Impact of Obesity on Children in Saudi Arabia and the Arabian Gulf States - Case Study Example

Critical analysis of research evidence in the impact of obesity on the children health in Saudi Arabia and the Arabian Gulf Countries Name: Lecturer: Course: Date: Table of Contents Table of Contents 2 Introduction 3 Method 4 Research Approaches 6 Longitudinal Studies 8 Cross-sectional studies 9 Systemic Review and Meta Analysis 14 Conclusion 15 References 17 Critical analysis of research evidence in the impact of obesity on the children health in Saudi Arabia and the Arabian Gulf Countries Introduction Obesity has generally been defined as a state of excessive or anomalous buildup of fat in the adipose tissue leading to health impairment (Dehghan, Akhtar-Danesh & Merchant, 2005). The studies used a range of methods to measure obesity, including waist circumference, body fat measurement percentage, body mass index (BMI) and skin-fold anthropometry (Musaiger (2011; 1; Torun et al, 2013; 1; Karnik & Kanekar, 2012; 1-7). Although the prevalence of obesity continues to increase worldwide, its proportion differs from one country to the other. It is widely documented that mortality rates and morbidity rates rise with increased body weight (Madani, 2000; 1; Story, 1999; s43-s47). A recent 2010 survey by Harvard University established that some 43 million preschool children suffered from obesity worldwide, with estimates showing that nearly 1 billion adults would have the condition if nothing is done to reverse the situation (HSPH, 2010;1). Few researches on the impacts of obese have been done in the Arabian speaking countries (Al-Ghamdi, 2013). This justifies the need for critical analysis of research evidence on the impact of obesity on the children health in Saudi Arabia and the Arabian Gulf Countries Researchers have also taken a keen interest on obesity among Arabian Gulf states such as Saudi Arabia, Qatar, Oman, UAE and Bahrain, since the countries have since 1960s witnessed remarkable increase in wealth, and weight, following the sighting of oil reserves (HSPH, 2010). Current estimates reveal that the rates of obesity in a number of the Arab Gulf states almost exceed those in developed nations such as the United States and Australia (Hector et al 2012). For instance, in Saudi Arabia, Studies by Harvard School of Public Health indicate that some 44 percent of females and 28 percent of males are obese, while another 71 percent of females and 66 percent of the males are either obese or overweight (HSPH, 2010;1). In Kuwait, 48 percent of females and 36 percent of the males are obese, while 74 percent of males and 77 percent of females are either obese or overweight. The trends also show that the rates are higher among the female children than male one, although they appear to be rising fast among the men (HSPH, 2010;1). The key objective of this paper is to critically analyze research evidence that documented the impact of obesity among children in Saudi Arabia and other Arabian Gulf countries. A systematic review of literature that explored obesity in children in the Eastern Mediterranean Region (EMR) between 2000 and 2013 was carried out. The existing studies show that the number of cases of obesity among preschool and school-going children has escalated which has greatly impacted the social and economic situations in the country as well as increased pressures on the healthcare system (Torun et al, 2013; 1; Badran & Laher, 2011; 1; Guerra, Nobre & Augusto, 2013). Method In carrying out the assessment, systematic literature review of studies published in English between 2000 and 2013 were carried. The basis of the thirteen-year period conformed with the normal age of children from birth to adolescent stage. Targeted databases included Google Scholar, PubMed, Medline database and WHO Info Base among other open access databases. Surveys by health agencies and ministries to establish the impact of obesity in adolescents, school-going children and preschool children was also conducted. The researcher used keywords such as “obesity in Saudi Arabia”, “Obesity in EMR”, “impacts of obesity EMR”, “children obesity Saudi Arabia”, “children nutritional status EMR” and “body mass index Saudi Arabia EMR.”. In surveying the studies which examined the impact of obesity, only studies that were published in English and whose scope covered national representative samples were used. Studies examining the impact of obesity in rural and remote areas, urban areas or towns within specific countries were not included. In cases where more than one national study within the same country, the most recent one was selected for inclusion analysis. The information captured included the size of the sample, the characteristics of demography, the country, findings and the study year (Uman et al, 2010). In cases where original study failed to report the year of the study, the publication year of the study was used. Searches were made for studies that used quantitative and qualitative methodologies. Of the two, limited articles were found that use qualitative, contextual and exploratory research designs to explain the perceptions, experiences and the essence of obesity and its impact on Saudi children. Because of the likely limitation, the researcher focused on articles that use descriptive quantitative research designs, since they utilize both the elements of qualitative and quantitative research methodologies. At this level, 6 articles were selected and afterwards reviewed and analyzed to examine how they addressed the impacts of obesity in Saudi Arabia and the Arabian Gulf Countries. Of the articles selected, the researcher adopted critiquing frameworks to evaluate quantitative, longitudinal and quantitative explanatory and systematic reviews. In general, longitudinal reviews and quantitative approaches formed the basis of review of the articles (Holland, Thomson & Henderson, 2006). Research Approaches In the 6 articles selected, the researchers used descriptive research designs to establish relationship between their obesity statuses and its relation with certain variables, such as health. The researches concentrated on logic, objectivity and numbers, in addition to convergent reasoning. The articles selected used descriptive research designs. Babbie (2012) argued that the choice of a method is linked to providing a context for a course of action and logic of the study. This is also essential in ensuring that the whole research process is reliably transparent. Descriptive quantitative research design does not fit perfectly into the definition of qualitative or quantitative research designs. Rather, they make use of aspects of both methodologies within the same study. Generally, it involves collecting data that describe certain variables, which are then organized, analyzed and described. Descriptive researches are targeted at explaining “what is.” In which case, survey and observation methods are used in data collection. They also seek to balance aspects of quantitative and qualitative research methodologies. Quantitative research mainly involves quantifying the correlation between variables that represent the characteristics of the subjects. Usually, to quantify such variables, values of effect statistics like correlation coefficient may be used (Holland, Thomson & Henderson, 2006). They may also be experimental, where participants are assessed before and after treatment, and descriptive, where the participants are evaluated once. Quantitative research approaches are however unable to explain the continuous and sometimes situation specific perceptions, understanding and experiences that suggest ways in which people perceive the impacts of obesity on Saudi children, how they deal with them and how they respond to the changes (Mann, 2014). Qualitative research studies are however able to provide a deeper insight into the impacts as they are greatly perceptive to contextual issues and are more capable of bringing into perspective significant micro-social processes such as ways in which the children experience and deal with the changes in obesity as they transit through life. This signifies a key limit with the articles. Since age was a critical factor in this specific literature review, focus was placed on articles that analyzed data longitudinally and cross-sectionally (Holland, Thomson & Henderson, 2006). However, inconsistencies posed by the analyses of these two methods may question the reliability of cross-sectional estimates of change. Louis et al (1985) showed that when a true correlation between dependent variable and age of quadratic or non-linear is established, although it is modeled as linear, then the age that has been estimated will be a function of age distribution. Indeed, this literature survey seeks to demonstrate these points through analysis of the correlation between age and obesity and their impacts using longitudinal study. Of the 6 articles, 4 were cross-sectional research designs, where various cohorts were surveyed at a specific point in time. Overall, only one longitudinal design was surveyed, where one specific cohort was selected and surveyed over a considerable time period. The same children with obesity were studied over a significant period. One of the studies used systematic review. Longitudinal Studies Longitudinal studies are chiefly repeated measurement design or within the same subjects. However, they may also be between independent-group designs or between subjects. Of the six studies, only Ibrahim’s (2012; 1) study used a longitudinal design to investigate the prevalence and features of metabolic syndrome in adolescents with obese. However, lack of randomization of sample, implies there was bias in the sampling method. Hence, the sample may not be representative of the population. In the study, children were selected from School Health Screening Centre in Fwarwaniah, and studied between the academic year 2009 to 2010. The scope of variables used in Ibrahim’s study was wide (2012; 1), which means it provided comprehensive data analysis. The study used anthropometric assessment to measure the height and weight circumference. It also measured blood pressure as well as defined hypertension. In addition to examining family history of obese, family history of hypertension was also examined. However, insulin level was not measured, to make the study more accurate in the existence of insulin resistance. The study surveyed two groups of variables. These included the characteristics of the participants in the study and the dependent variables that defined the key research questions. These were effective in making the findings more objective, reliable and authentic. In regards to the prevalent of metabolic syndrome, the findings suggested the prevalence of metabolic syndrome to be 28.4 percent among general population of obese and overweight children. The findings of the study were consistent as they reflected an earlier study by Cook et al (2003), which found the prevalence to be 31.2 percent (Ibrahim, 2012; 1). Data was expressed using mean and standard deviation, while statistical analysis used SPSS 16, student t test and Chi Square to establish statistical variations in qualitative variables. The key hypothesis of the study was that childhood obesity is a key risk factor for metabolic syndrome in children and adolescents are obese and overweight. The findings of the study were consistent with the hypothesis as it was established that obesity is indeed a key risk factor for metabolic syndrome and insulin resistance in adolescents and children. The study reported that one-third of children with obesity showed symptoms of metabolic syndrome (Ibrahim, 2012; 1). Ibrahim’s (2012; 1) study has a number of limitations. First, the study used limited geographical scope. Of the six governorates in Kuwait, only one was surveyed for the study (Al Farwaniah). This is an indicator that the findings are not generalizable. The study also surveyed a small population sample of only 352 children. Cross-sectional studies Cross-sectional study designs are essential for the purpose of making a study descriptive in nature, usually in the form of a survey (Levin, 2006; 1). They are often carried out to examine the correlation between certain risk factors (Olsen and Marie, 2004; 7). Consistent with these statements, four studies adopted this research approach. In examining the impact of obesity on pulmonary functions of children in Saudi Arabia, Alghadir & Aly (2012; 607-608) used direct approach and a structured survey design to collect data. The researchers collected data on lung infection of children with obese from their families using face-to-face interviews and a structured questionnaire. This was effective in providing cause-and-effect relationship among the variables, hence providing reliable evidence on the impact of obesity on pulmonary functions of children in Saudi Arabia. Another study by Ali et al’s (2013) aimed at investigating why a high proportion of children and adolescents aged between 6 and 18 years fail to meet their dietary recommendations. The study used a cross-sectional study design to evaluate children and adolescent’s dietary needs. Like a study by Alghadir & Aly (2012; 607-608) and Al-Musharaf et al. (2012), it was able to produce convincing findings on cause and effect. The researchers aimed to standardize their data using different tools. Like a study by Alghadir and Aly (2012; 607) and Al-Musharaf et al. (2012), the researcher used anthropometric measurements such as height, weight and BMI. The researchers aimed to make their findings more standardized by adopting reference values such as International Obesity Task Force (IOTF) (Riz and Yousef, 2012). The scope of the study by Riz and Yousef (2012) had several limitations. The researchers did not measure blood pressure, hence limiting the correlation of obesity and overweight with the metabolic syndrome as a potential risk factor for type-2 diabetes and atherosclerotic cardiovascular disease. Such limitations also affected Ali et al’s (2013) study making it less generalized as the exclusion criteria comprise obesity linked to genetic syndromes, and medications or disease that affect lipid metabolism. The results can also be interpreted within the context that hospital based retrospective analysis are limited. Unlike the study by Alghadir & Aly (2012), Al-Musharaf et al. (2012) used a randomized cross-sectional study design. Hence, the selected sample was not open to bias making the findings more representative of the population. Al-Musharaf et al. (2012) surveyed 331 children in Saudi Arabia with one cohort group consisting of children and adolescents between the ages of 6 and 17 years old. Riz and Yousef (2012) also used random cross-sectional study design, making the sample more representative and not open to biased selection. Overall, 315 children in Qatari primary school were surveyed. Children were randomly selected for the study. The study was also comprehensive as document survey was also integrated in the study. Comprehensive and objective data for children’s age and gender were acquired from the school records. Riz and Yousef (2012) had aimed to establish the correlation of obesity and overweight among children between the ages of 6 and 11 years in Qatar who had lipid profile and waist circumference as unfavorable cardiovascular risk factors. Al-Musharaf et al’s (2012) investigation into the prevalence of Vitamin D deficiency due to obesity in children in Saudi Arabia is however not generalisable. Two cohorts were studied. The researchers examined 253 children aged between 6 and 10 years old, while 276 adolescents aged between 11 and 18 years of age were surveyed in the United Arab Emirates. Hence, it was able to generate more dependable data. Regarding statistics analysis, Alghadir & Aly (2012; 607-608) used a range of tools, making the findings more precise, valid and reliable. The researchers expressed data as mean and standard deviation. Additionally, they used ANOVA to determine the differences of ventilator function among three study and three cohort groups, such as 6 to 12 years who had normal weight, 6 and 12 years who are overweight and 6 to 13 years who are obese. Analyses by the other three studies were less critical and open to confounding, which happens when a section or a substantial association between two variables emerges when both are causally linked to the third variable. All the four studies surveyed two groups of variables. These included the characteristics of the participants in the study and the dependent variables that defined the key research questions. These made the findings more objective, valid and reliable. The findings of the four studies also reflected their hypotheses, indicating completeness of data. They were also consistent with earlier studies. The hypothesis of Ali et al’s (2013) study was that majority of children in United Arab Emirates can meet their energy needs while the quality of the diet and the intake of some micronutrients may never meet the recommendations. The findings were consistent with the hypothesis that stated that there is indeed a need for interventions targeted at 6 and 18 year-old children. It was consistent with earlier studies that the quality of diet in Saudi for children has to be improved (Supinya, Saetae & Manaboriboon, 2012; Branscum & Sharma, 2012). Riz and Yousef (2012) found that more girls than boys in certain geographic area in Doha were either obese or overweight. This reflected the hypothesis that children screened for overweight or obese can substantially experience increased waist circumference in comparison to those who were not obese or overweight. The study by Alghadir & Aly (2012; 607-608) found that ventilatory functions in the children lowered the predicted value, hence requiring additional examination to find out the logic behind the findings in each group as well as among three groups in the normal weight of the children. This was also consistent with the hypothesis that stated that the more overweight or obese a Saudi child has, the more likely he will experience reduced ventilatory function. Al-Musharaf et al’s (2012) study found that Vitamin D was evident in all the children diagnosed with obese. The findings were consistent with a hypothesis that calcium intake and vitamin D status were analogous in normal and obese/overweight children. All the studies had underlying weaknesses based on their sample sizes. The study by Alghadir & Aly (2012; 607-608) is less generalizable since a small sample size of 60 subjects was used. Additionally, no follow up interview were conducted to corroborate the findings. Al-Musharaf et al’s (2012) study is also less generalizable as a small sample size of 331 subjects was used. Additionally, no follow up interview were conducted to corroborate the findings. Both make the study less reliable (Sharma, 2011; 2167). Riz and Yousef (2012) focused a limited geographic scope making the data less representative. For instance, since the study was based at Qatar primary school. This is further compounded by the fact that a small sample size population of 325 people was used to represent the whole of Qatar’s population of children (Riz and Yousef, 2012). The same could be said of Ali et al’s (2013). The study was less generalizable as only 253 children aged and 276 adolescents were targeted and surveyed. This makes it difficult to say that the findings represented the entire population of children and adolescents with obese in UAE. Ali et al’s (2013) study also had a limited geographic scope. Additionally, no follow up interview were conducted to corroborate the findings (Taha, Ahmed & Sadiq, 2009; 605-607). Systemic Review and Meta Analysis Systematic reviews summarize the outcomes of several intervention trials. They are hence effective in acquiring the data on what interventions actually worked (Garg, Hackam & Tonellu, 2008; 253-260). Although they tend to be descriptive, they often entail systematic search of literature. Hence, they focus majorly on the area of study selected by the author (Uman, 2011; 1; Egger et al, 1997; Biondi-Zoccai et al 2006). Consistent with this explanation, a survey by Taha, Ahmed & Sadiq (2009; 605) used systematic review of literature. The choice of the methodology was effective in contributing to meta analysis since based on survey of literature, the study was the first of its kind to have surveyed the prevalent risk factors of metabolic syndrome among Saudi Arabian children with obese (2009; 605-607). Meta analysis and systematic review allows the findings to be combined with similar studies, hence contributing to meta-analysis. The small sample size also reflects consistency with studies using this research study design. The study surveyed 57 children and adolescents. The researcher offered in-depth analysis through a document survey of medical records of patients diagnosed with obese in Saudi Arabia from 2004 to 2008. The researchers collected data on the BMI, height, weight and age of the subjects, as well as insulin concentration and fasting lipid profile. These made the study more objective. In terms of consistency, the key hypothesis of the study was that obesity in children is linked to development of metabolic syndromes. These were consistent with the findings. Taha, Ahmed & Sadiq’s (2009; 605-607) found that while endpoints of cardiovascular risk are less prevalent in children, elements of insulin resistance syndrome such as hypertension and dyslipedemia are not. Taha, Ahmed & Sadiq’s (2009; 605-607) survey had several weaknesses. Since the study had a retrospective nature, some data on some of the 20 subjects were missing. This made the study less reliable. Further, the study was less generalizable as only 57 participants were targeted and surveyed. This makes it difficult to say that the findings represented the entire population of children and adolescents with obese in Saudi Arabia. Further indications that the study was not generalizable included the fact that the exclusion criteria comprise obesity linked to genetic syndromes, and medications or disease that affect lipid metabolism. The results can also be interpreted within the context that hospital based retrospective analysis are limited. The study also had a limited geographic scope. Additionally, no follow up interview were conducted to corroborate the findings (Taha, Ahmed & Sadiq, 2009; 605-607). Conclusion All the articles analyzed used quantitative research method. Indeed, a survey of literature on most studies on obesity and overweight reveal a similar trend. Indeed, absence of studies in this area shows that a knowledge gap exists on qualitative findings on impacts of obese. Lack of qualitative studies in Saudi Arabia indicates over involvement and interest among researchers and policymakers on statistical methods that can answer “what” questions rather than “how” and “why”. It also indicates lack of a balance in investing in researching skewed towards supporting quantitative research resources for generation of data (Rooyen, Telford-Smith & Strumpher, 2010). This shows that there is a need for more qualitative researches in the areas. Qualitative research studies are able to provide a deeper insight into the impacts as they are greatly perceptive to contextual issues and are more capable of bringing into perspective significant micro-social processes such as ways in which the children experience and deal with the changes in obesity as they transit through life. This signifies a major limitation in the articles. Based on analysis of the articles, all the articles used small sample size. They also focused on a limited geographic area. These made them less generalizable. This implies that there is need for more generalized studies on the impact of obesity on the children health in Saudi Arabia and the Arabian Gulf Countries. 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