Dr. Awatif Ali Alam Associate Professor Community Medicine

College of Medicine King Saud University

1/ 4 / 2008 1 A.Alam

Contents:BackgroundPrevalence Etiology Objectives Methodology Results & Discussion Awareness Messages 1-3 Conclusions & Recommendations

1/ 4 / 2008 2 A.Alam

Background:• Childhood obesity is a public health problem of increasing importance in population undergoing cultural transition.

• The cause of pediatric obesity has not been elucidated completely, although it is suspected that a complex interaction of factors is responsible.1/ 4 / 2008 3 A.Alam

Background:

The poor success rate of adult obesity treatment programs in the general population points to the need to develop prevention approaches aimed toward children.

1/ 4 / 2008 4 A.Alam

Prevalence: A national study in Saudi Arabia

reported an overall prevalence of overweight in 12.7% of girls and 10.68% of the boys.

Obesity was found among 6.74% versus 5.98% of the boys.

1/ 4 / 2008 5 A.Alam

Etiology:

Causes differ from person to person ( mutifactorial ) They may include: - genetics, - environmental factors, - diseases, - parent's psychological characteristics, - parent-child relationship, - television watching, - physical activity , - nutritional habits and - behavioral factors.

1/ 4 / 2008 6 A.Alam

Objectives:1- Estimating the prevalence of obesity

among elementary female school students attending certain private schools in Riyadh City.

2- Identifying socio-behavioral and confounding factors related to childhood obesity.

3- Improving the awareness of students towards some health related practices.

1/ 4 / 2008 7 A.Alam

Rationale: Obesity may track from childhood to

adulthood, where morbidity is very evident.

Obesity in adolescence is directly associated with increased morbidity and mortality in adult life independent of adult body weight.

1/ 4 / 2008 8 A.Alam

Materials and Methods:

A cross-sectional study ( 2007).

Four private elementary female schools located in North West Riyadh city .

Multistage stratified random sampling technique.

Female students at grades 4-6.

A pre-designed validated standard questionnaire .

1/ 4 / 2008 9 A.Alam

Materials and Methods:The main included items: 1- Identification \socio-demographic variables.

2- Standardized anthropometric measurements.

3- Pattern of food and soft drink intake.

4- Pattern of physical activity.

5- Pattern of spending leisure time at home.

1/ 4 / 2008 10 A.Alam

The students were categorized into “obese” and “non-obese” according to a special classification based on age as follows:

BMI=weight (kg) \ height (m2)

1/ 4 / 2008 11 A.Alam

Results & Discussion

1/ 4 / 2008 12 A.Alam

Table 1:Frequency distribution of students according to age and obesity status .

Age Non-Obese Obese Total

Frequency

% Frequency

% Frequency

%

8 years 16 100.0

- - 16 1.5

9 years 144 92.3 12 7.7 156 14.5

10 years 356 88.1 48 11.9 404 37.7

11 years 268 81.7 60 18.3 328 30.6

12 years 128 76.2 40 23.8 168 15.7

Total 912 85.1 160 14.9 1072 100.0

X2 for linear trend = 25.305, p-value < 0.001.

1/ 4 / 2008 13 A.Alam

Results and Discussion:-

Sample size= 1200,Response rate = 1072 ( 89.3%). 160 (14.9%) were obese, and 912

(85.1%) were non-obese. The proportion of “obese” students

inversely increased by age where X2 for linear trend = 25.305 and the p-value was < 0.001.

“If this trend continues it can be alarming to the general health status “.

1/ 4 / 2008 14 A.Alam

Table 2: Commonest demographic features.Demographic features

Non-Obese(n=912)

Obese(n=160)

Total(n=1072)

Number

% Number % Number

%

Nationality:Saudi Non Saudi

804 108

84.590.0

148 012

15.510.0

952 120

88.811.2 X2 = 2.56, P = 0.108

Type of housing:

ApartmentVillaBig house

040 532 340

83.384.286.7

008 100 052

16.7 15.8 13.3

048 632 392

4.5 58.9 36.6

X2 = 1.37, P value = 0.505

Working Status of Mothers:-

Non-workingWorking

544368

85.085.2

96 64

15.014.8

640 432

59.7 40.3

X2 = 0.01, P = 0.933

1/ 4 / 2008 15 A.Alam

Results and Discussion:- A similar trend was noticed when obesity status

was investigated by schooling grade,( where X2 for linear trend = 12.581, and p-value

= 0.00039 ). The majority of participating students were

found to be living in villas or big houses, including 152/160 (95%) of the obese ones.

About 60% of mothers were housewives. An almost equal proportion of obese students

had “working or non-working mothers” and such factor did not correlate to obesity where :

chi-square = 0.01 and p-value = 0.933. 1/ 4 / 2008 16 A.Alam

Lifestyle items Non-Obese(n = 912)

Obese(n = 160)

Total(n = 1072)

Number % Number % Number %

Exercise statusNoYes

88824

9.690.4

28 132

17.582.5

116956

10.889.2

X2 = 8.69, p = 0.003

Number of meals/day:TwoThreeFour

224552136

24.660.514.9

40 9624

25.060.015.0

264648160

24.660.514.9

X2 = 0.02, p = 0.99

Eating fast food:NoYes

120792

13.286.8

20140

12.587.5

140932

13.186.9

X2 =0.052 P = 0.82

Snack intake:-NoYes

192720

21.178.9

32128

20.080.0

224848

20.979.1

Drinking Sodas:NoYes

248664

27.272.8

12148

7.592.5

260812

24.275.8

X2 =0.09 P = 0.76

1/ 4 / 2008 17 A.Alam

Results and Discussion:- Of all students ,956/1072 (89.2%) admitted

performing one kind or another of exercise ,where 824/956 (86.2%) were within normal BMI limits and 132/956 (13.8%) were obese.

116/1072 (10.8%) students never exercised ,which indirectly refers to the low impact of structured physical education and training in their schools .

(there was a statistically significant difference between exercise among non-obese and obese students

p-value = 0.0003).

1/ 4 / 2008 18 A.Alam

Awareness Message (1)

Physical Activity: - valuable to burn fat, - increase energy expenditure, - maintain lost weight, - improving blood pressure and - improve blood lipid profile.

1/ 4 / 2008 19 A.Alam

Results and Discussion:-Other lifestyle correlates:1.Eating fast food (79.10%), 2.Snack intake (86.94%), 3.Soda drinks (75.75%).

The invasion of western lifestyle , The affluent living style , The pressing need for public awareness . Controlling food industry.

“ Nourishment versus pleasure “?1/ 4 / 2008 20 A.Alam

1/ 4 / 2008 21 A.Alam

Awareness Message (2):

 Diet Management : Fasting or extreme caloric restriction is not advisable for children:

Psychologically stressful, May adversely affect the child's growth, Perception of "normal" eating.

“ Balanced diets with moderate caloric restriction, especially reduced dietary fat, have been used successfully in treating obesity. Nutrition education is necessary”.

1/ 4 / 2008 22 A.Alam

Results and Discussion:- The majority of students watched T.V. on

a regular daily basis 1016/1072 (94.8%) .

Globalization and the satellite.

The effect of food industry and advertisement of junk food.

The urge for introducing and maintaining awareness to all aspects of life.

1/ 4 / 2008 23 A.Alam

Awareness Message (3):

Behavior therapy:Involves changes in leisure time,Developing hobbies to promote a healthy life.

Some behavioral therapy strategies should include parent and family

involvement .

1/ 4 / 2008 24 A.Alam

Results and Discussion:-A total of 696/1072 (64.9%) of the studied

students never used the internet :

This result can be interpreted controversially.

Internet can be considered as a double edged weapon, depending on individual’s choice.

Awareness is greatly needed to guide students to follow the right direction and benefit from its technology.

1/ 4 / 2008 25 A.Alam

Based on the available evidence the prevalence of obesity among the studied population is alarming.

However, future national longitudinal studies which would include representative samples are needed.

Conclusions:

1/ 4 / 2008 26 A.Alam

Conclusions:

In order to promote healthier eating habits, and, consequently, decrease the rates of obesity, knowledge about food and nutrition is believed to be important.

1/ 4 / 2008 27 A.Alam

Preventive approaches include:

A. increasing the physical activity and body movement B. Healthful eating habits, C. Reducing television watching hours, and D. Family education .

It is generally accepted that early intervention can result in better future outcome. The main suggested approaches would be along the lines of promoting healthy behavior .

1/ 4 / 2008 28 A.Alam

Recommendations:

Other strategies to control obesity among Saudi children in general should include the promotion of physical activity through a national policy to encourage active living.

1/ 4 / 2008 29 A.Alam

Recommendations:

In view of the existence of obesity promoting environmental factors, the prevention and control of the situation is unlikely to fully succeed without having corresponding strategies to deal with it.

1/ 4 / 2008 30 A.Alam

Recommendations:

Interventions at the family or school level will need to be matched by changes in the social and cultural context so that the benefits can be sustained and enhanced.

1/ 4 / 2008 31 A.Alam

1/ 4 / 2008 32 A.Alam

1/ 4 / 2008 33 A.Alam