|Year : 2015 | Volume
| Issue : 1 | Page : 12-17
Obesity and overweight in a major family practice center, central region, Saudi Arabia
Ali Ibrahim Al-Haqwi1, Mansour Al-Nasir1, Nasreldin Ahmad2, Emad Masaudi2, Sultan S Alotaibi3, Bashir Hamad2
1 Department of Family Medicine, King Saud Bin Abdul-Aziz University for Health Sciences, Riyadh, Saudi Arabia
2 Department of Medical Education, King Saud Bin Abdul-Aziz University of Health Sciences, Riyadh, Saudi Arabia
3 Department of Family Medicine, Diabetic Center, Ministry of health, Qurayyat, Saudi Arabia
|Date of Web Publication||12-Jun-2015|
Ali Ibrahim Al-Haqwi
Department of Family Medicine, King Saud Bin Abdul-Aziz University for Health Sciences, Riyadh
Source of Support: None, Conflict of Interest: None
Background: Obesity and overweight are associated with significant health and health-related conditions, which have a negative impact on the quality of life. Objectives: To determine the proportion and characteristics of obesity among adults visiting a major family practice center in central Saudi Arabia and to compare the demographic and health-related conditions among obese and nonobese adults. Materials and Methods: A cross-sectional study conducted in a major family practice center in Riyadh, Saudi Arabia. Patients attending the center between 1 st September and 30 th November 30, 2013 were interviewed using a data collection form developed to meet the objectives of the study. Logistic regression was used to generate the odds ratios and their 95% confidence intervals for the association of body mass index and risks factors. Results : A total number of 300 adult participants were included in this study. The mean age and standard deviation were 46 years (±17 years). The proportion of overweight and obesity in the total sample was 32% and 50% respectively. Frequency of obesity was found to increase with age till the age of 50 where it drops afterward. Obesity significantly affects the participants within the age group from 40 to 60 more than other age groups (P < 0.001). Obesity was significantly associated with female gender and marital status (P < 0.018 and 0.006, respectively). The presence of obesity was found to decline significantly with increasing level of education. The presence of obesity was more in patients who have other chronic medical problems and those who reported less exercise. In addition to nonsmoking status, stepwise multiple logistic regressions showed that low level of education and having chronic medical diseases especially hypertension could be considered as predictors of developing obesity. Conclusion: This study confirmed previously published data about the seriousness of overweight and obesity among adults in Saudi Arabia. Certain patient categories are at a higher risk as women, married, and less educated patients. The positive role of education was clearly demonstrated and highlights the important role in effective health education strategies to minimize the negative public impact of obesity and overweight.
Keywords: Family practice, health education, obesity, overweight, primary health care
|How to cite this article:|
Al-Haqwi AI, Al-Nasir M, Ahmad N, Masaudi E, Alotaibi SS, Hamad B. Obesity and overweight in a major family practice center, central region, Saudi Arabia. Saudi J Obesity 2015;3:12-7
|How to cite this URL:|
Al-Haqwi AI, Al-Nasir M, Ahmad N, Masaudi E, Alotaibi SS, Hamad B. Obesity and overweight in a major family practice center, central region, Saudi Arabia. Saudi J Obesity [serial online] 2015 [cited 2020 Jan 29];3:12-7. Available from: http://www.saudijobesity.com/text.asp?2015/3/1/12/158690
| Introduction|| |
In 2014, the World Health Organization estimated that about 2 billion adults were overweight world-wide; over 600 million of them were obese.  The published reports showed that the trend of obesity and overweight is rising with time.
Obesity is defined as excess adipose tissue in the body and being widely measured using the body mass index (BMI, kg/m 2 ). Based on the BMI obesity is defined as BMI ≥ 30, and values between 25 and < 30 are considered as indication of overweight.
Obesity and overweight are associated with significant health and health related conditions. ,, Studies have demonstrated that obesity is associated with increased risk of diabetes mellitus, cardiovascular problems, coronary heart disease, gall bladder disease and cancer. In addition, obesity has a negative impact on the quality of life as it contributes to the presence of comorbid illnesses, sleep obstructive disorders, and significant physical disabilities. 
The association between obesity and psychological diseases was reported. It was found that obesity increases the risk of depression and depression was also found to be a predictor of the development of obesity. 
In addition, obesity and overweight carry a significant economic burden as it was estimated that about 3% of the total healthcare expenditure was related to the management of obesity-related health problems in many countries around the world. 
The recent rapid and extensive changes in the lifestyle in the Gulf region and Saudi Arabia led to major epidemiological changes including the alarming increase in the prevalence of noncommunicable diseases in the region. Diabetes mellitus, hypertension, dyslipidemia, coronary artery diseases, cerebral vascular diseases reach significant levels that represent a major health challenge to the health authorities in the region. ,
The reported findings about the prevalence of obesity in Saudi Arabia confirm the seriousness of this condition as up to three-quarters of adults were found to be either overweight or obese. ,,
This study was carried out to investigate the prevalence and characteristics of obesity among adults visiting a major family practice center in central Saudi Arabia and to compare the demographic and health-related conditions among obese and nonobese adults.
| Materials and methods|| |
This is a cross-sectional study conducted at a major family medicine center, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh during the period of 1 st September to 30 th of November 2013. This center offers a comprehensive medical care for about 800 patients per day who attend as a "walk-in" and by appointment for their acute and chronic medical conditions.
Adult patients visiting the center with various medical conditions during the period of the study were selected randomly and invited to participate.
The sample size for this study was estimated to be 288 participants. This was concluded by assuming the prevalence of overweight and obesity in Saudi Arabia as 75% , with ± 5% of precision, a 95% confidence interval (CI), and α = 0.05. A 20% nonresponse rate was considered as well. During the study period, 30 days were randomly selected, during which 10 patients were randomly selected using a systematic random sampling technique.
Patients who agreed to participate in the study after finishing the doctor consultation were directed to visit the interview room. The purpose of this study was explained, and a verbal consent was obtained. All participants were then interviewed face to face in a private room by an independent interviewer using a data collection form, especially designed for the study.
The data collection form included the basic demographic information as: Age, gender, marital status, level of education and employment status. Other risk factors associated with obesity were included, chronic diseases such as Hypertension, Diabetes Mellitus, Dyslipidemia, Bronchial Asthma, etc. Participants were asked to indicate wether they have any chronic diseases and if so, to specify them. Then association between presence of chronic diseases and obesity and overweight among participants was examined in this study.
The form included as well measurement of heights and weights. BMI was calculated and consequently, BMI groups were generated using the well-defined cut point as follows (underweight if BMI <18.5, normal weight if 18.5 ≤ BMI ≤ 25, overweight if 25 < BMI <30 and obese if BMI ≥ 30).
Statistical software program (SPSS, version 20, Armonk, NY: IBM Corp.) was used for the analysis. Demographic information was presented as frequencies and percentages. Chi-square test was used to assess the relationship between obesity and other categorical variables. Logistic regression was used to generate the odds ratios (ORs) and their 95% CIs for the association of BMI and risks factors.
The proposal of this study was approved by the ethics' committee at King Abdulla International Research Center, King Saud bin Abdul-Aziz University for Health Sciences, Riyadh, Saudi Arabia.
| Results|| |
A total number of 300 adult participants were included in this study. The mean age and standard deviation were 46 years (±17 years). Females constituted 62% of the sample, and more than half of participants were above the age of forty. The detailed demographic characteristics are shown in [Table 1]
Based on the available information of BMI for 281 of the participants, only 17% of them had a normal weight and 1% was underweight. Proportion of overweight and obesity was 32% and 50% respectively.
The participants were grouped into two categories; obese and nonobese and different characteristics of the two groups were tested and compared for further analysis as shown in [Table 2]. Frequency of obesity increases with age till the age of 50 which drops afterward.
|Table 2: Association between socio-demographic characteristics and obesity among participants|
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Obesity significantly affects the participants within the age group from 40 to 60 more than other age groups P < 0.001. Obesity was significantly associated with female gender and marital status as married individuals were more likely to be obese compared with other categories P values were; 0.018 and 0.006 respectively.
Interestingly, the frequency of obesity is inversely associated with the level of education, more advanced level of education the less likely the presence of obesity. This relationship was statistically significant.
[Table 3] shows the association of obesity with smoking, physical activity, and presence of chronic diseases. The presence of obesity was more in patients who have other chronic medical problems and those who reported less exercise. On the other hand, obesity was significantly less among smokers (P < 0.001).
Stepwise multiple logistic regressions are illustrated in [Table 4]. Low educational level, being a hypertensive, and nonsmoking status were considered as significant predictor for the development of obesity. The highest OR (4.79) was associated with the lowest level of education. P values and ORs are presented in [Table 4].
| Discussion|| |
The proportion of obesity and overweight in this study was 82%. Previous studies have shown an overall prevalence of obesity and overweight that ranged from 29% among adults to up to 85% among certain age groups. ,,,, This study demonstrated the magnitude and seriousness of this medical problem as the majority of the participants were either overweight or obese.
The higher proportion of obesity and overweight in this study, compared to other studies, could be explained partly by that the majority of the sample in this study was middle-age adults as the mean age and standard deviation were 46 years (±17 years) previous studies have reported a prevalence of obesity and overweight of up to 88% among patients at age group from 30 to 60 year. 
This study confirmed this observation as it was shown that the obesity increased with age and reaches a peak at the age group (40-50) before it declines afterward. The presence of co-morbidities and their associated complications could explain the observed less frequency of obesity and overweight among elder age group. In addition, this observation may reflect the less ability of some old obese subjects to visit health facilities compared to nonobese subjects within a same age group.
The observation of previously published studies ,,, that the obesity was significantly associated with female gender and being married is supported by the results of this study. This could be attributed to many socio-cultural reasons as women in the Saudi setting probably have fewer facilities to perform physical activity compared to men. Other contributing factors may include weight gain from recurrent pregnancies may increase the risk of overweight and obesity.
This study showed the significant protective role of education against obesity and overweight as the presence of obesity declines with increasing level of education. This finding is in keeping with local and international studies. , More educated patients will be more conscious about the role of health, diet and physical activity in maintain and promoting health. They will be probably having a better socio-economic status and will be prepared to search for healthier dietary choices.
Obesity was less among patients who reported having any kind of physical exercise. This demonstrates the importance of physical activity as a protecting factor against obesity. The association of obesity and lack of physical activity was recognized both in adolescents and adult population. ,
The reported relationship between smoking and weight, in the literature, was significantly influenced by the age. Smoking was found to be associated with a reduced risk of obesity and overweight among some older adults. , However, this relationship was not supported by evidence among smokers from younger age group.  These findings could explain the observed reduced risk of obesity and overweight among smokers in our study as the mean age of participant was 46 year and more than 56% of the sample was above the age 40 year. On the contrary, many smokers report weight gain after quitting smoking.
In addition to nonsmoking status, stepwise multiple logistic regressions showed that low level of education and having chronic medical diseases especially hypertension are significantly associated with obesity.
The association of obesity with unemployment could be explained by that majority of participants who were labeled as "unemployed" are retired and elderly women. In addition, obesity was more common among patients with chronic diseases as hypertension and diabetes. 
The main aim of the management of obesity-related medical and nonmedical problems should be addressed through the primary prevention of obesity and overweight. Studies have shown that interventions that aimed to promote a physical activity focus on dietary intake or combination of both will lead to significantly short- and long-term positive results. ,
Furthermore, effective behavioral models as social cognitive and learning theory, showed additional favorable outcomes, especially in younger age groups. 
The provision of accessible nutritional information increases the public awareness about the dietary values of food items, contributes to the selection and consumption of healthier choices and minimizes the incidence of overweight. 
The time has come to face the burden of the negative health and health-related consequences of obesity and overweight. This necessitates the presence of a national strategy that addresses preventive, curative, and rehabilitative interventions. ,
This strategy requires a collaborative efforts and close coordination from all sectors that are involved in the comprehensive management of obesity and overweight. The sectors include ministries of health, municipalities, education, universities and research centers, media, and nongovernmental organizations. ,
| Conclusion|| |
This study supported previously published data about the seriousness of overweight and obesity among adults in Saudi Arabia. It showed that certain categories are at a higher risk as women, married, and less educated patients. The positive role of education was clearly demonstrated and this highlights the important role in effective health education strategies to minimize the negative public impact of obesity and overweight. The effective national strategy is needed to plan, monitor the trend, and implement appropriate interventions to minimize the burden of obesity and overweight in the community. This is only achievable by efficient and effective collaboration and coordination with all concerned sectors.
Financial support and sponsorship
Conflict of interest
There are no conflict of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]