Obesity in Saudi Arabian adolescent girls: causes and health consequences

Adolescent Obesity in Saudi Arabia

Obesity in Saudi Adolescent Girls

Obesity is a serious health problem in any population, but it is of special concern in younger individuals. The longer a person is obese, the longer that person has potentially to suffer the negative health consequences of being overweight or obese. Thus when children or adolescents are obese, this condition must be considered seriously both by the individuals themselves (as well as by their families) and by health professionals. Given that obesity increases the health costs associated with treating an individual, the concern should be one that affects an even wider audience, that of public health officials,

One of the costs that every national government must contend with in the twenty-first century is that of healthcare and one of the ways that governments can contain the costs associated with treating obesity-related health conditions. Obesity is an avoidable condition, and thus public health policy that reduces the overall occurrence of obesity can benefit national economies as well as bring substantial benefits to the individuals involved. Reducing obesity in adolescents reduces the chance that they will become burdened with the serious health conditions that are related to (and in most cases caused by) obesity such as diabetes, increased risk for heart disease, increased risk for a range of cancers.

At least as important, reducing the rates of obesity among young Saudi women will also have the highly significant benefit of reducing the psychological harm that may occur to girls whose self-concept is damaged when they fail to meet cultural standards of beauty. The psychological harm that overweight individuals suffer from cannot be underestimated and may lead to serious mental health illnesses such as clinical depression and a range of diseases connecting to elevated rates of anxiety (Dwyer et al., 1970).

Aim for Literature Review and Assessment of Research Methods

This paper surveys the literature on the current state of obesity in Saudi Arabian female adolescents. While obesity (especially among younger people) has long been considered a consequence of Western dietary and other lifestyle factors, this is no longer the case. Obesity levels are rising across the globe, in largest measure because so many people across the globe have adopted Western diets in whole or part. Another important factor in increasing obesity rates is increasing sedentariness, which is correlated in part with greater participation in electronic media.

There are also cultural elements that are specific to young women in the Gulf states. These include fewer opportunities to participate in sports than in the case in countries with different traditions concerning what is appropriate for girls and women to do. The environment is also not conducive to exercise during much of the year: The ambient temperature makes it very difficult to exercise outside, especially for girls and women who wish to dress modestly. Such a lack of exercise per se was not a significant problem when diets were more traditional. However, the combination of Western-style diets with the lack of exercise that accompanies modern life for most people has been a factor that has tended to increase the rates of obesity in young women.

The goal of this literature review is to examine the past research that has been done in this area and in particular to examine the ways in which Saudi governmental policy has focused on medical interventions to obesity. While there is certainly a medical aspect that should be considered and included in any public health approach to treating obesity, other aspects of personal health must be considered. Thus one of the aims of this literature review is to document the lack of attention that the Saudi government has paid to behavioral approaches to reducing obesity. Saudi public health programs have also been negligent in considering the ways in which social and cultural aspects of Saudi life affect obesity.

The research methods that have been used in most of the studies cited here have depended on the self-report of participants as regards their own body image, weight, and eating habits (Roberts 1995; Hill & Roberts 1998). Self-report data are certainly valid and can in many cases be the only practical way in which to gather the amount of data that will prove to be useful for making broader, more generalizable statements. However, relying on self-reported data does have limitations (the problems of reliability in terms of memory as well as the fact that there are often emotional distortions in self-reports on such issues (Stunkard & Albaum, 1981).

The research that I myself plan to do will compensate for these methodological gaps in the research so far. There will be more ethnographic observation included, and there will also be interviews with public health professionals to determine their understanding of both the problem of obesity and the way in which their modeling of the problem is linked (or not) to their proposed solutions.

Gender Inequality as a Factor in Obesity

The female subjects in many of these studies are more accepting of being overweight because so many of the women that they know are also overweight: The more overweight person that someone knows, the more "normal" that individual is likely to find being overweight. While this affects both males and females, it is more true for women. More women are overweight or obese (due mainly to cultural factors), and this tends to increase the "normalcy" of being overweight for other girls and women. This is an aspect of the public health problem that is not present in self-reported data.

This fact tends to reduce the impetus for individuals to attempt to lose weight and -- at least as important and serious -- tends to affect individuals' ability to assess risk. In a population in which many people are overweight, far more of those individuals (versus individuals in a population of primarily average-weight individuals) are likely to underestimate the risks associated with being overweight (Brooks-Gunn etal, 1997). There may also be an important cultural aspect to this fact of being overweight as well: Low self-esteem is linked to being overweight or obese. Given the many barriers that young Saudi women face because of the gender inequality in the country, girls and women are more likely to be affected by low self-esteem than are males (Martinez, 1999:

While such a state -- in which obesity comes to be seen as "normal" because it is so common and therefore not as much of a risk as it actually is -- is dangerous for all populations, it is especially problematic for younger populations, as noted above, because they will have longer to cope with the consequences of their obesity (Goodman, Hinden, & Khandelwal, 2000).

There are remedies (albeit not easy ones for the individuals involved), as suggested by the research. However, and this is very important, the current public health approaches that the Saudi government has taken, as Mabrey et al. (2010) note, have focused fairly narrowly on medical approaches. This focus includes research that has been conducted on metabolic syndrome (which is caused primarily by being overweight). This is caused by clear-cut factors and has a number of possible poor consequences.

Mabrey et al. (2010) note that metabolic syndrome is on average 10 to 15% higher in the GCC states than in the rest of world and that females are disproportionately affected by metabolic syndrome. These researchers are among those who note that a strictly medical approach to such medical problems is far from sufficient. For while metabolic syndrome itself can be identified and described in purely medical terms, such an approach does nothing to explain why rates of metabolic syndrome are higher in this region or why they are higher among Saudi females than males.

Mabrey et al. (2010) note that any truly effective preventative strategies "will require identifying socio-demographic and environmental correlates" and this will be especially true for the factors that influence women. This is not only because females are more likely to be overweight or obese than are men but also because cultural factors are likely to be more important for females than for males. Saudi teenagers (like all other populations) can reduce their weight by reversing certain behaviors, including increasing exercise and changing their diets, but this is only true if there is cultural "permission" for individuals to do so.

Some of the traits that are associated with being overweight or obese are generally much less known than conditions like metabolic syndrome (which is considered to be a precursor to Type II Diabetes) (Al-Qahtani et al., 2006). These can be particularly damaging to girls and women because they affect females' concept of their gender identity. Females in Saudi Arabia are very much affected by cultural and religious attitudes about what is properly female. When they deviate from such standards, they may suffer significant emotional and psychological harm, which is all too likely in turn to produce greater stress, which may result in increased weight. This may occur either because individuals who are stressed may eat more as a method of soothing themselves (Resnick, 1997). It also may result because stress increases the body's production of certain hormones that themselves may increase weight (Jeffrey, 1996).

One of the conditions associated with being overweight or obese for females that may cause considerable psychological distress for the individuals affected is hirsutism, or excessive facial and body hair. This is something that Saudi females would be ashamed of. Shame always makes it harder to seek help (in this case to seek help for the underlying condition, which is obesity). This is likely to be especially true in a culture in which shame is a significant method of cultural control.

Al-Ruhaily et al. (2008) found that there has been a substantial include in PCOS, or polycystic ovarian syndrome, a condition that is caused by obesity, especially high fat deposits in the abdomen. One of the symptoms associated with PCOS is increase in body hair. There are other causes of hirsutism, including disturbances in the adrenal system (although this too can be the result of obesity) but the majority of women in the above study had as a cause of their increased facial hair their PCOS and thus their obesity. This is a condition that is common in Western populations, but that has been absent in Saudi Arabian women and especially in Saudi Arabian adolescents until recently. While this symptom is not dangerous on its own, it is a proxy for an underlying condition that is potentially dangerous and that, moreover, is associated with high rates of infertility (Batton-Smith, 2000).

One of the most obvious cultural and social ways in which Saudi females are affected by obesity in terms of their gender in ways that cannot affect men is the relationship between obesity and female fertility and pregnancy. Obesity affects not just the individual herself but also has effects on the next generation, for overweight and obese women who become pregnant are much more likely to suffer ill effects than are women of healthier weights. This is in addition, as noted above, to the fact that obesity can prevent a woman from becoming pregnant when she wants to.

El-Gilany (2010) found that overweight women were significantly more likely to suffer from pregnancy-induced hypertension, gestational diabetes, pre-eclamptic toxemia, urinary tract infections, and cesarean delivery. Their babies were more likely to suffer from macrosomia, low 1-minute Apgar scores and admission to neonatal care units (El-Gilany, 2010).

While it is slightly tangential, it is worth noting here that there is another practice that many Saudi women engage in during pregnancy that is both related to Western influence and to unhealthy body image. Alghamdi (2010) found that many Saudi women used dermal bleaching agents to lighten their skin and so to make themselves look more European or generally Western. The practice of bleaching skin, like that of adopting eating and other lifestyle habits that lead to obesity, reflect changing standards of body-image and even of femininity itself among Saudi women. As Saudi teens and women become more and more a part of the global society, they are increasingly affected by Western standards of beauty.

This is an ironic state, for just as Saudi women (like women in other non-Western countries), for the more that Saudi women are affected by Western ideals of femininity and beauty, many of them find themselves farther and farther away from being able to achieve such standards on a personal level since many of the traits of Western life that they are being exposed to and are adopting (primarily Western diet) are making them far more likely to become obese (Garn & LaVelle, 1985).

Saudi Arabian female adolescents are among the populations that are most affected in the world by rising rates of obesity. This fact has enormous and potentially terribly dire consequences for these teenagers in terms of both their physical and mental health (Cronke, Roche, Chumlera, & Kent, 1982). These poor consequences are all-too-likely to follow these teenagers for the rest of their lives (Serdula, 1993). Moreover, obesity in adolescence can negatively affect the babies of obese teens, thus directly affecting the next generation, and after birth, this next generation is more likely to be obese if they have a family member (such as their mother) who is also obese (Rimm & Rimm, 1976).

Finally, the costs of treating an obese population can be immense (Abraham & Nordsieck, 1960; Dietz, 1981; Pi-sunyer,1993). Treatment for Type II diabetes alone can be stupendously high, and Type II diabetes is directly caused by obesity. A reduction in the rates of Type II diabetes alone (discounting for the moment the rest of the diseases that are affected by obesity such as cancer and heart disease) would allow for significant health savings, which would benefit Saudi society as a whole.