Obesity in Adolescent Females in Saudi Arabia: Causes

Introduction

In the recent past, obesity has become one of the most rapidly spreading conditions, surpassing even HIV/AIDS in its global reach. This trend is especially pronounced in Western countries — for example, 40 to 60 percent of Canada's population is obese, while in the United States over 65 percent are affected (Al-Rukban, 2003). The situation is not markedly different in the Middle East. In Saudi Arabia, approximately 3 million people — about 20 percent of the total population — are classified as obese. As a consequence, the government spends a colossal share of national resources to mitigate the condition's impacts. Statistics from the Saudi Ministry of Health further indicate that women are obese at nearly twice the rate of men, with a female-to-male ratio of 2:1 (Keleher & MacDougall, 2009).

For a long time, obesity was believed to be caused solely by consuming more food than the body requires. While this remains a central factor, other causes must also be recognized. Genetic predisposition is one such factor, suggesting that obesity can be hereditary. Inadequate physical exercise is another causative agent, since fat that would otherwise be metabolized during activity is instead deposited in body tissues. Scientifically, obesity is defined by the World Health Organization as the excessive accumulation of fat that presents a risk to health, typically resulting when the body takes in more calories than it can burn.

Obesity is also known to trigger or worsen other medical conditions. High blood pressure, type II diabetes, stroke, and coronary artery disease are among the most notable conditions associated with obesity (Seidell, 2000).

The concerns about obesity in Saudi Arabia have been intensified by the fact that most teenagers face a growing risk of developing obesity and the complications that accompany it. About 60 percent of the teenage population is affected by the condition (Qauhiz, 2010). In addition to health consequences, obesity carries significant social stigma. There are also growing concerns about the long-term productivity of affected youth, and substantial government resources are devoted to treating obesity-related conditions, educating teenagers about prevention, and distributing medications (Dietz & Gortmaker, 1984). This paper examines ways in which the menace can be mitigated, in a bid to protect Saudi Arabia's socioeconomic foundations (Ginsberg, Jagendorf, Carmel, & Harries, 1981).

Information was compiled from books, records from public health institutions, and journals published by the government and international agencies such as the United Nations. These sources were chosen to ensure the accuracy of reported data. Internet sources were also consulted to obtain current information on the target population. The research was further necessitated by the fact that obesity has had a measurable toll on teenage productivity, and that overwhelming resources are being spent on managing the condition.

Purpose of the Literature Review and Research Methods

Most articles written on obesity in Saudi Arabia conspicuously omit teenagers as a population group vulnerable to the condition. The majority of existing articles and journals focus on adults. Furthermore, there has been no clear body of writing demonstrating the relationship between obesity and lifestyle, genetics, and associated comorbidities in the teenage population specifically. This knowledge gap is significant because it obscures where intervention efforts should be directed. The substantial economic contribution that teenagers will eventually make, combined with the importance of youth health for any country's future population, further justifies the need to research obesity among this age group (Al-Shammari, Khoja, & Al-Subaie, 1994).

Obesity is currently a leading global health threat. It is not confined to Saudi Arabia or the Gulf region but manifests at high prevalence rates in Western countries, Africa, and Asia alike. It is important at this stage to distinguish between the prevalence and the incidence of a condition. Prevalence refers to the rate of spread of a condition over a given period of time, while incidence refers to the number of new cases occurring at a specific point in time. In relation to obesity, prevalence trends have been particularly alarming, surpassing those of most other known conditions (Keleher & MacDougall, 2009).

In the United States, obesity is approaching epidemic status. Among adults, approximately two in three are affected, and among children, two in five are casualties (Al-Gelman, 2008). This is according to the Centers for Disease Control and Prevention (CDC) report from 2003 (WHO Organisation, 2006). The CDC also estimates that obesity costs the United States approximately 75 billion dollars annually in related healthcare expenditures.

The CDC defines and tracks obesity using the Body Mass Index (BMI) as a standard measure. Part of what contributes to obesity globally is the consumption of foods high in sugars, fats, and calories; genetic predisposition; and sedentary lifestyles. Opportunistic conditions commonly associated with obesity include cardiovascular disease, type II diabetes, and stroke (Solenberger, 2001).

Literature Review and Prevalence Trends

The World Health Organization (WHO) and CDC project that there will be approximately 2.5 billion cases of obesity worldwide if trends remain unchecked. This would affect a substantial portion of the global population, undermining the productive capacity of nations across age groups and demographics (Osman & Al-Nozha, 2000). It must be appreciated that obesity distribution varies considerably by continent, age, gender, and race. In the United States, obesity is relatively evenly distributed across males and females, adults and school-age children. In Africa, most obesity cases are observed among adult females and adolescents from wealthier families (Epstein & Cluss, 1986).

In Saudi Arabia, obesity prevalence is estimated at approximately 14 percent for children aged six years and under, rising to approximately 83 percent in the adult population (Qauhiz, 2010). Within the adult population, rates among females are consistently higher than those among males. The trend is attributed to factors such as education level, parity, socioeconomic status, age, and sex. Understanding the cause of obesity across different age groups in Saudi Arabia is therefore an important research priority.

This group comprises children aged six years and below. A recognized link exists between childhood and adult obesity, with the 14 percent rate in this age group gradually increasing as individuals approach adulthood. This connection is shaped by cultural, genetic, and behavioral factors. Early intervention can be employed to interrupt the transition of obesity from childhood into adulthood.

This age group forms the primary focus of the present paper. Participants were interviewed and data were collected through questionnaires; physical measurements, including BMI, were also recorded. BMI correlates an individual's height to body mass and falls within a standard range used to determine whether a person is underweight, normal weight, overweight, or obese (Epstein & Cluss, 1986).

In one study, 11 percent of adolescent participants were found to be underweight, 61 percent had a normal BMI, and 28 percent were overweight or obese. These findings indicate that Saudi adolescents are caught between two contrasting nutritional problems — underweight and overweight — reflecting poor nutritional patterns overall and suggesting that urgent education around healthy nutrition is needed.

In a separate data collection exercise examining nutritional patterns and health in relation to body height, body weight, and dietary composition, 14.5 percent of adolescents were underweight (below the 15th percentile), 16.5 percent were obese (above the 85th percentile), and the remaining 69 percent were in the normal range (between the 15th and 85th percentiles). These findings suggest that Saudi adolescents have undergone a shift in eating habits toward those typical of Western countries, contributing to a rise in diet-related complications.

A further study focused on male participants aged 6–18 years, with participants suffering from chronic or acute conditions excluded for the purposes of precision. Using the 50th percentile from the National Center for Health Statistics/CDC as a reference, obesity was defined as body weight more than 120 percent of the expected 50th percentile value, while overweight was defined as 110–120 percent of that value. On this basis, 11.7 percent of participants were classified as overweight and 15.8 percent as obese — findings that prompted calls for timely education on dietary choices to support proper health and development.

A key question emerging from the data is why female adolescents in Saudi Arabia are disproportionately affected by obesity compared to their male counterparts. The study examined several factors to explore this disparity.

Adolescent boys and girls were observed for at least two weeks with respect to their feeding habits. Over this period, females were found to consume snacks significantly more frequently than males. Males consumed snacks approximately once per fortnight, while females consumed snacks on an average of 12 out of 14 days. For staple foods such as rice, bread, nuts, and fish, the percentage of females consuming these items also exceeded that of males — 54.8 percent versus 50.5 percent. This indicates that females consume more energy-dense food products than males in Saudi Arabia, leading to greater caloric deposition and increased obesity risk, particularly when the body cannot metabolize all the calories consumed.

Dietary Habits and Physical Activity Among Adolescents

The same observation period was used to assess levels of physical activity among male and female adolescents. Physical activity is important because it burns calories and can significantly reduce obesity risk. The study found that approximately 30.4 percent of boys spent at least three hours per day watching television, compared to 54.6 percent of girls. Furthermore, 25.7 percent of boys and 42.9 percent of girls reported engaging in no physical exercise lasting at least 30 minutes. Notably, in the final week of observation, 31.1 percent of boys reported no physical exercise — while none of the girls engaged in any physical activity at all. This disparity is partly attributed to cultural norms that restrict females from participating in outdoor or public physical activities.

Two major factors thus emerge as drivers of obesity among females compared to males: dietary habits and engagement in physical activity. These factors are compounded by cultural constraints that limit females' ability to address both. Most females in Saudi Arabia tend to lead sedentary lives centered on household responsibilities, spending considerable time watching television while remaining physically inactive. Reduced participation in community events and social activities further diminishes opportunities for caloric expenditure. Obesity in the Arab world is increasingly recognized as a public health crisis with a distinctly gendered dimension, shaped as much by social and cultural factors as by individual behavior.

Understanding the reasons for the higher prevalence of obesity among Saudi females calls for concerted efforts to ensure that prevention recommendations are implemented. Failure to act will result not only in escalating healthcare costs but also in diminished workforce capacity as obesity rates continue to rise.

Obesity is not defined solely by total body mass but by the relationship between mass and height — the Body Mass Index (BMI). BMI is calculated by dividing body mass in kilograms by height in meters squared (kg/m²). Results fall into four categories: a BMI below 18.5 indicates underweight or malnourishment; a BMI of 18.5–24.9 is considered normal; a BMI of 25–29.9 indicates overweight, a critical stage bordering on obesity; and a BMI of 30 or above indicates obesity, requiring urgent intervention. A BMI above 40 is classified as severe obesity (Keleher & MacDougall, 2009). Special considerations apply when assessing pregnant women, growing children, and highly muscular individuals such as athletes.

Focusing specifically on adolescent females, it is important to trace national trends over recent decades. For the period 1995–2000, 36.9 percent of Saudi Arabia's population was overweight and 35.6 percent was obese. Within these figures, children aged 7–15 years represented the highest rates, with boys constituting 16.7 percent and girls constituting 19.4 percent of the total obese population (Ginsberg, Jagendorf, Carmel, & Harries, 1981).

By 2006, obesity rates had increased sharply: 56 percent of men and 66 percent of women were classified as obese. Among teenagers, 18 percent were obese, while preschoolers accounted for 15 percent. In 2008, approximately 18 percent of deaths in Saudi Arabia were obesity-related. In the same year, 95 percent of patients (424,968 individuals) making appointments at diabetic clinics were Saudi nationals, with women outnumbering men — further evidence of the disproportionate burden borne by females (Bleich, Cutler, Murray, & Adams, 2008).

Urban populations in Saudi Arabia are more prone to obesity than rural populations, a pattern attributed to the prevalence of high-calorie foods in cities and the more sedentary nature of urban life. The higher obesity rates among females are further explained by cultural norms: females are not permitted to visit public gyms or swimming pools, and in many schools girls are not allowed to change into sportswear for physical education. As a result, females are generally confined to domestic settings and do not engage in the kinds of physical activity that would help burn calories (Amuna & Zotor, 2008).