1. Dr. Awatif Ali Alam Associate Professor Community Medicine College of Medicine King Saud University 1/ 4 / 2008 1 A.Alam

2. Contents: Background Prevalence Etiology Objectives Methodology Results & Discussion Awareness Messages 1-3 Conclusions & Recommendations 1/ 4 / 20082 A.Alam

3. 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 / 20083 A.Alam

4. 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 / 20084 A.Alam

5. 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 / 20085 A.Alam

6. 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 / 20086 A.Alam

7. 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 / 20087 A.Alam

8. 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 / 20088 A.Alam

9. 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 / 20089 A.Alam

10. 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 / 200810 A.Alam

11. 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 / 200811 A.Alam

12. Results & Discussion 1/ 4 / 200812 A.Alam

13. Table 1:Frequency distribution of students according to age and obesity status. AgeNon-ObeseObeseTotal Frequency% % % 8 years16100.0--161.5 9 years14492.3127.715614.5 10 years35688.14811.940437.7 11 years26881.76018.332830.6 12 years12876.24023.816815.7 Total91285.116014.91072100.0 X2 for linear trend = 25.305, p-value < 0.001. 1/ 4 / 200813 A.Alam

14. 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 = 25.305 and the p-value was < 0.001. “If this trend continues it can be alarming to the general health status “. 1/ 4 / 200814 A.Alam

15. Table 2: Commonest demographic features. Demographic features Non-Obese (n=912) Obese (n=160) Total (n=1072) Number% % % Nationality: Saudi Non Saudi 804 108 84.5 90.0 148 012 15.5 10.0 952 120 88.8 11.2 X 2 = 2.56, P = 0.108 Type of housing: Apartment Villa Big house 040 532 340 83.3 84.2 86.7 008 100 052 16.7 15.8 13.3 048 632 392 4.5 58.9 36.6 X 2 = 1.37, P value = 0.505 Working Status of Mothers:- Non-working Working 544 368 85.0 85.2 96 64 15.0 14.8 640 432 59.7 40.3 X 2 = 0.01, P = 0.933 1/ 4 / 200815 A.Alam

16. Results and Discussion:-  A similar trend was noticed when obesity status was investigated by schooling grade, ( where X 2 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 / 200816 A.Alam

17. Lifestyle itemsNon-Obese (n = 912) Obese (n = 160) Total (n = 1072) Number% % % Exercise status No Yes 88 824 9.6 90.4 28 132 17.5 82.5 116 956 10.8 89.2 X 2 = 8.69, p = 0.003 Number of meals/day: Two Three Four 224 552 136 24.6 60.5 14.9 40 96 24 25.0 60.0 15.0 264 648 160 24.6 60.5 14.9 X 2 = 0.02, p = 0.99 Eating fast food: No Yes 120 792 13.2 86.8 20 140 12.5 87.5 140 932 13.1 86.9 X 2 =0.052 P = 0.82 Snack intake:- No Yes 192 720 21.1 78.9 32 128 20.0 80.0 224 848 20.9 79.1 Drinking Sodas: No Yes 248 664 27.2 72.8 12 148 7.5 92.5 260 812 24.2 75.8 X 2 =0.09 P = 0.76 1/ 4 / 200817 A.Alam

18. 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 / 200818 A.Alam

19. 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 / 200819 A.Alam

20. 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 / 200820 A.Alam

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22. 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 / 200822 A.Alam

23. 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 / 200823 A.Alam

24. 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 / 200824 A.Alam

25. 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 / 200825 A.Alam

26.  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 / 200826 A.Alam

27. 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 / 200827 A.Alam

28. 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 / 200828 A.Alam

29. 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 / 200829 A.Alam

30. 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 / 200830 A.Alam

31. 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 / 200831 A.Alam

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