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Prevalence of Overweight, Obesity, and Abdominal Obesity Among Urban Saudi Adolescents: Gender and Regional Variations

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Prevalence of Overweight, Obesity, and Abdominal Obesity Among Urban Saudi Adolescents: Gender and Regional Variations J HEALTH POPUL NUTR 2014 Dec;32(4):634-645 ©INTERNATIONAL CENTRE FOR DIARRHOEAL ISSN 1606-0997 | $ 5.00+0.20 DISEASE RESEARCH, BANGLADESH Prevalence of Overweight, Obesity, and Abdominal Obesity among Urban Saudi Adolescents: Gender and Regional Variations Hazzaa M. Al-Hazzaa1,2, Nada A. Abahussain3, Hana I. Al-Sobayel4, Dina M. Qahwaji5, Nouf A. Alsulaiman6, Abdulrahman O. Musaiger7 1Pediatric Exercise Physiology Research Laboratory, College of Education, King Saud University, Riyadh, Saudi Arabia; 2Obesity Research Chair, King Saud University, Riyadh, Saudi Arabia; 3School Health, Ministry of Education, Eastern Province, Saudi Arabia; 4Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia; 5Department of Clinical Nutrition, College of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia; 6PO Box 8342, Jeddah, 21482, Saudi Arabia; 7Arab Center for Nutrition, Manama, Bahrain, and Nutrition and Health Studies Unit, Scientific Research, University of Bahrain, Bahrain ABSTRACT The nutrition transition with associated lifestyle-related non-communicable diseases has rapidly reached many developing countries, including Saudi Arabia. Therefore, the objective of this study was to examine the prevalence of overweight, obesity, and abdominal obesity among Saudi adolescents. This school-based multicentre cross-sectional study was conducted during 2009-2010 in three major cities in Saudi Arabia: Al-Khobar, Jeddah, and Riyadh. Participants included 2,908 students of secondary schools (1,401 males and 1,507 females) aged 14 to 19 years, randomly selected using a multistage stratified cluster-sampling technique. Weight, height, and waist-circumference were measured; prevalence of overweight and obes- ity was determined using age- and sex-specific BMI cutoff reference standards of the International Obesity Task Force (IOTF). Abdominal obesity was determined using waist-to-height ratio (WHtR) cutoffs (above 0.5). The prevalence of overweight was 19.5% in males and 20.8% in females while that of obesity was 24.1% in males and 14% in females. The prevalence of abdominal obesity in males and females was 35.9% and 30.3% respectively. Higher prevalence of obesity was observed among adolescents in private schools. Across all ages, overweight and obesity ranged from 39.9% to 45.6% in males and from 30.4% to 38.7% in females. ANCOVA, controlling for age, showed significant interaction effects (city by gender). It is conclud- ed that the proportions of overweight, obesity, and abdominal obesity, observed among Saudi adolescents were remarkably high. Such high prevalence of overweight and obesity is a major public-health concern. Key words: Adolescents; BMI; Obesity; Waist-circumference; Saudi Arabia INTRODUCTION with co-morbidities (4-6). Metabolic complications associated with obesity during childhood increase In recent years, paediatric obesity has increased the risk of type 2 diabetes and early cardiovascu- considerably across the developed and developing lar disease (7). Furthermore, obesity in adolescence countries (1). This has prompted World Health Or- was shown to correlate significantly with increased ganization (WHO) to designate obesity as one of the risk of severe obesity in adulthood (8). Obesity may most important public-health threats (2, 3). Indeed, also affect psychological health as obese children childhood obesity is well-recognized to associate are more likely to report low self-esteem compared Correspondence and reprint requests: to their non-obese peers (9). Dr. Hazzaa M. Al-Hazzaa Professor and Director Nutrition transition with associated lifestyle- Pediatric Exercise Physiology Research Laboratory related non-communicable diseases, which was College of Education, King Saud University first observed in the developed countries, has rap- PO Box 2458, Riyadh 11451 idly reached many developing countries, including Saudi Arabia Email: [email protected] Saudi Arabia (10-12). In fact, during the past three Fax: 966 11 4673179 decades, the kingdom of Saudi Arabia has under- Obesity among Saudi adolescents Al-Hazzaa HM et al. gone enormous lifestyle-related transformation, ary schools in three major cities of Saudi Arabia; which has largely contributed to the increase in the Riyadh, Jeddah, and Al-Khobar, that are located in prevalence of obesity observed among Saudi chil- the central, western and eastern regions of Saudi dren and youths (10). Recent national estimates Arabia respectively. The three cities represent three of the prevalence of obesity (based on body mass different regions in Saudi Arabia and are all con- index from data collected in 2005) indicated that sidered cosmopolitan cites. The minimum needed overweight and obesity rates among Saudi adoles- sample-size in each city was determined so that the cents aged 13-18 years were 26.6% and 10.6% re- sample proportion would be within ±0.05 of the spectively (13). Furthermore, while the prevalence population proportion with a 95% confidence lev- of high BMI among children and adolescents in el. The population proportion has been assumed some of the developed countries, like the United to be 0.50 as this magnitude yields the maximum States, is showing a plateau between 1999 and 2008 possible sample-size required. The random selec- (14), the prevalence of obesity among Saudi chil- tion of the sample was based on a multistage strati- dren and adolescents is still increasing. Evidence fied cluster-sampling technique. At the first stage, from serial cross-sectional assessments carried out a systematic random-sampling procedure was used over the years, on Saudi children and adolescents, in order to select the schools. The schools were using BMI (or fat percentage), showed a noticeable stratified into secondary schools for boys and girls, rise in obesity level over the past two decades (15- with further stratification into public and private 17). Because of this rapid increase in childhood schools for boys and girls. The selection of the pri- obesity in Saudi Arabia over the past years, data vate/public schools was proportional to size. Four from even a recent prevalence study a few years schools (two each from boys and girls schools) were back may be considered outdated. selected from each of the four geographical areas of each city (East, North, South, and West). At the Abdominal obesity, which represents both subcu- second stage, classes were chosen from each grade taneous and visceral fat accumulation, has been (level), using simple random-sampling design. In linked to increased cardiometabolic risks in chil- this way, one class was randomly selected in each dren and adolescents (18,19). The use of waist- grade of the three grades (Grade 10, 11, and 12) in circumference (WC) and waist-to-height ratio each secondary school. Thus, we had a total selec- (WHtR) for determining abdominal obesity in tion of at least 24 classes in each city (12 each from children was shown to be simple, sensitive, and boys and girls schools). All students in the selected specific (20,21). WC and WHtR also appeared to be classes, who were free from any physical abnormal- better predictors of cardiometabolic disease risk in ity, were invited to participate in the study. Due to children than is BMI (20,22-24). Despite the useful- the differences in class-size from city to city and ness of WC and WHtR in assessing central obesity, from private to public schools, the sample-sizes for only one previous local study (25) employed WC the participating cities were varied. The data collec- while none has used WHtR in studying obesity tion occurred during 2009-2010. The study proto- among Saudi children and adolescents. Therefore, col and procedures were approved by the Board of the objective of this cross-sectional comparative Educational Research Center at King Saud Univer- study was to provide recent estimates of the preva- sity as well as by the General Directorate of Edu- lence of overweight and obesity, using BMI cutoff standards as well as the levels of abdominal obesity, cation in each of the respective cities. In addition, using WC and WHtR, in representative samples of we obtained approval from school authorities and Saudi adolescents from three major cities in Saudi parental consents for conducting the survey. The Arabia, namely Riyadh, Al-Khobar, and Jeddah. total sample-size consisted of 2,908 adolescents, comprising 1,401 males and 1,507 females aged be- MATERIALS AND METHODS tween 14 and 19 years. Selection of participants Anthropometric measurements The present study is a part of the Arab Teens Life- A trained researcher performed the anthropomet- style Study (ATLS). The ATLS is a school-based ric measurements in the morning and according to cross-sectional multicentre collaborative study standardized procedures. Weight was measured to (26). The sampling technique and the methodol- the nearest 100 g, using calibrated portable scale. ogy were fully described in previous publications Measurements were done with minimal cloth- (26-28). Briefly, the sample was drawn from ado- ing and without shoes. Height was measured to lescent males and females enrolled in the second- the nearest cm, without shoes, using a calibrated Volume 32 | Number 4 | December 2014 635 obesity. Obesity amongSaudiadolescents 636 values for age, weight, height, BMI, and BMI, WC but height, for weight, age, values the For whole sample, respectively. males years showed 16.5 significantly and higher 16.7 were males 48.2%). Mean values for age of the males and fe exceeded that of the male participants (51.8% vs 1. The of in number females the slightly sample grouped by gender and of the participants, city characteristics are The descriptive shown in Table of lessthan0.05. yadh). The level of significance was set at a p value and female) and cities (Al-Khobar, Jeddah, (male and Ri genders across WHtR and WC, BMI, of each in differences the test to age of effects the for ling control while 3) by (2 ANCOVA two-way a used we addition, In performed. also were categories WHtR andcategories BMI of tests, chi-square with lations, with Bonferroni test.
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