Dr. Awatif Ali Alam Associate Professor Community Medicine College of Medicine King Saud University 1/ 4 / A.Alam

Contents: Background Prevalence Etiology Objectives Methodology Results & Discussion Awareness Messages 1-3 Conclusions & Recommendations 1/ 4 / 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 / 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 / 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 / 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 / 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 / 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 / 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 / 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 / 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 (m 2 ) 1/ 4 / A.Alam

Results & Discussion 1/ 4 / A.Alam

Table 1:Frequency distribution of students according to age and obesity status. AgeNon-ObeseObeseTotal Frequency% % % 8 years years years years years Total X2 for linear trend = , p-value < / 4 / 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 X 2 for linear trend = and the p-value was < “If this trend continues it can be alarming to the general health status “. 1/ 4 / A.Alam

Table 2: Commonest demographic features. Demographic features Non-Obese (n=912) Obese (n=160) Total (n=1072) Number% % % Nationality: Saudi Non Saudi X 2 = 2.56, P = Type of housing: Apartment Villa Big house X 2 = 1.37, P value = Working Status of Mothers:- Non-working Working X 2 = 0.01, P = / 4 / A.Alam

Results and Discussion:-  A similar trend was noticed when obesity status was investigated by schooling grade, ( where X 2 for linear trend = , and p-value = ).  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 = / 4 / A.Alam

Lifestyle itemsNon-Obese (n = 912) Obese (n = 160) Total (n = 1072) Number% % % Exercise status No Yes X 2 = 8.69, p = Number of meals/day: Two Three Four X 2 = 0.02, p = 0.99 Eating fast food: No Yes X 2 =0.052 P = 0.82 Snack intake:- No Yes Drinking Sodas: No Yes X 2 =0.09 P = / 4 / 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 = ). 1/ 4 / 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 / 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 / A.Alam

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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 / 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 / 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 / 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 / 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 / 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 / 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 / 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 / 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 / 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 / A.Alam

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