Determinants of Overweight and Obesity in Saudi Arabia
Risk factors associated with increased body mass index (BMI) are well researched in Saudi Arabia. However, the majority of the evidence is crosssectional, and there is a need for longitudinal and randomized controlled trial studies to increase the strength of the evidence and establish causality between risk factors and disease outcomes (AlAbdulKader, Tuwairqi, and Rao 2020). This review draws on peer-reviewed publications and recently collected national surveys. Findings from the peer-reviewed publications, identified through the PubMed (using “obesity” and “Saudi” in combination with search terms, such as “diet,” “fruit,” “fast food,” and “inactivity”), supported the analysis of the contribution of dietary behaviors and physical inactivity to the development of overweight and obesity in the Saudi population. Whenever possible, recent publications—not older than five years—were used in the analysis. The following national surveys were used: • The 2019 World Health Survey (MOH 2020) was used as a source of data on the intake of fruits and vegetables as well as on the physical activity level among the adult Saudi population. • The 2017 and 2018 Household Sports Practice Surveys (GASTAT 2017, 2018) were used as a source of recent data on the physical activity of the Saudi Arabia population. • The 2013 Saudi Health Interview Survey (MOH and IHME n.d.) was used as a source of data on dietary habits and the level of physical activity among the adult Saudi population.
DIETARY BEHAVIORS CONTRIBUTING TO OVERWEIGHT AND OBESITY Excessive energy intake contributes to an increase in overweight and obesity prevalence. The energy intake positively predicts body weight, while total energy expenditure per kilogram of body weight negatively predicts it. Based on the Food and Agriculture Organization’s food balance sheets, the availability of kilocalories per capita in Saudi Arabia increased from 1,717 in 1961 to 3,194 in 2017 (FAO 2020). National cross-sectional surveys in Saudi Arabia found that the excess of food energy supply was 1,448 kilojoules per day in 1996 and that the excess increased by 519 kilojoules per day in 2004 (Vandevijvere et al. 2015). A recent study confirmed a significant difference in the mean daily energy intake between girls ages 8–11 years with obesity (intake of 2,677 plus or minus 804 kilocalories per day) and normal weight (intake of 1,806 plus or minus 403 kilocalories per day) (Al-Kutbe et al. 2017). The number of calories consumed per day was found to differ significantly between Saudi children ages 9–12 years who have obesity and those who have normal weight, with daily energy intake being higher by about 300 kilocalories among children with obesity (Alturki, Brookes, and Davies 2018b).
Dietary behaviors of the adult population A comprehensive diet history questionnaire was last used in 2013 in a nationally representative survey. The 2013 Saudi Health Interview Survey used a 42-item questionnaire to ask respondents about their typical weekly consumption of specified food and beverage items, the type of oil or fat most often used for meal preparation, and the usual type of dairy products and bread in the household
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