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ANALYSIS

Association between nutritional habits and

obesity/overweight in Hai’l Region Saudi Arabia

Albandri Abdullah Benammar1, Abdelbaset Mohamed Elasbali2, Hussain

Gadelkarim Ahmed3,4

1Department of Clinical Nutrition, College of Applied Medical Science, University of Ha’il, Saudi Arabia

2Department of Clinical Laboratory Sciences, College of Applied Medical sciences, Jouf University, Qurayyat, Saudi Arabia

3College of Medicine, University of Ha’il, Saudi Arabia

4Department of Histopathology and Cytology, FMLS, University of Khartoum, Sudan

Correspondence to:

Prof. Hussain Gadelkarim Ahmed;

College of Medicine, University of Ha’il,

Saudi Arabia;

Email: [email protected]

Citation

Albandri Abdullah Benammar, Abdelbaset Mohamed Elasbali, Hussain Gadelkarim Ahmed. Association between nutritional habits

and obesity/overweight in Hai’l Region Saudi Arabia. Medical Science, 2020, 24(106), 4232-4242

ABSTRACT

Background: The growing prevalence of obesity/overweight is raising concerns worldwide. Many factors have been addressed to be

associated with the epidemiology of obesity/overweight. Therefore, the present study aimed to measure the association between

nutritional habits and obesity/overweight in Hai'l Region Saudi Arabia. Methodology: In this cross-sectional study, 750 Saudi

volunteers were recruited during the period from May to October 2020. The study was planned to assess the effects of the

nutritional habit on body weight status. Results: The overall prevalence of overweight/obesity was 490/732(67%), including

281/732(38.4%) overweight, 134/732(18.3%) obese, and 75/732(10.2%) morbid obesity. Conclusion: Obesity/overweight is prevalent

in Northern Saudi Arabia, which might be attributed to nutritional habits. High frequency of meats, dairy products, and sugar-

sweetened drinks are factors influencing the prevalence rates of obesity/overweight.

Keywords: Nutritional habits, Obesity, Overweight, Saudi Arabia

1. INTRODUCTION

The prevalence of overweight/obesity is increasing in Saudi Arabia in recent years raising major health concerns particularly among

the younger generation (Alreshidi et al., 2020). Several factors are having indicated to share in the recent uprising of obesity and its

related comorbidities in Saudi Arabia (Ahmed et al., 2020). The major factors contributing to the increased prevalence rates of

RESEARCH 24(106), November - December, 2020

Medical Science ISSN

2321–7359 EISSN

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obesity/overweight are physical inactivity, which is reported to be very low, particularly in Northern Saudi Arabia (Alreshidi et al.,

2020). About 60% of the Saudi population was considered as physically inactive (Almuzaini and Jradi, 2019). Taking into account

reports from different Saudi regions obesity/overweight is ranging from 35-63.6% (Ahmed et al., 2014). Increased patterns of

comorbidities with high reported stress levels are other factors that can contribute to the increasing proportion of

obesity/overweight in Saudi Arabia (Alreshidi et al., 2020).

Another important factor is dietary factors, health literacy, socioeconomic status, family income, and various environmental

factors (Ruiz et al., 2019). The environmental influence comprising behavioral factors including physical activity, psychosocial

interactions, and diet, and energy balance (Drewnowski et al., 2020). A recent study from Saudi Arabia has shown that

obesity/overweight is still prevalent with major risk factors including high family income, being an employee, living in urban areas,

being better educated, and married (Ahmed et al., 2020). As obesity/overweight is strongly influenced by behavioral and habitual

influences, food intake habits require personalized management determinant factors. Therefore, the present study aimed to measure

the association between nutritional habits and obesity/overweight in Hai’l Region Saudi Arabia.

2. MATERIALS AND METHODS

In this cross-sectional study, 750 Saudi volunteers were recruited during the period from May to October 2020.The study was

planned to assess the effects of nutritional habits on body weight status. A purposeful questionnaire was premeditated and

circulated over different social media clusters irrespective of age or gender. Besides the demographical characteristics of the

patients, the questionnaire involved the measures of several dietary intake habits and food types.

Data Analysis

Following the initial representation of the data in Microsoft Excel, the obtained data were then sent to the SPSS program and

analyzed obtained. Statistical significant values, such as relative risk were produced applying a 95% confidence interval. A Chi-square

test was done (P-value <0.05 was considered statistically significant).

Ethical Consent

The proposal for the present study was approved by the Ethical Committee at the College of Medicine, University Hai’l, Saudi Arabia.

HREC00133/CM-UOH.04/20.

3. RESULTS

Of the 750 participants, 292(39%) were males and 458(61%) were females, aged 15 to 80 years, and mean age of 36 years. The

demographic characteristics, most participants aged 21-29 years (n=182) followed by 40-49 years (n=180), males were more

frequent in the age group 21-29 years (n=100), hence, females were more frequent in the age range 40-49 years (n=116), as

indicated in Table 1, Fig 1.

Most participants (both sex) were with the university level of education (n=548) followed by postgraduate (n=105). Married

individuals represent the majority of participants (n=439), followed by single marital status persons (n=276). About 106, 566, and 78

participants claimed high, average, and low family income, respectively, as shown in Table 1, Fig 1.

Table 1. Distribution of the study participants by demographical characteristics

Category Variable Males (n=292) Females (n=458) Total (n=750)

Age ranges

≤20 years 15 86 101

21-29 100 82 182

30-39 52 111 163

40-49 64 116 180

≥50 61 63 124

Education

Basic 3 8 11

Secondary 34 52 86

University 199 349 548

Postgraduate 56 49 105


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Marital status

Single 114 162 276

Married 171 268 439

Others 7 28 35

Family income

Limited 47 31 78

Average 200 366 566

High 45 61 106

Figure 1. Description of participants by demographical characteristics

As shown in Table 2, Fig 2, the overall prevalence of overweight/obesity was 490/732(67%), including 281/732(38.4%)

overweight, 134/732(18.3%) obese, and 75/732(10.2%) morbid obesity. The distribution of the study participants by fruits and

vegetables habitual intake was summarized in Table 2, Fig 3. The majority of the study subjects used to eat fruits 2-4 times and once

per week regardless of BMI value. Underweight, normal weight, obese, and morbidly obese individuals are frequently used to eat

vegetables (carrots - tomatoes - cucumber) 2-4 times/week 12/20(60%), 111/222(50%), 120/281(43%), 58/134(43%), and

33/75(44%), respectively. Underweight, normal weight, obese, and morbidly obese individuals frequently used to eat green

vegetables (spinach - lettuce – mallow) once/week 9/20(45%), 94/222(42%), 123/281(44%), 62/134(46%), and 34/75(45%),

respectively.

Table 2. Distribution of the study participants by fruits and vegetables habitual intake

Variable BMI Total

Under.wt Normal.wt Over.wt Obese Morbid obese

How often do you eat the following foods per week

Fruit

2-4 times 6 90 128 56 27 307

5-6 times 0 25 34 15 12 86

Once 13 83 102 52 28 278

Rarely 1 24 17 11 8 61

Total 20 222 281 134 75 732

Vegetables (carrots - tomatoes - cucumber)

2-4 times 12 111 120 58 33 334

5-6 times 6 61 103 53 28 251

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Once 0 37 52 19 13 121

Rarely 2 13 6 4 1 26

Total 20 222 281 134 75 732

Green vegetables (spinach - lettuce - mallow)

2-4 times 5 64 91 36 26 222

5-6 times 2 20 34 17 6 79

Once 9 94 123 62 34 322

Rarely 4 44 33 19 9 109

Total 20 222 281 134 75 732

Figure 2. Description of the study population by body weight status

Figure 3. The study participants by fruits and vegetables habitual intake

Underweight3%

Normal-weight30%

Overweight39%

Obese18%

Morbid obese10%

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Table 3, Fig 4 summarized the distribution of the study participants by dairy products habitual intake. The whole milk intake

more frequently consumed once/week in underweight 7/20(35%), rarely in normal weight, overweight, obese, and morbid obese

representing 75/222(34%),105/281(37%), 52/134(39%), and 34/75(45%), in that order. Low-fat milk was rarely consumed by all study

subjects regardless of their BMI. Cheese & Yogurt intake was 2-4 times/week in all study subjects regardless of their BMI.

Table 3. Distribution of the study participants by dairy products habitual intake

Variable BMI Total


How often do you consume the following foods per week

Whole milk

2-4 times 6 23 48 26 13 136

5-6 times 3 37 41 16 12 109

Once 7 67 87 40 16 217

rarely 4 75 105 52 34 270

Total 20 222 281 134 75 732

Low-fat milk

2-4 times 1 25 42 15 21 104

5-6 times 0 22 21 8 7 58

Once 3 51 79 24 14 171

Rarely 16 124 139 87 33 399

Total 20 222 281 134 75 732

cheese & yogurt

2-4 times 8 87 109 46 31 281

5-6 times 4 55 69 38 23 189

Once 8 68 91 42 14 223

Rarely 0 12 12 8 7 39

Total 20 222 281 134 75 732

Figure 4. The study participants by dairy products habitual intake

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Table 4, Fig 5 summarized the distribution of the study participants by proteins (meat & egg) habitual intake. Red meat was

frequently consumed 2-4 times in all weight groups. Fish was frequently consumed rarely in all weight groups. The chicken was used

2-4 times/week in underweight 11/20(55%), and 5-6 times/week in normal weight 105/222(47%), overweight 107/281(38%), obese

72/134(54%), and morbid obese37/75(49%). Eggs were consumed 2-4 times/week in all groups except obese group 45/134(34%).

Table 4. Distribution of the study participants by proteins (meat & egg) habitual intake

Variable BMI Total



Red meat

2-4 times 10 77 118 65 31 301

5-6 times 2 23 26 18 7 76

Once 6 87 109 43 32 277

Rarely 2 35 28 8 5 78

Fish

2-4 times 0 9 11 5 3 28

5-6 times 1 3 7 3 0 14

Once 7 112 137 69 33 258

Rarely 12 98 126 57 39 332

Chicken

2-4 times 11 92 135 54 28 320

5-6 times 9 105 107 72 37 330

Once 0 18 25 5 10 58

Rarely 0 7 14 3 0 24

Eggs

2-4 times 15 90 119 42 23 289

5-6 times 3 44 55 38 15 155

Once 2 62 85 45 34 228

Rarely 0 26 22 9 3 60

Figure 5. The study participants by proteins (meat & egg) habitual intake

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Table 5, Fig 6, summarized the distribution of the study participants by carbohydrates & seeds habitual intake. Rice & corn

flakeswere more frequently consumed 2-4times/week by underweight 7/20(35%), 5-6 times by normal weight 52/222(23%), and

once/week by overweight 89/281(32%), obese 50/135(37%), and morbid obese 22/75(29%). White bread was used 2-4 times by

underweight 13/20(65%), overweight 86/281(31%), and morbid obese 26/75(35%), normal weight 74/222(33%) and obese

45/134(34%) used it 5-6 times. Brown bread was uncommonly used by underweight and normal weight, whereas, commonly used

by overweight, obese, and morbidly obese. Pasta - Noodles – Indomie consumed 5-6 times/week consumptions were determined in

underweight 6/20(30%), normal weight 52/222(23%), overweight 50/281(18%), obese 30/134(22%), and morbid obese 20/75(27%).

Potatoes consumed 5-6 times/week consumptions were determined in underweight 4/20(20%), normal weight 34/222(15%),

overweight 35/281(12%), obese 18/134(13%), and morbid obese 10/75(13%).

Nuts consumed 5-6 times/week consumptions were determined in underweight 3/20(15%), normal weight 17/222(8%),

overweight 34/281(12%), obese 6/134(4%), and morbid obese 10/75(13%).

Alfshar- dessert - chocolate consumed 5-6 times/week consumptions were determined in underweight 6/20(30%), normal

weight 47/222(21%), overweight 42/281(15%), obese 20/134(15%), and morbid obese 20/75(27%).

Table 5. Distribution of the study participants by carbohydrates & seeds habitual intake

Variable BMI Total



Rice & corn flakes

2-4 times 7 73 77 24 16 197

5-6 times 6 52 50 30 20 158

Once 7 50 89 50 22 218

Rarely 0 47 65 30 17 159

White bread

2-4 times 13 56 86 32 26 213

5-6 times 5 74 79 45 25 228

Once 1 48 69 33 12 163

rarely 1 44 47 24 12 128

Brown bread

2-4 times 3 54 82 31 27 197

5-6 times 1 36 43 24 10 114

Once 5 59 90 42 14 210

Rarely 11 73 66 37 24 211

Pasta - Noodles - Indomie

2-4 times 7 50 75 25 25 182

5-6 times 4 22 17 12 4 59

Once 8 90 129 63 28 318

Rarely 1 60 60 34 18 173

Potatoes

2-4 times 9 80 97 44 18 248

5-6 times 4 34 35 18 10 101

Once 7 83 127 56 35 308

Rarely 0 25 22 16 12 75

Nuts

2-4 times 2 43 62 37 14 158

5-6 times 3 17 34 6 10 70

Once 11 129 146 74 36 396

Rarely 4 33 39 17 15 108

Alfshar- dessert - chocolate

2-4 times 10 77 109 36 19 251

5-6 times 6 47 42 20 20 135

Once 3 70 99 50 23 245

Rarely 1 28 31 28 13 101


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Figure 6. Description of the study participants by carbohydrates & seeds high frequent intake (5-6 times/week)

The distribution of the study participants by drinks habitual intake were summarized in Table 6, Fig 7. Soft drinks consumed 5-6

times/week consumptions were determined in underweight 2/20(10%), normal weight 36/222(16%), overweight 23/281(8%), obese

12/134(9%), and morbid obese 6/75(8%).

Tea & Coffee consumed 5-6 times/week consumptions were determined in underweight 13/20(65%), normal weight

144/222(65%), overweight 186/281(66%), obese 91/134(68%), and morbid obese 48/75(64%).

Table 6. Distribution of the study participants by soft drinks, tea, and coffee habitual consumption

Variable BMI Total


How often do you drink the following foods per week

Soft drinks

2-4 times 6 34 38 18 12 108

5-6 times 2 36 23 12 6 79

Once 8 59 87 34 23 211

Rarely 4 93 133 70 34 334

Tea & Coffee

2-4 times 1 40 57 28 10 136

5-6 times 13 144 186 91 48 482

Once 5 30 32 11 14 92

Rarely 1 8 6 4 3 22

4. DISCUSSION

The growing prevalence of obesity/overweight is raising concerns worldwide. Many factors have been addressed to be associated

with the epidemiology of obesity/overweight, but the most effective are those linked to the socioeconomic and food intake habits,

which vary greatly even in similar geographical territories. Consequently, food intake habits require personalized management

determinant factors. Therefore, the present study aimed to measure the association between nutritional habits and

obesity/overweight in Hai'l Region Saudi Arabia.

In the present study, the overall prevalence of overweight/obesity was 67%, including 38.4% overweight, 18.3% obese, and

10.2% morbid obesity. These findings exceeded the previously reported values from the same study area (Ahmed et al., 2014). A

recent systemic review from Saudi Arabia has shown that obesity/overweight in adolescents started off high and sustained to

upsurge over time. The growing burden of obesity/overweight at such an alarming rate necessitate rapid strategies at the

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White bread

Brown bread

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Potatoes

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community level to reduce this uprising health problem. Adolescents can serve as a suitable experimental means that assists in

studying the multi-faceted etiology of adolescent obesity/overweight and enables the implementation of operative intervention and

prevention strategies (Habbab and Bhutta, 2020).

Figure 7. Description of the study participants by soft drinks, tea, and coffee habitual consumption

The findings of the present study showed that the frequency of consumption of fruit and vegetable was relatively low,

particularly among those with increased BMI. Regular fruit intake was inversely linked to the incidence of abdominal obesity. High

vegetable intake reduces the risk of hyperglycemia, hence, high fruit intake reduces the risk of metabolic syndrome (Lim and Kim,

2020).

The findings of the current study showed no statistically significant differences between weight status and dairy product

consumption. Dairy product intake as a part of a healthy lifestyle can promote obesity/overweight (Calleja et al., 2020). Dairy

product consumption is expected to affect dietary energy value, which is a factor determined by dietary quality. Even though some

studies suggesting that dairy products consumption is improbable to contribute to overweight/obesity, regularly tends to decline

among adolescence, potentially due to concerns about weight gain (O'Sullivan et al., 2015).

The findings of the current study showed no statistically significant differences between weight status and protein dietary

product intake. Meats, which usually containing fats are high in energy and therefore, associated with increased risk of

overweight/obesity. Although, there is an argument about whether high meats consumption and overweight/obesity, literature

indicated a positive relationship between meets intake and overweight/obesity (Wang and Beydoun, 2009).

The findings of the current study showed no statistically significant differences between weight status and carbohydrates and

seeds intake. Increased frequencies of whole-grain intake are associated with healthier consequences (Jawhara et al., 2019).

However, the quality and type of carbohydrates consumed are associated with the risk of overweight/obesity (Kim et al., 2018).

Soft drinks did not show any significant association in all study populations. It was well established that, the regular consumption

of sugar-sweetened beverages increases the risk of obesity (Bassett et al., 2020).

The great majority of the participants in the present study habitual tea and coffee consumers. A study assessed the role of sugar

consumption with obesity without lifestyle measures of health awareness, found that sugar consumption in tea or coffee is

contrariwise linked to obesity. These indicate that intake of a small amount of sucrose several times a day may reduce or control

body weight (Gyntelberg et al., 2009).

5. CONCLUSION

Obesity/overweight is prevalent in Northern Saudi Arabia, which might be attributed to nutritional habits. High frequency of meats,

dairy products, and sugar-sweetened drinks are factors influencing the prevalence rates of obesity/overweight. Interventional health

programs at national levels are highly recommended to control the increasing burden of obesity/overweight in Saudi Arabia.

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Acknowledgment

The authors would like to thank the participant for their response and assistance in data collection.

Funding

The Scientific Research Deanship at the University of Hai’l, Saudi Arabia, has funded this research through project number BA-2014.

Conflict of interest

The authors declare that there are no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were following the ethical standards of the institutional and/or

national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards

(ethical approval number: HREC00133/CM-UOH.04/20.

Informed consent

Informed consent was obtained from all individual participants for whom identifying information is included in this manuscript.

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Data and materials Availability

All data associated with this study are present in the paper.

Peer-review

External peer-review was done through double-blind method.

Article History

Received: 21 October 2020

Reviewed & Revised: 22/October/2020 to 09/November/2020

Accepted: 10 November 2020

E-publication: 19 November 2020

P-Publication: November - December 2020

Publication License

This work is licensed under a Creative Commons

Attribution 4.0 International License.

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We recommended authors to print article as color digital

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