|Year : 2018 | Volume
| Issue : 1 | Page : 29-34
Central obesity among adult Saudi males in Riyadh city: Prevalence, risk factors, and associated morbidities
Mohammed Alsheef1, Hassan Alassiry2, Emad Alotaibi2, Nawaf Alamri2, Amar Halwani2, Tariq A Wani1, Hala Aljishi1
1 King Fahad Medical City, Riyadh, KSA
2 King Saud Bin Abdulaziz University for Health Sciences, Riyadh, KSA
|Date of Submission||10-Jun-2017|
|Date of Decision||30-Oct-2017|
|Date of Acceptance||05-Nov-2018|
|Date of Web Publication||13-Mar-2020|
Dr. Mohammed Alsheef
King Fahad Medical City, Riyadh
Source of Support: None, Conflict of Interest: None
Background Obesity is increasing in the Saudi population with a prevalence of 35.5%. Data on the prevalence and risk factors of central obesity are lacking. Numerous studies demonstrate that mortality is higher among individuals with central obesity compared to a generalized pattern. Central obesity is considered as the cornerstone for metabolic syndrome and is associated with an increased risk of cardiovascular disease and type 2 diabetes mellitus (T2DM).
Objectives The objectives of this study were to determine the prevalence, risk factors, and associated morbidities of central obesity among adult Saudi males attending primary healthcare centers (PHCCs) in Riyadh, Saudi Arabia.
Materials and Methods This cross-sectional study collected data from seven healthcare sectors in Riyadh city from May to August 2015. A multistage stratified random sampling technique was used; data were collected from 269 male adults attending nine PHCCs. The questionnaire enquired about demographic information, tobacco use, dietary habits, physical activity, a history of hypertension (HTN) and diabetes mellitus, family history, and anthropometric measurements. Central obesity was defined as waist-to-height ratio >0.5, waist-to-hip ratio (WHR) >0.90, and waist circumference (WC) >102 cm. Data entry and analysis were managed using the Statistical Package for the Social Sciences version 20.0 software (SPSS).
Results Based on body mass index (BMI), this study revealed that 37.9% of the participants were overweight or obese (32.7%). The prevalence of central obesity was 42.4%. Diabetes mellitus, HTN, and coronary heart disease were found among 36.1, 26.0, and 8.2% of the participants, respectively. Linear regression analysis demonstrated that T2DM [odds ratio (OR) 2.48], a family history of obesity (OR 2.79), a family history of T2DM (OR 1.80), current smoking (OR 5.78), ever smoking (OR 5.15), physical inactivity (OR 4.85), drinking energy beverages (OR 0.45), consuming more fried food (OR 2.20), and consuming fast food (OR 3.03) were significantly associated with central obesity.
Conclusion The prevalence of central obesity when determined using WC was higher when compared to its prevalence determined using BMI. WC is recommended to be included as another important tool to assess for obesity and predict for other risk factors of cardiovascular diseases for patients attending PHCCs. Health education programs should be adopted to increase awareness about the risks of central obesity and encourage a healthy diet and active lifestyle. Further studies need to be performed with a larger sample size and in different regions of Saudi Arabia.
Keywords: Central obesity, risk factors, Saudi Arabia
|How to cite this article:|
Alsheef M, Alassiry H, Alotaibi E, Alamri N, Halwani A, Wani TA, Aljishi H. Central obesity among adult Saudi males in Riyadh city: Prevalence, risk factors, and associated morbidities. Saudi J Obesity 2018;6:29-34
|How to cite this URL:|
Alsheef M, Alassiry H, Alotaibi E, Alamri N, Halwani A, Wani TA, Aljishi H. Central obesity among adult Saudi males in Riyadh city: Prevalence, risk factors, and associated morbidities. Saudi J Obesity [serial online] 2018 [cited 2020 Sep 28];6:29-34. Available from: http://www.saudijobesity.com/text.asp?2018/6/1/29/280260
| Introduction|| |
Obesity is defined as a condition of abnormal or excessive fat accumulation in the adipose tissues, to the extent that health may be impaired. It is considered as one of the most common nutritional disorders in developed countries, and it is considered one of the most difficult disorders to manage. Obesity has social and psychological impacts,, because it affects people of all ages in both developed and developing countries. Excessive food intake and a lack of physical activity are the two important risk factors for the development of obesity. The importance of a lack of physical activity has been emphasized by studies demonstrating that sedentary lifestyle choices were associated with an increased risk of obesity.
Obesity is a major risk factor for many chronic diseases including coronary heart disease (CHD), type 2 diabetes mellitus (T2DM), hypertension (HTN), dyslipidemia, Alzheimer’s disease, and breast cancer.,, It has been associated with increases morbidity and mortality and significant negative impact on life expectancy in different societies worldwide.,,
Obesity can be classified into general obesity and regional obesity or abdominal obesity. General obesity is measured by body mass index (BMI). A BMI ≥ 30 is considered obese, with a BMI ≥ 25 being overweight, and a BMI ≥ 18 being normal weight., In contrast, central obesity is defined by a waist circumference (WC) of >102 cm in men and >88 cm in women. Some studies show that mortality is higher if fat is centrally distributed compared with a more generalized pattern of distribution.,
The prevalence of obesity is increasing with 300 million adults considered obese worldwide. In the United States, the percentage of overweight children and adults has more than doubled in the last 30 years. Central obesity increases with age in both normal and overweight individuals independent of the changes in total body fat. In Kingdom of Saudi Arabia (KSA), obesity is a major health problem with an increase in its prevalence among adults and children.,,,, However, the prevalence of central obesity in KSA was not adequately explored. Given the recognition of obesity as an emerging public health crisis in the country and the particular importance of central obesity, it is important to determine the prevalence of central obesity and associated risk factors among Saudis.
The objectives of this study were to determine the prevalence of central obesity, its risk factors, and some comorbidities among Saudi adult males attending primary healthcare centers (PHCCs) in Riyadh, KSA, during 2015.
| Materials and methods|| |
This cross-sectional study was conducted among Saudi adult males attending PHCCs in Riyadh, KSA. The study was conducted after obtaining ethical approval from Institute Research Board (IRB) at King Fahad Medical city.
This study was conducted at PHCCs in Riyadh city during 2015. Riyadh city is divided into seven major sectors (first north, second north, south, east, west, first middle, and second middle). A total of 88 PHCCs were distributed as follows: west sector with 19 PHCCs; east sector with 18 PHCCs; south sector with 12 PHCCs; first north sector with nine PHCCs; second north sector with 12 PHCCs; first middle sector with nine PHCCs; and second middle sector with nine PHCCs.
Sample size was estimated using the following equation: n = (Zα/2)2 × (pq)/E2 (where n is the sample size, (Zα/2) = 1.96 for the two-sided test with 95% confidence level, p = expected population prevalence [0.23], q = 1−p, and E = minimum possible acceptable difference). The sample size was determined to be 272.
A multistage stratified cluster randomized sampling technique was used in this study. Two PHCCs from the east and the west sectors (because they have the more total population) and one PHCC from the remaining five sectors were selected randomly. From each PHCC, 30 files of adult males were randomly selected using systemic sampling technique based on the file number. The selected individuals were invited to participate in the study through phone call. There was a replacement sample for those who refused to participate.
The participants in this study were interviewed by one of the investigators using a data collection sheet used by World Health Organization (WHO). This data collection sheet was used for other related research projects and was adopted and modified for the use of this study, with questions pertaining to demographic information, tobacco use, physical activity, a history of HTN and diabetes mellitus, and a family history of obesity and dietary habits. Weight (kg), height (m), WC (cm), and hip circumference (cm) were recorded. According to the WHO’s criteria, central obesity was defined as a waist-to-height ratio >0.5, WHR >0.90, and WC >102 cm, while total obesity was considered to be BMI ≥ 30. BMI was calculated for each participant [BMI = weight (kg)/height2 (m)].
Data were analyzed using the Statistical Package for the Social Sciences version 20.0 software (SPSS Inc., Chicago, IL, United States). Pearson chi-square test was used for categorical variables. Logistic regression analysis was used to detect the association of central obesity with risk factors included in our model. Odds ratio (OR) was calculated with a 95% confidence interval (CI) for the likelihood of the person being centrally obese. The level of significance was set at <0.05 throughout the study.
| Results|| |
A total of 269 participants were included in this study. The mean age of the participants was 41.9 years, mean BMI was 28.29 ± 5.46, and mean WC was 99.29 ± 15.25 cm [Table 1]. The prevalence of central obesity was 42.4%. More than two-third of the participants were either overweight (37.9%) or obese (32.7%) [Figure 1]. The prevalence of T2DM, HTN, and CHD were 36.1, 26, and 8.1%, respectively. The comparison of central obesity (as measured by WC) and general obesity (as measured by BMI) showed that 81.8% of the obese participants were centrally obese, and 35.3% of the overweight participants had central obesity. Furthermore, six out of the 79 participants with a normal BMI had central obesity (7.6%) [Table 2]. The association between central obesity and T2DM, HTN, and CHD was 53.6% (P = 0.005), 54.3% (P = 0.019), and 45.5% (P = 0.761), respectively [Table 3].
|Table 1 The demographics and anthropometric characteristics of participants in Riyadh, KSA, 2015|
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|Figure 1 Weight status according to BMI among participants in Riyadh, KSA, 2015|
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|Table 2 Association between central obesity and general obesity among participants in Riyadh, KSA, 2015|
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|Table 3 Association between central obesity (waist circumference) and type 2 diabetes mellitus, hypertension, and coronary heart disease among participants in Riyadh, KSA, 2015|
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Linear regression analysis showed that T2DM (OR 2.48), a family history of obesity (OR 2.79), a family history of T2DM (OR 1.80), current smoking (OR 5.78), former smoking (OR 5.15), physical inactivity (OR 4.85), the frequent intake of fast food meals (OR 3.04), frequent fried food intake (OR 2.19), and a lack of fruit in the diet (OR 3.64) were positively associated with central obesity [Table 4].
|Table 4 Association between central obesity and some lifestyle-related factors using logistic regression analysis|
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| Discussion|| |
This study revealed a high prevalence of central obesity among adult Saudi males in Riyadh city (42.4%), and it was in accordance with the reported prevalence of central obesity among military personnel in Saudi Arabia (40.9% overweight, 29% obese, and 42.4% central obesity).
In this study, central obesity among the participants was associated with T2DM and HTN, which could explain that central obesity is a significant and independent predictor of both T2DM and HTN and is the cornerstone for metabolic syndrome. In a previous study in the western region of Saudi Arabia, the prevalence of metabolic syndrome was 21%, while 20% of the participants were having central obesity.,
The high prevalence of obesity (32.7%) and overweight (37.9%) among the participants in this study is in agreement with the findings of a large cross-sectional study, which showed that obesity and overweight were affecting 35.5% and 36.9% of the study population, respectively. Similarly, Saeed found that the overall prevalence of obesity ranged from 33.8 to 44.4%, and Alqarni documented obesity in the range of 3.8–63.6% with consistently higher prevalence among females. Importantly, the rate of obesity varies significantly in the different regions of Saudi Arabia, with a prevalence of 33.9% being documented in Ha’il and 11.7% in Jizan, with a clear correlation between lifestyle and dietary parameters and obesity. This finding emphasizes the importance of lifestyle interventions in controlling this epidemic.
In this study, it was found that central obesity was found in individuals who were normal, overweight, or obese as defined by BMI. Such findings were described by Li et al. In this regard, it was found that determining central obesity using BMI could overlook some individuals with the condition; therefore, another tool such as measuring WC is suggested to detect central obesity.
Physical inactivity was found to have a strong association with central obesity (OR 4.85). Inprevious reports, it was demonstrated that increased sedentary time, low light-intensity time, and low mean activity intensity were associated with high WC.In this study, other risk factors such as “ever smoking” (OR = 5.2) and “currently smoking” (5.8) were found to be associated with central obesity. These findings were in agreement with published studies that found that a higher WHR in those who have never smoked compared to current cigarette smokers (OR 0.0113, 95% CI: 0.0081–0.0145, P < 0.001).
It has been proved that a diet rich in calories plays a vital role in causing overweight and obesity. In this study, the frequent intake of fast food and fried food were strongly associated with central obesity [Table 4]. Collison et al. confirmed a correlation between sugar-sweetened carbonated beverage (SSCB) consumption and WC and BMI in Saudi boys aged 10–19 years.
In this regard, investigators emphasized to implement interventions to reduce obesity including the lifestyle modification of proven benefit. Education is central to achieving lifestyle modification. Farsi et al. specifically called for “education policy-makers to raise public awareness of the obesity epidemic and to implement strategies to prevent, identify, and manage it at earlier ages and stages.” It is likely that legislative measures will be necessary to achieve these changes, as promoted recently by NHS in England.
Limitations of study
The main limitations of this study are the small sample size, the study only being conducted among adult males, and only studying the Riyadh city population.
| Conclusion|| |
The prevalence of central obesity using WC was higher compared to its prevalence when using BMI. WC is recommended to be included as another important tool to assess for obesity and predict for the other risk factors of cardiovascular diseases for patients attending PHCCs. Health education programs should be adopted to increase awareness about the risks of central obesity and encourage a healthy diet and active lifestyle. Further studies are needed to be performed with a larger sample size and in different regions of Saudi Arabia.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
WHO. Obesity: Preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 2000;894:i-xii, 1-253.
Prentice AM. The emerging epidemic of obesity in developing countries. Int J Epidemiol 2006;35:93-9.
Gidding SS, Leibel RL, Daniels S, Rosenbaum M, Van Horn L, Marx GR. Understanding obesity in youth. A statement for healthcare professionals from the Committee on Atherosclerosis and Hypertension in the Young of the Council on Cardiovascular Disease in the Young and the Nutrition Committee, American Heart Association. Writing Group. Circulation 1996; 94: 3383–7.
Stunkard A, Mendelson M. Obesity and the body image. 1. Characteristics of disturbances in the body image of some obese persons. Am J Psychiatry 1967;123:1296-300.
Stunkard A, Burt V. Obesity and the body image. II. Age at onset of disturbances in the body image. Am J Psychiatry 1967;123:1443-7.
Lau DC, Yan H, Dhillon B. Metabolic syndrome: A marker of patients at high cardiovascular risk. Can J Cardiol 2006;22(Suppl B):85-90B.
Gortmaker SL, Must A, Sobol AM, Peterson K, Colditz GA, Dietz WH. Television viewing as a cause of increasing obesity among children in the United States, 1986–1990. Arch Pediatr Adolesc Med 1996;150:356-62.
Burton BT, Foster WR, Hirsch J, Van Itallie TB. Health implications of obesity: An NIH Consensus Development Conference. Int J Obes 1985;9:155-70.
Razay G, Vreugdenhil A, Wilcock G. Obesity, abdominal obesity and Alzheimer disease. Dement Geriatr Cogn Disord 2006;22:173-6.
Hunter DJ, Willett WC. Diet, body size, and breast cancer. Epidemiol Rev 1993;15:110-32.
Sjostrom LV. Morbidity of severly obese subjects. Am J Clin Nutr 1992;55:508-15S.
Sjostrom LV. Mortality of severely obese subjects. Am J Clin Nutr 1992;55(2 Suppl):516-23S.
Allison DB, Fontaine KR, Manson JE, Stevens J, VanItallie TB. Annual deaths attributable to obesity in the United States. JAMA 1999;282:1530-8.
Abolfotouh MA, Soliman LA, Mansour E, Farghaly M, El-Dawaiaty AA. Central obesity among adults in Egypt: Prevalence and associated morbidity. East Mediterr Health J 2008;14:57-68.
Reisin E, Frohlich ED, Messerli FH, Dreslinski GR, Dunn FG, Jones MM et al.
Cardiovascular changes after weight reduction in obesity hypertension. Ann Intern Med 1983;98:315-9.
Stevens VJ, Corrigan SA, Obarzanek E, Bernauer E, Cook NR, Hebert P et al.
Weight loss intervention in phase 1 of the Trials of Hypertension Prevention. The TOHP Collaborative Research Group. Arch Intern Med 1993;153:849-58.
Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP). Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001;285:2486-97.
Bjorntorp P. Obesity. Lancet 1997;350:423-6.
Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F et al.
Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): Case control study. Lancet 2004;364:937-52.
Al-Isa AN. Changes in body mass index (BMI) and prevalence of obesity among Kuwaitis 1980–1994. Int J Obes Relat Metab Disord 1997;21:1093-9.
Troiano RP, Flegal KM, Kuczmarski RJ, Campbell SM, Johnson CL. Overweight prevalence and trends for children and adolescents. The National Health and Nutrition Examination Surveys, 1963 to 1991. Arch Pediatr Adolesc Med 1995;149:1085-91.
Borkan GA, Hults DE, Gerzof SG, Robbins AH, Silbert CK. Age changes in body composition revealed by computed tomography. J Gerontol 1983;38:673-7.
Al-Shammari SA, Khoja TA, Al-Maatouq MA. The prevalence of obesity among saudi males in the Riyadh region. Ann Saudi Med 1996;16:269-73.
Al-Nozha MM, Al-Mazrou YY, Al-Maatouq MA, Arafah MR, Khalil MZ, Khan NB et al.
Obesity in Saudi Arabia. Saudi Med J 2005;26:824-9.
Al Quwaidhi AJ, Pearce MS, Critchley JA, Sobngwi E, O’Flaherty M. Trends and future projections of the prevalence of adult obesity in Saudi Arabia. 1992–2022. East Mediterr Health J 2014;20:589-95.
Alqarni SS. A review of prevalence of obesity in Saudi Arabia. J Obes Eat Disord 2016;2:2. doi: 10.21767/ 2471-8203. 100025
Farsi DJ, Elkhodary HM, Merdad LA, Farsi NM, Alaki SM, Alamoudi NM et al.
Prevalence of obesity in elementary school children and its association with dental caries. Saudi Med J 2016;37:1387-94. doi: 10.15537/smj.2016.12.15904
Horaib GB, AlKhashan HI, Mishriky AM, Selim MA, Alnowaiser N, Binsaeed AA et al.
Prevalence of obesity among military personnel in Saudi Arabia and associated risk factors. Saudi Med J 2013;34:401-7.
Appel SJ, Harrell JS, Davenport ML. Central obesity, the metabolic syndrome, and plasminogen activator inhibitor-1 in young adults. J Am Acad Nurse Pract 2005;17:535-41.
Alzahrani AM, Karawagh AM, Alshahrani FM, Naser TA, Ahmed AA, Alsharef EH. Prevalence and predictors of metabolic syndrome among healthy Saudi Adults. Br J Diabetes Vasc Dis 2012;12:78-80.
Lee J, Ma S, Heng D, Tan CE, Chew SK, Hughes K et al.
Should central obesity be an optional or essential component of the metabolic syndrome? Ischemic heart disease risk in the Singapore Cardiovascular Cohort Study. Diabetes Care 2007;30:343-7.
Saeed AA. Anthropometric predictors of dyslipidemia among adults in Saudi Arabia. Italian J EBPH 2013;10:7-11.
Al-Othaimeen AI, Al-Nozha M, Osman AK. Obesity: An emerging problem in Saudi Arabia. Analysis of data from the National Nutrition Survey. East Mediterr Health J 2007;13:441-8.
Li C, Ford ES, McGuire LC, Mokdad AH. Increasing trends in waist circumference and abdominal obesity among US adults. Obesity (Silver Spring) 2007;15:216-24.
Healy GN, Wijndaele K, Dunstan DW, Shaw JE, Salmon J, Zimmet PZ et al.
Objectively measured sedentary time, physical activity, and metabolic risk: The Australian Diabetes, Obesity and Lifestyle Study (AusDiab). Diabetes Care 2008;31:369-71.
Shi L, An R, Van Meljgaard J. Cigarette smoking and abdominal obesity: A meta-analysis of observational studies. J Subst Use 2013;18:440-9.
Collison KS, Zaidi MZ, Subhani SN, Al-Rubeaan K, Shoukri M, Al-Mohanna FA. Sugar-sweetened carbonated beverage consumption correlates with BMI, waist circumference, and poor dietary choices in school children. BMC Public Health 2010; 10:234. doi: 10.1186/1471-2458/10/234
[Table 1], [Table 2], [Table 3], [Table 4]