevention do not always translate into effective self-management behaviors, suggesting a persistent knowledge-to-practice gap [22].

Despite the increasing prevalence of obesity in Iraq, evidence regarding obesity-related awareness, attitudes, and self-management among adults remains limited, particularly in the Kurdistan Region. Understanding these domains is essential for designing culturally appropriate health promotion programs and identifying population groups requiring targeted interventions. Therefore, this study aimed to assess the levels of awareness, attitudes, and self-management behaviors toward obesity among adults in northern Iraq and to identify the sociodemographic factors associated with these outcomes.

Materials and Methods

Study Design

A quantitative cross-sectional descriptive study was conducted to assess obesity-related awareness, attitudes, and self-management behaviors among adults residing in Rania City, Kurdistan Region of Iraq. This design was selected to determine the prevalence of obesity-related knowledge, perceptions, and health practices and to identify the sociodemographic factors associated with these outcomes.

Study Setting

The study was carried out in Rania City, located in the Raparin Administration, Sulaymaniyah Governorate, Kurdistan Region, Iraq. The study setting included urban, suburban, and rural communities to ensure representation of adults with diverse socioeconomic and educational backgrounds. Data were collected between 27 November 2024 and 10 January 2025 through both community-based and online surveys.

Study Population and Sampling

The target population comprised adults aged 18 years and older living in Rania City. Participants were recruited using a non-probability convenience sampling technique from community centers, healthcare facilities, markets, schools, universities, and through an online questionnaire distributed via community and student social media groups.

The minimum sample size was calculated using Cochran's formula for an unknown population proportion (Z = 1.96, p = 0.50, margin of error = 5%), yielding a minimum required sample of 384 participants. To improve statistical precision and compensate for potential incomplete responses, the final sample included 582 adults.

Inclusion Criteria

Participants were eligible if they:

  • Were aged 18 years or older.
  • Were permanent residents of Rania City.
  • Were able to understand the study questionnaire.
  • Voluntarily agreed to participate and provided written or electronic informed consent.

Exclusion Criteria

Individuals were excluded if they:

  • Were younger than 18 years of age.
  • Resided outside Rania City.
  • Had cognitive impairment or language barriers preventing questionnaire completion.
  • Declined to participate in the study.

Study Instrument

Data were collected using a structured self-administered questionnaire developed following a comprehensive review of the literature and previously validated obesity knowledge, attitude, and practice instruments. The questionnaire consisted of four sections:

  1. Sociodemographic and anthropometric characteristics (12 items), including age, sex, marital status, residence, educational level, occupation, family history of obesity, smoking status, attendance at obesity-related educational courses, sleep duration, height, and weight.
  2. Obesity awareness (13 items), assessing participants' knowledge regarding obesity definition, risk factors, complications, prevention, and treatment. Responses were scored as correct (1) or incorrect (0), with negatively worded items reverse-coded. Total scores were categorized according to Bloom's criteria as low (<60%), moderate (60–79.9%), or high (≥80%) awareness.
  3. Attitudes toward obesity (6 items) measured using a five-point Likert scale ranging from strongly disagree (1) to strongly agree (5). Total scores were categorized as negative (<60%), neutral (60–79.9%), or positive (≥80%).
  4. Self-management behaviors (8 items) assessed participants' weight-monitoring practices, dietary habits, physical activity, meal planning, reading food labels, and seeking professional advice using a five-point frequency scale ranging from never (1) to always (5). Self-management scores were classified as low, moderate, or high according to Bloom's cut-off values.

Validity and Reliability

Content validity was evaluated by a panel of six experts in nursing, community health, and statistics using Lawshe's Content Validity Ratio (CVR) and the Content Validity Index (CVI). Items that did not meet the recommended CVR threshold were revised or removed.

The questionnaire was translated into Kurdish and back-translated into English to ensure semantic equivalence. A pilot study involving 50 participants was conducted to assess clarity, feasibility, and cultural appropriateness. Internal consistency was evaluated using Cronbach's alpha, yielding coefficients of 0.736 for awareness, 0.703 for attitudes, 0.832 for self-management, and 0.836 for the overall questionnaire, indicating acceptable to excellent reliability.

Data Collection Procedure

Data collection was conducted over a two-month period using both paper-based questionnaires administered in community settings and an online version created using Google Forms. Before participation, respondents received information regarding the study objectives and procedures and provided written or electronic informed consent. Participant anonymity and confidentiality were maintained throughout the study.

Body Mass Index Assessment

Body mass index (BMI) was calculated using participants' self-reported weight and height according to the equation:

BMI = Weight (kg) / Height (m²)

BMI categories followed the World Health Organization (WHO) classification:

  • Underweight: <18.5 kg/m²
  • Normal weight: 18.5–24.9 kg/m²
  • Overweight: 25.0–29.9 kg/m²
  • Obesity: ≥30.0 kg/m².

Statistical Analysis

Data were analyzed using IBM Statistical Package for the Social Sciences (SPSS) version 27.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics, including frequencies, percentages, means, and standard deviations, were used to summarize participant characteristics and study variables. The Kolmogorov–Smirnov test assessed data normality. Associations between categorical variables were examined using the chi-square test. Independent predictors of awareness, attitudes, and self-management were identified using multivariable ordinal logistic regression and binary logistic regression, with adjusted odds ratios (AORs) and 95% confidence intervals (CIs) reported. Relationships among awareness, attitudes, and self-management were evaluated using Spearman's rank correlation coefficient. Statistical significance was established at p ≤ 0.05.

Ethical Considerations

Ethical approval was obtained from the Institutional Review Board of the College of Nursing, University of Raparin (Reference No. 2866/28-5-2023) before commencement of the study. The study was conducted in accordance with the principles of the Declaration of Helsinki. Written or electronic informed consent was obtained from all participants before data collection. Participation was voluntary, and respondents were informed of their right to withdraw at any time without consequence. All collected information was anonymized and treated confidentially for research purposes only.

Results

A total of 582 adults participated in the study. The participants had a mean age of 28.42 ± 9.32 years (range ≥18 years) and a mean body mass index (BMI) of 25.23 ± 3.99 kg/m². Females constituted 53.6% of the study population, while 46.4% were males. Based on BMI classification, 42.6% of participants had normal weight, 38.8% were overweight, 12.9% were obese, and 5.7% were underweight. The majority were single (57.2%), resided in suburban areas (52.2%), had completed secondary education (45.5%), and were students (47.6%). Most participants had never attended an obesity-related educational course (89.3%) and reported sleeping less than eight hours per day (52.1%) (Table 1).

Regarding obesity awareness, 40.4% of participants demonstrated a moderate level of awareness, 31.4% had low awareness, and only 28.2% achieved a high awareness level. Most respondents correctly recognized obesity as a disease (82.3%), acknowledged that regular physical activity helps reduce obesity (93.6%), and understood that excessive consumption of sugary beverages and high-fat foods contributes to obesity (96.2%). Similarly, more than 90% recognized obesity as a major risk factor for chronic diseases such as cardiovascular disease, diabetes mellitus, and certain cancers. However, substantial misconceptions remained regarding the effectiveness of lifestyle modification for severe obesity and the role of pharmacological treatment, indicating important knowledge gaps among the study population (Table 2).

Participants generally expressed favorable attitudes toward obesity prevention and management. Overall, 91.8% demonstrated positive attitudes, whereas 8.2% exhibited neutral attitudes, and none showed negative attitudes. The highest agreement was observed for statements emphasizing that obesity is a serious health problem requiring attention (94.1% agreed or strongly agreed), overweight individuals should be encouraged to seek professional help (92.9%), and additional public health campaigns are needed to increase obesity awareness (92.2%). These findings indicate widespread recognition of obesity as an important public health issue despite the observed deficiencies in knowledge and self-management behaviors (Table 3).

Self-management behaviors were considerably weaker than participants' attitudes. Nearly half of the respondents (48.6%) demonstrated a moderate level of self-management, 34.7% had poor self-management practices, and only 16.7% achieved a high self-management level. Weight monitoring represented the most frequently practiced behavior (mean score 3.48 ± 0.99), whereas regular physical activity for at least 30 minutes on five days per week showed the lowest adherence (mean score 2.81 ± 1.20). Seeking professional advice regarding weight management and routinely reading food labels were also reported infrequently, suggesting that healthy lifestyle behaviors were inadequately implemented despite generally favorable attitudes toward obesity prevention (Table 4).

Chi-square analysis demonstrated significant associations between several sociodemographic variables and obesity-related awareness, attitudes, and self-management. Higher awareness was significantly associated with older age, male sex, being married, higher educational attainment, BMI category, and occupation (all p < 0.05). Positive attitudes were significantly associated with age, sex, residence, educational level, BMI category, occupation, family history of obesity, smoking status, and attendance at obesity-related educational courses. Better self-management behaviors were significantly associated with older age, marital status, residence, higher education, occupation, and participation in obesity-related educational courses (p < 0.05) (Table 5).

Multivariable regression analysis identified several independent predictors of obesity-related outcomes. Lower educational attainment was the strongest predictor of reduced awareness compared with participants holding bachelor's degrees or higher. Positive attitudes were independently associated with older age, being married, suburban residence, normal or overweight BMI, student or government employment, and having a family history of obesity. Attendance at an obesity-related educational course emerged as the strongest predictor of self-management behaviors; participants who had not attended such a course had significantly lower odds of demonstrating better self-management (AOR = 0.323, 95% CI: 0.189–0.559, p < 0.001) (Table 6).

Spearman's correlation analysis demonstrated statistically significant positive relationships among the three study domains. Awareness showed a moderate positive correlation with self-management (ρ = 0.389, p < 0.001), indicating that greater obesity-related knowledge was associated with improved self-management practices. Weak but significant positive correlations were also observed between awareness and attitudes (ρ = 0.108, p = 0.009) and between attitudes and self-management (ρ = 0.119, p = 0.004), suggesting that although favorable attitudes contribute to healthier behaviors, knowledge plays a more influential role in promoting effective obesity self-management.

Table 1. Sociodemographic and anthropometric characteristics of the participants (N = 582)

Variable Category n %
Age (years) ≤21 183 31.4
  22–29 188 32.3
  30–38 109 18.7
  ≥39 102 17.5
Mean age (years) 28.42 ± 9.32    
Sex Male 270 46.4
  Female 312 53.6
Marital status Single 333 57.2
  Married 249 42.8
Residence Urban 219 37.6
  Suburban 304 52.2
  Rural 59 10.1
Educational level Primary school 21 3.6
  Intermediate school 29 5.0
  Secondary school 265 45.5
  Diploma 128 22.0
  Bachelor's degree or above 139 23.9
Occupation Student 277 47.6
  Government employee 181 31.1
  Self-employed 44 7.6
  Housewife 35 6.0
  Jobless 26 4.5
  Private employee 19 3.3
Family history of obesity Yes 270 46.4
  No 312 53.6
Smoking status Never 486 83.5
  Current 61 10.5
  Former 35 6.0
Attended obesity course Yes 62 10.7
  No 520 89.3
Sleep duration <8 hours/day 303 52.1
  ≥8 hours/day 279 47.9
BMI category Underweight 33 5.7
  Normal weight 248 42.6
  Overweight 226 38.8
  Obese 75 12.9
Mean BMI (kg/m²) 25.23 ± 3.99    

Table 2. Participants' awareness regarding obesity (N = 582)

Statement Correct n (%) Incorrect n (%)
Obesity is a disease 479 (82.3) 103 (17.7)
Fruits and vegetables help reduce obesity 314 (54.0) 268 (46.0)
Regular exercise helps reduce obesity 545 (93.6) 37 (6.4)
Sugary drinks and high-fat foods contribute to obesity 560 (96.2) 22 (3.8)
Children of obese parents have higher obesity risk 412 (70.8) 170 (29.2)
Obesity increases chronic disease risk 528 (90.7) 54 (9.3)
Obesity increases food allergy risk* 230 (39.5) 352 (60.5)
Obese people live as long as non-obese people* 349 (60.0) 233 (40.0)
Abdominal obesity is more harmful than hip/thigh fat 370 (63.6) 212 (36.4)
Obesity increases healthcare costs 492 (84.5) 90 (15.5)
Obesity management requires multiple strategies 432 (74.2) 150 (25.8)
Anti-obesity medications can be effective 251 (43.1) 331 (56.9)
Lifestyle modification is the best treatment for severe obesity* 175 (30.1) 407 (69.9)

*Reverse-coded item.

Table 3. Participants' attitudes toward obesity (N = 582)

Item Mean ± SD
Obesity is a serious health problem 4.51 ± 0.65
Overweight individuals should seek professional help 4.58 ± 0.66
Most obese people can lose weight with proper guidance 4.52 ± 0.66
Obesity is caused by lack of self-control 4.36 ± 0.75
More public health campaigns are needed 4.54 ± 0.66
Obese individuals are more intelligent than non-obese individuals* 4.18 ± 0.85

Overall attitude level

Level n %
Positive 534 91.8
Neutral 48 8.2
Negative 0 0.0

*Reverse-coded item.

Table 4. Self-management behaviors regarding obesity (N = 582)

Behavior Mean ± SD
Monitoring body weight 3.48 ± 0.99
Regular physical activity 2.81 ± 1.20
Seeking professional advice 2.83 ± 1.14
Avoiding high-calorie foods 3.31 ± 1.11
Reading food labels 3.18 ± 1.14
Planning healthy meals 3.21 ± 1.13
Limiting sedentary behavior 3.17 ± 1.04
Encouraging healthy eating among family/friends 3.76 ± 1.05

Overall self-management level

Level n %
Low 202 34.7
Moderate 283 48.6
High 97 16.7

Table 5. Association between sociodemographic characteristics and awareness, attitudes, and self-management

Variable Awareness p Attitudes p Self-management p
Age <0.001 0.038 0.001
Sex 0.008 0.008 0.166
Marital status 0.001 0.167 0.039
Residence 0.806 0.001 0.003
Educational level <0.001 0.006 <0.001
BMI category 0.008 0.001 0.194
Occupation <0.001 0.001 <0.001
Family history of obesity 0.311 0.028 0.901
Smoking status 0.376 0.008 0.436
Attendance at obesity course 0.130 0.045 <0.001
Sleep duration 0.060 0.765 0.223

Chi-square test.

Table 6. Independent predictors of awareness, attitudes, and self-management (multivariable logistic regression)

Predictor Outcome AOR (95% CI) p
Lower educational level Awareness 0.029–0.176 <0.001
Age 30–38 years Awareness 0.552 (0.305–0.997) 0.049
Younger age Attitudes 0.053–0.133 <0.05
Married status Attitudes Reference —
Suburban residence Attitudes 3.676 (1.573–8.591) 0.003
Normal BMI Attitudes 8.152 (2.285–29.083) 0.001
Student Attitudes 43.261 (7.456–250.997) 0.001
Government employee Attitudes 4.964 (1.113–22.141) 0.036
Lower educational level Self-management 0.229–0.458 <0.01
Suburban residence Self-management 0.640 (0.449–0.912) 0.013
No attendance at obesity course Self-management 0.323 (0.189–0.559) <0.001

Table 7. Correlations among awareness, attitudes, and self-management (Spearman's correlation)

Variables Correlation coefficient (ρ) p
Awareness vs. Attitudes 0.108 0.009
Awareness vs. Self-management 0.389 <0.001
Attitudes vs. Self-management 0.119 0.004

Discussion

This study is among the first to comprehensively evaluate obesity-related awareness, attitudes, and self-management behaviors among adults in the Kurdistan Region of Iraq. The findings revealed a substantial burden of overweight and obesity, with more than half of the participants classified as either overweight or obese. Although participants generally demonstrated positive attitudes toward obesity prevention, their awareness was only moderate, and self-management behaviors remained inadequate. These findings indicate a clear gap between knowledge, attitudes, and actual health practices, emphasizing the need for interventions that promote sustainable behavioral change rather than simply increasing awareness.

The prevalence of overweight and obesity observed in this study (51.7%) is consistent with the increasing burden reported across the Middle East. A recent systematic review reported pooled prevalence rates of 33.1% for overweight and 21.2% for obesity among adults in Middle Eastern countries, highlighting obesity as one of the region's most significant public health concerns [13]. Similarly, Pengpid and Peltzer reported that obesity and overweight affect a substantial proportion of Iraqi adults, largely driven by rapid urbanization, unhealthy dietary patterns, and physical inactivity [14]. However, the prevalence of obesity in the present study (12.9%) was lower than the national estimate reported previously in Iraq, which may be explained by the relatively young age of the study population and the predominance of students within the sample [15].

Participants demonstrated moderate overall awareness regarding obesity, with only 28.2% achieving a high awareness level. Although most respondents correctly identified obesity as a disease and recognized its association with chronic diseases such as diabetes and cardiovascular disease, important misconceptions persisted regarding nutritional management and treatment options. Similar findings have been reported among adults in Pakistan, Bangladesh, Cameroon, and the Philippines, where general knowledge about obesity was acceptable but understanding of effective prevention and treatment strategies remained limited [18–21]. These knowledge gaps may reflect insufficient public health education, limited nutrition counseling, and widespread misinformation regarding obesity management.

Higher educational attainment emerged as the strongest predictor of obesity awareness in the present study. Participants with bachelor's degrees consistently demonstrated greater knowledge than those with lower educational levels. This finding agrees with previous investigations conducted in Saudi Arabia, Bangladesh, South Africa, and Cameroon, which reported education as one of the strongest determinants of obesity-related knowledge [16,20,22]. Education improves health literacy and enables individuals to access, interpret, and apply health information more effectively, thereby enhancing awareness of obesity risk factors and prevention strategies.

Despite moderate awareness, participants demonstrated overwhelmingly positive attitudes toward obesity prevention, with more than 90% expressing favorable perceptions regarding healthy lifestyle practices and the importance of professional support. Comparable findings have been reported among Saudi adults and Malaysian university students, where most participants recognized obesity as a serious health problem requiring lifestyle modification [16,23]. Positive attitudes likely reflect increasing exposure to health promotion campaigns, social media, and healthcare messages emphasizing the health consequences of obesity. Nevertheless, a considerable proportion of participants still believed obesity was largely attributable to poor self-control, indicating the persistence of weight stigma and misconceptions that may negatively influence healthcare-seeking behavior and psychological well-being [24].

Although attitudes were highly positive, self-management behaviors remained suboptimal. Only 16.7% of participants demonstrated high levels of obesity self-management, while approximately one-third reported poor self-management practices. Regular physical activity showed the lowest adherence among all measured behaviors, whereas monitoring body weight was relatively more common. Similar discrepancies between positive attitudes and actual behaviors have been observed in studies conducted in Pakistan, Bangladesh, and Tanzania, where participants acknowledged the importance of healthy lifestyles but struggled to implement regular exercise and dietary modifications [18,21,25]. This knowledge-to-practice gap may be influenced by environmental barriers, limited recreational facilities, time constraints, cultural norms, and inadequate professional guidance.

Attendance at an obesity-related educational course was identified as the strongest independent predictor of self-management behaviors. Participants who had attended educational programs were significantly more likely to engage in healthy lifestyle practices than those without previous education. These findings support previous evidence demonstrating that structured educational interventions improve self-care behaviors, dietary adherence, physical activity, and weight management outcomes [17,26]. Health education programs increase individuals' confidence in adopting healthier behaviors and provide practical strategies that facilitate long-term lifestyle modification.

The present study also demonstrated significant positive correlations among awareness, attitudes, and self-management behaviors. Awareness showed the strongest association with self-management, suggesting that increasing knowledge may directly improve healthy behaviors. Although attitudes were also positively associated with self-management, the relationship was relatively weak, indicating that favorable perceptions alone are insufficient to produce meaningful behavioral change. Similar findings have been reported in obesity knowledge, attitude, and practice studies conducted in Bangladesh, Cameroon, and the Philippines, where awareness served as a stronger determinant of healthy behaviors than attitudes alone [19,20,22]. Consequently, obesity prevention programs should incorporate behavioral change techniques in addition to educational components.

The findings have important implications for nursing practice and public health policy. Nurses are ideally positioned to deliver individualized education, behavioral counseling, and continuous follow-up to individuals at risk of obesity. Community-based health promotion programs should focus particularly on younger adults, individuals with lower educational attainment, and those who have never participated in obesity-related educational activities. Furthermore, integrating obesity education into schools, universities, workplaces, and primary healthcare settings could substantially improve public awareness and encourage healthier lifestyle practices. Digital health technologies and social media platforms may also provide effective channels for delivering culturally appropriate obesity education to younger populations.

Overall, this study highlights the need to move beyond simply increasing public awareness toward developing comprehensive interventions that facilitate sustained behavioral change. Improving obesity self-management requires multidisciplinary collaboration among nurses, physicians, dietitians, educators, and policymakers to create supportive environments that promote healthy dietary habits, regular physical activity, and long-term weight management. Such strategies are essential for reducing the growing burden of obesity and its associated chronic diseases in Iraq and similar low- and middle-income countries.

Limitations

This study has several limitations that should be considered when interpreting its findings. First, the cross-sectional design precludes establishing causal relationships between obesity-related awareness, attitudes, and self-management behaviors. Second, participants were recruited using a convenience sampling technique, which may have introduced selection bias and limited the representativeness of the study population. Third, the study was conducted exclusively in Rania City, Kurdistan Region of Iraq, which may limit the generalizability of the findings to other regions of Iraq or different cultural and socioeconomic settings. Fourth, anthropometric measurements, including height and weight, as well as self-management behaviors, were self-reported, making the results susceptible to recall bias and social desirability bias. Finally, the study did not assess dietary intake, physical activity using objective measures, or clinical indicators such as waist circumference, blood pressure, or metabolic biomarkers, which could have provided a more comprehensive evaluation of obesity-related health status. Future multicenter longitudinal studies using probability sampling and objective clinical measurements are recommended to validate these findings and better understand the factors influencing obesity-related behaviors among Iraqi adults.

Conclusion

This study demonstrated that although adults in Northern Iraq generally exhibited positive attitudes toward obesity prevention, their awareness was only moderate, and self-management behaviors remained insufficient. More than half of the participants were classified as overweight or obese, highlighting the growing public health burden of obesity in the region. Higher educational attainment and participation in obesity-related educational programs were associated with better awareness and healthier self-management practices, while awareness showed the strongest positive relationship with self-management behaviors. These findings suggest that improving knowledge alone is insufficient unless accompanied by interventions that promote sustainable behavioral change. Therefore, comprehensive, nurse-led, and community-based educational programs should be implemented to enhance obesity literacy, strengthen self-management skills, and encourage healthy lifestyle practices, ultimately contributing to the prevention and control of obesity among Iraqi adult.

 

 
 
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