Association of BMI with diet and physical activity of female medical students at the University of Dammam, Kingdom of Saudi Arabia

Investigating the beliefs of Saudi females regarding physical activity: a qualitative exploration

PURPOSE

Saudi women have been deprived of equal access to and opportunities for an active lifestyle due to sociocultural restrictions. Using the theory of planned behaviour, this elicitation study aimed to explore the salient beliefs of young Saudi women aged 18-35 regarding physical activity (PA).

METHODS

A descriptive qualitative methodology was utilized using a semi-structured interview. A total of 25 transcribed interviews were coded. Content analysis was used to identify the salient beliefs and to rank-order the beliefs using an adaptation of Burnard's model.

FINDINGS

Thirty-five salient beliefs were identified as dominant factors in the decision to engage in PA. The salient beliefs about PA are classified as positive (related to advantages, social approval, and enabling) and negative (related to disadvantages, social disapproval, and barriers). These included behavioural beliefs (concerning physical/psychological well-being and social opportunities), normative beliefs (concerning family, community, international and local media influencers' expectations), and control beliefs (concerning personal, social, natural, and built environment enablers as well as constraints).

CONCLUSIONS

Due to the elicited beliefs, young women may be able to adopt more active lifestyles and change their inactive behaviour. Addressing negative beliefs can help change their inactive behaviour. Strengthening positive beliefs and facilitators is also beneficial.

Dietary and Lifestyle Risk Factors of Obesity Among Young Adults: A Scoping Review of Observational Studies

PURPOSE OF REVIEW

Obesity is a growing public health concern worldwide, especially among young adults. This scoping review aims to identify and summarize the current evidence on dietary and lifestyle risk factors associated with obesity among young adults.

RECENT FINDINGS

A scoping review was performed using the PRISMA-ScR guidelines. A systematic search of five electronic databases published from inception to October 2023 was conducted. A total of 46 observational studies met the inclusion criteria and were included in the review. The findings suggest that high intake of energy-dense foods, unhealthy eating habits, poor sleep quality, and increased screen time were significant risk factors for obesity among young adults. In contrast, the association between obesity and sedentary behavior, low physical activity levels, alcohol consumption, and smoking habits was inconclusive. The reviewed evidence suggests that unhealthy dietary habits and lifestyle behaviors are associated with an increased risk of obesity among young adults. The findings highlight the need for further research on these modifiable risk factors to prevent and manage obesity among young adults.

Exercise Promotion in Saudi Arabia: Understanding Personal, Environmental, and Social Determinants of Physical Activity Participation and Well-Being

Physical activity promotion has received increasing attention globally due to the considerable benefits of regular activity for population health and well-being. In Saudi Arabia, government strategy explicitly aims to increase physical activity participation among residents. This study assessed the barriers to physical activity among the general Saudi population including any age and gender differences and examined the contribution of contextual factors and nature relatedness to health and well-being. A representative sample of 1046 Saudi adults (aged 18 years and above) completed an online survey that included four validated scales: the International Physical Activity Questionnaire-short form, the Exercise Benefits/Barriers Scale, the World Health Organization Five Well-Being Index and the Nature Relatedness Scale. Analyses indicated that young Saudi adults perceived more barriers than middle-aged and older adults, but few gender differences were observed. Furthermore, exercising outdoors, with other people and via sport predicted higher levels of mental well-being, as did nature relatedness. Therefore, developing a comprehensive strategy package that includes the development of outdoor environments for all age groups across regions and fostering a connection with nature may be particularly effective to improve the health and well-being of Saudi adults.

Mediterranean Diet, a Posteriori Dietary Patterns, Time-Related Meal Patterns and Adiposity: Results from a Cross-Sectional Study in University Students

The transition to university is connected to potentially obesogenic dietary changes. Our aim was to assess the relation of Mediterranean diet adherence, and a posteriori dietary and meal patterns with adiposity in Greek students at the University of the Peloponnese. A total of 346 students (269 women) participated. Anthropometry was performed, and a food frequency questionnaire was administered. The MedDietScore was higher in women and was not linearly related to adiposity. Principal component analysis revealed six patterns: (1) legumes/vegetables/fruits/tea/dairy/whole grains, (2) juice/sodas/liquid calories, (3) olive oil/fats, (4) meat/poultry/fish, (5) alcohol/eggs/dairy and (6) fast foods/sweets. Patterns 4 and 6 were related to overweight/obesity probability (OR = 1.5, 95% CI: 0.995-2.538 and OR = 2.5, 95% CI: 1.07-6.06, respectively) and higher waist circumference (men). Men "early eaters" (breakfast/morning/afternoon snack) had a higher MedDietScore and lower overweight probability (OR = 0.47, 95% CI: 0.220-1.020). Poor meal and dietary patterns relate to overweight and central obesity, which is important for targeted health promotion programs.

Weight-Related Status and Associated Predictors with Psychological Well-being among First-Year University Students in Bangladesh: A Pilot Study

University students (especially first-years) not only have to cope with their academic curriculum but also issues such as being away from the home environment and living independently for the first time. Those who do not adapt quickly to these new conditions are likely to be susceptible to physical and psychological vulnerabilities. The present study surveyed first-year Bangladeshi undergraduate students to investigate their weight status (i.e., the prevalence of being normal weight, underweight, overweight, and obese) and the prevalence of depression and associated risk factors. A cross-sectional survey was conducted among 404 first-year university students (aged 18–23 years) residing at a Bangladeshi university. The participants completed a survey examining socio-demographic and behavioral variables, alongside the WHO-5 Well-Being Index. Binary logistic regression was performed to determine significant associations between the variables under examination. Prevalence rates of being normal weight, underweight, overweight, and obese were 66.8%, 20.3%, 9.7%, and 3.2% respectively. Associated predictors of weight-related problems were being female and lack of physical exercise. The prevalence rate of depression was 68.1%. There were no significant gender differences and associated predictors of depression were lack of physical exercise, unsatisfactory sleep quality, excessive internet use, and excessive reading hours. Being underweight, overweight, or being obese alongside the prevalence of depression among first-year university students were high. Findings indicate that first-year university students are a vulnerable group for some physical and psychological problems. Findings recommend the need for intervention programs, alongside adequate and appropriate supportive services for first-year Bangladeshi university students.

Impact of the Intake of Snacks and Lifestyle Behaviors on Obesity among University Students Living in Jeddah, Saudi Arabia

Unhealthy eating habits increase the risk of obesity. This study investigated the association between obesity and the intake of snacks and lifestyle behaviors among university students in Saudi Arabia. The study included 662 students aged 18–29 years, studying at King Abdulaziz University. An online survey collected data on sociodemographic characteristics, height, and weight, to calculate body mass index (BMI), lifestyle behaviors, dietary habits, and snack intake. The prevalence of overweight and obese students was 18.6% and 12.7%, respectively. Sociodemographic characteristics and lifestyle behaviors had insignificant effects on obesity. Obese students consumed two meals daily and more cereals during breakfast. Non-obese students consumed more beverages at breakfast and had their daily meals with their families. The frequency of intake of snacks had an insignificant effect on obesity. However, obese students had a significantly higher intake of potato chips, popcorn, and biscuits, while non-obese students had a significantly higher intake of salads compared with obese students. Students consumed significantly less fruit and vegetables, chocolate, biscuits, nuts, and dairy products as snacks when inside the university compared to outside. To reduce obesity among students, universities should ensure access to healthy snacks, and provide health education programs to encourage healthy eating habits and lifestyles.

Association of Healthy Diet with Recovery Time from COVID-19: Results from a Nationwide Cross-Sectional Study

The world is still in need of an effective therapy to treat coronavirus disease-19 (COVID-19). This cross-sectional study was conducted on COVID-19 survivors in Saudi Arabia to investigate the influence of a healthy diet on the recovery time from COVID-19. A questionnaire was developed to assess participants' dietary habits, based on the 2015 Dutch food-based dietary guidelines. A total of 738 COVID-19 survivors participated in the study, of whom 237 (32.1%) were hospitalized for COVID-19 treatment while 501 (76.9%) were not hospitalized, and 320 (43.4%) were females and 418 (56.6%) were males. Overall, no significant difference was noted in healthy diet score between males and females; however, this score was significantly lower for Saudis compared to non-Saudis. Among the non-hospitalized patients, eating a more healthy diet was associated with a shorter duration of recovery (p < 0.05) and was significantly affected by gender (15.8 ± 9.3 male vs. 12.1 ± 8.9 female; p < 0.001) and marital status (12.1 ± 8.4 singles vs. 13.7 ± 9.3 married vs. 16.1 ± 11.8 divorced; p < 0.05). In contrast, no significant correlation was found with age or BMI. In this study, a more healthy diet was associated with a shorter duration of recovery from COVID-19. However, further studies are needed to thoroughly investigate the relationship between diet and recovery time from COVID-19.

A cross-sectional analysis of snacking habits, eating habits, physical activity, and indicators of obesity among high school students in Jakarta, Indonesia

Background

Changes in the lifestyle and eating habits of people in large cities in Indonesia have increased the risk of obesity. In Indonesia, the prevalence of obesity in adolescents increased from 1.6% in 2013 to 4.0% in 2018; in Jakarta, it increased from 4.2% in 2013 to 8.3% in 2018. Obesity is closely related to health behavior in adolescence, and it is a risk factor for the occurrence of non-communicable diseases (NCDs). This study aimed to describe the snacking habits, eating habits, physical activity, and indicators of obesity among adolescents in Jakarta.

Design and Methods

This study used a cross-sectional design involving 170, 10^th–12^th grade public high school students in Jakarta Province, recruited using purposive sampling technique. Using standardized instruments, the following surveys were delivered online: The Beverage and Snack Questionnaire, the Eating Habits Questionnaire, and the Youth Risk Behavior Survey Questionnaire (Q78). The Chi-squared test was used to determine the correlation between the study's variables.

Results

The majority of the 170 respondents were female (81.2%). Among the respondents, 11.2% were obese and 6.5% were overweight. Of the 170 respondents 52.4% had the habit of snacking, 64.1% had healthy eating habits, 73.5% engaged in physical activity ≤3 days/week, 79.4% watched TV <3 hours/day, and 61.2% played video games and spent time on computers ≥3 hours/day. The bivariate analysis results showed that there was no significant relationship between snacking habits, eating habits, and physical activity with indicators of obesity (p>0.05).

Conclusions

In general, the respondents in our study were found to have a healthy lifestyle, thus helping to prevent the development of an NCD. However, a number of the respondents were overweight and obese.

A Qualitative Study of Barriers and Enablers of Physical Activity among Female Emirati University Students

Interventions to promote physical activity participation should reflect social and culturally relevant influences of the target demographic. The aim of this study was to explore perceptions of barriers to and enablers of physical activity participation among female Emirati university students. Five semi-structured focus groups were conducted (n = 25). Participants were asked open-ended questions about benefits, barriers and enablers of physical activity, and recommendations to promote participation. Emergent themes were identified using Nvivo software. Commonly identified benefits included improved health, weight management, improved mood, and stress reduction. The main barriers were low family support, competing time demands from domestic and academic activities, lack of convenient access to women-only facilities, and hot weather. The main enablers and recommendations related to social support from family and friends, accessible and low-cost women-only facilities, and structured supervised sessions. Findings suggest that there are specific social-cultural influences of physical activity among female Emirati university students. Approaches to promote participation could include identifying benefits consistent with family and cultural values, using social media for education, support and modelling, on campus supervised physical activity sessions integrated with the academic timetable, low-cost women-only opportunities in the local residential area, and support for home-based activities.

High Adherence to the Mediterranean Diet Is Associated with a Reduced Risk of Obesity among Adults in Gulf Countries

The Mediterranean diet (MedDiet) is considered as a good example of a healthy dietary pattern that has protective effects on obesity. The aim of the present study was to assess the adherence of adults from three Gulf countries (Saudi Arabia, Oman, and Kuwait) to the MedDiet and its association with obesity risk. A cross-sectional study was conducted on 961 men and women (75.7%) aged 20–55 years old. Waist circumference (WC), and hip circumference (HC) were measured waist/hip ratio (WHR) and body mass index (BMI) were calculated. A validated 14-item Questionnaire was used to measure adherence to MedDiet. The mean of the adherence to MedDiet score was 5.9 ± 2.03 for the total sample. An inverse association was observed between the adherence to MedDiet and BMI after adjusting for potential confounders (p = 0.0003 in total participants, and p = 0.001 in women only). A protective effect was seen with a higher adherence to the MedDiet on HC, suggesting that a greater adherence to the MedDiet was associated with a decreased HC (p = 0.04 in total participants, and p = 0.01 in women only). In conclusion, low adherence to the MedDiet among participants from three gulf countries was associated with increased obesity indicators, BMI, and HC.

Barriers and Facilitators Associated with Physical Activity in the Middle East and North Africa Region: A Systematic Overview

Increasing physical inactivity levels in the Middle East and North Africa (MENA) region is a public health concern. We aimed to synthesize barriers and facilitators to physical activity and make appropriate recommendations to address physical inactivity. We conducted an overview of systematic reviews on physical activity barriers and facilitators in 20 MENA countries by systematically searching MEDLINE/PubMed and Google Scholar for systematic reviews published between 2008 and 2020. Our overview included four systematic reviews and 119 primary studies with data from 17 MENA countries. Lack of suitable sports facilities, time, social support and motivation, gender and cultural norms, harsh weather, and hot climate were the most commonly reported barriers to physical activity. Socio-demographic factors negatively associated with physical activity participation include advanced age, being female, less educated, and being married. Motivation to gain health benefits, losing/maintaining weight, being male, dietary habits, recreation, and increased Body Mass Index are positively associated with increased levels of physical activity. Interventions promoting physical activity in MENA should target schoolchildren, women and girls, working parents, and the elderly. Country-specific sociocultural and environmental factors influencing physical activity should be considered in the design of interventions. Current and future policies and national interventions must be consistently evaluated for effectiveness and desired outcomes.

Understanding eating choices among university students: A study using data from cafeteria cashiers' transactions

OBJECTIVE

To illustrate the use of automatically collected data from cashier transactions to understand eating habits among university students using cafeteria and to identify individual characteristics associated with the diverse behaviors.

METHODS

The study was carried out at a large university located in Pisa, central Italy, using data about meals automatically recorded from cashier transaction meals during the academic year 2015-16 as well as data from the administrative archive of the university. A model-based clustering relying on multivariate beta distribution was used to cluster eating choices while multivariate multinomial logistic regressions were applied to identify variables associated to diverse clusters identified.

RESULTS

Considering 4643 students and about 200,000 meals consumed, results suggest that healthy eaters represented a minority (11.2 %) of the study population while the large part of students composed their meals combining grains with processed food or proteins (32.7 %) and limiting the choice of fruit (42.9 %). Male gender and younger age were associated with eating behavior not in line with recommendations for a healthy diet.

CONCLUSIONS

Eating choice resulted to be "compromised" in most of students and specific characteristics associated with unhealthy choice were also identified that can help inform and target specific policy. The use of routinely collected data gives the opportunity to both cafeterias and university to take an active role in policy development.

Weight status, dietary habits, physical activity, screen time and sleep duration among university students

BACKGROUND

University life is a crucial period when dietary habits and lifestyle behaviours are formed and may have long-lasting effects on the development of obesity and related chronic diseases.

AIM

To investigate the association of overweight/obesity with dietary habits, physical activity, screen time and sleep duration among university students.

METHODS

A total of 438 students aged 18-26 years were recruited from Mohammed V University in Rabat, Morocco. Anthropometric measurements were assessed using standardized equipment. Data regarding dietary habits, physical and sedentary activities were collected via a self-administered questionnaire.

RESULTS

The prevalence of overweight and obesity was 14.8% and 1.6%, respectively. Students who reported frequent consumption (>3 times/week) of fast food, fried potatoes and sugary drinks were more likely to be overweight/obese than peers who did not. Similarly, odds of being overweight/obese were slightly higher among females who reported non-daily intake of fruits and milk or dairy products and among males who ate vegetables less frequently (<7 times/week). Approximately 26% of students were physically inactive, with a higher proportion of females (35.8%) than males (10.7%). Both short and long sleep durations were associated with an increased risk of overweight/obesity in males. In contrast, physical inactivity and increased screen time were associated with a slightly reduced risk of overweight/obesity, particularly in females.

CONCLUSIONS

Overall, unhealthy dietary habits were associated with an increased risk of overweight/obesity. A similar trend was also observed between abnormal sleep duration and overweight/obesity in males. Interventions to promote healthy dietary and lifestyle habits and prevent overweight/obesity in this population are needed.

Successful promotion of physical activity among students of medicine through motivational interview and Web-based intervention

Background

Regular physical activity supports healthy behavior and contributes to the reduction of preventable diseases. Students in their social transition period are the ideal groups for interventions. The higher education period, associated with demanding changes and poor time management, results in a low level of physical activity. In this age, social media usually are a suitable channel of communication and multicomponent interventions are the most desirable. It has not been sufficiently investigated how effective a Web-based approach is among university students when it comes to physical activity in the long-term period. We combined a Web-based approach with motivational interviews and tested these two interventions together and separate to assess their impact on improving the physical activity of medical students 1 year after the intervention.

Methods

All 514 first-year students at the Faculty of Medicine in Belgrade were invited to fill in a baseline questionnaire. Also, they underwent measurement of weight, height and waist circumference. After that, students selected a 6 months intervention according to their preference: Intervention through social media (Facebook) (Group 1) or combined with a motivational interview (Group 2). Group 3 consisted of students without any intervention. One year after completion of the 6 months intervention period, all students were invited to a second comprehensive assessment. Analyses were performed employing a wide range of statistical testing, including direct logistic regression, to identify determinants of increased physical activity measured by an average change of Metabolic Equivalent of Task (MET). This outcome measure was defined as the difference between the values at baseline and one year after completion of the 6 months intervention period.

Results

Due to a large number of potential determinants of the change of MET, three logistic regression models considered three groups of independent variables: basic socio-demographic and anthropometric data, intervention and willingness for change, and health status with life choices. The only significant model comprised parameters related to the interventions (p < 0.001). It accurately classified 73.5% of cases. There is a highly significant overall effect for type of intervention (Wald = 19.5, df = 2, p < 0.001) with high odds for the increase of physical activity. Significant relationship between time and type of intervention also existed (F = 7.33, p < 0.001, partial η² = 0.091). The influence of both factors (time and interventions) led to a change (increase) in the dependent variable MET.

Conclusion

Our study confirmed the presence of low-level physical activity among students of medicine and showed that multicomponent interventions have significant potential for positive change. The desirable effects of the Web-based intervention are higher if an additional booster is involved, such as a motivational interview.

Physical activity and sedentary behaviour in the Middle East and North Africa: An overview of systematic reviews and meta-analysis

To support the global strategy to reduce risk factors for obesity, we synthesized the evidence on physical activity (PA) and sedentary behaviour in the Middle East and North Africa (MENA) region. Our systematic overview included seven systematic reviews reporting 229 primary studies. The meta-analysis included 125 prevalence measures from 20 MENA countries. After 2000, 50.8% of adults (ranging from 13.2% in Sudan to 94.9% in Jordan) and 25.6% of youth (ranging from 8.3% in Egypt to 51.0% in Lebanon) were sufficiently active. Limited data on PA behaviours is available for MENA countries, with the exception of Gulf Cooperation Council countries. The meta-regression identified gender and geographical coverage among youth, and the PA measurement as predictors of PA prevalence for both adults and youth. Our analysis suggests a significant PA prevalence increase among adults over the last two decades. The inconsistency in sedentary behaviour measurement is related to the absence of standardized guidelines for its quantification and interpretation. The global epidemic of insufficient PA is prevalent in MENA. Lower PA participation among youth and specifically females should be addressed by focused lifestyle interventions. The recognition of sedentary behaviour as a public health issue in the region remains unclear. Additional data on PA behaviours is needed from low- and middle-income countries in the region.

Natural Landscape, Infrastructure, and Health: The Physical Activity Implications of Urban Green Space Composition among the Elderly

Urban green spaces (UGS) have been linked with a series of benefits for the environment, and for the physical health and well-being of urban residents. This is of great importance in the context of the aging of modern societies. However, UGS have different forms and characteristics that can determine their utilization. Common elements in UGS such as the type of vegetation and the type of surface are surprisingly understudied in regard to their relationship with the type of activity undertaken in UGS. This paper aims to explore the relationship between landscape diversity and the type of surface with the time spent and the physical activity intensity performed by seniors. To do so, this study uses GPS tracking data in combination with accelerometer data gathered from 63 seniors residing in Barcelona, Spain. Results showed that senior participants spent little time inside the analyzed UGS and sedentary behaviors (SBs) were more common than physical activities (PAs). The presence of pavement surfaces positively influenced the total time spent in UGS while gravel surfaces were negatively associated with time spent in active behaviors. The provision of well-defined and maintained paved areas and paths are some key infrastructures to be considered when designing UGS for overall urban residents and, especially, when aiming to potentiate the access for senior visitors.

The Twazon Arabic Weight Loss App: App-Based Intervention for Saudi Women With Obesity

Background

By 2022, it is estimated that the rate of female obesity (78%) in Saudi Arabia will almost double that of males (41%). Despite being mainly attributed to poor diet, sedentary lifestyle, and a lack of health awareness, behavioral modification interventions are relatively new to the population; bariatric surgery continues to be the treatment of choice for comorbidities. However, neither pre nor postoperative diet and exercise are promoted. Evidence-informed mobile health (mHealth) weight loss apps and interventions may be an effective tool for delivering a culturally relevant intervention.

Objective

This study aimed to determine the feasibility of a weight loss intervention that tests the effectiveness of Twazon, an originally designed Arabic weight-loss app that promotes lifestyle modification specific to Arab populations.

Methods

A pre-post single‐arm pilot study was carried out among a sample of 240 overweight volunteer Saudi women residing in Riyadh, Saudi Arabia who used the Twazon app over a 4-month period. Anthropometric, diet, and physical activity measures were assessed 3 times: baseline, 2-months and 4-months; frequency of app use and system usability were evaluated during the 2 latter data collection periods. Repeated measures analysis of variance was used to identify changes over time.

Results

A total of 40 participants completed the 4-month intervention with an attrition rate of 83%. An evaluation of the frequency of app use fostered 2 groups: engaged users (65%) and unengaged users (35%). At 4 months, the engaged users experienced more successful outcomes; body weight was lowered on average by 1.3 (SD 0.6) kg (P=.18), waist circumference (WC) was reduced by 4.9 (SD 1.1) cm (P<.001), and daily energy consumption was decreased by >600 calories (P=.002). Unengaged users experienced minor changes in body weight, WC, and reduced energy intake.

Conclusions

The findings have demonstrated that engagement with the Twazon app renders positive changes in body weight, WC, and energy intake. mHealth weight loss apps and interventions have the potential to be effective in promoting weight loss and healthy lifestyle modification in Saudi Arabia and similar populations.