Childhood Obesity in Saudi Arabia - Prevalence and Intervention - Essay Example

Childhood Obesity in Saudi Arabia: Prevalence and Intervention Introduction Childhood obesity (CHO) has become an increasingly severe problem acrossthe globe, especially in industrialized countries. In the 21st century, according to WHO (2013), childhood obesity has emerged as a worldwide public health issue, and it is among the major public health issues in Saudi Arabia(Mouzan et al. 2010). The prevalence of childhood obesity in SAhas beenlinked to the rapid rise in wealth during the oil boomin the 1930s. According to Alshibani (2012), in the Gulf area, Saudi Arabia leads in fast food consumption, which isknown to be the major cause of obesity and overweight. According to news reportsin 2008, 29/60of fast food manufacturers in the Gulf area werelocated in SA. The rise of CHO in Saudi Arabia is alarming because the nation was initially strict with regard to food consumption. In 2007, Saudi Arabia was ranked 29th on the Forbes’ list ofthe fattest nations.More than 2/3 of the population was consideredobese, exceeding the BMI threshold of 25 (Alshibani 2012). As reported in the news,anutritional journal revealed that one child out of every six between the ages of 6 and 18 is obese. Research has shownthat adulthood obesity is connected tochildhood obesity. Consequently, there has been an increase in the prevalence of obesity-associated conditions, such as diabetes, cardiovascular diseases, and hypertension, which are the major causes of deaths and kidney failure in SA. Other consequences of obesity include psychological, economic, and physical effects. The self-esteem of the victim deteriorates, which affectsboth cognitive and social growth. In recent years, the incidence of obesity in SA has risen among all age groups throughout the nation. Currently, it is estimated that 60% of the population in Saudi Arabia is overweight. However, according to King Saud University (2011), cases reported concerning children and adolescents are more alarming because thisgroup comprises above 50% of Saudi population. According to Amin, Al-Sultan, and Ali (2008), one out of every six children between 6 and 18 years in SA is obese. The rate appears to increase with the age according to Al-Othaimeen, Al-Nozha and Osman (2007). Consequently, it is paramount to define obesity and overweight.Although the definition has changed with time,itrefersto a surplus of body fat (BF). However, the cut off point for surplus fat in children has not been agreed. A study byDehghan, Akhtar-Danesh, and Merchant (2005) measured the thickness of skin in children 5 to 18 years and made classifications according to whetherthe percentage of fat was equal to or more than 25% inmales and 30% infemales. On the other hand, the CDC definition of obesity is overweight at or more than the 95th percentile of age BMI, which is comparable to the WHO definition. Additionally, it is classified as the risk of being overweight in the same percentile range. Aims To Explore the Determinants of Childhood Obesity in Saudi Arabia The first objective is to explore the determinants ofobesity. The literature reviewed indicatedthat childhood obesity in children 5 to 12 years is greaterthan in other age groups. It is possible thatchanges in lifestyle are a main contributor to this increase becauseparents feedtheir children fatty foods, which are believed to be a cause of overweight and obesity. Furthermore, contemporary parents have no time to ensure that their children get enough exercise. In addition, genetics are viewed asplaying a major role in enhancing the development of obesity. Therefore, lifestyle changes and genetics are the major determinants addressed in the present study. According to Madani (2000), determinants of obesity are present at an early stage in life because of cultural, genetic, andbehavioral factors. Although much of the existing research indicates that intervention can be done early because of the early occurrence of obesity, the challenge is to identifyand interveneappropriately withoutleading to serious health implications forthe public. The literature review revealed that most studies have found that lifestyle is the major determinant of childhood obesity. For instance, Alam (2008) revealed that among the 89.2% of students suffering from obesity exercised, but they often ate junk food while watching TV. Similarly, Washi and Egeib (2010) found a rise in childhood obesity in Saudi and concluded that lifestyle is the major cause. However, the literature reviewed lacks clear findings with regard to genetic causes.Apart from amention in the abstract, the literature review showed no connection. Nonetheless, this does not mean that genetics are not involved but a gap exists in the relevant literature. Hence, genetics are discussed as a determinant of childhood obesity. To Explore the Effects of CHO The second consideration is the outcome of childhood obesity.It is widely known that obesity has negative effects on children psychologically, physically, and economically. The obese child’s self-esteem is lowered because he or sherealizesthat his or her body is disfigured by layers of fat. However, children between 5 and 12 years are not asconscious of their body as adolescents are although they risk going into that stage in the same condition. Notably, childhood obesity usually persistsintoadulthood, and therefore, many adults are prone to conditions related to overweight. They may also suffer CVDs, osteoarthritis, andsome kinds of cancer. In essence, the epidemic of obesity has causeda considerable decline in both qualityof life and life expectancy, which has affected the provision of care and contributed to rising costs of health care. Hence, because of the complexity oftreating obesity later in life as well as related prolonged outcomes of childhood obesity, prevention during childhood has become a priority for public health. To Explore the Interventions of Reducing CHO Becausechildhood obesity is in the epidemic stage, interventions to manage or reduce it are paramount. Because childhood obesity is not a new issue, attempts have been made to control it, but little has been achieved in terms of eliminating the condition; instead it has increased over the years. In this regard, Muller et al. (2001) and Dehghan, Akhtar-Danesh, and Merchant (2005) promoted the idea that prevention is the best strategy to controlthe obesity epidemic. This is in agreement with other researchers and cliniciansin public health. Dehghan, Akhtar-Danesh, and Merchant (2005) agreed with AlMarzooqi and Naggi (2011) that to prevent childhood obesity, primary and secondary interventions are necessary. Individuals should avoid regaining weight after losing it. Scholars claim that most strategies point to behavioural transformation with regard to diet as well as exercise. According to Dehghan and Merchant (2005), children require strategies in order for all partakers, such as care providers, educators, parents, and policy makers to take part in fighting obesity in children. Fortunately, these strategies have shown some effectivenessin reducing the epidemic, although very little. Themes Determinants of Childhood Obesity Genetics According to Ahmad, Ahmad, and Ahmad (2010), there is an interplay between genetics and environmental factorsin causing childhood obesity. Individuals are predisposed to obesity by polymorphisms in numerous genes that control appetite and metabolism. The condition is a major characteristic of numerous rare genetic illnesses, which often manifests in childhood (Farooqi&O’Rahilly 2006). According to Farooqi and O’Rahilly (2006), 7% of children that suffer the early onset of obesity harbour one locus mutation. This percentage also applies when the onset is before10 years of age in those with an above normal BMI of 3 sd.The children of two obese parents have a greater likelihood of becoming obese than do children of normal-weight parents (Kolata 2007). The findings of previous studies vary with regard to percentages of obesity that are attributable to genetics—from 6% to 85%. Fast Food and Soft Drink Consumption The determinants of childhood obesity related to diet in Saudi Arabia are the consumption of fast food and soft drinks, physical inactivity, excess television viewing,sedentary lifestyles, and lack of parental awareness ofthe effects of food on weight gain. These factors have led to an increased rate of child obesity in SA. Al-Dossary, Sarkis, Hassan et al. (2010) noted that over 50% of children between 14 and 18 years weighed above the 85th percentile.The rise in the consumption of fast food and sugary drinks among children hashad a direct impact on child obesity in SA. In recent years, the fast food culture in Saudi Arabia has developed such that when children are hungry they eat pizzas, burgers, pastries, samosas, fries, and quench their thirst with soft drinks. Such eating habits have led to obesity. Some properties of fast food, including fatty acid composition and high glycemic index usually cause excess blood insulin and lead to insulin resistance development. Insulin resistance is manifested in weight gain, particularly around the abdomen, and it can cause high cholesterol levels, heart disease, high blood pressure, and type 2 diabetes. The consumption of sugary drinks and fast foods usually affects the neurochemical processes in the body, which in turn lead to a vicious cycle of increasinghunger that is not satisfied. Moreover, soft drinks are very high in calories. According to Paarlberg (2010), specialists have calculated that the current obesity epidemic can be accounted for by the consumption of a single extra 20-ounce soft drink every day. Lack of Physical Activity Physical inactivity is also a key determinant of child obesity in SA. According to Sharma (2007), most cases involving obesity and overweight result from excess energy/calorie intake as well as low physical activity levels and sedentary lifestyles. As physical activity decreases, energy expenditure also decreases. Al-Hazzaa (2006) noted that physical inactivity and obesity among children area predicament faced by Saudis. Instead of participating in active physical games,children live static lifestyles, either watching TV or playing computer games for long periods. Their bodies fail to get the exercise required for the maximum expenditure of energy. Furthermore,while watching TV, they munch on snacks, which increases their calorie intake and leads to obesity. Physical inactivity is also a consequence of limited playtime.Because more importance is placed on academic results, most children spend their time studying, whichleaves little or no time to play. The increase in the use of vehicles has also made children lazy, as they do not have to walk even short distances. Al-Hazzaa and Al-Rasheedi (2007) noted that a significant number of Saudi children are obese because of physical inactivity. Taking part in health-improving physical activities is an important determinant of energy use in children, causingan improved metabolic rate, cardiovascular fitness, and improved bone health. Sixty per cent of children in Saudi Arabia do not take part in physical activities of sufficient frequency and duration (Al-Hazzaa, 2002). Regular physical activity is imperative in reducing weight and improving insulin sensitivity among children with diabetes. Children should take part in unorganized play, especially on flat surfaces with few instructionsorvariables.Appropriate activities include throwing, running, tumbling, and swimming. Effect of Television Viewing and Advertisement Most children spend most of their time watching TV and other sedentary entertainment activities, such as playing computer and video games. On average, children 5 to 12 years in SA spend about six hours every day in front of screens (Baker et al. 2005). These sedentary pursuits have replaced behaviors that are more active, which has led to a decrease in energy expenditure. Lack of proper engagement in physical activities has led to higher likelihoods that children live less healthy lives. Children are more sedentary because of the extensive availability of computers, TVs, video games, and videos, among other forms of entertainment. Because of the sedentary lifestyle,the energy intake is significantly higher thantheenergy expenditure. Lack of Parental Awareness Parents offer their children unhealthy foods as rewards.For instance, they offer their children sweets as a reward for cleaning their room or they are taken for ice cream or pizza after winning a game (King Saud University, 2011). Gronbaek (2008) argued that most families with obese children usually specify dietary factors as having played a major role in the development of child obesity, including too much unhealthy food, such as cake, ice cream, and candy. Because of this lack of awareness, parents promote unhealthy eating habits, which leads to obesity. Some parents may also serve large portions of unhealthy foods instead of serving appropriate portions of healthy and nutritious foods. Cooking with unhealthy food products, such as chocolate, butter, and sugar, also leads to obesity. Not onlyparents but also society’s attitude to food often leads to theoverconsumption of fast food. Because parents fail to teach their children about good eating habits, most children are not aware about what constitutes good nutrition. Parents’ perception regarding healthy eating practices can positively influence children’s eating patterns and thus their weight. Because most children spend much time at home in the company of their parents and family,they develop consumption patterns based on the way their parents interact with food. Tibbs, Haire-Joshu and Schechtman (2001) assessed the impact of parental modeling on the food intake by children using questionnaires and multiple surveys.They found that parents reported more incidences ofeating together with their children or consuming meals that they wanted their children to consume. Nonetheless, they rarely modeled the eating of low-fat foods as snacks and did not show readiness to establish rules on the quantity of vegetables and fruit that their children should consume. Hence, it is reasonable to conclude that most parents are frequently inconsistent in modelling healthy eating behaviours fortheir children. Most parents fail to follow the recommended guidelines on the consumption of fruit, fats, and vegetables. Children thereforeconsume unhealthy foods because they do not learn or internalize proper dietary guidelines from their parents. Parents should set strict rules and keenly encourage and practice healthy eating practices when their children are still very young, which is also very valuable in preventing child diabetes. Effects of Childhood Obesity in Saudi Arabia Disease According to Amin, Al-Sultan, and Ali (2008), childhood obesity in SA is linked to various chronic diseases. Its prevalence has been used as an indicator for the status of health among children. According to WHO (2013), obesity in children 5 to 12 years is the cause of communicable diseases. Childhood obesity is also to blame for the rise inconditions, such as hypercholesterolemia, cardiovascular diseases, type 2 diabetes mellitus and hypertension, which develop when the obese child grows into adulthood (Madani 2000). These conditions were initially observed only in adults in SA, but currently they are commonly noted among children because of the prevalence of cases of childhood obesity. Hence, obesity isa major predisposing factor in chronic diseases among children in SAand cannot be overlooked. Parents need to be trained in providing their children with a proper healthy diet in order to prevent diseases related to childhood obesity. Social and Emotional Problems A study on primary schooling children in Al-Hassa indicated that the prevalence of Saudi Arabian childhood obesity is to blame for rising social and emotional problems among the affected children (Amin, Al-Sultan & Ali 2008). The majority of affected children experiencea variety of psychological and social problems. Childhood obesity affects self-esteem, and it has been shown to have a negative effect on the social and cognitive development of these children (Ahmad, Ahmad & Ahmad 2010). Obese childrenare sometimes mocked by their schoolmates, which leadsto low self-esteem and antisocial behaviour. These children feel alienated and may develop emotional problems that may affect their learning in both school and society. Children develop emotional depression, which not only affects the child but also theparents.The child cannot concentrate in school or other activities. Theparents worry about their child’s deteriorating self-esteem and safety. The child may develop long-term chronic anxiety and depression because of social discrimination and stigmatization. Financial Burdens on the Saudi government The Saudi government has recently injected an enormous amount of funds intothehealth sector to deal with childhood diseases linked to obesity, such as diabetes and hypertension. According to WHO, the government of Saudi Arabia has spent over SR30 billion annually on the treatment of complications related to childhood obesity (Ameninfo, 2013).Through the Saudi health ministry,the government has warned parents against the unhealthy feeding of their children. The government claims to contribute SR500 annually tocurb complications related to diabetes caused by childhood obesity.According to Saudi government financial reports, expenditures have ranged between SR98, 000and SR180, 000 in the treatment of patients experiencing renal complications. Becoming Obese Adults Obese childrenare likely to become obese adults. Consequently, childhood obesity has numerous social, health, emotional and economic implications. In many cases, childhood obesity persists in adulthood. An obese adult is prone to various healthcomplications related to cardiovascular diseases, diabetes, hyperlipidaemia, hypercholesterolemia, and hypertension among others. Infertility, certain types of cancer and osteoarthritis have also been observed among affected adults. The consequences of the epidemic of adult obesity include decreased life expectancy of affected individuals. Obesity entails large expenses for health care (Amin, Al-Sultan & Ali 2008), which affects the economic life of these adults. Affected adults are also faced with social and psychological problems, such as depression, employer discrimination, and work impairment. Intervention The rising crisis of childhood obesity in SA calls for preventative measures that will curb thiscondition. According to Lobstein, Baur and Uauy (2004), prevention is the only feasible solution to childhood obesity. Several measures are required toprevent childhood obesity. First, parents should improve theircapacity to support their children in changing, which in turn requires the support of the school and the community. For instance, schools should formulate policies to promote health with regard to diet and exercise. Additionally, peer groups should have beliefs that help the child.Consequently, the cultural values, traditional practices, andsocial attitudestransmitted by the schools should be conducive to promotinghealth. The community should be the first to ensure asupportive environment. Furthermore, safety policies in the neighbourhood should be adhered to,andthe streets and recreational facilities should be secure. In this regard, the municipal and regional authorities should be at the fore in upholding such policies, such as ensuring that the infrastructure is of high quality. They can also ensure that national and global entities that set these standards and offerservices promoteimproved public health and commercial practices, which would enhance the consistent promotion of healthy choices. Moreover, the choices may need legislative as well as regulatory support to resource and execute strategies to reduce obesity. Hence, they could ensure that necessary control measures are imposed, which should not contradict other government policies. Indeed, other policies should also be evaluated for their influence on health in order to ensure that all factors that could contribute to reducingobesity are addressed, such as education and transport policies (WHO 2010). For instance, the food supplied to the schools should be in line with official health and nutrition policies. There should be increased accessibility to necessary goods as well as services in addition to increased household revenue and improved living standards. With regard to different cultural practices in SA, lifestyle changes may include a decline in the time spent preparing food at home, thus raising the intake of processed and catered food.Furthermore, increasedmechanization ofhome chores, dependence on cars, and access to TVs and computers unavoidably affect social values and cultural norms regarding eating and exercise in families, at school, inwork environments and society. Severalprinciples have been formulated to establish obesity prevention at the community level. First, because education alone cannot transform the behaviours associated with overweight, interventions inthe environment and society are needed to promote and maintain behavioural change. Second, action is needed tointegratephysical activity into everyday life, not only during leisure time. Third, program sustainability is vital in enabling positive transformations in activity, obesity levels, and diet over time. Fourth, to ensure success, there should be support and collaboration amongpoliticians, the community, and all sectors of society. Fifth, programs couldbe tailored through local actionto implement national initiatives to satisfy real requirements, anticipations, and opportunities. The sixth principle entails reaching all sections of the community. Seventh, the formulated programs should be resourced sufficiently. Eighth, if necessary, programs should be incorporated into the initiatives that already exist. Ninth, these programs ought to reinforce the theory and evidence that is already known. Last, these programs should be closely scrutinized, assessed, and documented in order to disseminate information about their outcomes. Among the above approaches, those that particularly affect children are the following: changing food and exercise choices in schools, promoting walking infrastructure, providing safe access to infrastructures, and creatingaffordable outdoor play areas. In addition, food advertisements should be controlled, especially those aimedat children. These recommended approaches aimto stimulateregional, local, and national initiatives, which are appropriate for their context and offer a program that works (WHO 2010). The initiativesthat address the issue of increasing childhood obesity should be appropriate to their target. The Saudi Arabian government should incorporate preventative measures, such as nutrition, into relevant programs, such as enabling low-income families to buy micronutrient-rich foods with low levels of fat and sugars. They should enable the population to decrease their reliance on sugary soft drinks by offering water that the entire community can afford. Children can be encouraged to cycle or walk instead of using vehicles to travelshort distances (AlMarzooqi& Nagy 2011). Food outlets should be encouraged to prepare nutritious foods and sell them at affordable prices. The media should be encouraged to advertise healthy lifestyles and sensitize consumers tomaking the right choices. Moreover, the support of NGOswould be helpful in promoting healthy living; for instance, they couldtrain the community in the importance of monitoringtheir diets and maintaining a healthy body. Schools, neighbours, and workplaces should be training grounds for proper nutrition and preventative measures to ensure that all children are safe from obesity. Main Learning from the Literature Review and the Main Implications for Public Health and International Development Practice The literature review providedevidenceof the increasedprevalence of childhood obesity in Saudi Arabia.Hence, there is need to mitigate this increasebyensuring that children consume healthier food, take part in physical activities, and reduce sedentary activities.Measures to reduce childhood obesity should include increasing parental awareness of healthy food practices. Intervention strategies are important inboth primary and secondary schools to reduce the prevalence of obesity amongchildren. Adherence to such intervention strategies wouldreduce the prevalence of child diabetes in Saudi Arabia. There is need for government intervention in schools and parental involvement at home. Dossary et al. (2012) noted the need for interventions in curbing childhood diabetes, and they emphasizedthat interventions likely to encourage healthy lifestyles inschool-agedchildren are required at the national level, which would ensure their implementation and maintenance. Such intervention practices may also be applied at the international level to curb the increasing rates of diabetes worldwide. Conclusion According to previous research, obesity is a chronic condition with many causes. The condition in children between 5 and 12 years in Saudi Arabia significantly influences physical and psychological health. Additionally, obese children frequently suffer psychological conditions, such as depression.These children are more likelyto develop cardiovascular and digestive conditions during adulthood than children of normal weight are.The research shows that over-consumption of calories and decliningphysical exercise are major determinants of childhood obesity. The chief plan for intervention to control the present obesity epidemic may be either primary or secondary. Because these strategies are effective in children, prevention should begin early in life instead offocussing on adult obesitywhencontrol is difficult. Numerous potentially efficient plans may be executed to target diet, exercise, and the built environment. These strategies should be started at home as well as in preschools,primary schools, and care services after school because natural surroundings also influence the diet of children. 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