Obesity in children and adolescents in Gulf countries: Facts and solutions

What is the level of nutrition literacy of Saudi adolescents? A national wide exploratory cross-sectional study

Background

Despite being a prolific research topic, studies evaluating nutrition literacy in the Arab world are scant and still nonexistent in the Kingdom of Saudi Arabia. Therefore, a national study was launched with the aim to (1) assess nutrition literacy among Saudi adolescents aged 10-19 years old and (2) determine its correlates.

Methods

A cross-sectional study was launched across all Saudi provinces between 29 April and 6 June 2022, enrolling a convenience sample of 2,115 adolescents (mean age = 16.8 ± 2.5; girls: 48.7%). An online self-administered questionnaire was disseminated to eligible participants to collect relevant data.

Results

Study findings showed that nearly half of the adolescents (44.6%) had poor nutrition literacy. The male gender doubled the risk of adolescents having poor nutrition literacy (OR = 2.0, CI = 1.5-2.5, p < 0.001). Northern border residents were 14 times more likely to be nutritionally illiterate, in contrast to adolescents residing in Riyadh (OR = 14.0, CI = 7.3-28.0, p < 0.001). Adolescents were more likely to be nutritionally illiterate if they were underweight or overweight (OR = 2.7, CI = 1.6-4.7, p < 0.001; OR = 2.2, CI = 1.7-2.9, p < 0.001). School students had 2 times more risk of having poor nutrition literacy, in contrast to those who were enrolled in universities (OR = 1.8, CI = 1.4-2.4, p < 0.001). Nutrition illiteracy was 4 times higher among adolescents having caregivers else than their parents (OR = 3.9, CI = 2.2-6.9, p < 0.001). Parental education level also contributed to determining adolescents' nutrition literacy status.

Conclusions

It has become essential to courage the development of supportive school environments in Saudi Arabia to promote nutrition education and improve adolescents' nutrition literacy. Without a doubt, this calls for taking a holistic approach on the part of education and health ministries, nutrition professionals, educators, parents, and, most importantly, the teenagers themselves, who must have the desire and motivation to learn.

The Assessment of Functional Movement in Children and Adolescents: A Systematic Review and Meta-Analysis

Background

The Functional Movement Screen™ (FMS™) is an assessment of human movement that may signal potential deficits that could predispose an otherwise healthy person to injury risk. FMS™ scores are well reported in both athletic and adult samples. However, to date, there has been no comprehensive systematic review and meta-analysis of FMS™ data among school-aged children and adolescents.

Objective

We aimed to systematically review and analyse functional movement proficiency of children and adolescents, specifically when assessed using the FMS™, and to establish initial normative values for the FMS™ in this population group and to further estimate differences in functional movement proficiency between the sexes, by school level (i.e., between primary and secondary school-level children and adolescents), and based on differences in child and adolescent body mass index (BMI).

Methods

In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, prospective studies were identified from searches across eight databases (MEDLINE, SPORTDiscus, CINAHL, Web of Science, EMBASE, ERIC, PsychINFO and PubMed), without any date restrictions, up to December 2020. The primary meta-analysis estimated the overall FMS™ score for school-aged children and adolescents across published studies. An additional three subgroup meta-analyses estimated comparisons for FMS™ data with school level, sex, and BMI across published studies. FMS™ data were meta-analysed using a number of different meta packages (Schwarzer et al. in Meta-Analysis with R, 1st ed, Springer International Publishing, Berlin, 2015), available in R Studio.

Results

A total of 19 articles were included in the systematic review. Meta-analysis revealed a weighted FMS™ mean score of 14.06, with a standardised Tau value of 0.56, signalling a moderate-to-large degree of variability in FMS™ means between studies. The difference in FMS™ means between samples of males (weighted FMS™ mean 13.91) and females (weighted FMS™ mean 14.56) was compatible with a possible small effect size (standardised mean difference − 0.27). The variability in FMS™ means between studies was approximately five times greater in samples of secondary school children (factor difference in Tau values 5.16). The final meta-regression identified a negative association between BMI and FMS™ scores (r =  − 0.42), which signalled a moderate-to-large difference in FMS™ scores between healthy weight and overweight children/adolescents.

Conclusion

This systematic review and meta-analysis represents a novel and important synthesis of published FMS™ data from groups of children and adolescents. The study signals possible sex- and age-related differences in FMS™ scores, as well as a clear negative relationship between BMI and functional movement proficiency. More longitudinal research is needed to better understand the developmental trajectory and the effects of maturation milestones on FMS™ proficiency. Additional research is also needed to identify the types of interventions that could improve functional movement proficiency among ‘at risk’ groups, who are susceptible to functional movement deficiency, and whether changes in body composition mediate the relationship between these interventions and the improvement of FMS™ scores.

Modelling the inhibitors of cold supply chain using fuzzy interpretive structural modeling and fuzzy MICMAC analysis

The Cold Supply Chain (CSC) is an integral part of the supply chain of perishable products. The aim of this research is to examine the inhibitors that have a major impact on the performance of CSC operations in the United Arab Emirates (UAE). This study provides a synthesis and suggests a hierarchical model among CSC inhibitors and their respective relevance. The hierarchical synthesis of twelve (12) primary CSC inhibitors is achieved through a comprehensive literature review and consultation with academics and CSC professionals. This study used semi-structured interviews, a fuzzy interpretive structural modeling (FISM) and a Fuzzy-MICMAC (FMICMAC) analysis to explore and establish the relationship between and among identified inhibitors. FISM is used to examine the interaction between inhibitors, while FMICMAC analysis is used to examine the nature of inhibitors on the basis of their dependence and driving power. The results of the FISM and FMICMAC analysis show the inter-relationships and relative dominance of identified inhibitors. The results show that some inhibitors are of high strategic importance due to their high driving power and low dependence. These inhibitors seek more management attention in order to improve their effectiveness. The result of a hierarchical model helps to understand the influence of a particular inhibitor on others. 'Higher capital and operating costs' occupy the highest level in the FISM model. The 'fragmented cold supply chains', 'lack of skilled labor', 'inadequate information system infrastructure' and 'lack of commitment by top level management' had strong driving power but weak dependence, which characterizes them as independent inhibitors. Management should be extra careful when dealing with these inhibitors as they influence the effects of other variables at the top of the FISM hierarchy in the overall management of the cold supply chain. The study also suggests a number of recommendations for addressing these inhibitors in cold supply chains operating in the UAE. With due attention and care for these inhibitors, the operation of the cold supply chains is likely to be even more successful.

Overweight and obesity among the boys of primary public schools of Baish City in Jazan Province, Saudi Arabia: A cross-sectional study

Background

Overweight and obesity are important modifiable risk factors for various noncommunicable diseases. The link between obesity, poor health outcomes, and all-cause mortality is well established. Overweight and obesity during childhood increases the likelihood of diabetes, hypertension, coronary heart disease, stroke, certain cancers, obstructive sleep apnea, and osteoarthritis more early in younger age groups.

Objectives

The aim of the study was to estimate the prevalence and some correlates of overweight and obesity in the study population.

Methods

The present study was a cross-sectional study conducted during October 2017 among 300 boys of primary public schools from Baish City of Jazan Province, Saudi Arabia. A semi-structured questionnaire was used for data collection. Weight and height were measured using standard tools. The WHO Z-score reference values of body mass index-for-age were used for the screening of overweight and obesity. Analysis was done using the Statistical Package for the Social Sciences (SPSS version 19.0).

Results

The prevalence of overweight and obesity was 10.1% and 12.4%, respectively, among the study participants. There was a significant difference in the overweight and obesity between urban and rural study population. Overweight and obesity was found higher among children who took frequently junk food.

Conclusions

Overweight and obesity was substantially prevalent among primary schoolboys with a significant rural-urban difference.

The Relationship between Lifestyle Factors and Obesity Indices among Adolescents in Qatar

Background: Physical inactivity, sedentary behaviour and an unhealthy diet are factors that may increase weight and general and/or abdominal obesity. Objective: To evaluate the relationship between general and abdominal obesity and lifestyle factors among adolescents in Qatar. Methods: The study data are based on the Arab Teens Lifestyle Study (ATLS). The target population consisted of 1184 adolescents aged between 14 and 18 years old (563 boys and 621 girls), randomly selected through multistage sampling. A validated questionnaire was used to collect data on lifestyle indicators. Anthropometric indicators, which included body weight, height and waist circumference (WC), were measured according to standardised procedures. International Obesity Task Force (IOTF) age- and sex-specific body mass index (BMI) reference values were used to define overweight and obesity. Abdominal obesity was defined by the 'waist-to-height ratio' (WHtR > 0.5) and by sex- and age-specific WC cutoff values. Results: Females were more inactive than males (63.7% vs. 36.3%; p < 0.001). The proportion of adolescents who reported screen time of over 2 h per day was 82.5%. Females engaged in more sedentary behaviour than males (53.4% vs. 46.4%, p = 0.009). Being male (OR: 1.3; CI: 1.0-1.7) and skipping breakfast (OR: 1.5; CI: 1.2-2) were significantly associated with overweight/obesity. In contrast, high intake of fast food, fries, sweets and cake were negative predictors of general and abdominal obesity. Conclusions: The findings revealed the prevalence of unhealthy lifestyle habits among adolescents in Qatar and indicated relationships between certain dietary habits and obesity. The findings of this study may help in advocating for the implementation of an intervention that includes lifestyle changes targeting adolescents.

Childhood Overweight and Obesity is Increasing in Gulf Cooperation Council Countries: A Review of the Literature

Introduction: A review was conducted to examine the prevalence and risk factors of developing overweight and obesity in children residing in Gulf Cooperation Council (GCC) countries. Method: PubMed, Medline, and Google Scholar databases using PRISMA guidelines were searched from January 1, 2007, to January 1, 2017. The inclusion criteria were (a) studies written in English, (b) clinical trials that examined risk factors of childhood overweight or obesity, (c) studies involving children 5 to 10 years of age, and (d) studies conducted in GCC countries. Results: Three main types of childhood obesity risk factors were identified (individual, familial, and lifestyle behavioral factors). The dietary, physical activity, and screen time lifestyle behavior risk factor findings were inconclusive. Discussion: Childhood obesity is increasing in GCC countries. Lifestyle behavior risk factors are still unclear. Researchers need to use instruments that have been psychometric tested and culturally acceptable. A follow-up review should be conducted.

Prevalence of obesity among school-age children and adolescents in the Gulf cooperation council (GCC) states: a systematic review

Background

The Gulf Cooperation Council (GCC) countries have among the highest prevalence of adult obesity and type 2 diabetes in the world. This study aimed to estimate the recent prevalence of obesity among school-age children and adolescents in the GCC States.

Methods

The literature search for obesity prevalence data was carried out in July 2017 in Google Scholar, Physical education index, Medline, SCOPUS, WHO, 2007-2017, and updated in November 2018.In addition, 22 experts from the GCC were contacted to check the search results, and to suggest studies or grey literature which had been missed. Eligible studies were assessed for quality by using the Joanna Briggs Institute (JBI) tool for prevalence studies. Conduct of the systematic review followed the Assessment of Multiple Systematic Reviews Tool (AMSTAR) guidance. A narrative synthesis was conducted.

Results

Out of 392 studies identified, 41 full-text reports were screened for eligibility; 11 of which were eligible and so were included, from 3 of the 6 GCC countries (United Arab Emirates, Kuwait, Saudi Arabia). Surveillance seems good in Kuwait in compared to other countries, with one recent national survey of prevalence. Quality of the eligible studies was generally low-moderate according to the JNBI tool: representative samples were rare; participation rates low; power calculations were mentioned by only 3/11 studies and confidence intervals around prevalence estimates provided by only 3/11 eligible studies; none of the studies acknowledged that prevalence estimates were conservative (being based on BMI-for-age). There was generally a very high prevalence of obesity (at least one quarter-one third of study or survey participants obese according to BMI-for-age), prevalence increased with age, and was consistently higher in boys than girls.

Conclusions

The prevalence of obesity among school-age children and adolescents appears to have reached alarming levels in the GCC, but there are a number of major gaps and limitations in obesity surveillance in the GCC states. More national surveys of child and adolescent obesity prevalence are required for the GCC states.

Trial registration

PROSPERO registration number CRD42017073692.

Assessment of body weight, maternal dietary knowledge and lifestyle practices among children and adolescents in north Jordan

OBJECTIVE

To estimate the prevalence of overweight and obesity among children and adolescents in north Jordan and to evaluate the dietary knowledge of their mothers.

DESIGN

Cross-sectional study.SettingsSchools, Irbid, Jordan.

SUBJECTS

Male and female participants (n 516) aged 6-18 years.

RESULTS

Thirty per cent of our sample population was overweight or obese, and about 11 % was underweight. Males tend to have a higher BMI and waist circumference than females except in the age group ≥15 years. Children who ate in front of the television tended to have higher BMI and waist circumference. Forty per cent of the mothers answered four or more questions correctly out of six, which indicated a sufficient level of nutritional knowledge.

CONCLUSIONS

The study revealed that obesity is a growing health problem in children and adolescents in north Jordan. This finding is considered a serious concern for public health and calls for the creation of new prevention programmes at the individual, family and community level.

Adolescents' self-perceived and actual weight: Which plays a dominant role in weight loss behaviour in Lebanon?

BACKGROUND

The decision to lose weight among adolescents is complex and is guided by a number of body-related factors. This study examined the extent of agreement between actual weight, measured as body mass index, and self-perceived weight and assessed their relative importance in weight loss behaviour among Lebanese adolescents.

METHODS

Data on 278 adolescents aged 13-17 years were drawn from the nationwide Nutrition and Non-Communicable Disease Risk Factor Survey (Lebanon, 2009). Binary multivariable logistic regressions were conducted to test associations with "effort to lose weight" as the outcome variable, controlling for a number of potential confounders.

RESULTS

Close to 36% reported trying to lose weight. Around 21% and 13% were overweight and obese, respectively, and 40% and 10% perceived their weight as slightly high and very high, respectively. Inaccurate perceivers, those underestimating or overestimating their weight, constituted 39%, with overall percent agreement between actual and self-perceived weight being 60.8% (kappa statistic = 0.319, 95% CI [0.242, 0.396]). About a third of the overweight adolescents (30.5%) and more than half of the obese (56.8%) underestimated their weight. In the multivariable analysis, self-perceived weight was statistically significant and a stronger predictor of weight loss effort than body mass index (adjusted odds ratios = 14.42 and 6.42 for slightly high and very high perceived weight, respectively, compared to odds ratios = 1.47 and 2.31 for overweight and obese adolescents, respectively).

CONCLUSION

Health professionals need to consider self-perceived weight in conjunction with actual weight in their pursuit of weight management goals and in planning prevention programmes that guide weight loss behaviours for adolescents.

Obesity and Related Factors Among Children and Adolescents in Qatar

Overweight and obesity are major public health issues worldwide impacting millions of people. The prevalence of increased body weight among children and adolescents is becoming a global phenomenon. The State of Qatar is also experiencing the effects of obesity pandemic among adults and younger populations. In order to examine obesity and overweight parameters, a literature review was carried out using key scientific databases. Furthermore, this mini-review examines the selected factors that could be associated with obesity and overweight situation among children and adolescents living in Qatar. The results showed that the obesity is indeed a major public health issue among youth in Qatar.

Quantity and quality of obesity-related research in Arab countries: assessment and comparative analysis

BACKGROUND

Obesity is a serious worldwide medical condition, considered by some researchers as one of the most serious public health problems of the 21st century. The main objective of this study was to assess the quantity and quality of obesity-related research from Arab countries and compare it with that from non-Arab Middle Eastern countries.

METHODS

Original scientific articles or reviews published by Arab countries about obesity up until 2011 were screened using the ISI Web of Science database. Research activity was assessed by analyzing the annual research productivity, journals names, citations, top 10 active institutions, and the contribution of each Arab country to obesity research.

RESULTS

The total number of original and review research articles published globally about obesity was 110,167. The leading country in obesity research was United States of America (42.47%). Turkey, Israel, and Iran were in the top 30 countries while Kingdom of Saudi Arabia (KSA), Egypt, and Kuwait ranked 39th, 43rd, and 47th, respectively. A total of 1,121 documents about "obesity" were published by Arab countries, representing 1.0% of the global research output, with 13,343 citations (average citation of 11.9 per document) and an h-index of 44. The Arab countries' research output was very low until the mid-1990s and then increased steadily. Of the 1,121 documents, 107 (9.55%) were published in the Saudi Medical Journal. KSA, with a total of 318 publications ranked first among Arab countries in research quantity while Kuwait ranked first after adjustment based on population size. King Saud University in KSA was the most productive institution with a total of 140 documents. Compared with other non-Arab Middle Eastern countries, the research productivity from Arab countries was lower than that from Turkey, higher than that from Iran, and close to that from Israel. However, the h-index of documents about obesity published from Arab countries was lower than that of Turkey and Israel, but slightly higher than that from Iran.

CONCLUSIONS

The present data reveals a good contribution by some Arab countries, particularly Arab gulf countries, to obesity research. More efforts are needed by other Arab countries to bridge the gap in this topic and to improve the quality of obesity-related research originating from Arab countries.