Levels and correlates of physical activity, inactivity and body mass index among Saudi women working in office jobs in Riyadh city

Prevalence of pre-obesity and above and its associated factors in adult women: an analysis of the 2020 Korea National Health and Nutrition Examination Survey

PURPOSE

This study was conducted to determine the prevalence of pre-obesity (overweight) and above in adult women and to identify associated factors.

METHODS

Data were obtained from the eighth Korea National Health and Nutrition Examination Survey (KNHANES VIII-2), conducted in 2020. The sample comprised 2,288 women aged 19-64 years who participated in the KNHANES VIII-2. Data were analyzed using complex sample design analysis with SPSS version 20.1.

RESULTS

The prevalence of pre-obesity and above among adult women was 46.5%, with 18.6% classified as having pre-obesity and 27.9% as having obesity. A higher prevalence of pre-obesity and above was observed in women aged 50-59 years (odds ratio [OR]=1.67, p=.019) or 60-64 years (OR=1.80, p=.029); women whose highest educational attainment was high school (OR=1.28, p=.018) or middle school or less (OR=1.60, p=.017); those in middle-income households (OR=1.55, p=.005); those engaging in muscle-strengthening activities less than 2 days per week (OR=1.37, p=.019); and those sleeping less than 6 hours per night during the week (OR=1.37, p=.025).

CONCLUSION

As nearly half of all adult women have either pre-obesity or obesity, prevention and management strategies must target both groups. Interventions should be prioritized for women in their 50s and older, as well as those with low education or income levels. Additionally, receiving adequate sleep of 7 hours or more and engaging in muscle-strengthening activities at least 2 days per week are important components of obesity management.

Family-friendly work conditions and well-being among Malaysian women

BACKGROUND

Although participation in paid work improves women's quality of life and well-being, the health benefits decline for women with young children. Implementing family-friendly work conditions is one strategy for improving working women's well-being, especially those with competing unpaid work responsibilities.

OBJECTIVE

This study investigated the extent to which accessibility and use of 11 specific family-friendly work conditions were associated with physical health, anxiety and depression in Malaysian women with young children.

DESIGN

A cross-sectional design using a retrospective self-complete, anonymous, online survey was conducted between March and October 2021.

METHODS

Women with a child aged 5 years or less (N = 190) completed an online survey measuring their exposure (availability and use) to 11 specific family-friendly work conditions, and their physical health, anxiety, and depression. The sample included women who were currently and recently working and with both formal and informal employment.

RESULTS

After accounting for potential confounders, women who used paid maternity leave have a lower likelihood of having anxiety symptoms.

CONCLUSION

Future research is needed to extend the findings from this study by over-sampling women who are informally employed and not currently working. Policy creation and development processes, including research and decision-making, should be led by and inclusive of women. For example, research funding could be allocated to 'lived experience' research that privileges the co-design of research with consumers. Based on these findings, the extent to which family-friendly work conditions fulfill their intent to improve the well-being for working women requires further critique.

Healthy eating behaviors and food consumption frequencies of retail workers

BACKGROUND

Retail workers comprise millions of people, but little is known about their eating behaviors and food consumption patterns.

OBJECTIVE

To examine the healthy eating behaviors and food consumption frequencies of retail workers in shopping malls.

METHODS

The sample of this descriptive study consisted of 385 retail employees working in ready-made garment stores of shopping malls in Istanbul (42% of those eligible). A descriptive information form, the nutrition subscale of the Health-promoting Lifestyle Profile (HPLP), and the Food Consumption Frequency Survey were used as data collection tools.

RESULTS

It was determined that more than half of the participants skipped breakfast and other meals and consumed fast food and packaged and acidic drinks five to six days a week. The mean score of the participants on the HPLP-nutrition subscale was determined to be 11.79±3.29.

CONCLUSIONS

The retail workers in shopping malls were found to have insufficient healthy eating behaviors, a low frequency of healthy food consumption, and a high level of fast-food consumption. Maintaining healthy eating habits is crucial for the health of employees. It is necessary for workplaces to take steps to help their employees become aware of and practice healthy eating. Workplaces should also be encouraged to provide healthy food options for their employees.

The State of Cardiac Rehabilitation in Saudi Arabia: Barriers, Facilitators, and Policy Implications

Cardiovascular disease (CVD) is a critical public health issue in Saudi Arabia, where it is the leading cause of death. The economic burden of CVD in the country is expected to triple by 2035, reaching $9.8 billion. This paper provides an overview of CVD in Saudi Arabia and its risk factors, impact on healthcare, and effects on patients' quality of life. The review emphasizes the potential of cardiac rehabilitation (CR) programs in addressing the CVD epidemic. CR programs have been shown to reduce morbidity, mortality, and hospital readmissions while improving patients' cardiovascular health and overall well-being. However, these programs are underutilized and inaccessible in Saudi Arabia. The paper highlights the urgent need for CR programs in the country and suggests key strategies for implementation. These include increasing patient referrals, tailoring programs to individual needs, enhancing patient education, and making CR accessible through home-based options. Fostering multidisciplinary collaboration and developing tailored guidelines for Arab countries can further enhance the impact of CR programs. In conclusion, this review underscores the vital importance of comprehensive CR programs in Saudi Arabia to combat the rising CVD burden, improve patient quality of life, and align with the goals of the Saudi 2030 Vision for a healthier society.

The Impact of COVID-19 on Physical Activity Among Adults in Saudi Arabia: A Cross-Sectional Study

Background

Physical inactivity has been identified as a major factor in developing and progressing chronic non-communicable diseases such as obesity. The Kingdom of Saudi Arabia ranks high worldwide in rates of obesity. During the coronavirus disease 2019 (COVID-19) pandemic, public health measures have been enforced. These included social distancing, masking, reduction of workplace daily hours, prevention of social gatherings, and home quarantine measures. These ultimately restricted the ability to perform regular physical health activities. The aim of this study is to understand the impact of COVID-19 on physical activity among adults in the Kingdom of Saudi Arabia.

Methodology

A cross-sectional study was conducted among the Saudi population. An online survey was sent through social media to gather data regarding individual physical activity before and after the start of the COVID-19 restrictions. The data were collected from March 20, 2021, until May 20, 2021, and analyzed using chi-square and paired t-test using the SAS software version 9.4.

Results

In total, 433 participants completed the survey. There were 183 (42.3%) males, and the majority of the participants were Saudi nationals (284, 65.6%). Most of the participants (181, 41.8%) were in the age group 25-35 years and 253 (58%) had bachelor’s degrees. Although the results did not show a statistically significant difference between pre- and post-COVID-19 respondents in terms of physical activity, married participants, participants from the eastern province, and participants who did not exercise regularly were all significantly impacted by lack of exercise compared to their counterparts (p < 0.05).

Conclusions

Taking measures to prevent the spread of COVID-19 is essential. Nonetheless, recommendations should be sought for physical activity during lockdowns, and large-scale research should be conducted to better understand what causes the exaggeration of sedentary lifestyles during lockdowns and how to prevent them. Further studies need to be conducted, and national guidelines should be made available in case of a future lockdown.

Exploring Female University Students' Participation in Physical Activity in Saudi Arabia: A Mixed-Methods Study

Background

The importance of physical activity in improving physical and mental health has been emphasized in many studies. Researchers in Saudi Arabia have reported an increase in physical inactivity among Saudis, especially among University female population. Current efforts in the field in Saudi Arabia have yet to explore barriers and facilitators that influence female University student's participation in physical activity. This study aims to provide an assessment of the situation regarding physical activity among female University students in Saudi Arabia.

Methods

This mixed method study preceded a participatory action research initiative. The first part of the mixed method consisted of a cross-sectional survey of 375 female University students in Saudi Arabia who completed the short form of the International Physical Activity Questionnaire. The second part consisted of semi-structured, in-depth interviews with 14 female University students and 16 female exercise trainers.

Results

Results showed that most participants (91%) spent more time in walking activity compared to moderate (66%) and vigorous activity (57%) for at least 10 min at a time over a period of 7 days. Results showed that 70% of participants did not meet the WHO recommendation of 150 min per week of moderate activity, while around 62% of participants did not meet the WHO recommendation of 75 min per week of vigorous activity. Barriers to participation included limited facilities for physical activities, academic workload, gender role, and the need to adhere to cultural standards. Facilitators included valuing positive results, general health concerns, and family support.

Conclusion

Knowledge gained from this study might support organizations and public health authorities to develop physical activity interventions that better address Saudi women's perceived needs. These findings are an important contribution to current knowledge in light of recent advances in women's rights in Saudi Arabia.

Barriers and facilitators affecting physical activity among adults in Saudi Arabia during COVID-19 quarantine

The quarantine period in Saudi Arabia from May to June 2020 due to the coronavirus disease (COVID-19) pandemic prevented many people from engaging in physical activity (PA), which may have had negative effects on their health. Therefore, it is important to understand the factors, barriers, and facilitators affecting PA of people during quarantine. This cross-sectional study was conducted using an electronic survey that was distributed to adults between 18 and 69 years old. The survey included demographic-related questions and the International Physical Activity Questionnaire-Short Form. The survey was completed by 1859 participants ranging in age from 18 to 69 years old (42.5% male, 57.5% female). The major factors influencing exercise were being male (odds ratio [OR] = 1.26; 95% confidence interval [CI] 1.03-1.53), being single (OR = 1.37; 95% CI 1.12-1.67), completing higher education at a Master/Doctorate level (OR = 1.83; 95% CI 1.23-2.72), and being resilient (OR = 1.05; 95% CI 1.03-1.08). The facilitators for doing regular exercise were having enough space at home (OR = 1.62), free time (OR = 1.77), good motivation (OR = 1.56), and being free from work (OR = 1.43) and family responsibilities (OR = 1.40). Sex, marital status, level of education and resilience were important factors affecting the type and level of PA during the quarantine period resulting from the COVID-19 pandemic.

Measurement and prevalence of adult physical activity levels in Arab countries

OBJECTIVES

This study aims to examine the reported prevalence of sufficient physical activity among adults in Arab countries and to determine the use of validated instruments for assessing physical activity.

STUDY DESIGN

This is a systematic literature review.

METHODS

This review follows recommendations outlined in the Meta-Analysis of Observational Studies in Epidemiology guidelines. The protocol for this study was preregistered with PROSPERO. Cross-sectional, cohort and intervention studies with a minimum of 300 adults aged ≥18 years assessing physical activity using a questionnaire or other self-report measure in the Arabic language were identified from seven electronic databases (MEDLINE, Embase, Cochrane Database of Systematic Reviews, CINAHL, PsycINFO, SPORTDiscu and PubMed). Databases were searched from 1st January 2008 to 17th September 2018. Descriptive analysis was performed using frequency and percentages. The prevalence of physical activity was calculated as the average prevalence for the reported percentages from the studies with similar tools.

RESULTS

Fifty studies involving 298,242 participants were included in this review. The mean (range) sample size was 5964.8.1 (323-197,681). Data were collected from participants in 16 of the 22 Arab countries. Great variation exists across the studies in determining whether adults were sufficiently active or not. Twenty studies reported usable data from the Global Physical Activity Questionnaire and the International Physical Activity Questionnaire (moderate & high categories). In these studies, prevalence of physical activity ranged from 34.2 to 96.9%. It was not possible to compare the other studies owing to variation in instruments used to assess physical activity and in the case definition used for 'physically active'.

CONCLUSIONS

This study highlights the need for wider reporting of physical activity and the adoption of valid and reliable instruments to support the development of evidence-informed policy and programmes at both country and regional level. International tools need to be correctly validated, or context-specific tools must be developed to accurately measure physical activity.

Comorbidities and Risk Factors for Severe Outcomes in COVID-19 Patients in Saudi Arabia: A Retrospective Cohort Study

Purpose

The first novel coronavirus disease-19 (COVID-19) case in the Kingdom of Saudi Arabia (KSA) was reported in Qatif in March 2020 with continual increase in infection and mortality rates since then. In this study, we aim to determine risk factors which effect severity and mortality rates in a cohort of hospitalized COVID-19 patients in KSA.

Method

We reviewed medical records of hospitalized patients with confirmed COVID-19 positive results via reverse-transcriptase-polymerase-chain-reaction (RT-PCR) tests at Prince Mohammed Bin Abdulaziz Hospital, Riyadh between May and August 2020. Data were obtained for patient’s demography, body mass index (BMI), and comorbidities. Additional data on patients that required intensive care unit (ICU) admission and clinical outcomes were recorded and analyzed with Python Pandas.

Results

A total of 565 COVID-19 positive patients were inducted in the study out of which, 63 (11.1%) patients died while 101 (17.9%) patients required ICU admission. Disease incidences were significantly higher in males and non-Saudi nationals. Patients with cardiovascular, respiratory, and renal diseases displayed significantly higher association with ICU admissions (p<0.001) while mortality rates were significantly higher in COVID-19 patients with cardiovascular, respiratory, renal and neurological diseases. Univariate cox proportional hazards regression model showed that COVID-19 positive patients requiring ICU admission [Hazard’s ratio, HR=4.2 95% confidence interval, CI 2.5–7.2); p<0.001] with preexisting cardiovascular [HR=4.1 (CI 2.5–6.7); p<0.001] or respiratory [HR=4.0 (CI 2.0–8.1); p=0.010] diseases were at significantly higher risk for mortality among the positive patients. There were no significant differences in mortality rates or ICU admissions among males and females, and across different age groups, BMIs and nationalities. Hospitalized patients with cardiovascular comorbidity had the highest risk of death (HR=2.9, CI 1.7–5.0; p=0.020).

Conclusion

Independent risk factors for critical outcomes among COVID-19 in KSA include cardiovascular, respiratory and renal comorbidities.

Lean non-alcoholic fatty liver disease and associated metabolic disturbance: A Saudi Arabian cross-sectional study

Non-alcoholic liver disease (NAFLD) is a metabolic liver disease associated with visceral adiposity and insulin resistance. Recently, NAFLD has been described in lean individuals who additionally have impaired metabolic parameters similar to their non-lean counterparts. We aimed to explore this further in Saudi Arabia. From 2016 to 2019, we prospectively studied a group of newly diagnosed NAFLD patients at a tertiary hospital in Saudi Arabia. Patients were classified into three groups: lean (body mass index [BMI] <25), overweight (BMI ≥25 and <30), and obese (BMI ≥30). We made comparisons between these groups on basic clinical, demographic, and laboratory parameters. In total, 1753 patients were recruited and 1262 patients met the inclusion criteria. Altogether, 159 (12.6%), 365 (29%), and 737 (58.4%) patients were in the lean, overweight, and obese categories, respectively. Lean NAFLD patients were, on average, younger than those in the overweight group (mean 49.95 ± 15.3) and had a significantly higher high-density lipoprotein value (HDL) (mean 52.56 ± 16.27). Sex, hyperlipidemia, type 2 diabetes, and hypertension were significantly associated with BMI. Lean NAFLD patients displayed the features of metabolic syndrome including elevated glycosylated hemoglobin and abnormal lipid profile but had higher serum HDL. This is in contrast to the widely held belief that lean individuals have no dysmetabolic changes compared to overweight individuals. Recognition of this problem is essential so that lean NAFLD patients can be screened for metabolic changes and managed appropriately to prevent complications.

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.

Development and feasibility of a mobile phone application designed to support physically inactive employees to increase walking

Background

Physical inactivity is a global health concern. mHealth interventions have become increasingly popular, but to date, principles of effective communication from Self-Determination Theory have not been integrated with behavior change techniques to optimize app effectiveness. We outline the development of the START app, an app combining SDT principles and 17 purposefully chosen BCTs to support inactive office employees to increase their walking during a 16-week randomized controlled trial. We also explored acceptability, engagement with, associations between app usage and behavioral engagement, and perceived impact of the app in supporting behavior change.

Methods

Following development, fifty insufficiently physically active employees (M age = 44.21 ± 10.95 years; BMI = 29.02 ± 5.65) were provided access and instructions on use of the app. A mixed methods design was used to examine feasibility of the app, including the User Mobile App Rating Scale, app engagement data, step counts, and individual interviews. Linear mixed modeling and inductive thematic analysis were used to analyze quantitative and qualitative data, respectively.

Results

Walkers rated the app quality favorably (M = 3.68 out of 5). Frequency of entering step counts (i.e., frequency of self-monitoring) on a weekly basis positively predicted weekly step counts measured via Fitbits at both the between-and within-individual levels. App features (entering daily step counts, reminders, and motivational messages) were perceived to assist walkers in fostering goal achievement by building competence and via self-monitoring.

Conclusions

The START app may be a useful component of walking interventions designed to increase walking in the workplace. Apps designed to promote walking behavior may be effective if they target users’ competence and integrate BCTs.

Trial Registration: This study was part of a pilot larger randomized controlled trial, in which a component of the intervention involved the use of the mobile app. The trial was retrospectively registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12618000807257) on 11 May 2018 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375049&isReview=true.

Assessing the Severity of Illness in Patients With Coronavirus Disease in Saudi Arabia: A Retrospective Descriptive Cross-Sectional Study

Objectives: We aimed to describe the epidemiological and clinical characteristics of patients with COVID-19 in Saudi Arabia in various severity groups.

Methods: Data for 485 patients were extracted from the medical records from the infectious disease center of Prince Mohammed bin Abdul Aziz Hospital in Riyadh. Patients' basic information, laboratory test results, signs and symptoms, medication prescribed, other comorbidities, and outcome data were collected and analyzed. Descriptive data were reported to examine the distribution of study variables between the severe and not severe groups.

Results: Of 458 included patients, 411 (89.7%) were classified as not severe, 47 (10.3%) as severe. Most (59.1%) patients were aged between 20 and 39 years. Patients with severe conditions were non-Saudi, with a chronic condition history, and tended to have more chronic conditions compared with those without severe disease. Diabetes, hypertension, and thyroid disease were significantly higher in patients with severe disease. Death was reported in only 4.26% of severe patients. Only 16 (34.04%) patients remained in the hospital in the severe group.

Conclusions: Severe cases were more likely to have more comorbidities, diabetes, hypertension, and thyroid disorders were most common compared with non-severe cases.

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.

Correlates and Levels of Physical Activity and Body Mass Index Among Saudi Men Working in Office-Based Jobs

Obesity and overweight are global public health concerns with major consequences. Physical inactivity has been repeatedly linked with a high Body Mass Index (BMI) and the increasing prevalence of non-communicable diseases. In Saudi Arabia, approximately 60% of the entire population is considered physically inactive. The aim of this study was to investigate the correlates and burden of physical inactivity and high BMI among male office workers. A cross-sectional study was conducted among 395 adult Saudi males between the ages of 18 and 60 years working in governmental offices in AL Madinah. The self-administered instrument collected information regarding demographic characteristics and lifestyle practices. BMI was calculated from measured height and weight. Descriptive statistics were calculated and the probabilities of being overweight/obese and physically inactive were estimated using logistic regression. Approximately two-thirds of the participating men were overweight or obese and in the low category of physical activity. Being 35 years old or above, having a least one morbidity, and not eating a healthy diet, were all factors independently associated with low level of physical activity and high BMI. Being married was also associated with High BMI in this population. This study identified Saudi males working in office-based jobs as a high-risk group for being overweight, obese, and physically inactive. The detected risk factors are modifiable and require interventions addressing the intrapersonal and the environmental factors most likely to mitigate or ameliorate the consequences of this destructive lifestyle.

Obesity and Cardiovascular Risk in the Arab Gulf States

Purpose of Review

Rapid economic growth in the Gulf Cooperation Council (GCC) states over the last half-century has been associated with a rise in obesity and cardiovascular morbidity and mortality. In this review, we shed some light on the factors driving the obesity epidemic, promising interventions to overcome this public health crisis, and challenges precluding a successful public health impact.

Recent Findings

Overweight and obesity rates have nearly tripled in the GCC countries over the past four decades. Cardiovascular morbidity and mortality have been rising in parallel. Several sociodemographic, environmental, and behavioral factors have been correlated with sedentary lifestyle and unhealthy diet habits, and ultimately the rise in overweight and obesity rates. Numerous studies have documented factors unique to the population of the Arab Gulf states, but high-quality data is scarce. Despite the growing awareness of the extent of the problem, several barriers to weight loss and physical activity need to be addressed. A few interventions to combat obesity at different levels have been reported with some promising outcomes. Using the social-ecological model (SEM), we review recently published interventions and discuss some challenges to overcome in order to make progress in fighting the obesity epidemic in the GCC.

Summary

Obesity prevalence has been mounting worldwide, and the Arab Gulf states are no exception. This public health crisis is drawing the attention of policymakers and several stakeholders. However, a lot needs to be done to reduce the burden of obesity and improve cardiovascular risks in the Arab Gulf states.

Perception of tertiary care clients toward the availability of physical therapy service at primary health care centers in Saudi Arabia: a cross-sectional survey

[Purpose] To explore the views of clients referred for physical therapy in a tertiary care setting regarding the integration of physical therapy service at primary health care centers. [Participants and Methods] A self-administered questionnaire was distributed to eligible Saudi clients. The questionnaire consisted of three sections including demographic information section; closed-ended section with 6 Likert scale items on the perceptions of potential advantages of physical therapy service at the primary health care level; and open-ended section on potential disadvantages and barriers of implementing physical therapy service. The surveys were described and analyzed quantitatively and qualitatively. [Results] A total of 412 participants were included in the analysis (56.8% females). Participants’ mean age was 35.7 ± 21.9 years; 67.2% were Riyadh city residents; and 38.1% had musculoskeletal conditions. Seventy-five percent responded in support for the availability of physical therapy service at the primary health care level. Demographic characteristics had no effect on the level of support to the service availability. [Conclusion] The results of this survey demonstrated high positive support for the integration of physical therapy service at primary health care centers in Saudi Arabia. However, challenges and barriers identified by the study results require attention when physical therapy services are to be established.

Correlation between breast cancer and lifestyle within the Gulf Cooperation Council countries: A systematic review

BACKGROUND

In the six Gulf Cooperation Council countries (GCCCs), Bahrain, Saudi Arabia, Kuwait, Oman, Qatar and the United Arab Emirates, breast cancer (BC) is the greatest cause of cancer incidence and mortality. Obesity and physical inactivity are established risk factors for BC globally and appear to be more of a problem in high income countries like the GCCCs.

AIM

To determine whether obesity and physical inactivity are associated with BC incidence in the GCCCs using the United Kingdom as a comparator.

METHODS

This systematic review was carried out according to PRISMA guidelines. A cancer registry and a statistical data search was done to identify the BC incidence over the past two decades and the prevalence of obesity and physical inactivity in the GCCCs. Additionally, a systematic search of the databases, MEDLINE, Web of Science, and PubMed between 1999 and 2019 was performed to determine whether obesity and physical inactivity are risk factors for BC in the GCCCs. All papers were critically appraised according to their research methods and were assessed for quality and risk of bias.

RESULTS

BC was the top malignancy in each GCC country. Women tended to be diagnosed with BC at a younger age than women in the United Kingdom. The greatest 10-year increase in BC incidence was seen in Saudi Arabia (54.2%), approximately seven times the rate of increase seen in the United Kingdom (7.6%). The prevalence of obesity and physical inactivity was greater in all the GCCCs in comparison to the United Kingdom. A total of 155 full studies were reviewed of which 17 were included. Of those, eight looked at the prevalence of obesity and physical inactivity in the Gulf States and nine looked at these as risk factors for BC. Only one study found an association between BC and obesity (odds ratio = 2.29). No studies looked solely at the link between physical inactivity and BC.

CONCLUSION

The prevalence of obesity and physical inactivity was high within the GCCCs, but the majority of the included studies found no positive correlation between obesity or physical inactivity and BC. A high proportion of women in this study were pre-menopausal which could contribute to the negative findings.

Are long working hours associated with weight-related outcomes? A meta-analysis of observational studies

The relationship between long working hours and body weight outcomes remains inconclusive; thus, we conducted a meta-analysis to assess the effect of long working hours on weight-related outcomes. PubMed and Embase databases were searched from their inception to June 2019. A random-effects model was used to assess the pooled odds ratio (OR) and corresponding confidence interval (CI). Subgroup analyses and sensitivity analyses were conducted to explore sources of heterogeneity. Publication bias was evaluated by the Begg's and Egger's tests. A total of 29 articles involving 374 863 participants were included. The pooled OR of long working hours on weight-related outcomes was 1.13 (95% CI, 1.07-1.19). In subgroup analysis stratified by definition of outcomes, the pooled ORs of long working hours on "weight gain/BMI increase," "BMI ≥ 25 kg/m² ," and "BMI ≥ 30 kg/m² " were 1.19 (95% CI, 1.02-1.40), 1.07 (95% CI, 1.00-1.14), and 1.23 (95% CI, 1.09-1.39), respectively. We found evidence of publication bias, but correction for this bias using the trim-and-fill method did not alter the combined OR substantially. There was evidence to suggest that long working hours are associated with adverse weight-related outcomes. Preventative interventions such as improved flexibility and healthy working schedules should be established for employees.

Overweight and obesity among adults in the Gulf States: A systematic literature review of correlates of weight, weight-related behaviours, and interventions

Obesity has increased to an epidemic level in the Gulf States. This systematic review is the first to explore the scientific evidence on correlates and interventions for overweight (body mass index [BMI] ≥ 25) or weight-related behaviours in the region. A systematic search of peer-reviewed articles was conducted using PubMed and PsycINFO. Ninety-one studies were eligible for this review including 84 correlate studies and seven intervention studies. Correlate studies of overweight focused on sociodemographic factors, physical activity, and dietary habits. Low physical activity, sedentary behaviour, and unhealthy dietary habits were associated with overweight. The most-reported sociodemographic correlates of overweight were increased age, being married, low education, urban residence, and unemployment. Correlate studies of physical activity and dietary behaviours mostly focused on sociodemographic variables. Being female and increased age (the latter less consistently) were associated with low physical activity. Interventions were very heterogeneous with respect to the target group, intensity, and behavioural strategies used. The effectiveness of interventions was difficult to evaluate because of the chosen study design or outcome measure, the small sample size, or high attrition rate. Few studies have investigated sociocognitive and environmental determinants of weight-related behaviours. Such information is crucial to developing health promotion initiatives that target those weight-related behaviours.

Socioeconomic determinants of excess weight and central obesity among Iranian women: Application of information, motivation, and behavioral skills model

INTRODUCTION

In developing countries, there is an increased risk of incidence of noncommunicable diseases due to general and abdominal obesity. Therefore, this study aimed to assess socioeconomic determinants of excess weight and central obesity among women in Tehran city based on information motivation behavioral skills model (IMB).

MATERIALS AND METHODS

A cross-sectional study was conducted among 260 women aged between 20 and 49 years old using cluster sampling. A skilled interviewer completed socioeconomic status (SES), food insecurity, and IMB questionnaires. Analysis of variance, Chi-square tests, and regression model were used for statistical analysis. The multiple logistic regression analysis was used to identify independent predictors of the excess weight and central obesity using SPSS 21.

RESULTS

The mean and standard deviation of participants' age was 34.7 (±7.59) years old. The prevalence of overweight and obesity in adult women was estimated 35% and 21.2%, respectively. The prevalence of abdominal obesity was 34.6%. Independent predictors of overweight/obesity in women were age (odds ratio [OR] =1.09, 95% confidence interval [CI] =1.03-1.14), educational level (OR = 2.35, 95% CI = 1.05-5.27), and total expenditure (OR = 3.14, 95% CI = 1.06-9.37). Whereas, independent predictors for increased the likelihood of central obesity were age (OR = 1.12, 95% CI = 1.06-1.18), marital status (OR = 6.44, 95% CI = 1.94-21.40), low education (OR = 0.38, 95% CI = 0.16-0.91), number of rooms (OR = 1.19, 95% CI 1.03-3.45), and self-regulation score (OR = 0.94, 95% CI = 0.88-1.00).

CONCLUSIONS

The socioeconomic determinants, especially age, level of education, and expenditure, as well as self-regulation, play an important role in excess weight and central obesity among women. Therefore, further research is needed to reach women in different SES groups with a variety of interventions through concurrent triangulation of longitudinal studies and qualitative research.

The Development of an Arabic Weight-Loss App Akser Waznk: Qualitative Results

Background

Obesity and its related illnesses are a major health problem around the world. Saudi Arabia has one of the highest national obesity rates globally; however, it is not easy to intervene to prevent obesity and becoming overweight owing to Saudi Arabia’s cultural and social norms, and linguistic barriers. In recent years, there has been an exponential growth in the usage of smartphones and apps in Saudi Arabia. These could be used as a cost-effective tool to facilitate the delivery of behavior-modification interventions for obese and overweight people. There are a variety of health and fitness apps that claim to offer lifestyle-modification tools. However, these do not identify the motivational features required to overcome obesity, consider the evidence-based practices for weight management, or enhance the usability of apps by considering usability attributes.

Objective

This study aimed to explore the opportunity and the need to develop an Arabic weight-loss app that provides localized content and addresses the issues with existing apps identified here. This study has explained the steps taken to design an Arabic weight-loss app that was developed to facilitate the adjustment of key nutritional and physical activities and behaviors, which considers the social and cultural norms of Saudi Arabia.

Methods

Qualitative studies were conducted with 26 obese Saudi Arabians, who tested the level of usability of 2 weight-loss apps and then provided feedback and recommendations. The app Akser Waznk is an interactive, user-friendly app designed primarily for iPhones. It has several features intended to assist users to monitor and track their food consumption and physical activities. The app provides personalized diet and weight loss advice. Unique features such as Let’s Walk are designed to motivate users to walk more. An augmented reality function is implemented to provide information regarding fitness equipment, fruits, and vegetables. The app uses behavior-change techniques to increase activities and healthy behaviors and evidence-informed practices for weight-loss management. The Akser Waznk app considers user privacy and data security by applying a number of guidelines and procedures.

Results

The development of the app took 26 months. In all, 7 experts (5 dietitians, and 2 physical activity professionals) evaluated the app’s contents. Moreover, 10 potential users (5 men and 5 women) tested the app’s level of usability, its features, and performance during a pilot study. They reported that the app’s design is interactive, and the motivational features are user-friendly.

Conclusions

Mobile technology, such as mobile apps, has the potential to be an effective tool that facilitates the changing of unhealthy lifestyle behaviors within the Saudi community. To be successful, the target group, the usability, motivational features, and social and cultural norms must be considered.

Physical inactivity in Saudi Arabia revisited: A systematic review of inactivity prevalence and perceived barriers to active living

OBJECTIVES

Saudi Arabia has recently witnessed enormous economic growth accompanied by undesirable lifestyle behaviors, along with an associated increase in non-communicable diseases (NCD's). This systematic review presents a comprehensive and an updated overview of the status of physical activity (PA) or inactivity among the Saudi population and examines the major barriers and correlates of PA.

METHODS

A systematic search was conducted using MEDLINE and Google Scholar databases. The electronic search yielded an initial 434 articles. However, the majority of these articles were eliminated because they did not meet the inclusion criteria. The remaining relevant papers were 65 articles that became the bases for this review.

RESULTS

The majority of Saudi children, youth and adults were not active enough to meet the recommended guidelines for moderate to vigorous PA. Saudi females were disproportionately less active than males, beginning from early school years. The proportions of Saudis who are at risk of inactivity are exceedingly higher than those at risk for other coronary heart diseases. Active Saudi boys tend to have favorable levels of blood lipids and body composition profile compared to inactive boys. Increased urbanization, crowded traffic, extreme weather, cultural barriers, lack of social support, the absence of female school PA program and lack of time and resources, all make PA a difficult choice for the Saudis.

CONCLUSION

More intensified efforts toward promoting PA and reducing sedentary behaviors among the Saudi population are needed to curtail the risks of NCD's.

Development of 'Twazon': An Arabic App for Weight Loss

BACKGROUND

Weight gain and its related illnesses have become a major public health issue across the world, with Saudi Arabia and other Gulf countries seeing dramatic increases in obesity and overweight, and yet there is very little information on how to intervene with this demographic due to cultural and linguistic barriers. As the use of smartphones and apps has also increased in the region, information communication technologies could be a cost-effective means of facilitating the delivery of behavior-modification interventions directly to the target population. Although there are existing apps that offer lifestyle-modification tools, they do not give consideration to the evidence-based practices for weight management. This offers an opportunity to create an Arabic language weight loss app that offers localized content and adheres to evidence-informed practices that are needed for effective weight loss.

OBJECTIVE

This paper describes the process of developing an Arabic weight loss app designed to facilitate the modification of key nutritional and physical activity behaviors among Saudi adults, while taking into consideration cultural norms.

METHODS

The development of the Twazon app involved: (1) reviewing all available Arabic weight loss apps and compared with evidence-based practices for weight loss, (2) conducting a qualitative study with overweight and obese Saudi women to ascertain their preferences, (3) selecting which behavioral change strategies and guidelines to be used in the app, (4) creating the Saudi Food Database, (5) deciding on graphic design for both iPhone operating system and Android platforms, including user interface, relational database, and programming code, and (6) testing the beta version of the app with health professionals and potential users.

RESULTS

The Twazon app took 23 months to develop and included the compilation of an original Saudi Food database. Eight subjects gave feedback regarding the content validity and usability of the app and its features during a pilot study. The predominant issue among the group was the lack of information explaining how to use the app. This has since been resolved through the implementation of a tutorial. No other changes were required to be made.

CONCLUSIONS

Information communication technologies, such as smartphone apps, may be an effective tool for facilitating the modification of unhealthy lifestyle habits in Saudi; however, consideration must be given to the target population, cultural norms, and changing trends in the global market. The effectiveness of the app will be better determined during a 6-month intervention with 200 overweight and obese Saudi women.