1. AHMED AWAD ALDHAHRI SUPERVISOR DR DARFIANA NUR Meta-Analysis of a Systematic Review on Adult Obesity in Kuwait

2. Background Obesity has become a global issue due to associated health problems (Swinburn, et al, 2011). Consistently increasing prevalence rates worldwide (Nguyen & El-Serag, 2010). Linked with multiple health conditions and illnesses (Halfon, N, et al, 2012) A leading factor for morbidity and mortality across the globe (Griffin, et al, 2013).

3. Background Around one-third of the total world population is obese (Wang et al, 2008). Other consequences associated include social, psychological and economic (Rofail, et al, 2013). Projection of the future trends reports a continuous increase in obesity levels across countries (Wang, et al, 2011). Kuwait being among the top list of countries with the highest obese population (Karageorgi et al, 2013).

4. Systematic Review: Karageorgi et al (2013) Review the findings and methodology of studies on the prevalence, trends and risk factors of obesity in Kuwait. A systematic review of relevant studies. Searched 111 cross-sectional – from 1997-2002 – articles from the PubMed Database. Keywords: Obesity and Adults and Kuwait. 111 articles reduced to 18 after being filtered.

5. Systematic Review ( Karageorgi et al,2013) Abstract and full-text reviews. Ranged from 177 to 3861 individuals.  Random sampling for 30% studies. Findings:  The prevalence (BMI ≥ 30) in studies with a nationally representative sample ranged from 24% to 48%  In adults > 50 years was greater than 52%  Women were found to be more obese than men.  An increase in trends of obesity was found from 1980 to 2009.  Multiple risk factors were involved.

6. Objectives To extend the existing systematic review in the literature using more databases until the end of 2014. To conduct and exhaustive search and inclusion of obesity research in Kuwait. To filter obesity research in literature related to important factors such as lifestyle and sociocultural To implement meta analyses based on studies.

7. Meta analysis What is a Meta-Analysis? A statistical technique used to integrate findings from different studies. Generally used for evaluation of effectiveness of healthcare interventions (Crombie, 2009). Validity of meta-analysis quality of the systematic review.

8. Meta analysis Fixed Effect Model Assumption: All included studies share a common effect size, µ. Observed Effects distributed about µ Variance σ 2 Depends on the sample size for each study. Random Effect Model Assumption: Instead of one single common effect size, it is assumed that there is a distribution of true effect sizes. Representation of the mean of the population of true effects. True effect sizes θ are distributed about μ with a variance value of σ2 The observed effect T for any given θ will be distributed about that θ with a variance σ2 that depends primarily on the sample size for that study Borenstein, Hedges & Rothstein, 2007.

9. Meta analysis Meta Analysis in R R is basically an open-source, and free statistical environment. Runs on Windows, Mac OS, and Linux Platforms Comprises of 20+ packages of meta-analytic packages on CRAN. Involves tools for meta-regression, multivariate meta-analyses, and Bayesian meta-analysis. Source: R-project.org, 2015

10. Research Timeline Draft of Introduction (Chapter 1): End of October, 2015 Literature Review (Chapter 2): Mid of November, 2015 Systematic Review (Chapter 3) : End of January, 2016 Meta analysis (Chapter 4) : End of April, 2016 Conclusion & Future Research (Chapter 5): End of May, 2016 Seminar : Mid of June, 2016 Progress Presentation : End of June, 2016

11. References Al-Kandari, Y. (2006). Prevalence of obesity in Kuwait and its relation to sociocultural variables. Obesity Reviews, 7(2), 147-154. doi:10.1111/j.1467- 789x.2006.00231.x Borenstein, M., Hedges, L., & Rothstein, H. (2007). Meta-Analysis Fixed effect vs. random effects. Meta-analysis.com Crombie, L. (2009). What is a Meta analysis. Sanofi-aventis. Al Rashdan, I., & Al Nesef, Y. (2009). Prevalence of Overweight, Obesity, and Metabolic Syndrome Among Adult Kuwaitis: Results From Community- based National Survey. Angiology, 61(1), 42-48. doi:10.1177/0003319709333226 Swinburn, B.A et al. (2011). The global obesity pandemic: shaped by global drivers and local environments. The Lancet. 378(9793) Griffin, J.W. et al. (2013). Morbid obesity in total shoulder arthroplasty: risk, outcomes, and cost analysis. Journal of Shoulder and Elbow Surgery. 23(10). Ghazali, S. et al (2010). The Relationship between Lifestyle and Body Mass Index Among University Students in Kuwait. The Egyptian Journal of Community Medicine. 28(1) Nguyen, D.M., & El-serag, H.B., (2010). The Epidemiology of obesity. Gastroentorology Clinics of North America. 39(1). Remington, et al. (2010). Chronic Disease Epidemiology and Control, American Public Health Association, Washington, DC, USA, 3 rd edition, 2010. Rofail, D., et al. (2013). A Review of the Social, Psychological, and Economic Burdens Experienced by People with Spina Bifida and Their Caregivers. Neurology and Therapy. 2(1). World Health Organization,. (2015). WHO | Obesity and overweight. Retrieved 16 September 2015, from http://www.who.int/mediacentre/factsheets/fs311/en/ http://www.who.int/mediacentre/factsheets/fs311/en/ Wang, Y.C. et al, (2011). Health and economic burden of the projected obesity trends in the USA and the UK. The Lancet. 378(9793)