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Obesity and associated risk factors among students of health colleges of King Saud University, Saudi Arabia: A cross-sectional study.

Byline: Elshazaly Saeed, Asaad Mohammed Assiri, Ibrahim AwadEljack, Abdullah S Aljasser, Abdulrahman Mohammed Alhuzimi, Ahmed Assad Assiri, Nasser Ali Alqahtani, Saud Amer Alshahrani and Yousif A Al-Ammar

Abstract

Objective: To determine the prevalence of obesity and associated risk factors among medical students in Saudi Arabia.

Methods: The cross-sectional study was conducted from December 2012 to March 2013 at King Saud University, Riyadh, Saudi Arabia. Using stratified sampling technique, undergraduate students of either gender from the health colleges were included. Information was collected through a pretested questionnaire. Measurements of the height and weight were noted and body mass index for all the subjects was calculated.

Results: Of the 292 students, 146(50%) were males and 146(50%) were females. Obesity was found in 40(13.7%)students. It was more prevalent among males than females (p<0.05) and among those who had chronic diseases (p30 kg/m2).

There are a variety of factors that play a role in obesity. This makes it a complex health issue to address. Overweight and obesity result from an energy imbalance. This involves eating too many calories and not getting enough physical activity. Body weight is the result of genes, metabolism, behaviour, environment, culture and socioeconomic status. Behaviour and environment play a large role causing people to be overweight and obese.5

Previous studies conducted in Saudi Arabia investigated the prevalence of obesity among Saudi population, but little or no data was available about the prevalence of obesity and associated risk factors among medical students. Epidemiological surveys to determine the prevalence of obesity and associated risk factors are of high importance, especially those targeting university students. Being overweight or obese greatly raises the risk for other health problems; thus, more studies are needed among youths to provide evidence-based data to the health authorities to assist in the design of appropriate strategies in controlling obesity in the study areas. The current study was planned to determine the prevalence of obesity among students of the university health colleges and to identify the associated risk factors in Saudi Arabia.

Subjects and Methods

The cross-sectional study was conducted from December 2012 to March 2013 at King Saud University (KSU), Riyadh, Saudi Arabia. Riyadh is the capital and the largest city of Saudi Arabia. It is also the capital of Riyadh Province, and belongs to the historical regions of Najd and Al-Yamama. It is situated in the centre of the Arabian Peninsula on a large plateau, and is home to 5.7 million people, and the urban centre of a region with a population of close to 7.3 million people.6 KSU is a public university in Riyadh. The university was created to meet the shortage of skilled workers in Saudi Arabia. The student body of KSU consists of about 51,168 students of both genders. The female students have their own disciplinary panel and there is a centre supervising the progress of female students, either personally by female faculty members or by male faculty members via a closed television network.7

The study comprised undergraduate students from five major health colleges under KSU: Medicine, Dentistry, Pharmacy, Applied Health Sciences and Nursing. The study sample was collected from each college proportional to the size of the students' population.

The sample size was estimated using the single population proportion formula: N = (Za +Zb)2 ((r1q1) + (r2q2)) (P1-P2)2 where, p = prevalence of obesity, q1= (1- P1), q2= (1- P2) and Z = standard score which corresponds to 1.96. For calculations, a 95% confidence interval (CI) (z) was used. Equal number of males and females in the study were ensured using stratified simple random sampling.

The prevalence of obesity among male and female aged 18-24 years was taken from a previous study8 as shown below:

PF = 15.9

QF = 84.1

PM = 29.6

QM = 70.4

Za = 1.96 (95%)

ZB = 0.842 (80%)

N= {(1.96+0.842)2 [(0.159x0.841) + (0.296x0.704)]} / {(0.159 - 0.296)2} = 292 participants.

Ethical clearance was obtained from the institutional review board, and informed consent was obtained from all the students. Data was collected using a questionnaire that was developed based on possible risk factors and was pretested in a few subjects similar to the study participants for validity. The questionnaire included information such as socio-demographic characteristics, lifestyle factors, family history of obesity, presence or absence of some chronic diseases. The height and weight of all the subjects were measured.

Data analysis was performed using SAS version 9.2 (SAS Institute, Inc., Cary, NC).

Categorical variables were summarised as frequencies and percentages and contentious variables were summarised as mean and standard deviation. Comparison between groups for categorical variable was done using chi-square test or Fisher's exact test, where for continuous data student t-test or Mann Whitney Utest were used. Multiple logistic regression models with stepwise selection were used to identify multivariate predictors for obesity. To quantify the strength of multivariate association, we used odds ratios (OR) with 95% confidence intervals (CI). P <0.05 was considered statistically significant.

Results

Of the 292 students, 146(50%) each were males and females.The mean age of the students was 21.2+-1.2 years (range: 18-24 years). Overall, 193(66.6%) students had a high income, 69(23.8%) had an intermediate income and 28(9.6%) had low income. Overall 40(13.7%) were obese; 37(25.3%) in males and 3(2.1%) in females (Table-1).

Table-1: Characteristics of the participants.

Variable###Level###N = 292###%

Age###Mean(SD)###21.26(1.21)###-

Gender###Male###146.00###50.0

###Female###146.00###50.0

Nationality###Saudi###281.00###96.2

###Non-Saudi###11.00###3.8

Marital Status###Single###282.00###96.6

###Married###10.00###3.4

Monthly income###Low###28.00###9.7

###Moderate###69.00###23.8

###High###193.00###66.6

###Missing###2.00###-

Father Obese###Yes###34.00###11.6

###No###258.00###88.4

Mother Obese###Yes###59.00###20.2

###No###233.00###79.8

Brothers Obese###Yes###87.00###29.8

###No###205.00###70.2

Dyslipidaemia/Hyperlipidaemia###Yes###12.00###4.1

###No###280.00###95.9

Chronic diseases###Yes###272.00###93.2

###No###20.00###6.8

Body mass index###Underweight###29.00###9.9

###Normal weight###147.00###50.3

###Overweight###76.00###26.0

###Class I obesity###26.00###8.9

###Class II obesity###7.00###2.4

###Class III obesity###7.00###2.4

Body mass index###Non-Obese###252.00###86.3

###Obese###40.00###13.7

Besides, 29(9.9%) students were under weight, 147(50.3%) were normal weight, 76(26.0%) were overweight, 26(8.9%) had obesity World Health Organisation (WHO) class-1, 7(2.4%) had obesity class-2 and 7(2.4%) had obesity class-3 (Table-2).9

Table-2: Covariate analysis of gender and the variables.

Covariate###Level###Gender###P-value

###Male###Female

###N=146###N=146

Nationality###Saudi###145 (99.32)###136 (93.15)###0.006

###Non-Saudi###1 (0.68)###10 (6.85)

Monthly income###Low###22 (15.17)###6 (4.14)###0.003

###Moderate###28 (19.31)###41 (28.28)

###High###95 (65.52)###98 (67.59)

Physical Activity###Yes###97 (66.9)###60 (41.1)###<.001

###No###48 (33.1)###86 (58.9)

Obesity in Family members###Yes###84 (57.53)###74 (50.68)###0.240

###No###62 (42.47)###72 (49.32)

Father Obese###Yes###18 (12.33)###16 (10.96)###0.715

###No###128 (87.67)###130 (89.04)

Mother Obese###Yes###29 (19.86)###30 (20.55)###0.884

###No###117 (80.14)###116 (79.45)

Brothers Obese###Yes###42 (28.77)###45 (30.82)###0.701

###No###104 (71.23)###101 (69.18)

Dyslipidaemia/Hyperlipidaemia###Yes###9 (6.16)###3 (2.05)###0.077

###No###137 (93.84)###143 (97.95)

Chronic diseases###Yes###14 (9.59)###6 (4.11)###0.064

###No###132 (90.41)###140 (95.89)

Body mass index###Underweight###6 (4.11)###23 (15.75)###<.001

###Normal weight###52 (35.62)###95 (65.07)

###Overweight###51 (34.93)###25 (17.12)

###Class I obesity###24 (16.44)###2 (1.37)

###Class II obesity###6 (4.11)###1 (0.68)

###Class III obesity###7 (4.79)###0 (0)

Male students were more likely to get obesity compared to female students (p< 0.001) (Table 3).

Table-3: Covariate analysis of body mass index (BMI) and the variables.

Covariate###Level###BMI###P-value

###Non-Obese###Obese

###N=252###N=40

Gender###Male###109 (74.66)###37 (25.34)###<.001

###Female###143 (97.95)###3 (2.05)

Monthly income###Low###24 (85.71)###4 (14.29)###0.358

###Moderate###56 (81.16)###13 (18.84)

###High###170 (88.08)###23 (11.92)

Physical Activity###Yes###135 (85.99)###22 (14.01)###0.741

###No###117 (87.31)###17 (12.69)

Obesity in Family members###Yes###129 (81.65)###29 (18.35)###0.012

###No###123 (91.79)###11 (8.21)

Father Obese###Yes###25 (73.53)###9 (26.47)###0.021

###No###227 (87.98)###31 (12.02)

Mother Obese###Yes###51 (86.44)###8 (13.56)###0.972

###No###201 (86.27)###32 (13.73)

Brothers Obese###Yes###70 (80.46)###17 (19.54)###0.059

###No###182 (88.78)###23 (11.22)

Dyslipidaemia/Hyperlipidaemia###Yes###5 (41.67)###7 (58.33)###<.001

###No###247 (88.21)###33 (11.79)

Chronic diseases###Yes###11 (55)###9 (45)###<.001

###No###241 (88.6)###31 (11.4)

Fast Food Daily###One meal###5 (71.43)###2 (28.57)###0.595

###Two meals###116 (87.22)###17 (12.78)

###Three meals###111 (85.38)###19 (14.62)

###More than 3 meals###20 (90.91)###2 (9.09)

Anxiety###Yes###49 (83.05)###10 (16.95)###0.416

###No###203 (87.12)###30 (12.88)

A total of 20(6.8%) students had chronic diseases, and of those 9(45%) had obesity and 11(55%) were none-obese. The obesity increases among the students suffering from chronic diseases than those who did not have chronic diseases (p<0.001). Obesity increased among students who had family history of obesity (p< 0.01). In the univariate analysis, no statistically significant difference was observed between obesity in students who had physical activity versus those who did not have (p=0.741).

Multiple logistic regression model was also worked out (Table-4).

Table-4: Multiple logistic regression model.

Covariate###Level###Response = Obese

###Odds Ratio###95%CI Low###95%CI Up###P-value

Gender###Male###18.51###5.26###65.09### Risk Factors (2015), Obesity Situation and trends, found at (http://www.who.int/ gho/ncd/risk_factors/obesity_text/en/).

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13. Mansour MA, Yaqoub YA, Mohammed AA. Obesity in KSA. Saudi Med J, 2005; 26: 824-9.

14. KSA Ministry of Health. National campaign against overweight and obesity 2012. [Online] 2012 [Cited 2015 April 12]. Avaliable from URL: http://www.moh.gov.sa/en/HealthAwareness/Campaigns/badana/Pages/default.aspx.

15. Tayem YI, Yaseen NA, Khader WT, Abu Rajab LO, Ramahi AB, Saleh MH. Prevalence and risk factors of obesity and hypertension among students at a central university in the West Bank.Libyan J Med. 2012; 7.

16. Al-Nakeeb Y, Lyons M, Collins P, Al-Nuaim A, Al-Hazzaa H, Duncan MJ, et al. Obesity, physical activity and sedentary behaviour amongst British and Saudi youth: a cross-cultural study. Int J Environ Res Public Health. 2012; 9: 1490-506.

17. WHO. The World Health Report 2002: Global status report on non-communicable diseases 2010. Geneva, Switzerland:World Health Organization, 2011.
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Publication:Journal of Pakistan Medical Association
Geographic Code:7SAUD
Date:Mar 31, 2017
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