(1996). In this study, weight, height, and dietary patterns were obtained from 540 adolescent girls aged 12 to 18 years. These researchers used the body mass index of the National Health and Nutrition Examination Survey (NHANESI) as their reference for adolescence (Madani et al., 1996). The respective prevalence rates among this sample was found to be 14.7% underweight (<15th percentiles), 69.0% normal weight (15th-85th percentiles) and 16.3% overweight or obese (>85th percentiles). Based on these findings, Madani and his associates posited that the dietary practices of Saudi adolescents were comparable to their peers in other developed countries in the West and may reflect a tendency on the part of Saudi youth to adopt more Western-like lifestyles.
Al-Abbad (1995) assessed the prevalence of obesity and a number of the condition's associated risk factors following the same criteria used in the Madani et al. (1996) study. In Al-Abbad's analysis, 700 randomly selected students from six female intermediate and high schools in Al-Khobar city ranging in age from 11 to 21 years were evaluated. This researcher determined that the respective prevalence rates of underweight, normal, and overweight/obesity were 11.3%, 60.1% and 28.6% among this sample (Al-Abbad, 1995). Based on these alarming findings, Al-Abbad stressed the need for developing a nation-wide overweight prevention initiative to help all Saudi citizens, but especially young Saudis, achieve normal weight levels and develop a health lifestyle.
Finally, a study by Al-Nuaim et al. (1996) evaluated the prevalence of overweight and obesity (defined as children who weighed more than 120% of the expected median percentile of the reference population, and overweight as 110-120%) among 9,061 male school children ranging in age from 6 to18 years of age in Saudi Arabia. Exclusion criteria in this study were potential subjects with chronic or acute diseases. The percentage of expected BMI at the 50th percentile for each of the age groups was calculated using the 50th percentile of the National Center for Health Statistics/Center for Disease Control (NCHS/CDC) reference population for the expected standard population values (Al-Nauim et al., 1996). These researchers determined that the overall prevalence of overweight among the sample was 11.7% and obesity was 15.8% (Al-Nauim et al., 1996). Based on these findings, the authors concluded that there is a glaring need for early health education initiatives to help young people in Saudi Arabia make the healthy choices that are needed to improve their diet, development, overall health and longevity (Al-Nauim et al., 1996).
To gain an overall picture of the research to date, the results of these foregoing studies are recapitulated and summarized in Table 2 below.
Recapitulation and summary of obesity-related studies of Saudi youth
The prevalence of obesity in Saudi Arabia ranged between 14% in children younger than 6 years of age to approximately 83% in adults.
Saudi females are more prone to becoming overweight or obese than males.
Abahussain et al. (1999)
11% were underweight, 61% were normal weight and 28% were overweight or obese.
Subjects were 676 Saudi adolescent girls ranging in age from 12 to 19 years residing in Al-Khobar city, located in Saudi Arabia's Eastern Province.
Madani et al. (1996)
The prevalence rates among this sample was found to be 14.7% underweight (<15th percentiles), 69.0% normal weight (15th-85th percentiles) and 16.3% overweight or obese (>85th percentiles).
Subjects were 540 Saudi adolescent girls aged 12 to 18 years.
Prevalence rates of underweight, normal and overweight/obesity were 11.3%, 60.1% and 28.6%, respectively.
Subjects were 700 randomly selected students from six female intermediate and high schools in Al-Khobar city between the ages 11-21 years.
Al-Nuaim et al. (1996)
The prevalence of overweight among the sample was 11.7% and obesity was 15.8%.
Subjects were 9,061 Saudi male school children between the ages 6-18 years.
The proposed study will be guided by the following research questions:
What is the current prevalence level of obesity among Saudi high school students?
What are recent trends in the prevalence level of obesity among Saudi high school students?
What are the primary causes of obesity among Saudi high school students?
What are the most commonly consumed food types among Saudi high school students?
What types of physical education and healthy diet information are provided in Saudi high school curricular offerings?
What interventions have proven effective in treating obesity in adolescents in general and among Arab adolescents in particular?
What cultural factors must be taken into account in formulating future interventions?
What is the current level of knowledge among Saudi high school students concerning healthy lifestyle choices as they relate to food intake and exercise regimens?
The Design -- Methods and Procedures
Data Collection. A custom survey instrument will be used to assess Saudi high school students' knowledge levels concerning healthy diet choices and eating practices. The first section of the survey instrument will consist of a series of yes/no, fill-in-the-blank and multiple choice questions to collect relevant demographic information. The second section of the survey instrument will consist of a series of Likert-scaled questions ranged from "strongly agree" to "strongly disagree" to assess knowledge levels concerning healthy dietary practices, and the final section will be an open-ended comment format that encourages respondents to share any additional thoughts, views, opinions and empirical observations.
The specific sample size required for this analysis represents an important factor because of its potential effect on sampling error, effect size and statistical significance (Vogt, 1999). Although using larger samples can reduce the sampling error and the probability of Type II errors, larger samples can also be prohibitively costly and time consuming (Rubin & Babbie, 2001). Conversely, samples that are disproportionately small may result in inaccurate results that may not be generalizable. One approach to determining the appropriate sample size is to select a sample that reflects the population under study and then consider the sampling error that is appropriate for this population (Rubin & Babbie, 2001). For the purposes of the proposed study, the appropriate sample size was calculated using statistical power analysis. Based on widely accepted social science research practices, a power level of 0.80 was used. Another element that corresponds with power analysis is the alpha level. In this regard, the acceptable level of risk for the proposed study has been established at 0.05 risk (Ruben & Babbie, 2001). In order for the results of the custom survey to be meaningful, the use of Cohen's (1988) criteria indicates that an effect size would be somewhere between small (0.2) and medium (0.5); therefore, the minimum sample size needed for the proposed study will be at least 99 respondents (Cohen, 1988).
Data Analysis. The statistical data generated from the demographic and Likert-scaled questions will be analyzed using SPSS Version 11.0 for Windows (Student Version). This data will be presented in tabular and graphic form and interpreted in a narrative fashion. The open-ended comments will be analyzed to identify recurring themes.
VII. Limitations and Delimitations
A primary limitation of the proposed study will be the number of subjects who agree to participate in the research, which is expected to be less than one hundred. Another limitation will be the synthesis of the qualitative data concerning dietary practices that may introduce the potential for researcher bias.
The proposed study will be delimited to Saudi Arabian high school students, but the findings that emerge from the research may be generalizable to other similarly situated Arab countries as well.
VIII. Significance of the Study
The costs that are associated with inordinately high levels of obesity in both economic and human factors are staggering. Although there remains a need for further study of these costs as they apply specifically to Saudi Arabia, the research was consistent in showing that comparable effects are found in most industrialized nations, including those in the West. In this regard, Frieden, Galvez and Landrigan (2003) emphasize that, "With the high and rising rates of morbidity and mortality due to obesity, the lost productivity, the impact on quality of life, and the burden on the health care system -- an estimated $117 billion in the year 2000 -- it is a problem that is too costly to ignore" (p. 684). Moreover, the risk of childhood obesity and its continuation to adulthood is well established. The World Health Organization conducted a survey in Saudi Arabia using the National Centre for Health Statistics Standards that identified a prevalence rate of 14% obesity among Saudi citizens from birth to age 6 years (Madani, 2000). The research to date suggests that body mass and obesity levels in childhood correspond to those experienced later in life. The research also implicates a number of genetic, behavioural, and cultural factors that influence obesity levels in young people which can be identified and appropriate interventions formulated in response. As Madani concludes, "The challenge for early identification and intervention has important public health implications" (2000, p. 9).