|Year : 2014 | Volume
| Issue : 1 | Page : 13-18
Prevalence of overweight and obesity among Saudi primary school students in Tabuk, Saudi Arabia
Waleed Hamoud Al-Enazy, Salem Khalil Al Dahi, Ibrahim Mohammed Al Hariri
Department of Family Medicine, Armed Forces Hospitals Administration - Northwestern Region, Tabuk, Saudi Arabia
|Date of Web Publication||25-Jul-2014|
Salem Khalil Al Dahi
Department of Home Health Care Services, North West Armed Forces Hospital, P.O. Box 100, Tabuk 71411
Source of Support: None, Conflict of Interest: None
Background: Childhood obesity is one of the most serious health challenges of the 21st century. The problem is global and the prevalence is increasing at an alarming rate. Objectives: To determine the prevalence and risk factors of overweight and obesity among Saudi primary school students in AlAbnaa primary schools in Tabuk. Materials and Methods: A cross-sectional study was conducted among primary schools students in AlAbnaa Schools in Tabuk, Saudi Arabia. Sampling frame included all genders. In the first stage, a sample of four primary schools had been selected using simple random technique-two primary school for boys and two for girls. In the second stage, stratified sampling technique had been used. The data was collected through a self-administered validated questionnaire. Height and weight of the subjects were measured and body mass index (BMI) was calculated. Recently published 2007 World Health Organization (WHO) growth charts which depended on data from widely different ethnic backgrounds and cultural settings were used for defining overweight and obesity among students. Results: A total of 331 out of the target study subjects of 350 responded to the survey giving a response rate of 94.6%. Age of the respondents ranged from 6-13 years old and the mean age was 9.7 ± 2.1 years. The prevalence of overweight and obesity among male primary school students were 7.3% and 17.4%, respectively while the prevalence among female students were 12.4% and 20.9%, respectively. Overweight and obesity were more prevalent among student living with both parents (P = 0.031), with highly educated parents (P = 0.008), with history of maternal obesity (P = 0.001), with working mothers (P = 0.024), and with smaller family size (P = 0.004). Conclusion: The results of the current study provide alarming evidence-based data on the considerable prevalence of childhood overweight and obesity among Saudi primary school children in Tabuk, Saudi Arabia.
Keywords: Children in primary schools, obesity, overweight
|How to cite this article:|
Al-Enazy WH, Al Dahi SK, Al Hariri IM. Prevalence of overweight and obesity among Saudi primary school students in Tabuk, Saudi Arabia. Saudi J Obesity 2014;2:13-8
|How to cite this URL:|
Al-Enazy WH, Al Dahi SK, Al Hariri IM. Prevalence of overweight and obesity among Saudi primary school students in Tabuk, Saudi Arabia. Saudi J Obesity [serial online] 2014 [cited 2020 Jun 5];2:13-8. Available from: http://www.saudijobesity.com/text.asp?2014/2/1/13/137569
| Introduction|| |
Childhood obesity/overweight is one of the most common health problem in the world. It is estimated that about 22 million children under 5 years suffer from obesity or overweight all over the world.
In USA, data from National Health and Nutrition Examination Survey (NHANES) surveys (1976-1980 and 2003-2004) showed that the prevalence of overweight is increasing: For children age 2-5 years, the prevalence increased from 5% to 18.8%.  The prevalence of overweight among Canadian boys increased from 15% in 1981 to 28% in 1996 while the prevalence of obesity has increased during the same period from 5% to 13.5%.  Studies from Australia,  Japan,  Spain,  England,  and Bahrain  have all indicated rising trends in obesity among school children over the past two decades.
In Saudi Arabia, a study on 48,000 children (6-18 years old) in 1991 found that the prevalence of overweight among Saudi boys was 17.6% and obesity 11.3%.  Another study done in 1996 on Saudi male students showed that the prevalence of overweight and obesity was 11.7% and 15.8%, respectively.  A previous study concluded that obesity prevalence among Saudi school boys (6-12 years old) increased from 3.4% in 1988 to 24.5% in 2005. 
Obesity is not a single disease but is instead a syndrome with multifactorial etiology that includes metabolic, genetic, environmental, social, and cultural interaction.  Obesity is a complex condition in which excess of body fat may put the person at risk of hypertension, diabetes, metabolic syndrome, stroke, certain types of cancer (endometrial, breast, prostate and colon), dyslipidemia, gall bladder disease, sleep apnea, osteoarthritis, increase in all causes of mortality, emotional distress, discrimination, and social stigmatization.  Type 2 diabetes has increasingly been reported in children and adolescents, so much so that in some parts of the world type 2 diabetes has become the main type of diabetes in children. The global rise of childhood obesity and physical inactivity is widely speculated to play a crucial role. , Obese children are also at high risk of developing orthopedic problems like genu valgum, slipped capital femoral epiphysis and tibia vara. 
Childhood is a critical period for the initiation of obesity and associated morbidity. Obesity at any age will increase the risk of persistence of obesity at subsequent ages; in at least two studies, half of all obese children remained obese as adults. ,
The family and home environment are often implicated in the development of childhood obesity. A number of studies highlighted the association between environmental factors, mainly factors related to sedentary lifestyle (like eating unhealthy food or physical inactivity) and childhood obesity. 
Low level of physical activity in children is also influenced by the amount of physical activity undertaken by parents. Children with active parents were six times more likely to be active compared with parents who are not active. 
Time spent on watching TV or computer screens and video games appears to be an important index of sedentariness which could increase the risk of obesity. , Reducing television viewing and computer use may have an important role in preventing obesity and in lowering body mass index (BMI) in young children.  Recent studies also showed that short sleep duration may be a risk factor for obesity in children. ,
The objectives of this study are to determine the prevalence and risk factors of overweight and obesity among Saudi primary school students in Tabuk, Saudi Arabia.
| Materials and methods|| |
Study designs and subjects
A cross-sectional study was conducted among Saudi primary schools students in AlAbnaa schools in Tabuk, Saudi Arabia during the school year 2011-2012. Sampling frame included all boys and girls studying in AlAbnaa primary schools in Tabuk. There were nine primary schools for boys with 4,000 students and eight primary schools for girls with 3,500 students. In the first stage, a sample of four primary schools had been selected through simple random technique-two primary schools for boys and two for girls. In the second stage, stratified sampling had been used. First class of each grade of a selected school was treated as stratum; the sample from each stratum was equally selected by systematic random technique from students list, i.e. by selecting the odd numbers from the students list. The estimated sample size of 315 was increased to 350 in order to compensate for drop out.
There are several methods for estimating adiposity. , However, in this study, BMI was used as the measure of adiposity. BMI is the most frequently used measure of weight in relation to height. BMI is cheap and has a good specificity. It exclude subjects who are not overweight or obese, but it misses some who are obese (i.e. less sensitive),  it is also the preferred method of expressing body fat percentile from clinical measurements. 
Permission from the educational authorities in Tabuk was obtained with the help of the school health department in Tabuk Military Hospital. The data were collected through a pre-designed self-administered questionnaire. A pilot study on 30 primary students was conducted before the main study. The questionnaire was pre-tested by students' parents and it was clear and understandable. An appointment with school directors was arranged, schools were visited on separate days. Height and weight of selected students were measured. Height was measured without shoes, back straight, with heels together and arms at the side; the reading as measured in centimeter to the nearest 0.5 cm. The students then stood on weighing scale-Seca weighing scale (made in Germany) -without shoes and with light clothing, the weight was measured to the nearest 0.1 kg. After finishing the measurement of height and weight, each student received a self-administered questionnaire. It was filled by his/her parent, and returned back next day.
The BMI was calculated. Recently published 2007 WHO growth charts which depended on data from widely different ethnic backgrounds and cultural settings (Brazil, Ghana, India, Norway, Oman and the USA)  were used. Students with BMI below −2 SD (from the mean) for age and sex were defined as underweight. Students with BMI between −2 SD and +1 SD were defined as normal. Students with BMI between +1 SD and +2 SD were defined as overweight. Students with BMI above +2 SD (from the mean) were defined as obese. Statistical analysis was performed using the Statistical Package for Social Science (SPSS), version 19. Chi-square test was used to identify the significant factors associated with the prevalence of overweight and obesity. A P value less than 0.05 was considered statistically significant.
| Results|| |
A total of 331 out of the target study subjects of 350 responded to the survey giving a response rate of 94.6%. Age of the respondents ranged from 6-13 years old and the mean age was 9.7 ± 2.1 years with 95% CI = 9.5-9.9 years. The prevalence rates of overweight and obesity among male students were 7.3% and 17%, respectively while those among females were 12.4% and 20.9%, respectively. Overall, the prevalence rate of overweight among primary school students in Al Abnaa schools in Tabuk was 9.7% and that for obesity was 19% [Figure 1].
|Figure 1: Prevalence of overweight and obesity among Saudi primary school students by gender|
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[Table 1] presents the participants' socio-demographic and lifestyle factors. According to age, 53.8% of the students belonged to 10-13 years age-group. Majority of them (53.8%) were male. About 95% of them were living with both parents. Slightly more than half of the participants (50.5%) were born to a father with bachelor degree or higher while only 40.2% of them had a mother with at least a bachelor degree of education. As to the family size, 57.4% belonged to families with more than 6 members. The occupation of most of their fathers (73.7%) was military. Maternal employment was reported among almost one-third of them (31.1%). Having history of paternal obesity was claimed by 26.3% while 31.1% of them reported to have history of maternal obesity. Watching TV, using the computer, or playing video games for more than 4 hours per day was claimed by 60.4%. Sleep duration of more than eight hours per day was reported by only 12.4% of them.
|Table 1: Socio-demographic and lifestyle factors of the study participants (n=331)|
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[Table 2] shows the association between BMI and participants' socio-demographic and lifestyle factors. There was significant association between obesity and students living with both parents (P = 0.031), with highly educated parents (P = 0.008), with history of maternal obesity (P = 0.001), with working mothers (P = 0.024), and with smaller family size (P = 0.004). However, there was no significant association with age, gender, paternal occupation, history of paternal obesity, time spent watching TV and using the computer or playing video games, and duration of sleep per day of the participants.
|Table 2: Association of body mass index with socio-demographic and lifestyle factors of the study participants (n=331)|
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| Discussion|| |
The results of the current study support the previous findings which stated that the prevalence of overweight among male school children 6-12 years was 7.3% while that of obesity was 17.4%. This prevalence rate is higher than previously reported by El-Hazmi and Warsy,  who conducted a cross-sectional national epidemiological household survey in different areas of Saudi Arabia from 1994 to 1998. Their study group included 12,071 children (boys 6,281; girls 6,420), with ages ranging from 1-18 years. The prevalence of overweight among boys aged 6-12 years was 8.6% while the prevalence of obesity was 4.9%. This apparent increase could reflect more deterioration in the situation in Saudi Arabia regarding childhood obesity which indicates a need for rapid and effective action to decease this problem burden.
Al-Hazaa concluded that obesity prevalence increased among Saudi school boys to 24.5%.  In 2008, locally published study done in Al-Hassa showed that the prevalence of overweight in primary school boys were 14.2% while that of obesity was 9.7% although the age range in that study was 10-12 years. 
There is evidence that prevalence of childhood overweight and obesity in Saudi Arabia is growing dramatically, this perhaps is a tax of urbanization and sedentary life style, and the problem seemed to be worsening when the children grow older. In the present study, time spent in watching TV, playing videogames, or using computers as well as duration of sleeping were not significantly associated with obesity. A further detailed study concentrating on those factors is highly recommended.
In the present study, a significant association was observed between students' obesity and high paternal education, working mothers, and lower family size. Results from studies abroad in this regards however were conflicting. Studies from Germany and France showed that the risk of childhood obesity was significantly lower in children with higher parental occupational and educational level. , On the other hand, studies from Turkey and Italy found no association between childhood obesity and parental occupational and educational level. ,
Compared to the findings of international studies which confirmed a significant association between children and total media time and childhood obesity, ,, the lack of significant association in our study could be related to the sample size which was relatively small and/or recall bias. The time spent watching video, TV, and playing electronic games is enough to increase calories consumption and to reduce metabolic rate, eating while watching TV is also a common practice among our families.
Our failure to include some important risk factors of overweight and obesity such as physical activity and dietary factors are among limitation of this study. However, the main objective of the present study is estimation of the prevalence of overweight and obesity among primary school children in Tabuk, Saudi Arabia.
| Conclusion|| |
The results of the study provide alarming evidence-based data on the considerable prevalence of childhood overweight and obesity among primary school children in Tabuk, Saudi Arabia. It highlights the higher prevalence among girls (although not significant), those of higher socio-economic standards, living with both parents and with history of maternal obesity.
| References|| |
|1.||NHANES data on the prevalence of overweight among children and adolescents: United states, 2003-2004. CDC National centre for health Statistics, Health E-stat. |
|2.||Tremblay M, Willms D. Secular trends in the body mass index of Canadian children. Canad Med Assoc J 2000;163:1429-1433. |
|3.||Magarey AM. Prevalence of overweight and obesity in Australian Children and adolescents, reassessment of 1985 and 1995 data against new standard international definition. Med J Aust 2001;164:561-564. |
|4.||Mastushita Y. Trends in Chidhood obesity in Japan over the last 25 years from the national nutritional survey. Obes Res 2004; 12:205-214. |
|5.||Moreno L, Fleta J, Sarria A, Rodrigues G. Secular increase in body fat percentage in male children Zaragoza, Spain. Prev Med 2001;33:357-363. |
|6.||Susan CH. Prevalence and trends in overweight and obesity in three cross sectional studies of British children, 1974-1994. J Epidemiology and Community health; 49:46-74. |
|7.||Al-sendi A, Shetty P, Musaiger A. Anthropometric and body composition indicators of Bahrini Adolescents. Ann Hum Biol 2003;30:367-379. |
|8.||Al-Sekait. The growth pattern of school children in Saudi Arabia. Saudi Medical Journal 1992; 13:141-146. |
|9.||Al-Nuaim AR. The pattern of growth and obesity in Saudi Arabian male school children. International Journal of Obesity 1996;20:1000-1005. |
|10.||Al-Hazaa HM. Prevalence and trends in obesity among school boys in central Saudi Arabia between 1988 and 2005. Saudi Medical Journal 2007;28:1569-1574. |
|11.||Dietz W. Burniat W. Child and adolescence obesity causes and consequences. Cambridge: University press, 2002:15-17. |
|12.||Brownell KD. A school based behavior modification, nutrition education and physical activity program for obese children. Am J clinic Nutr 192;35:277-283. |
|13.||Pinhas-Hamiel O. Increased incidence of non-insulin dependent diabetes mellitus among adolescents. J Paediatrics. 1996;128:608-615. |
|14.||Young TK, Dean HJ, Glett B. Childhood obesity in a population at high risk of type 2 diabetes. J Paediatrics. 2000;136:365-369. |
|15.||Power C. Measurement and long term health risks of child and adolescent fatness: Review. International journal of obesity 1997;21:507-526. |
|16.||Vanhala M. Relation between obesity from childhood to adulthood and the metabolic syndrome: Population based study. BMJ. 1998:317-319 |
|17.||Serdula MK, Ivery D, Coates RJ, Fredman DS. Do obese children become obese adults? Review of the literature. Prev Med. 1993;22:167-177. |
|18.||Biddle S, Salis J, Cavill N. Young and active? Young people and health enhancing physical activity: Evidence and implication. London: Health Education Authiority, 1998. |
|19.||Susan S. Obesity in childhood and adolescence. Australian family physician 2000;29:321-326. |
|20.||Ma G, Li Y, Hu X. Effect of television viewing on paediatric obesity. Biomed Environ sci 2002;15 (suppl 4):291-297. |
|21.||Arluk S, Branch J, Swain J. Childhood obesity relationship to time spent in sedentary behavior. Mil Med 2003;168 (suppl 7):583-6. |
|22.||Epstein LH, Roemmich JN, Robinson JL, Paluch RA, Winiewiez DD, Fuerch JH, et al. Arandomised trial of the effects of reducing television viewing and computer use on body mass index in young children. Arch Pediatr Adolesc Med. 2008;162 :239-245. |
|23.||Rebecca K, Swarnarekha B, Tinku T. Television viewing and sleep are associated with overweight among urban and semi-urban south Indian children. Nutritional Journal 2007;6:20-25. |
|24.||Agras W, Hammer L. Risk factors for childhood overweight: Prospective study from birth to 9.5 years. J Pediatr 2004; 145:20-25. |
|25.||Helen N. Measurement and definition of obesity in childhood and adolescence: A field guide for the uninitiated. Nutrition Journal 2007;6:53. |
|26.||Goran M. Measurent issue related to studies of childhood obesity: Assessment of body composition, body fat distribution, physical activity and food intake. Pediatrics 1998; 101:505-518. |
|27.||Malina RM. Validity of body mass index as indicator of the risk and presence of overweight in adolescents. AMJ Clinic Nutr 1999;70:131-136. |
|28.||Roche AF. Grading body fatness from limited anthropometric data. AMJ Clinic Nutr 1999; 70:131-136. |
|29.||World Health Organization. Infant and young child nutrition: The WHO multicentre growth reference study, 2007. |
[Table 1], [Table 2]