|Year : 2015 | Volume
| Issue : 2 | Page : 329-334
Influence of lifestyle patterns on perceptions of obesity and overweight among expatriates in Abha city of Kingdom of Saudi Arabia
Gaffar Sarwar Zaman
Department of Clinical Biochemistry, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia
|Date of Web Publication||6-Jul-2015|
Dr. Gaffar Sarwar Zaman
Department of Clinical Biochemistry, Government College of Medicine, King Khalid University, Abha
Kingdom of Saudi Arabia
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: We evaluated the influence of lifestyle patterns such as watching TV, working with computer and idle sitting time on perceptions of obesity and beliefs about overweight are associated with obesity and overweight amongst Expatriates in Abha. Materials and Methods: The method used in this study was a cross-sectional survey with a self-administered paper-based questionnaire. The survey collected information on lifestyle choices and the risk factors that contribute to obesity. In addition, height and weight were measured. Results: Greater number of our study subjects spent over 2 h/day without any physical activity, specifically accounting for over 2 h/day each in viewing TV, computer, and spending idle time. This increased lack of physical activities was significantly associated with overweight. While the overweight subjects were aware of very wide options for treating their condition, a significant number believed in self-effort in managing their diet and exercise regimen as the best efforts to reduce their overweight. Interestingly very few overweight subjects considered medication or surgery as a potential therapeutic option and 75% of the overweight subjects considered overweight to be of no or only slight concern on wellbeing. Conclusions: Overweight and obesity among expatriates within Saudi Arabia poses an important public health problem. The lack of awareness about the potential impact of obesity on health and optimal treatment options is a serious concern, which needs to be addressed by appropriate public health programs at national level.
Keywords: Lifestyle patterns, obesity, public health
|How to cite this article:|
Zaman GS. Influence of lifestyle patterns on perceptions of obesity and overweight among expatriates in Abha city of Kingdom of Saudi Arabia. J Nat Sc Biol Med 2015;6:329-34
|How to cite this URL:|
Zaman GS. Influence of lifestyle patterns on perceptions of obesity and overweight among expatriates in Abha city of Kingdom of Saudi Arabia. J Nat Sc Biol Med [serial online] 2015 [cited 2020 Jan 27];6:329-34. Available from: http://www.jnsbm.org/text.asp?2015/6/2/329/159995
| Introduction|| |
Lifestyle in any society is a reflection of the prevailing culture,  which can influence expatriates to adopt to enhance their social integration. This is especially of importance in the current scenario of increased global migration. Many studies suggests that expatriates do not develop healthy adult lifestyles that include regular exercise due to various barriers such as lack of role models, social support, time, transportation, finance, social norms, and adequate information. This is of further of concern among women in conservative Saudi Arabian society, which makes it unacceptable for females to participate in sports or other physical activities outdoors. There are also indications of disordered eating being the result of conflicts between traditional lifestyle and liberalization.  Several studies have also documented the impact of the content of TV and the Internet on children's lifestyle choices; these range from the effect of popular TV characters poor eating habits  to consumption of high calorie food which are extensively advertised in the media. ,,, In addition to these direct consequences of TV and Internet, it by default promotes a sedentary lifestyle habits among children's, which ultimately leads to the development of obesity. ,,,, It is indeed not surprising that among children and adolescents, most published research has linked increased television viewing hours with being overweight or obese, ,,,,,,,,, however, a few studies suggests that such associations are very weak and not of clinical concern,  while a few studies are not consistent with these findings ,, and some studies refute these conclusions. ,
Body mass index (BMI) with some exceptions is the most acceptable and universal method of measuring overweight and obesity.  BMI (kg/m 2 ) is defined as weight (kg) divided by height squared (m 2 ). It is recommended by the WHO and is an economical method for assessing obesity in large epidemiological studies.  Here, we examined the relationships between sociodemographic, behavioral, and psychosocial lifestyle factors with overweight and obesity among expatriates living in Abha, Kingdom of Saudi Arabia. We also assessed the self-image and opinions about overweight and obesity in this population.
| Materials and Methods|| |
The study was conducted in Abha, Kingdom of Saudi Arabia from September 1, 2013 to February 15, 2014 and involved 550 expatriates. The study was approved by the King Khalid University Ethical Committee. The aim of this study was to identify known risk factors for obesity, self-image, and opinions about overweight and obesity in a cohort of expatriates in Abha city of Kingdom of Saudi Arabia and to establish various levels of obesity in this population. To achieve our aim, a cross-sectional survey with a self-administered paper-based questionnaire was developed [Table 1]. The survey collected information on lifestyle choices and the risk factors that contribute to obesity. Height, weight, and waist circumference (WC) were measured. Questions were designed to get information on hours spent on watching TV, working with computer, idle sitting time, and walking and leisure activities. Perceptions of obesity and beliefs about overweight were also asked. Respondents were also asked if they would like to lose weight and how they believed the overweight could be treated. The questionnaire was acceptable and within the cultural norms for all the expatriates.
Data management and analysis
The data collected from each expatriate in each location were recorded every day and packed in a big A4 envelope. All the envelopes were labeled with the date of survey, venue, and number of participants. The questionnaires were stored securely to maintain the confidentiality of information and ensure data security. A spreadsheet, Microsoft Excel™ ((Microsoft Corporation, New Mexico, USA) was used for the data compilation and analysis. The data were analyzed using GraphPad Prisim (GraphPad Software Inc., San Diego CA, USA).
| Results|| |
The features of the lifestyle patterns observed in our study population are presented in [Table 2]. 19.1% of the participants watched TV for 4 or more h/day while 51.64% watched TV for 2-3 h/day. A number (29.27%) of the participants watched TV for <1 h/day. Eighteen percent of our study population used a computer for 4 or more h/day, and 50% used it for 2-3 h/day. Over 50% (51.45%) of the participants reported that they sat idle for 2-3 h during the 7 days preceding the study.
The study subjects were categorized as normal weight or overweight based on their BMI and WHO criteria. The correlation of BMI with the lifestyle patterns of the study subjects is summarized in [Table 3]. Statistically significant relationship was observed between participants BMI status and time spent sitting idle (P = 9.40 × 10−15 ), time spent on the computer (P = 6.34 × 10−27 ), and time spent watching TV (P = 3.43 × 10−9 ). Regarding idle sitting time, 34.2% of overweight and obese participants sat idle for 4 or more h/day. Forty percent of overweight or obese participants reported watching TV for 4 or more h/day. Respondents who were overweight or obese reported a steady increase in the TV time and idle sitting time. Interestingly, study subjects who spent >2 h of idle time or watched TV for >2 h/day or spent time on internet for over 2 h had a higher BMI and were categorized as overweight [Table 3].
The study subject's beliefs about the treatments for overweight/obesity are summarized in [Table 4]. A substantial number (68.55%) of respondents believed that the obesity might best be treated by the individual's effort to change the diet and exercise regime. In terms of the dietitian's methods to treat obesity, approximately 8.73% believed that a dietitian could help in the treatment of obesity. Interestingly, the least common treatment option selected was surgery (3.27%).
The study subject's beliefs about BMI and obesity status are summarized in [Table 5]. The perception of heredity as a cause of obesity significantly (P = 5.09 × 10−9 ) differed between normal weight and overweight subjects, with significantly more number of obese individuals associating obesity with heredity factors. Over 37% of respondents who reported that heredity was not at all important were overweight or obese, while only 40.87% of normal weight subjects indicated heredity as not being important in obesity. 19.57% of normal weight subjects reported that the heredity was only slightly important in being overweight while 38.13% of obese subjects mentioned heredity as a slightly important cause of overweight. 18.13% who were overweight or obese and 37.83% who were not overweight reported that heredity was somewhat important for obesity. 6.25% of overweight subjects and 1.74% normal weight subjects indicated heredity as a very important cause of obesity.
The perception of the study subjects about the various obesity treatment and BMI status is listed in [Table 6]. The variables of treatment by hospital, clinics or specialists, treatment general practitioners, treatment by dieticians, treatment by social workers, treatment by individual effort, and treatment by surgery were statistically significant (P = 8.47 × 10−26 ) with the BMI status. It is, however, interesting to note that significantly greater number of overweight subjects (73.75%) believed dietary factors and exercise as a valuable treatment in reducing obesity.
Almost 27.83% subjects who believed in the treatment by dietitians as the best option were not overweight. 25.65% who believed individual effort is the best treatments for obesity were not overweight. It is also interesting to note that prescription medication and surgery were least preferred option by both normal weight and overweight subjects. It was also surprising to note general practitioners bring least preferred by the overweight subjects, which indicate the need to enhance confidence among overweight subject to consult their general practitioners, who could be valuable source of information in planning diet and exercise regimen tailored to individual's needs. Interestingly, social works were also one of the least preferred options by both normal weight and overweight subjects, which is indeed disappointing considering the role social workers can play in counseling and guiding overweight subjects. Nevertheless, it is indeed interesting to know the high degree of variability in perception of treatment options among normal weight and overweight expats in our study subjects.
| Discussions|| |
The mechanisms most commonly proposed to explain the link between television viewing and obesity are reduced leisure-time physical activity and increased energy intake.  Television viewing is hypothesized to supplant physical activity and/or increase caloric intake through snacking in response to the numerous cues in advertisements for energy dense foods of poor nutritional content. ,, Our study provides some support for both mechanisms. Men and women who were frequent television viewers were more likely to be inactive in their leisure time. Low consumption of fruit and vegetables, which is contrasted with a diet high in fat,  was also associated with high levels of television viewing. A third possible explanation of the link between television time and obesity is the low metabolic rate associated with television viewing. It is evident that prolonged excessive internet use and TV viewing takes away valuable time from certain necessary activities that children should engage in. , Excessive internet use and TV viewing not only result in the lack of sleep but also affect concentration levels. Indeed in our study overwhelming majority of children received <9 h of sleep; more specifically most of the overweight and obese children received <7 h of sleep (data not shown). This is particularly significant since numerous studies have reported that link of lack of sleep with becoming obese among both children and adults. ,,, In a European study, the EPIC-PANACEA survey, which was conducted in nine European countries, physical activity at work and leisure-time physical activity were inversely correlated with BMI and WC. , TV watching leads to harmful habits such as passive snacking and lust for sugar-sweetened soft drinks and energy-dense foods.  Which leads to lower metabolic rate in comparison with other sedentary activities like sewing, playing board games, driving a car, reading, and writing.  Finally, the relation between TV watching and metabolic diseases could be partly attributed to the psychological stress induced by TV, which enhances insulin resistance, sympathetic system activation, visceral adiposity, and metabolic syndrome. Notably, the aforementioned associations between physical activity, sedentary lifestyle patterns, and cardiometabolic risk factors were observed almost exclusively among males rather than females. , Intervention studies specifically targeted at reducing television viewing have yielded encouraging results in reducing obesity levels among children and adolescents.  Furthermore, some evidence indicates that recommendations aimed at reducing sedentary behaviors may be more effective than those targeted at promoting physical activity.  Studies have found that sedentary behaviors, particularly television viewing, adopted in childhood track into adulthood, and some even suggest that sedentary behaviors track more strongly than physical activity. ,,,
| Conclusions|| |
Overweight and obesity among expatriates within Saudi Arabia poses an important public health problem. Embracing Western influences due to its global consumerism culture, changes in diets, attitudes, and lifestyle due to the economic boom and sudden transition have had a profound impact on the health of the people. This research provides the singular important information concerning attitudes and body image concerns among expatriates in the Kingdom of Saudi Arabia. Hence, there is a need for more public health educational programs by health professionals as well as effective interventions on health awareness and education for the population. Social ties and social networks, to which an individual belongs, have a great influence on the beliefs and attitudes of the individual toward overweight and obesity.
| References|| |
Adler A, Ansbacher HL, Ansbacher RR, editors. Superiority and Social Interest: A Collection of Later Writings. New York: W. W. Norton; 1979.
Eapen V, Mabrouk AA, Bin-Othman S. Disordered eating attitudes and symptomatology among adolescent girls in Saudi Arabia. Eat Behav 2006;7:53-60.
Rössner S. Television viewing, life style and obesity. J Intern Med 1991;229:301-2.
Jain A. Temptations in cyberspace: New battlefields in childhood obesity. Health Aff (Millwood) 2010;29:425-9.
Bener A, Al-Mahdi HS, Ali AI, Al-Nufal M, Vachhani PJ, Tewfik I. Obesity and low vision as a result of excessive Internet use and television viewing. Int J Food Sci Nutr 2011;62:60-2.
Bener A, Al-Mahdi HS, Vachhani PJ, Al-Nufal M, Ali AI. Do excessive internet use, television viewing and poor lifestyle habits affect low vision in school children? J Child Health Care 2010;14:375-85.
Robinson TN. Reducing children′s television viewing to prevent obesity: A randomized controlled trial. JAMA 1999;282:1561-7.
Crespo CJ, Smit E, Troiano RP, Bartlett SJ, Macera CA, Andersen RE. Television watching, energy intake, and obesity in US children: Results from the third National Health and Nutrition Examination Survey, 1988-1994. Arch Pediatr Adolesc Med 2001;155:360-5.
Andersen LF, Lillegaard IT, Øverby N, Lytle L, Klepp KI, Johansson L. Overweight and obesity among Norwegian schoolchildren: Changes from 1993 to 2000. Scand J Public Health 2005;33:99-106.
Andersen RE, Crespo CJ, Bartlett SJ, Cheskin LJ, Pratt M. Relationship of physical activity and television watching with body weight and level of fatness among children: Results from the Third National Health and Nutrition Examination Survey. JAMA 1998;279:938-42.
Hernández B, Gortmaker SL, Colditz GA, Peterson KE, Laird NM, Parra-Cabrera S. Association of obesity with physical activity, television programs and other forms of video viewing among children in Mexico city. Int J Obes Relat Metab Disord 1999; 23:845-54.
Gortmaker SL, Must A, Sobol AM, Peterson K, Colditz GA, Dietz WH. Television viewing as a cause of increasing obesity among children in the United States, 1986-1990. Arch Pediatr Adolesc Med 1996;150:356-62.
Dietz WH Jr, Gortmaker SL. Do we fatten our children at the television set? Obesity and television viewing in children and adolescents. Pediatrics 1985;75:807-12.
Rey-Lo´pez et al. Food and drink intake during television viewing in adolescents: The Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study. Public Health Nutrition 2011; 1-7.
Gortmaker SL, Dietz WH Jr, Cheung LW. Inactivity, diet, and the fattening of America. J Am Diet Assoc 1990;90:1247-52, 1255.
Hu FB, Leitzmann MF, Stampfer MJ, Colditz GA, Willett WC, Rimm EB. Physical activity and television watching in relation to risk for type 2 diabetes mellitus in men. Arch Intern Med. 2001;161:1542-48.
Fleming-Moran M, Thiagarajah K. Behavioral interventions and the role of television in the growing epidemic of adolescent obesity - Data from the 2001 Youth Risk Behavioral Survey. Methods Inf Med 2005;44:303-9.
Lowry R, Wechsler H, Galuska DA, Fulton JE and Kann L. Television Viewing and its Association with Overweight, Sedentary Lifestyle, and Insufficient Consumption of Fruits and Vegetables Among US High School Students: Differences by Race, Ethnicity and Gender. Journal of School Health 2002;72:413-421.
Utter J, Neumark-Sztainer D, Jeffery R, Story M. Couch potatoes or French fries: Are sedentary behaviors associated with body mass index, physical activity, and dietary behaviors among adolescents? J Am Diet Assoc 2003;103:1298-305.
Janssen I, Katzmarzyk PT, Boyce WF, Vereecken C, Mulvihill C, Roberts C, et al.
Comparison of overweight and obesity prevalence in school-aged youth from 34 countries and their relationships with physical activity and dietary patterns. Obes Rev 2005;6:123-32.
Eisenmann JC, Bartee RT, Wang MQ. Physical activity, TV viewing, and weight in U.S. youth: 1999 Youth Risk Behavior Survey. Obes Res 2002;10:379-85.
Gomez LF, Parra DC, Lobelo F, Samper B, Moreno J, Jacoby E, et al
. Television viewing and its association with overweight in Colombian children: Results from the 2005 National Nutrition Survey: A cross sectional study. Int J Behav Nutr Phys Act 2007;4:41.
Hardy LL, Dobbins TA, Denney-Wilson EA, Okely AD, Booth ML. Descriptive epidemiology of small screen recreation among Australian adolescents. J Paediatr Child Health 2006;42:709-14.
Burke V, Beilin LJ, Durkin K, Stritzke WG, Houghton S, Cameron CA. Television, computer use, physical activity, diet and fatness in Australian adolescents. Int J Pediatr Obes 2006;1:248-55.
Must A, Bandini LG, Tybor DJ, Phillips SM, Naumova EN, Dietz WH. Activity, inactivity, and screen time in relation to weight and fatness over adolescence in girls. Obesity (Silver Spring) 2007;15:1774-81.
Marshall SJ, Biddle SJ, Gorely T, Cameron N, Murdey I. Relationships between media use, body fatness and physical activity in children and youth: A meta-analysis. Int J Obes Relat Metab Disord 2004;28:1238-46.
Jordan AB, Robinson TN. Children, television, and weight status: summary and recommendations from an expert panel meeting. Ann Am Acad Pol Soc Sci 2008:615.
Hancox RJ, Poulton R. Watching television is associated with childhood obesity: But is it clinically important? Int J Obes (Lond) 2006;30:171-5.
Lesley A, Duncan A, Schaller MA, Justin H. Perceived vulnerability to disease: Development and validation of a 15-item self-report instrument. Elsevier 2009;47:541-6.
Lee JM, Pilli S, Gebremariam A, Keirns CC, Davis MM, Vijan S, et al.
Getting heavier, younger: Trajectories of obesity over the life course. Int J Obes (Lond) 2010;34:614-23.
Robinson TN. Television viewing and childhood obesity. Pediatr Clin North Am 2001;48:1017-25.
Story M, Faulkner P. The prime time diet: A content analysis of eating behavior and food messages in television program content and commercials. Am J Public Health 1990;80:738-40.
Harrison K, Marske AL. Nutritional content of foods advertised during the television programs children watch most. Am J Public Health 2005;95:1568-74.
Powell LM, Szczypka G, Chaloupka FJ, Braunschweig CL. Nutritional content of television food advertisements seen by children and adolescents in the United States. Pediatrics 2007;120:576-83.
Subar AF, Ziegler RG, Patterson BH, Ursin G, Graubard B. US dietary patterns associated with fat intake: The 1987 National Health Interview Survey. Am J Public Health 1994;84:359-66.
Taras H, Potts-Datema W. Sleep and student performance at school. J Sch Health 2005;75:248-54.
Vandewater EA, Bickham DS, Lee JH. Time well spent? Relating television use to children′s free-time activities. Pediatrics 2006;117:e181-91.
Ozturk A, Mazicioglu M, Poyrazoglu S, Cicek B, Gunay O, Kurtoglu S. The relationship between sleep duration and obesity in Turkish children and adolescents. Acta Paediatr 2009;98:699-702.
Van Cauter E, Knutson KL. Sleep and the epidemic of obesity in children and adults. Eur J Endocrinol 2008;159 Suppl 1:S59-66.
Magee CA, Iverson DC, Caputi P. Sleep duration and obesity in middle-aged Australian adults. Obesity (Silver Spring) 2010;18:420-1.
Patel SR, Hu FB. Short sleep duration and weight gain: A systematic review. Obesity (Silver Spring) 2008;16:643-53.
Besson H, Ekelund U, Luan J, May AM, Sharp S, Travier N, et al.
A cross-sectional analysis of physical activity and obesity indicators in European participants of the EPIC-PANACEA study. Int J Obes (Lond) 2009;33:497-506.
Roditis ML, Parlapani ES, Tzotzas T, Hassapidou M, Krassas GE. Epidemiology and predisposing factors of obesity in Greece: From the Second World War until today. J Pediatr Endocrinol Metab 2009;22:389-405.
Dulloo AG, Antic V, Yang Z, Montani JP. Propellers of growth trajectories to obesity and the metabolic syndrome. Int J Obes (Lond) 2006;30 Suppl 4:S1-3.
Ainsworth BE, Haskell WL, Leon AS, Jacobs DR Jr, Montoye HJ, Sallis JF, et al.
Compendium of physical activities: Classification of energy costs of human physical activities. Med Sci Sports Exerc 1993;25:71-80.
Pinto Pereira SM, Ki M, Power C. Sedentary behaviour and biomarkers for cardiovascular disease and diabetes in mid-life: The role of television-viewing and sitting at work. PLoS One 2012;7:e31132.
Stamatakis E, Hamer M, Mishra GD. Early adulthood television viewing and cardiometabolic risk profiles in early middle age: Results from a population, prospective cohort study. Diabetologia 2012;55:311-20.
Doak CM, Visscher TL, Renders CM, Seidell JC. The prevention of overweight and obesity in children and adolescents: A review of interventions and programmes. Obes Rev 2006;7:111-36.
Hills AP, King NA, Armstrong TP. The contribution of physical activity and sedentary behaviours to the growth and development of children and adolescents: Implications for overweight and obesity. Sports Med 2007;37:533-45.
Hancox RJ, Milne BJ, Poulton R. Association between child and adolescent television viewing and adult health: A longitudinal birth cohort study. Lancet 2004;364:257-62.
Field AE, Coakley EH,Must A,et al. Impact of overweight on the risk of developing common chronic diseases during a 10-year period. Arch Intern Med. 2001;161:1581-86.
Raitakari OT, Porkka KV, Taimela S, Telama R, Räsänen L, Viikari JS. Effects of persistent physical activity and inactivity on coronary risk factors in children and young adults. The cardiovascular risk in young Finns study. Am J Epidemiol 1994;140:195-205.
Janz KF, Dawson JD, Mahoney LT. Tracking physical fitness and physical activity from childhood to adolescence: The Muscatine study. Med Sci Sports Exerc 2000;32:1250-7.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]