The Prevalence of Obesity in Saudi Adolescents - Essay Example

THE PREVALENCE OF OBESITY IN SAUDI ADOLESCENTS by Student’s Name Code + Name of Course Institution City/State Professor Date Table of Contents Introduction 7 Aims of the Information on Obesity to Aspects of Public Health or International Development 8 Investigation of prevalence of obesity in the Saudi adolescent population 8 Identification of causal factors and associated risks 9 These causal factors have far reaching complications in the adolescent’s metabolism and these increases to a large extent the risk for contracting early cardiovascular disease and type II diabetes. Furthermore, obesity in youth tracks to adulthood. Apart from overall obesity, abdominal obesity has been associated with a rise in cardio-metabolic risk in adolescents (Theodore et al. 2011, p. 527). Current evidence from different studies has indicated that the disease is a condition which is multifactorial and is largely influenced by a number of variables. The mentioned factors including demographic and genetic variables, such as family history, ethnicity, overweight, sex and age cannot be changed. However, the type which is associated with lifestyle factors can be modifiable. This comes as a surprise considering the fact that this nation is an economic powerhouse but is still experiencing vast lifestyle changes over past years leading to increased adolescent obesity. It therefore follows that for a good understanding of the association between lifestyle factors and obesity is essential for effective management and prevention of obesity in the respective groups. In a move to likely improve public health, several measures can be undertaken to better manage and prevent obesity in the region. 9 Development of recommendations of preventing Obesity among adolescents 10 The results of studies related to adolescent obesity conducted in Saudi Arabia have given recommendations which are relevant to public Health and International development. The predominance of obesity has risen at a startling rate over the last years. This has made the problem to be termed as a 'global epidemic' by the WHO and this applies to the Saudi Arabian situation. The disease is a major public health concern throughout Saudi Arabia. From the research, women are at a higher risk of being obese than male adolescents due to cultural and religious beliefs. It has also been established that there are higher incidences of obesity in the lower social-economic groups. The most worrying trend is the fact that obesity is at an epidemic level with body weight being the prevalent disease of adolescents. 10 As much as the public in general has grown increasingly aware of the consequences of obesity to their personal health, what turns out is that generally the public health sector through its policies together with the community at large need to come up with approaches of preventing prevalence of obesity amongst the adolescents. The prevention of obesity should be an action by the public health at a most inclusive and broadest level. For example, the local communities can break away from the traditional norms which discourage their women from participating in sports by encouraging women to participate in sports (El Ansari et al. 2010). The Saudi Arabian government should provide national leadership together with resources for programmes and research to its public health sector so as to reduce the global number of people affected by the disease. In addition, broad and continued campaigns aimed at reducing intake of junky foods intake could be adopted. Most research reports recommended or emphasized comprehensive approaches which range from clinical, educational, economic, regulatory, as well as social strategies which should act as the guiding principle meant to effectively reduce consumption of such processed foods which lead to poor dietary choices. The overwhelming number of overweight and diabetic patients is a challenge to the country’s public health sector. Coupled by a shortage of doctors as well as nurses, the situation is likely to worsen. The country’s private and public sector will have to develop more residency programs and medical schools in the near future to satisfy the country’s medical needs. 10 It is recommended that schools can be used in mitigation of obesity problem because school settings enable engagement of practices which reduce the sedentary lifestyles among the adolescents. Such broad-based approaches are necessary for prevention of adolescent obesity. Across Saudi Arabia, these efforts are taking root. Various recommendations range from adoption of new school policies as well as state legislations as regards to physical education requirements in school (Mahfouz et al, 2011p. 321). These initiatives should aim at controlling the standards for nutrition for foods and beverages which are sold to students in schools. Some initiatives by the community can be geared towards promoting physical activities of young adolescents, for example expanding bike paths and improvement of the recreational facilities for exercises. This should now be the primary focus of public health initiatives in combating prevalence of the disease. Most of the studies conducted still offer very little Information on the association of obesity in line with geographical factors in the region affecting different adolescents in Saudi Arabia. The public initiatives including research have only been restricted in the urban areas where obesity is perceived to be on the increase (Al-Rukban 2003). The data available indicates that unhealthy eating habits and physical inactivity are correlated with BMI of the Saudi adolescents. This has formed the initial fodder for the public health sector in search for a means or combating the scourge. Local studies which use representative samples however together with valid instruments for assessing lifestyle factors are still scarce. 11 Themes 12 Social Determinants of Obesity in Adolescents 12 Socioeconomic Status and Minority Issues 14 Gene and Environment Interactions Link with Obesity 15 Certain characteristics in the genetic make-up may increase susceptibility of adolescents to excess body weight/ obesity. However, this susceptibility in the genetic make-up exists together with environmental or behavioural factors. Genetic factors like Prader-Willi syndrome alone cause obesity. The interactions between genetic and environmental factors lead to phenotypic obesity expressions. It should be noted that variants in genetics are associated with adolescent obesity and diabetes (Al-almaie, M 2005, p. 610.). These are closely associated in several families from numerous studies better in an effort to understanding the physiologic and genetic contributions or anticipation of obesity. Through conducting of studies in adolescent obesity, consideration of the genetic factors and mechanisms as well as the pharmacogenomics could be a basis for personalized treatment approaches in the future. Genetic variants together with their risk for comorbidities and obesity associations could be examined (Al-Hazzaa 2007, p.463.). 15 Gender Inequality and Girls’ Obesity 16 The female adolescents in Saudi Arabia are significantly prone to obesity development compared to the males. The increased levels of obesity in female adolescents are attributed to cultural prohibition of physical exercises for girls. The prohibition of physical exercise is an inequality issue in Saudi Arabia which has existed from time in memorial. Obesity is a national public health issue which affects both divides of the population but women including teenagers and adults are on the receiving end to a greater extent. Some cultural practices actually prohibit the opening girl’s schools. To a large extent, nonreligious education is still being regarded unsuitable for girls. Furthermore, girl’s curriculum has for a long time not been as comprehensive as it is being offered in boy's schools. 16 Most schools lack sports education for girls due to prohibition by social norms which restrict them from engaging in physical activities in public places. Additionally, some cultural and religious beliefs increased the susceptibility of women being overweight or obese because the women are prohibited from using public facilities like hotel gyms or physical activity in schools for girls. Some girls avoid exercises due to the fear of changing clothes outside home because of cultural shyness (Al-Saeed Wet al 2007, p. 28). 16 Future actions on the Obesity Issue 16 Policy analyses reveal that the common triggers for public action in line with public health problems are being activated in respect to the obesity epidemic. Disapproval in the social context which shifts social norms, medical research as well as self-help initiatives for obese individuals can form part of the initiatives meant to manage the problem. Widespread and coordinated movements and campaigns, coordinated group advocacy by the International community would likely scale down the scourge (Theodore & Tulchinsky 2009). The public Health sector of Saudi Arabia ought to be put in full place to prevent obesity effectively. Obesity research has been very limited and so there is need to fund more research by the government to ensure the information I readily available to the masses. The impetus to be added here is the government’s political will in prioritizing prevention of obesity in the national public health sector. For effective prevention nationwide efforts will require support from the state, and local governments which will commit enough resources for more research, surveillance, programs, dissemination and evaluation. Through schools, the adolescents eating habits and physical activity can be conditioned at a young age (Mahfouz et al. 2011, p.319). School-based interventions, which focus on prevention of obesity, have to target physical activity enhancement of physical activities and healthy nutrition amongst the adolescents. School teachers are essentially useful when it comes to implementing obesity prevention interventions among the adolescents. 16 Main learning from the literature review and the main implications for public health or international development practice 18 The major lessons derived from our literature review suggest that obesity problem among the adolescents have far reaching implications for public health and also the International development practice. Obesity has economic, social and psychological effects due to an individual and the society. Disintegrating the lessons derived suggests that:- 18 Obesity Impacts on the self Esteem and psychology of Individuals 19 Overweight state signals an increase in risks which are medically related. These also expose people to psychosocial problems coming from the widespread prejudice waged against fat people. This particularly occurs among adolescents. Obese people especially teenagers most often suffer from being teased by their peers, or they at times face harassment or discrimination from their own family members. Additionally, apart from the physical implications obesity has on health, obesity brings about a big social burden by obese people who are too lazy to work or maybe too sick (Strauss 2000, p.15). Obesity is sometimes described as “the only remaining acceptable form of social prejudice”. This impedes the treatment of obese and overweight patients. The over shadow by the social and health implications of obesity are an economic cost to any state and to an individual. Obesity account in Saudi Arabia is estimated to be at 2-7% of all the health care expenses every year. Apart from the obesity direct costs there are also costs resulting from impaired performance at school. 19 Obesity is usually associated with excessive morbidity, premature death, and serious psychosocial problems hence its damages causes serious harm to the citizen’s welfare. In economic costs for in-patient there are figures highly recorded for obese people who suffer from diseases. These include type 2 diabetes, heart attack, hypertension, osteoarthritis etc. There are some indirect costs associated with days of work lost due to sicknesses arising from obesity. Output is also foregone due to premature death. By using the UAE environmental method of cost benefit, the deaths resulting from obesity have burdened the state alone may be close to € 4bn every year. 19 Effects on Health, Social and Economic Interests 20 Global Scenario of Adolescent Obesity 22 Conclusion 22 Reference 23 Al-Rukban M 2003, ‘Obesity among Saudi male adolescents in Riyadh, Saudi Arabia’,Saudi Medical Journal, vol. 24, no. 1, pp. 27-33, MEDLINE 24 Al-Hazzaa H, Abahussain N, Al-Sobayel H, Qahwaji D &Musaiger A 2012, ‘Lifestyle factors associated with overweight and obesity among Saudi adolescents’, BMC Public Health, vol. 12, no. 354, pp. 1-22, 24 Al-Hazzaa H, 2007, ‘Rising trends in BMI of Saudi adolescents: evidence from three national cross sectional studies’, Asia Pacific Journal of Clinical Nutrition, vol. 16, no. 3, pp. 462-466, Academic Search Complete. 24 El Ansari, W, El Ashker, S & Moseley, L 2010, ‘Associations between physical activity and health parameters in adolescent pupils in Egypt’, International Journal of Environmental Research and Public Health , vol. 7, no. 4, pp. 1649-1669, MEDLINE. 25 El-Hazmi, M &Warsy, A 2002, ‘The prevalence of obesity and overweight in 1–18-year-old Saudi children’, Annals of Saudi Medicine, vol. 22, no. 5-6, pp. 303-307, MEDLINE 25 Fu, W, Lee, H, Ng, C, Tay, Y, Kau, C &Hong, C 2003, ‘Screening for childhood obesity: international vs population-specific definitions. Which is more appropriate?’, International Journal of Obesity & Related Metabolic Disorders vol. Vol. 27, no.9, pp. 1121 25 Jabbour, S, Giacaman, R &Yamout, R 2012, Public health in the Arab world, Cambridge University Press, Cambridge, UK. 25 Jellalian, E & Steele, R 2008, Handbook of childhood and adolescent obesity, Springer, Hamburg, Germany 25 Lementowski, P &Zelicof, S 2008, ‘Obesity and osteoarthritis,’ American Journal of Orthopaedics [serial on the Internet], vol.37, no.3, pp. 148-151: MEDLINE. 25 Mahfouz , A, Abdelmoneim, I, Khan, M, Asim, D, Daffalla, M &Moussa, H 2008. ‘Obesity and Related Behaviors among Adolescent School Boys in Abha City, Southwestern Saudi Arabia,’Journal Of Tropical Pediatrics, vol. 54, no.2, pp. 120. 25 Mahfouz, A, Shatoor, A, Khan, M, Daffalla, A, Mostafa, O & Hassanein, M 2011, ‘Nutrition, physical activity, and gender risks for adolescent obesity in south-western Saudi Arabia, Saudi Journal of Gastroenterology , vol. 17, no. 5, pp. 318-322   25 Moreno, L, Ahrens, W & Pigeot, I 2011, Epidemiology of obesity in children and adolescents, Springer, Hamburg, Germany. 26 Oxford Business Group 2008, The Report: Saudi Arabia, King Abdulaziz City for Science and Technology, Riyadh. 26 Poirier, P & Eckel, R 2002, ‘Obesity and cardiovascular disease,’ Current Atherosclerosis Reports [serial on the Internet], vol. 4, no. 6, pp. 448-453. Available from: MEDLINE 26 Qahwaji, D 2012, ‘Physical activity patterns and eating habits of male adolescents’, Life Science Journal , vol. 9, no. 2, pp. 1055-1064, 26 Ryan, G & Bernard, H 2003, ‘Techniques to Identify Themes’, Field Methods, vol. 15, no. 1, pp. 85-109. 26 Strauss, R 2000, ‘Childhood obesity and self-esteem,’ Pediatrics [serial on the Internet], vol. 105, no. 1, pp. e15 26 Theodore, H &Tulchinsky, A 2009, The New Public Health, Academic Press, California. 26 Washi, S & Ageib, M 2010, ‘Poor diet quality and food habits are related to impaired nutritional status in 13- to 18-year-old adolescents in Jeddah’, Nutrition Research [serial on the Internet], vol. 30, no. 8, pp. 527-534, CINAHL Plus. 26 Introduction Saudi Arabia is rapidly developing in urbanisation, which affects lifestyle trends and eating habits of Saudi adolescents. Urbanisation has led to the consumption of fast foods, which are usually high in fat and energy content e.g., cakes, chocolate and French fries (Mahfouz et al. 2011, p.13.). In adolescents, obesity causes negative consequences related to mortality and morbidity in adulthood (Al-almaie, M 2005, p. 607.). Prevalence of Obesity in young adolescents has grown to be a major problem in Saudi Arabia and it is turning out to be a serious global epidemic with major implications on the public health situation in the country. This is due to major changes in their nutrition and urbanization at a rapid rate in the latest decades. There are a number of issues whose interplay worsens the obesity situation. Therefore, the issues which apparently emerge out of the situation form the themes relating to obesity and overweight disease. Aims of the Information on Obesity to Aspects of Public Health or International Development This literature narrative review investigates the prevalence of obesity amongst the Saudi adolescent population, identifies the causal factors and associated risks. Additionally, it is essential in developing recommendations on how such life-threatening health issues can be prevented. The aims relate to the themes in that the information on prevalence of obesity in adolescents from different studies point to similar topics making us to draw parallels which would be essential in addressing the problem amongst the adolescents. Investigation of prevalence of obesity in the Saudi adolescent population Obesity prevalence is increasing substantially among the adolescents. The national prevalence baseline rates for obesity and overweight in Saudi adolescents, indicates intermediate levels between industrialized and developing countries. In the recent past, there have been increases in the numbers of overweight adolescents. Obesity is a major contributor’s diseases incidence due to its link to cardiovascular risks like diabetes and hypertension. Studies from the countries east of the Mediterranean indicate the alarming peak of obesity among adolescents and also adults. Non-communicable diseases incidences are very high accounting for over 50% of deaths in the region. Studies have concluded that obese Saudi adolescents’ multiple risk factors are associated with metabolism syndrome. Studies therefore aimed at estimating metabolic abnormalities prevalence among Saudi adolescents point to the association between body composition and obesity abnormalities. Most females are affected to a large extent with this problem due to cultural factors which restrict them from using public facilities for exercises. This particular happens in the urban setting (Jabbour et al. 2012, p. 127). Interventions of curbing the same should therefore lay emphasis on the females so as to reduce the impact of the disease in the country. Childhood obesity is not confined to industrialised countries, as high rates of overweight and obesity are already evident in some developing countries, like Thailand, which exhibited increasing obesity rates among school children 6–12 years of age from 1991 (12.2%) to 1993 (15.6%). Similarly, in 1996, the prevalence of obesity throughout Saudi Arabia was about 15.8% for males ranging from 6 to 18 years of age (Burniat 2002, p. 35). Identification of causal factors and associated risks The prevalence of obesity due to the male and female adolescents is attributed to cultural reasons and urbanization among other factors. The objectives of most of the researches conducted are important in the evaluation of the relationships between several lifestyle factors; for example, sedentary behaviours, physical activity, and diet habits and the measures to take to curb obesity among the Saudi adolescents (Mahfouz 2012, n.pag). Economic development in the country over the past decades has been transformed in terms of the nutrition and lifestyle behaviours. Food is more affordable to most families in relation to income. This has completely changed the food concept from a nourishment means to a lifestyle determinant and source of pleasure. These eating habits coupled with lack of exercises or physical activities have contributed widely to increased obesity prevalence amongst the adolescents. These causal factors have far reaching complications in the adolescent’s metabolism and these increases to a large extent the risk for contracting early cardiovascular disease and type II diabetes. Furthermore, obesity in youth tracks to adulthood. Apart from overall obesity, abdominal obesity has been associated with a rise in cardio-metabolic risk in adolescents (Theodore et al. 2011, p. 527). Current evidence from different studies has indicated that the disease is a condition which is multifactorial and is largely influenced by a number of variables. The mentioned factors including demographic and genetic variables, such as family history, ethnicity, overweight, sex and age cannot be changed. However, the type which is associated with lifestyle factors can be modifiable. This comes as a surprise considering the fact that this nation is an economic powerhouse but is still experiencing vast lifestyle changes over past years leading to increased adolescent obesity. It therefore follows that for a good understanding of the association between lifestyle factors and obesity is essential for effective management and prevention of obesity in the respective groups. In a move to likely improve public health, several measures can be undertaken to better manage and prevent obesity in the region. Development of recommendations of preventing Obesity among adolescents The results of studies related to adolescent obesity conducted in Saudi Arabia have given recommendations which are relevant to public Health and International development. The predominance of obesity has risen at a startling rate over the last years. This has made the problem to be termed as a 'global epidemic' by the WHO and this applies to the Saudi Arabian situation. The disease is a major public health concern throughout Saudi Arabia. From the research, women are at a higher risk of being obese than male adolescents due to cultural and religious beliefs. It has also been established that there are higher incidences of obesity in the lower social-economic groups. The most worrying trend is the fact that obesity is at an epidemic level with body weight being the prevalent disease of adolescents. As much as the public in general has grown increasingly aware of the consequences of obesity to their personal health, what turns out is that generally the public health sector through its policies together with the community at large need to come up with approaches of preventing prevalence of obesity amongst the adolescents. The prevention of obesity should be an action by the public health at a most inclusive and broadest level. For example, the local communities can break away from the traditional norms which discourage their women from participating in sports by encouraging women to participate in sports (El Ansari et al. 2010). The Saudi Arabian government should provide national leadership together with resources for programmes and research to its public health sector so as to reduce the global number of people affected by the disease. In addition, broad and continued campaigns aimed at reducing intake of junky foods intake could be adopted. Most research reports recommended or emphasized comprehensive approaches which range from clinical, educational, economic, regulatory, as well as social strategies which should act as the guiding principle meant to effectively reduce consumption of such processed foods which lead to poor dietary choices. The overwhelming number of overweight and diabetic patients is a challenge to the country’s public health sector. Coupled by a shortage of doctors as well as nurses, the situation is likely to worsen. The country’s private and public sector will have to develop more residency programs and medical schools in the near future to satisfy the country’s medical needs. It is recommended that schools can be used in mitigation of obesity problem because school settings enable engagement of practices which reduce the sedentary lifestyles among the adolescents. Such broad-based approaches are necessary for prevention of adolescent obesity. Across Saudi Arabia, these efforts are taking root. Various recommendations range from adoption of new school policies as well as state legislations as regards to physical education requirements in school (Mahfouz et al, 2011p. 321). These initiatives should aim at controlling the standards for nutrition for foods and beverages which are sold to students in schools. Some initiatives by the community can be geared towards promoting physical activities of young adolescents, for example expanding bike paths and improvement of the recreational facilities for exercises. This should now be the primary focus of public health initiatives in combating prevalence of the disease. Most of the studies conducted still offer very little Information on the association of obesity in line with geographical factors in the region affecting different adolescents in Saudi Arabia. The public initiatives including research have only been restricted in the urban areas where obesity is perceived to be on the increase (Al-Rukban 2003). The data available indicates that unhealthy eating habits and physical inactivity are correlated with BMI of the Saudi adolescents. This has formed the initial fodder for the public health sector in search for a means or combating the scourge. Local studies which use representative samples however together with valid instruments for assessing lifestyle factors are still scarce. Themes The themes drawn from the obesity issue are related to the aims in a way that information gathered from the aims are a reflection of the trend in the issues amongst the adolescent. In addressing the obesity issue, these links would be of great help in crafting interventions based on the themes. Social Determinants of Obesity in Adolescents Generally speaking, lifestyle trends and urbanization are the main contributors of obesity among the Saudi Arabian adolescents. The studies presented by different researches have linked lifestyles patterns with obesity. Al-Hazzaa particularly identified a number of lifestyle factors which are closely associated with the overweight problem among the adolescents. These are supposed to be the most likely targets for management and prevention of obesity among the Saudi adolescents (Al-Hazzaa et al. 2012, P.3). Primary obesity prevention can be achieved by promoting active life styles as well as adopting healthy diets. These should be a national priority or strategy of combating the problem through the public health sector. Obesity usually results due to a number of factors ranging from biological to environmental. In the prevention and management of obesity however, it should be distinguished that obesity which is associated with lifestyle factors is modifiable as opposed to that which is associated with family history. Research in the previous years have revealed that obesity in adolescents is linked with lifestyle factors comprising of life without exercises, being physically inactive as well as unhealthy choices in diets on a large scale and not due to the biological determinants. Information on the lifestyle factors, which are attributed to obesity among adolescents, is currently limited in Saudi Arabia due to limited research. The data available indicates that unhealthy choices in diets and physical inactivity are correlated with the adolescents’ BMI. The continued negligence by parents and a preference for junk food among adolescents have promoted lifestyle trends which worsen the situation. A better understanding of lifestyle factors and their relationship with obesity is essential for effective prevention as well as management of obesity among adolescents (Al-almaie, M 2005, p. 608.). This ought to be a policy issue which will help in improving the situation by the public health sector for better management and prevention of the disease amongst adolescents. Associations of being overweight or obese with several lifestyle factors like physical inactivity, dietary habits and sedentary behaviours among Saudi adolescents is an issue, which needs to be addressed in the primary stage. As far as sedentary behaviours and physical activity are concerned, many adolescents remain indoors and thus spend a bigger part of their time playing video games or watching TV, and this goes for a good number of hours on a daily basis. This situation makes it hard for a big number of girls and boys to engage in any kind exercise. This is a major cause of obesity, especially among the southern Saudi Arabian population (Al-Hazzaa et al. 2012, p. 3). Recommendations for preventing and the managing obesity in adolescents should emphasize on the modification of lifestyles. These include starting with physical activity which is moderated then going to vigorous physical activity. Avoiding unhealthy eating habits, like frequency of fast foods consumption, use of sugar-sweeteners, skipping meals, infrequent fruits and vegetables consumption is another way of prevention of this trend among the young population (Qahwaji 2012, p. 1171). This follows that the primary management strategies of the scourge should be initiated from the family level, through the community then to the state through the public Health sector. The findings that obesity and being overweight is associated with low physical activity levels continue to highlight the importance of the role of physical activity (most especially vigorous exercises) to prevent adolescent obesity (Moreno et al. 2011, p.21). Physical inactivity is the factor leading to obesity in adolescents. Efforts made to tackle obesity in adolescents have to include intervention, research, and education intervention by involving policy makers, educators, health care providers and parents. Socioeconomic Status and Minority Issues Different researchers have found that the adolescent obesity problem relates to socio-economic status as well as race/ethnicity. The adolescents in the Saudi Arabian ethnic populations face potential high risk of obesity, with some cases being related to differences in the socioeconomic status difference among the rural and urban folks. The relationship of socio-economic status and obesity amongst adolescents might not necessarily be consistent with age or gender (Al-almaie, M 2005, p. 609.). Food-intake manners or practices of eating behaviours or contributes to being obese prevalent in adolescents. Minority issues include cultural attitudes as well as beliefs related to obesity altogether. Adoption of western feeding habits including eating junk and processed foods majorly contributes to the obesity problem some issuers of greater relative importance like parental attitudes on eating, weight control and physical activity come into play here. The obesity problem started as a result of the economic booms in oil production, which lead to better socio-economic situations (Al-Saeed et al. 2007, p. 18). Wealth association with obesity is in the sense that with more money, more processed products can be acquired and in the process obesity increases to alarming levels. Gene and Environment Interactions Link with Obesity Certain characteristics in the genetic make-up may increase susceptibility of adolescents to excess body weight/ obesity. However, this susceptibility in the genetic make-up exists together with environmental or behavioural factors. Genetic factors like Prader-Willi syndrome alone cause obesity. The interactions between genetic and environmental factors lead to phenotypic obesity expressions. It should be noted that variants in genetics are associated with adolescent obesity and diabetes (Al-almaie, M 2005, p. 610.). These are closely associated in several families from numerous studies better in an effort to understanding the physiologic and genetic contributions or anticipation of obesity. Through conducting of studies in adolescent obesity, consideration of the genetic factors and mechanisms as well as the pharmacogenomics could be a basis for personalized treatment approaches in the future. Genetic variants together with their risk for comorbidities and obesity associations could be examined (Al-Hazzaa 2007, p.463.). Gender Inequality and Girls’ Obesity The female adolescents in Saudi Arabia are significantly prone to obesity development compared to the males. The increased levels of obesity in female adolescents are attributed to cultural prohibition of physical exercises for girls. The prohibition of physical exercise is an inequality issue in Saudi Arabia which has existed from time in memorial. Obesity is a national public health issue which affects both divides of the population but women including teenagers and adults are on the receiving end to a greater extent. Some cultural practices actually prohibit the opening girl’s schools. To a large extent, nonreligious education is still being regarded unsuitable for girls. Furthermore, girl’s curriculum has for a long time not been as comprehensive as it is being offered in boy's schools. Most schools lack sports education for girls due to prohibition by social norms which restrict them from engaging in physical activities in public places. Additionally, some cultural and religious beliefs increased the susceptibility of women being overweight or obese because the women are prohibited from using public facilities like hotel gyms or physical activity in schools for girls. Some girls avoid exercises due to the fear of changing clothes outside home because of cultural shyness (Al-Saeed Wet al 2007, p. 28). Future actions on the Obesity Issue Policy analyses reveal that the common triggers for public action in line with public health problems are being activated in respect to the obesity epidemic. Disapproval in the social context which shifts social norms, medical research as well as self-help initiatives for obese individuals can form part of the initiatives meant to manage the problem. Widespread and coordinated movements and campaigns, coordinated group advocacy by the International community would likely scale down the scourge (Theodore & Tulchinsky 2009). The public Health sector of Saudi Arabia ought to be put in full place to prevent obesity effectively. Obesity research has been very limited and so there is need to fund more research by the government to ensure the information I readily available to the masses. The impetus to be added here is the government’s political will in prioritizing prevention of obesity in the national public health sector. For effective prevention nationwide efforts will require support from the state, and local governments which will commit enough resources for more research, surveillance, programs, dissemination and evaluation. Through schools, the adolescents eating habits and physical activity can be conditioned at a young age (Mahfouz et al. 2011, p.319). School-based interventions, which focus on prevention of obesity, have to target physical activity enhancement of physical activities and healthy nutrition amongst the adolescents. School teachers are essentially useful when it comes to implementing obesity prevention interventions among the adolescents. Health professionals like social workers and nurses are also important resources for implementing interventions which are school-based. Schools thus have to ensure that messages regarding proper diet are a part of the school environment. It is also the Community organizations and other stakeholders efforts and in examining opportunities for physical activities and healthful diet making them available, accessible, and affordable. Families also have a part to play by making their homes conducive for physical activities and healthful diet. As part of the public health initiatives, individuals, institutions and organizations, across Saudi Arabia need to change some societal norms, which in the long term will help reduce adolescent obesity among the girls who are tied by traditions which precipitate the overweight condition. As the public health sector focuses on addressing the problem of obesity including the cultural and societal issues which lead to excess weight, poor dietary choices, and physical inactivity, other different stakeholders need to make hard choices that are geared to improving the obesity situation. Some researchers have recommended businesses and Industries (especially those dealing with junk, processed foods or canned foods) to re-examine most of their products as well as strategies of marketing them. The local and state governments at the national levels have to consider these factors in setting their priorities for different resources and programs in the public health sector. The Saudi Arabian public health and the global world in general have shifted attention to efforts of obesity prevention efforts. Various interest groups, national governments and intergovernmental organizations based on existing studies have examined a variety of situations aimed at reducing the obesity problem among the adolescents and at the same time proposed actions aimed at reducing the disease prevalence nationally and globally. A number of action plans and strategies have been developed to address some recommendations from research reports. Through these reports, the communities in Saudi Arabia have gained some insights from them with evidence on prevention of obesity, nutrition, and physical activities lessons being learnt by the public health sector in issues of development and action plans for preventing obesity Main learning from the literature review and the main implications for public health or international development practice The major lessons derived from our literature review suggest that obesity problem among the adolescents have far reaching implications for public health and also the International development practice. Obesity has economic, social and psychological effects due to an individual and the society. Disintegrating the lessons derived suggests that:- Obesity Impacts on the self Esteem and psychology of Individuals Overweight state signals an increase in risks which are medically related. These also expose people to psychosocial problems coming from the widespread prejudice waged against fat people. This particularly occurs among adolescents. Obese people especially teenagers most often suffer from being teased by their peers, or they at times face harassment or discrimination from their own family members. Additionally, apart from the physical implications obesity has on health, obesity brings about a big social burden by obese people who are too lazy to work or maybe too sick (Strauss 2000, p.15). Obesity is sometimes described as “the only remaining acceptable form of social prejudice”. This impedes the treatment of obese and overweight patients. The over shadow by the social and health implications of obesity are an economic cost to any state and to an individual. Obesity account in Saudi Arabia is estimated to be at 2-7% of all the health care expenses every year. Apart from the obesity direct costs there are also costs resulting from impaired performance at school. Obesity is usually associated with excessive morbidity, premature death, and serious psychosocial problems hence its damages causes serious harm to the citizen’s welfare. In economic costs for in-patient there are figures highly recorded for obese people who suffer from diseases. These include type 2 diabetes, heart attack, hypertension, osteoarthritis etc. There are some indirect costs associated with days of work lost due to sicknesses arising from obesity. Output is also foregone due to premature death. By using the UAE environmental method of cost benefit, the deaths resulting from obesity have burdened the state alone may be close to € 4bn every year. Effects on Health, Social and Economic Interests Obesity negative health effects are unending and they result in economic and social consequences. Morbidity and Mortality rates among obese and overweight people are higher than it is for lean people. The initial problems, which occur in adolescents who are obese, are usually emotional or psychological. Psychological interventions conducted on obese individuals show that loss of weight is associated with a social functioning and an improved self-esteem. A study by Strauss investigating the association between obesity and self-esteem reported that low self-esteem levels among obese adolescents brought loneliness, nervousness and more sadness resulting to depression (Strauss 2000, p.16). Obesity however also leads to, high blood pressure, diabetes, early puberty, skin infections, sleep problems, heart disease, cancer, liver disease, eating disorders, such as bulimia and anorexia, asthma and problems of the respiratory system. Some studies have indicated a close connection between cancer and obesity. These cancer types include oesophagus, colon, liver, kidney, gallbladder, breast and pancreas. The mechanisms possible for these negative implications are due to carcinogenic ingredients in food and an increased calorie amount in food. Additionally, an increased adipose tissue which accumulates on skin adversely affects the endocrine functions of the skin causing changes in growth and hormone factor secretions, which eventually leads to cell proliferation, inflammation, carcinogenesis and oxidative stress. Bergström report suggested that individuals who face the overweight risk and being obese increases the susceptibility to contracting kidney cancer at 1.5 to 3 times more compared with people who have a normal BMI. Atherosclerosis condition has been documented to be more frequent in overweight adolescents. The overweight likelihood is at 2 - 4 times more at risk of developing. The frequency of contracting type-2 diabetes is higher in obese and overweight adolescents. Metabolic syndrome like hyperinsulinemia has been reported among the Asian adolescents at low BMI’s when compared to Caucasians. This may be probably due to greater central obesity and more body fat. Obesity in adolescents has been proven to increase mortality rates upon adulthood. Modest reduction of weight significantly reduces risks of serious conditions of health. Obesity as a chronic metabolic condition increases cardiovascular diseases risk for example, stroke, coronary artery disease, and atherosclerosis. The conditions mentioned are as a result of accumulation of excess adipose tissue, which in a negative way affects the cardiac function and structure. Additionally, obesity causes Hypertension which is another complications resulting from of obesity (Poirier & Eckel 2002, p. 4.). Research on obesity and hypertension school-based study among young adolescents with findings suggests that prevalence of these diseases was three times higher among obese adolescents compared to non-obese students. A systemic review by Fu, Lee and Tay aimed to investigate blood pressure from childhood as well as adolescent going into adulthood. The authors report was that children with a higher blood pressure in the adolescent period exhibited a higher susceptibility of developing hypertension later in their adult life. There is a link between diabetes mellitus and obesity. Information from the National Health and Nutrition Examination Survey on National Health results has proved that diabetes mellitus risk raised by 4.5% for every kilogram of increased weight in an individual's weight. The condition is due to a rise in deposition of adipose tissue fat over a period of time. A rise in abdominal fat together with other influences for example genetic conditions do interfere with resistance of insulin leading to inflammation and hyperglycaemia which results to type 2 diabetes. Studies investigating the link between diabetes mellitus and obesity among adolescents have found that diabetes mellitus prevalence increased among the study subjects. This indicated that shedding weight for individuals who face overweight risks or obesity significantly reduced the diabetes incidence (Lementowski & Zelicof 2008, p. 5.). Global Scenario of Adolescent Obesity Obesity has increased to epidemic heights in the developed countries on the globe. The Saudi Arabian country is said to be the third leading country in prevalence of obesity in the whole world. The WHO estimates that 35.6 % of its population is overweight (Oxford Business Group 2008, p. 181.). Close to 90,000 patients are diabetic in the country owing to excess consumption of sugary food products. Obesity has been declared by the World health organization to be among the highly neglected diseases which impact on the international public health. The fifth listing of obesity by the World Health Report of 2002 confirms the seriousness of the disease in developed countries over the past years. The rates have significantly increased as at now. Conclusion Obesity in young adolescents has grown to be a major problem in Saudi Arabia and it is turning out to be a serious global epidemic with major implications on the public health situation in the country. The important themes derived from the obesity situation are: Lifestyle trends and urbanization, cultural aspects, socio-economic effects among others. The information generated is important for the public health sector in formulation of policies aimed at mitigating the disease among the adolescents in Saudi Arabia. Obesity has impacts on the psychological, physical, and socio-economic conditions of the Saudi Arabian people affected by the scourge. These effects areas well translated in the global standings of prevalence of the disease. Reference Abahussain, A, Abdulrahman, O,Musaiger, J & Nicholls, 1999. "Nutritional status of adolescent girls in the Eastern Province of Saudi Arabia." Nutrition and health 13, no. 3, pp.171-177. Acton, A (ed) 2012, Issues in Eating Disorders, Nutrition, and Digestive Medicine: 2011 Edition, Scholalry Editions, Atlanta, Georgia Al-almaie, M 2005, ‘Prevalence of obesity and overweight among Saudi adolescents in Eastern Saudi Arabia,’ Saudi medical journal 26, no. 4, pp. 607-611. Al-Rukban M 2003, ‘Obesity among Saudi male adolescents in Riyadh, Saudi Arabia’,Saudi Medical Journal, vol. 24, no. 1, pp. 27-33, MEDLINE Al-Hazzaa H, Abahussain N, Al-Sobayel H, Qahwaji D &Musaiger A 2012, ‘Lifestyle factors associated with overweight and obesity among Saudi adolescents’, BMC Public Health, vol. 12, no. 354, pp. 1-22, Al-Hazzaa H, 2007, ‘Rising trends in BMI of Saudi adolescents: evidence from three national cross sectional studies’, Asia Pacific Journal of Clinical Nutrition, vol. 16, no. 3, pp. 462-466, Academic Search Complete. Al-Hazzaa, H 2004, "Prevalence of physical inactivity in Saudi Arabia: a brief review." Eastern Mediterranean Health Journal 10, no. 4/5 : 663-670. Al-Rukban, O 2003, "Obesity among Saudi male adolescents in Riyadh, Saudi Arabia." Saudi medical journal 24, no. 1, pp. 27-33 Al-Saeed W, Al-Dawood K, Bukhari I &Bahnassy A 2007, ‘Prevalence and socioeconomic risk factors of obesity among urban female students in Al-Khobar city, Eastern Saudi Arabia, 2003’, Obesity Reviews, vol. 8, no. 2, pp. 93-99, Academic Search Complete El Ansari, W, El Ashker, S & Moseley, L 2010, ‘Associations between physical activity and health parameters in adolescent pupils in Egypt’, International Journal of Environmental Research and Public Health , vol. 7, no. 4, pp. 1649-1669, MEDLINE. El-Hazmi, M &Warsy, A 2002, ‘The prevalence of obesity and overweight in 1–18-year-old Saudi children’, Annals of Saudi Medicine, vol. 22, no. 5-6, pp. 303-307, MEDLINE Fu, W, Lee, H, Ng, C, Tay, Y, Kau, C &Hong, C 2003, ‘Screening for childhood obesity: international vs population-specific definitions. Which is more appropriate?’, International Journal of Obesity & Related Metabolic Disorders vol. Vol. 27, no.9, pp. 1121 Jabbour, S, Giacaman, R &Yamout, R 2012, Public health in the Arab world, Cambridge University Press, Cambridge, UK. Jellalian, E & Steele, R 2008, Handbook of childhood and adolescent obesity, Springer, Hamburg, Germany Lementowski, P &Zelicof, S 2008, ‘Obesity and osteoarthritis,’ American Journal of Orthopaedics [serial on the Internet], vol.37, no.3, pp. 148-151: MEDLINE. Mahfouz , A, Abdelmoneim, I, Khan, M, Asim, D, Daffalla, M &Moussa, H 2008. ‘Obesity and Related Behaviors among Adolescent School Boys in Abha City, Southwestern Saudi Arabia,’Journal Of Tropical Pediatrics, vol. 54, no.2, pp. 120. Mahfouz, A, Shatoor, A, Khan, M, Daffalla, A, Mostafa, O & Hassanein, M 2011, ‘Nutrition, physical activity, and gender risks for adolescent obesity in south-western Saudi Arabia, Saudi Journal of Gastroenterology , vol. 17, no. 5, pp. 318-322   Moreno, L, Ahrens, W & Pigeot, I 2011, Epidemiology of obesity in children and adolescents, Springer, Hamburg, Germany. Oxford Business Group 2008, The Report: Saudi Arabia, King Abdulaziz City for Science and Technology, Riyadh. Poirier, P & Eckel, R 2002, ‘Obesity and cardiovascular disease,’ Current Atherosclerosis Reports [serial on the Internet], vol. 4, no. 6, pp. 448-453. Available from: MEDLINE Qahwaji, D 2012, ‘Physical activity patterns and eating habits of male adolescents’, Life Science Journal , vol. 9, no. 2, pp. 1055-1064, Ryan, G & Bernard, H 2003, ‘Techniques to Identify Themes’, Field Methods, vol. 15, no. 1, pp. 85-109. Strauss, R 2000, ‘Childhood obesity and self-esteem,’ Pediatrics [serial on the Internet], vol. 105, no. 1, pp. e15 Theodore, H &Tulchinsky, A 2009, The New Public Health, Academic Press, California. Washi, S & Ageib, M 2010, ‘Poor diet quality and food habits are related to impaired nutritional status in 13- to 18-year-old adolescents in Jeddah’, Nutrition Research [serial on the Internet], vol. 30, no. 8, pp. 527-534, CINAHL Plus. Read More

Most females are affected to a large extent with this problem due to cultural factors which restrict them from using public facilities for exercises. This particular happens in the urban setting (Jabbour et al. 2012, p. 127). Interventions of curbing the same should therefore lay emphasis on the females so as to reduce the impact of the disease in the country. Childhood obesity is not confined to industrialised countries, as high rates of overweight and obesity are already evident in some developing countries, like Thailand, which exhibited increasing obesity rates among school children 6–12 years of age from 1991 (12.2%) to 1993 (15.6%). Similarly, in 1996, the prevalence of obesity throughout Saudi Arabia was about 15.

8% for males ranging from 6 to 18 years of age (Burniat 2002, p. 35). Identification of causal factors and associated risks The prevalence of obesity due to the male and female adolescents is attributed to cultural reasons and urbanization among other factors. The objectives of most of the researches conducted are important in the evaluation of the relationships between several lifestyle factors; for example, sedentary behaviours, physical activity, and diet habits and the measures to take to curb obesity among the Saudi adolescents (Mahfouz 2012, n.pag). Economic development in the country over the past decades has been transformed in terms of the nutrition and lifestyle behaviours.

Food is more affordable to most families in relation to income. This has completely changed the food concept from a nourishment means to a lifestyle determinant and source of pleasure. These eating habits coupled with lack of exercises or physical activities have contributed widely to increased obesity prevalence amongst the adolescents. These causal factors have far reaching complications in the adolescent’s metabolism and these increases to a large extent the risk for contracting early cardiovascular disease and type II diabetes.

Furthermore, obesity in youth tracks to adulthood. Apart from overall obesity, abdominal obesity has been associated with a rise in cardio-metabolic risk in adolescents (Theodore et al. 2011, p. 527). Current evidence from different studies has indicated that the disease is a condition which is multifactorial and is largely influenced by a number of variables. The mentioned factors including demographic and genetic variables, such as family history, ethnicity, overweight, sex and age cannot be changed.

However, the type which is associated with lifestyle factors can be modifiable. This comes as a surprise considering the fact that this nation is an economic powerhouse but is still experiencing vast lifestyle changes over past years leading to increased adolescent obesity. It therefore follows that for a good understanding of the association between lifestyle factors and obesity is essential for effective management and prevention of obesity in the respective groups. In a move to likely improve public health, several measures can be undertaken to better manage and prevent obesity in the region.

Development of recommendations of preventing Obesity among adolescents The results of studies related to adolescent obesity conducted in Saudi Arabia have given recommendations which are relevant to public Health and International development. The predominance of obesity has risen at a startling rate over the last years. This has made the problem to be termed as a 'global epidemic' by the WHO and this applies to the Saudi Arabian situation. The disease is a major public health concern throughout Saudi Arabia.

From the research, women are at a higher risk of being obese than male adolescents due to cultural and religious beliefs. It has also been established that there are higher incidences of obesity in the lower social-economic groups. The most worrying trend is the fact that obesity is at an epidemic level with body weight being the prevalent disease of adolescents. As much as the public in general has grown increasingly aware of the consequences of obesity to their personal health, what turns out is that generally the public health sector through its policies together with the community at large need to come up with approaches of preventing prevalence of obesity amongst the adolescents.

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