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3
Abstract
ENGLISH ABSTRACT
Background: With the overweight or obesity, one more likely develops chronic
diseases and/or to be less satisfied. Obese teens are usually destined to be likewise
overweight in their mature years, which translates to them having a higher chance of
succumbing to illnesses and dying prematurely, as well as a financial burden on the
healthcare system.
Objective: The present investigation seeks to investigate the parameters that lead to
obesity and to estimate the incidence of overweight and obesity amongst female high
school students in Dammam and Khobar, Saudi Arabia.
Methods: Both a combination of approaches and creative means were utilized for this
project. First, cross-sectional study was done at Dammam and Khobar, namely 3/09-
30/12/2023, used a self-administered questionnaire (10th, 11th, and 12th grade). The
teachers, a group of female teachers, were selected for this study to interview them on a
semi-structured way on issues affiliated to obesity, in the school health services and
policies.
Findings: Of the 374 kids that took part in the field test, 239 (63.9%) went to public
schools and 135 (36.1%) went to private schools. Here is the number: 26. Only those
8% of the population that met the criteria for obesity or overweight were considered for
the study. Multiple causes were identified by the survey as contributing to the alarming
rise in childhood obesity. The high incidence of obesity among children attending
public schools was also strongly impacted by the variable indicating the kind of school
(p-value < 0.001).
Chapter 2: Literature Review
4
Additional factors that were taken into account were a parent with a low level of education
(p-value < 0.001), while a parent with a high level of education (p-value < 0.001) also
had an impact. In addition, the study examined the correlation between kids who live with
both parents (p-value < 0.001) and students whose family income is above the median
level (p-value 0.018), as well as other characteristics, to see if they were able to achieve
the desired weights. The study focused on the participants' methods of determining their
weight and whether they determined themselves to be overweight or obese (p <0.001). It
also examined the amount of activity they engaged in to lose weight (p <0.001) and their
dietary habits for gaining weight. To summarize, the study findings indicate that a
significant proportion of adolescent females in Saudi Arabia are experiencing excessive
weight or obesity. Highlights the need of implementing effective health-conscious
policies in schools, both at the broader societal level and at the individual level.
Chapter 2: Literature Review
5
CH.1 – INTRODUCTION
This chapter provides an overview of the history and setting of the study (section 1.1),
emphasizes its significance and scope (section 1.3), and discusses the specific
terminology employed (section 1.4). The objectives and aspirations are clearly defined
in Section 1.4. Section 1.5 outlines the subsequent components of the thesis.
1.1 Background
A significant public health issue, obesity impacts countries that are both developed and developing. The rising incidence of being overweight can be linked to several causes, such as individual poor lifestyles and insufficient regular exercise (Kumari et al., 2022). Around the world, obesity is a major medical issue. When contrasted with other countries, Saudi Arabia has one of the world's greatest percentages of overweight and obesity. Overweight and obese people are expected to affect almost one-third of Saudi Arabia's population (Alhumud, 2020).
Obesity, a condition characterized by prolonged overweight, can significantly impair health by increasing the risk of acquiring severe health consequences such as cardiovascular disease, cancer, or diabetes. The health consequences of these hazards can be unpredictable, potentially resulting in irreversible harm to an individual's well-being and even mortality (Bray et al., 2017; Bendor et al., 2020; Keramat et al., 2021).
This poses a challenge not just for emerging nations aspiring to replicate the economic success of large economies, but also for the major economies themselves. In 2016, the World Health Organization (WHO) identified around 1.9 billion people and 340 million teens and children as either overweight or obese (Jatoi et al., 2022).
The prompt surge in obesity rates might be delayed by the collective impact of poor exercise habits, dietary patterns, and genetic predisposition (Alhumud, 2020).
Chapter 2: Literature Review
6
Saudi Arabia has one of the highest obesity rates in the world, with its population being
the most overweight internationally, according to the latest figures.
The Ministry of Health of Saudi Arabia provides training to healthcare workers to identify early
indications and symptoms of medical conditions. Statistics indicate that the obesity rate
among the Saudi population is 35 percent, which is equivalent to nearly one-third of the
population.
Also, 22% of kids between the ages of 5 and 19 are deemed to be overweight or obese,
pursuant to research conducted by the Global Obesity Association. The measure targets
deliberately at this age the range. Al-Hazzaa (2018) discovered that between 30 and
38.4 percentages of individuals afflicted from a combination of diabetes, coronary
artery disease, or cancer, and that 75.2% of adults were overweight. Therefore, NCDs
(non-communicable diseases) developed as a consequence of healthcare systems in
Saudi Arabia undergoing the necessary modifications to match modern lifestyles.
The ongoing difficulty in Saudi Arabia lies in the endorsement by Saudi men of the
notion that young women driving is unsuitable, perpetuating sexist and archaic traditions.
Moreover, in the context of pubertal transition, adolescents consume a substantial quantity of unhealthy food items, such as fast food and sugary beverages, which are high in calories (Alasqah et al., 2021).
Adolescent ladies in Saudi Arabia have a notably high occurrence of excess body fat.
This is attributed to reasons such as restricted availability of social gathering venues and sports programs, along with suboptimal food habits.
Adolescent females have a higher likelihood of adopting harmful food habits compared to adolescent boys, and these
tendencies may manifest well in advance of puberty (Neumark-Sztainer et al., 2011; Purkiewicz et al., 2021).
Additionally, preoccupation with a societal and culturally idealized body type can be detrimental and exacerbate the issue at hand (Alhumud,
Chapter 2: Literature Review
Two potential consequences that may ensue are diminished self-esteem and the
development of an eating disorder. However, there is another aspect to consider: the
factors that contribute to human obesity. At this time, it is critical to determine the cause
of the high prevalence of overweight high school females in Dammam and Khobar.
A significant population of adolescents and high school pupils resides in the eastern
region of the Saudi Arabian province. Adolescent Saudi Arabian women are obese or
overweight. In the Eastern Province of the country, particularly in the major cities of
Dammam and Khobar, there is a dire need for long-term high schools.
We will examine social and cultural factors, dietary practices, school-provided health
services and athletic programs. They will consider the factors that may contribute to the
high prevalence of overweight among secondary school females in Dammam and
Khobar, Eastern Province, Saudi Arabia. In conclusion, schools should be able to
determine in the future what resources female students require to assist them in losing
weight on campus with the aid of the findings of this study.
This would assist policymakers and health care professionals in developing targeted
programs and efficacious approaches to encourage weight loss among this demographic.
1.2 Context
This research was conducted in the eastern Saudi Arabian cities of Dammam and
Khobar. Because of their substantial populations, these urban centers amalgamate
elements of both ancient and contemporary cultures. Additionally, both public and
private institutions catering to pupils of every age group and socioeconomic status are
renowned in this region (Alhumud, 2020). In order to address the primary research
inquiries: What was the prevalence of secondary female obesity and overweight
(OW/OB) within the study's sample, taking into consideration socioeconomic
status are
1.3 Significance and Definitions of Key Terms
Diabetes, heart disease, and high cholesterol levels are some of the issues that may
result when one is overweight. To find a person's body mass index (BMI), use their
body mass in kilos and square it. Overweight can be detected with its help. Anyone with
a body mass index (BMI) is over thirty is regarded as obese, while individuals whose
BMI is 25–29.9 are categorized as overweight. Obesity is an important issue in the
community since it is linked with several chronic medical conditions, including heart
disease, stroke, diabetes, and cancer (Alqasem et al., 2020). Anxiety and depressive
disorders can set in as a consequence of an overall decrease in quality of life (Fernandes
et al., 2023). Medical educators and school nurses promote the adoption of healthy lifestyles and
actively strive to reduce student injuries and diseases (Qurashi, 2019). Health education, which
is a part of school health care, helps students in making informed choices regarding
their health. Examples that serve as illustrations include the act of abstaining from
harmful substances, engaging in physical activity, maintaining a healthy diet, and taking
care of one's mental well-being (Alqasem et al., 2020). The primary focus of school
health services is on providing counseling, facilitating problem-solving, and offering
emotional support. Hammad and Berry (2017) provide crisis, individual, and group
services.
Chapter 2: Literature Review
1.4 Aims and Objectives
The objective of this research is to determine the density of overweight and obesity (OW/OB) among female student teenagers of the cities namely Dammam and Khobar,
Saudi Arabia, as well as to identify the factors that are responsible for OW/OB where
the dietary habits of the adolescents have been included. Moreover, for my research
project, I decided to study the diverse foods that are offered during the lunch hour in the
school cafeteria. Therefore, as the last point, it is advisable to evaluate the extent to
which, female students need, kindergarten health services for obesity.
1.5 Research Outline
Chapter 2 is all about mental health and behaviour among adolescents. The review
centre is focusing on the research presented in the literature which had to do with adolescent obesity and the Saudi health studies. Chapter 3 details the wide range of methods used in the principal study. Chapter 4 explains, checks, and controls obesity, sociodemographic traits, and other risk factors. The resources of chapter 5 are being used to outline the reported results. Chapter 6 goes in-depth to indicate factors affecting the family and community. It also provides a direction to researchers, policymakers, as well as family and communities. The appendixes follows the last page.
Chapter 2: Literature Review
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CH.2 – LITERATURE REVIEW
The chapter commences with a concise introduction to the subject matter (section 2.1), which is succeeded by literature evaluations addressing the subsequent concerns: In the final section of this chapter, which follows Prevalence of Obesity (section 2.2), Risk Factors (section 2.3), and School Health Services (section 2.4), the literature review's implications are succinctly summarized and the knowledge gaps are explicitly delineated (section 2.5).
2.1 Background
Obesity is a worldwide health concern due to its accelerated increase in both developed and developing nations (Kumari et al., 2022). The risk of developing type 2 diabetes, cardiovascular disease, and various malignancies in adulthood is elevated in adolescents who are obese (Keramat et al., 2021). Inactivity, genetics, inadequate nutrition, and hormonal changes associated with puberty are all contributors to adolescent obesity (Alhumud, 2020). Additionally, mood disorders, depression, and social isolation have been found to be associated with it (Kansra et al., 2021). There is a proposition that educational institutions could serve as persuasive environments to promote healthy behaviors and address the escalating prevalence of obesity among adolescents (Hammad & Berry, 2017). Additionally, physical activity programs, school health services, and nutrition initiatives may help reduce adolescent obesity (Alqasem et al., 2020). Furthermore, with knowledge of the causes of obesity among high school girls and effective school-based health services, it may be possible to devise more targeted treatments.
Chapter 2: Literature Review
12
2.2 Prevalence of Obesity
Be it of adult age or be it male or female, obesity is a universal and serious concern that disrupts the contemporary society with the time being ever evolving (Tiwari et al., 2023).
"Global, regional, and national prevalence of overweight and obesity in children and adults from 1980 to 2013: An analysis addressing various aspects of the healthcare workforce, termed "A comprehensive assessment" was published in the medical magazine, The Lancet, on the 29th of May. A multi-national group, accompanied by IHME "Systematic Analysis" from the University of Washington, is GDB Study (GBD 2013) leaded.
Studies led by the GBD made very clear that more than one-third of the human population has excess weight or obesity (Ng, W. et al., 2014). Obesity which was one of the high-incidence health conditions in the Middle East in the past has gone up again remarkably after the 30years period of decline. One of the main complications resulting in greater percentage of obese population in Bahrain, Egypt, Saudi Arabia, Oman and Kuwait is linked with their young members.
During the last 33 years the incidence of overweight among the adolescents of the region was close to a twofold as much as in 2013 with its maximum in that year. The finding of more than one in ten girls with the BMI classification of obese is presented with that value of 22%, whereas in boys this concern was reported for 24%. A lot of obese kids and teens are found around the world in current realities.
In 2016, WHO World Health Organization predicted more that 340 million of children and teens between ages 5-19 have overweight or obesity (WHO, 2016). Statistical data received from over 20,000 boys, and girls' schools; in fact, the Obesity and Overweight prevalence among teenager students was 25.7 percent which directly declared by the
Chapter 2: Literature Review
In 2022, Albaker and coworkers conducted an investigation. Among 351,195
youngsters spanning in age from 2 to 19, the findings of a graduation-base
questionnaires were released a while ago.
Based on the study, the proportion of overweight children was 11.2% and the
percentage of obese children reduced to 9.4%. Furthermore, amongst girls and young
adults (14–19 years old), 10.8% were overweight or obese, while 7.9% were obese.
With a rate of 9.9% in both Eastern and Central Saudi Arabia, obesity was the most
prevalent in those regions (Bolenzi et al., 2023). Based on these numbers, it's clear that
more and more women are struggling with a crucial aspect of their lives: a lack of
physical, emotional, or mental security.
2.3 Risk Factors
Teenager obesity was found to lead to many interrelated predisposing conditions. The
genotypic profile is going to influence the amount of adiposity in the body. Use our
algorithm to convert the text into plain audio: Scientific research establishments proven
that heritability for obesity is from 40% to 70%. Your genetics informs all the ways by
which you acquire body fat, how much you eat, and how your energy is utilized. The
growth in adolescent adiposity is therefore not just explained by genetic predispositions,
but several other factors that, together with genetic predisposition determine prevalence
rates of obese children and adolescents.
The environmental factors composed of the changes in lifestyle, urbanization and
globalization have an impact on adolescent obesity in a great deal (Al Moghair et al.,
2019). While external pressures such as discrimination and racism are effects of this, diets
have shifted to foods that are fatty, sweet and salty (Hammad & Berry, 2017). Moreover,
fast food intake and processed food also have contributed to what can be described as a
nuisance or a toll in the adolescent obesity levels. Inadequate provision of safe recreation
Chapter 2: Literature Review
facilities, torrid weather, and the overuse of technology jointly or in isolation all lead to
the sedentary lifestyle being very common among Saudi teenagers (Mohdher et al., 2019).
The most common form of electronic devices used by most of the teens include mobile
phones, computers and video games. Healthy diet is the key factor on adolescent weight
issues in obesity. The other factor that contributes to teen obesity is a wrong diet which
cannot only put a child at risk of severe health but social, psychological effects too.
Currently, poor people in Saudi Arabia hardly have disciplined diets consisting of
vegetables, grains, and fruits; instead they prefer fatty diets as well as those which are
high in sugar and sodium. For the very first time, the detectable rise of Abu-Dhabi’s
adolescents in the consumption of sugar-sweetened beverages has been observed in line
with weight gain and a high overall calorie intake (Alsubaie, 2010).
The child having obesity is more likely if the parent has obesity themselves, or the child has other risk factors such as individual and environmental factors (Hammad & Berry, 2019).
Adolescents obesity is principally associated with family history which is demonstrated by Mohdher et al in their study (2019). Yet, there is a range of factors that turn the obesity of Saudi female teens into an actuality. Some of the contributing factors are attributed to the sedentary lifestyle, culture, ignorance of nutrition, lack of exercise and calorie-dense foods with citations included (Alfulayw et al., 2022).
Children are instructed in health festivals, schools, and seminars on how to avoid obesity and maintain good health (Mohdher et al., 2019).
Chapter 2: Literature Review
Education, support, and weight and health counseling are offered at institutions in
Dammam and Khobar. School counselors and health professionals assist students in
establishing objectives, developing individualized health plans, and monitoring their
progress. School health services in Khobar and Dammam prioritize preventive
measures, including wellness exams, vaccinations, and referrals to specialists
(Chaabane et al., 2021). School health services have the potential to mitigate the
prevalence of overweight and other medical conditions among students through the
timely identification and intervention of health concerns. There are 20,385 secondary-
level female pupils enrolled in 98 (61%) institutions in Dammam, of which 79 are
public and 19 are private. The 63 schools in Khobar (39 percent) enroll 10,133 pupils
(39 public, 24 private).
2.5 Summary and Implications
Similar to adolescents around the globe, Saudi female adolescents are rotund. The
review of relevant literature emphasized the need for additional research on obesity
among Saudi Arabian female high school pupils. By examining the prevalence, risk
factors, and health services accessible to overweight or obese female high school pupils
in these regions, this study will fill a lacuna in the literature.
Schools may be effective partners in the battle against juvenile obesity. Potentially
mitigating adolescent obesity are school-based initiatives that advocate for exercise,
healthy nutrition, and obesity awareness (Hussein et al., 2021). Numerous Saudi
Arabian institutions, according to the literature review, lacked adequate funding and
qualified medical personnel, which led to substandard health services. This research
examines the prevalence of obesity among female high school pupils in Dammam and
Khobar, Saudi Arabia. Health education programs and school interventions could be
influenced by this research.
Chapter 2: Literature Review
CH.3 – RESEARCH METHODOLOGY
The present chapter elucidates the approach and blueprint employed to accomplish the objectives of this undertaking. The following sections provide comprehensive descriptions of the components utilized in the study: participants (section 3.3), research design (section 3.2), study location (section 3.2), procedure and timeline for each stage (section 3.4.2), and ethical considerations (section 3.4.3).
3.1 Research design
To achieve the study aims, a mixed methods technique was utilized, integrating both qualitative and quantitative information. The study began by conducting a survey using questionnaires among female high school students in Dammam and Khobar, Saudi Arabia. The participants were in the 10th, 11th, and 12th grades. The survey took place from September 1, 2023, until September 29, 2023. A random selection was made using cluster-stratified sampling, choosing six public and four private institutions from the research region. Teachers were later interviewed using a semi-structured method.
3.2. Study setting
This study was conducted in the Eastern province, specifically in these two cities:
Dammam and Khobar.
3.3 Participants
The sample size was calculated using this formula:
Sample size (n) = Z I^2-α/2 P q / d^2
Where n is the sample size, Z is the degree of confidence, P is the expected prevalence, and d is precision, which is the same as effect size (Lemeshow et al., 1990).
Chapter 4: Results
The research participants were 374 female secondary school students in Dammam and
Khobar (10th, 11th, and 12th grade) who enrolled in the chosen high schools between 15
and 19 years old and completed an informed consent form. Pregnant or weight-changing
high school girls are ineligible. Also included are 27 teachers who have worked at the
schools for at least one year.
3.4 Data collection methods
The quantitative Data was collected via a class questionnaire. The survey
conducted in Arabic to encourage as many people as possible to fill it out, and the
qualitative data was collected by interviewing randomly selected schoolteachers from
the selected schools.
3.4.1 Instruments:
Part 1: Quantitative questionnaire, which includes 38 questions;
Section 1: Demographic data: includes age, nationality, residence, income,
father and mother occupation, sibling, academic performance, Sleep, and chronic
illness.
Section 2: The participants assessed anthropometric data and Body mass index (BMI) by measuring the weight and height of a trained nurse.
Section 3: Assess the students' dietary behavior using the questionnaire adopted from the World Health Organization (WHO)'s Global School-Based Student Health Survey (GSHS) for adolescents (WHO, GSHS, 2021). Health behavior information from the GSHS helps policymakers create, monitor, and evaluate school health programs and policies.
Section 4: To evaluate several school-based weight-related health promotion programs (Appendix E). The questionnaire was piloted among ten students for validity.
Participants assessed the questionnaire's format, clarity, and length.
Chapter 4 Results
Part 2: Qualitative interview questions, which include two sections;
Section 1: Assessment of the types of food offered at the school canteen that
contributed to students' obesity.
Section 2: Identify the gap of needs among female students regarding school
health services related to obesity (Appendix F); the interview lasted about 30 min in
Arabic after gaining the consent of the participants.
3.4.2 Procedure and Timeline
Students were recruited using multistage stratified cluster sampling between September
1 and October 1, 2023. The study was carried out in ten female high schools (four
private and six public), which were selected at random using cluster-stratified sampling.
Two classes were selected from each grade. A self-administered, validated
questionnaire adapted from an international study (Global School-based Student Health
Survey and Youth Risk Behavioral Surveillance) was distributed to students in class for
data collection. The survey was translated from English to Arabic. The questionnaire
was rendered from English to Arabic by a bilingual team consisting of two medical
professionals and one experienced outside medical translator.
Using sex-specific BMI growth tables for Saudi children and adolescents, the BMI of
school students was computed. Following that, an evaluation was conducted by a
random sample of schoolteachers regarding the contribution of hazardous and healthy
food options to obesity in school cafeterias, as well as the obesity-related disparity in
school health services for female students. 30-minute face-to-face time From September
1 to October 1, 2023, interviews were conducted in private rooms and were recorded for
audio.
Chapter 4 Results
20
Students provided written informed consent subsequent to the school administration,
instructors, and students being briefed on the study's objectives and methodologies.
Consent forms detail the objectives, risks, significance, confidentiality, and withdrawal
policies of the research.
3.4.2 Ethics and Limitations
The investigation was granted approval by the Institutional Review Board. Each
participant was duly apprised that their answers would remain anonymous and solely be
utilized for scientific objectives. At any time, participants may discontinue their studies.
Institutional Review Board (IRB) approval was granted for IRB-UGS-2022-03-502.
Potential constraints stemming from participants' recollection and failure to furnish
adequate information, including the possibility of bias in reporting dietary, weight, and
physical activity behaviors, knowledge, and exposure to advertisements. Causality
cannot be deduced from cross-sectional data. In addition, the fact that the participants
are mature female adolescents may introduce selection bias.
3.5 Statistical Analysis
Input of student information was performed using SPSS. The data will be subjected to
statistical analysis. The limit of significance is 5% (P-value less than 0.05). Descriptive
and inferential statistics were employed in the data analysis process. Mean, standard
deviation, occurrence, and percentage were employed to characterize the attributes of
the participants, the prevalence of obesity, dietary behavior, level of physical activity,
and school health services. We conducted an analysis on the relationship between
obesity and demographics, dietary habits, exercise routines, and school health care by
employing inferential statistics such as chi-square tests, t-tests, and regression analyses.
The chi-square test was employed to investigate the impact of categorical factors on adiposity. By employing a multiple linear regression analysis, predictors of obesity in participants can be identified.
Thematic analysis was conducted on audio recordings of interviews conducted with randomly selected instructors from a subset of schools, utilizing the Nvivo software. In accordance with Braun and Clark's phases, the analysis procedure consists of the following: data familiarization, initial coding, code arranging and classification to identify themes, theme review, final theme definition, and interpretation.
CH.4 – RESULTS
In the results chapter, the collected data were analyzed to address the quantitate and the qualitative part of this research regarding
1. Quantitative part:
1.1 Student's background characteristics
Table 1: Demonstrates the social and demographic characteristics of the students.
Demographic
Information Answer category n=374 %
Type of school
Private 135 36.1%
Public 239 63.9%
Grade
10th grade 154 41.2%
11th grade 104 27.8%
12th grade 116 31.0%
Age
15 years 150 40.1%
16 years 108 28.9%
17 years & above 116 31.0%
Nationality
Saudi 256 68.4%
Non-Saudi 118 31.6%
Father Education Level
Below university 114 30.5%
University and above 260 69.5%
Mother Education Level
Below university 171 45.7%
University and above 203 54.3%
Live With Whom
Single career 34 9.1%
Chapter 4 Results
23
Financial Level
Both 340 90.9%
Less than middle 63 16.8%
Middle and above 311 83.2%
Sleeping hours
Less than 8 Hrs. 171 45.7%
8 Hrs. and more 203 54.3%
Commuting to school
Private car 305 81.6%
Other modes (Walking or
School service) 69 18.4%
History of Chronic
Disease
Yes 51 13.6%
No 323 86.4%
Figure 1: Student's BMI (Body et al.)
24
remained in the eleventh grade, while 31.0% (116) were in the twelfth. Age was a range
of 15 to 18 years in this study, with a mean of 15.9 years, a standard deviation of 0.83,
and a median of 16. Of the students, 150 (40.1%) were 15, 108 (28.9%) were 16, and
116 (31.0%) were 18 years or older. 256 students, or 68.4%, were Saudi nationals. In
contrast, 118 (31.6%) individuals held a different nationality.
According to the study, 260 fathers of the students (69.5%) held a bachelor's degree or
higher, whereas 30.5% (114) did not. Concurrently, 203 student mothers represent
54.3% of university graduates. Achieving degrees below the university level comprises
171 individuals (or 45.7%). As indicated by the sample, 9.1% (34) of pupils had a solitary occupation, while 90.9% (340) lived with both parents. 63 respondents (16.8%) belonged to the lower middle class, whereas 311 (83.2%) belonged to the middle and elite classes. 171 (45.7%) of the students in the sample slept for less than eight hours, while 203 (54.3%) slept for more than eight hours. A mere 69 (18.4%) of the 305 pupils who commute to school via private automobile do so (18.4%).13.6% (51) of the participants have a chronic illness, compared to 86.4% (323) who do not.
1.2 BMI of the Student (Body et al.)
25.9% of the students were underweight, while 177 (47.3%) were of average weight, according to the findings. A mere 44 individuals (11.8%) are classified as obesity, while 56 individuals (15.0%) are overweight. (Depict 1).
Figure 2: Cluster bar count of student grades and BMI
Figure 2 shows that the 10th grade has the highest percentage of average weight (19.25% 72), the 11th grade 12.83% (48), and the 12th grade 15.24% (57). The lowest rate of all grades was obese: 5.61% (21) in 10th grade, 3.21% (12) in 11th, and 2.94% (11). The 10th grade was 10.43% (39), the 11th 6.95% (26) and the 12th 8.56% (32). Final overweight rates are 5.88% (22) in 10th grade, 4.81% (18), and 4.28% (16) in 12th.
1.3 Students respond to the research questionnaires
Table 2: Questionnaires answers among the students.
Question | Answer category | n=374 | %
A.Dietary behaviors
1. how often did you eat salty foods or
snacks during the past seven days?
Never eating 20 5.3
Sometime during the week 222 59.4
Once and more, daily 132 35.3
2. how often did you drink or eat milk
products in the past seven days?
Never consuming 55 14.7
Sometimes during the week 202 54
Once and more, daily 117 31.3
3. Within the last week, how frequently did you consume sugar items, such as
cookies, cakes, and pastries?
Never eating 25 6.7
Sometimes during the week 204 54.5
Once and more, daily 117 31.3
Chapter 4 Results
26
Once and more, daily 145 38.8
4. Within the last week, how frequently did you consume high-fat items, such as fried dishes?
Never eating 64 17.1
Sometimes during the week 228 61
Once and more, daily 82 21.9
5. How frequently did you consume at least one meal or refreshment from a fast-food restaurant in the previous week?
Never eating 62 16.6
Sometimes during the week 259 69.3
Once and more, daily 53 14.2
6. How frequently did you consume whole grains, legumes, and other fibre-rich foods as vegetables over the past week?
Never eating 99 26.5
Sometimes during the week 206 55.1
Once and more, daily 53 14.2
7. In the preceding thirty days, what was the frequency of your brunch consumption?
B.Weight behaviors
1. In the preceding twelve months, underwent a weight or measurement assessment?
Yes 298 79.7
No 76 20.3
Chapter 4 Results
27
2. What is a description of your weight?
underweight 71 19
About the right weight 163 43.6
Overweight or obese 140 37.4
3. Have you vomited or taken laxatives to prevent weight gain or loss within the past 30 days?
Yes 26 7
No 348 93
4. Have you consumed any tablets, granules, or liquids without a doctor's prescription to gain weight in the past 30 days?
Yes 17 4.5
No 357 95.5
5. Have you used physical activity to lose weight or prevent weight gain over the past 30 days? This includes exercising, participating in athletics, or engaging in other forms of physical activity.
Yes 189 50.5
No 185 49.5
6. Have you consumed any diet tablets, powders, or liquids over the past 30 days without a physician's prescription in an attempt to lose weight or prevent weight gain?
Yes 12 3.2
No 362 96.8
Chapter 4 Results
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C.Knowledge, Attitudes, Skills, and Sources of Information
1. Did any of your classes discuss the
health advantages of increasing your
consumption of fruits and vegetables
throughout the academic year?
Yes 142 38
No 232 62
2. Have you been instructed in any of your
classes this academic year regarding the
correlation between a healthful diet and
physical strength?
Yes 212 56.7
No 162 43.3
3. Have you received instruction on weight
management in any of your seminars this
academic year?
Yes 141 37.7
No 233 62.3
4. Were you instructed on the safe
preparation or storage of food in any of
your classes throughout the current
academic year?
Yes 135 36.1
No 239 63.9
5. Were any of your classes this academic
year about the dangers of consuming an
excessive amount of foods that are high in
fat, sugar, or salt?
Yes 176 47.1
No 198 52.9
Chapter 4 Results
29
6. Did any of your classes instruct you on
the process of developing a personal
physical fitness plan throughout the
academic year?
Yes 125 33.4
No 249 66.6
7. Did you receive instruction in any of
your classes this academic year regarding
community-based physical activity
opportunities?
Yes 126 33.7
No 248 66.3
8. Did you receive instruction on the
advantages of engaging in physical activity
in any of your classes this academic year?
Yes 155 41.4
No 219 58.6
9. Where on earth would you go to acquire
knowledge regarding nutrition and
healthful eating?
To my parents or guardians 119 31.8
To a teacher or other adults in my school 3 0.8
To a doctor or nurse 85 22.7
To my brothers or sisters 12 3.2
To my friends 5 1.3
To the Internet or social
media 142 38
Someplace else 8 2.1
D.Role of the Media and Advertising on weight
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30
1. How many billboard advertisements for
sugar-sweetened beverages have you
encountered in the past thirty days?
A lot 140 37.4
Few 234 62.6
2. How many advertisements for sugar-
sweetened beverages have you
encountered on social media or the Internet
in the past 30 days?
A lot 155 41.4
Few 219 58.6
E.School Health Services
1. Do you believe that students of your age
require additional information on healthful
eating?
Yes 260 69.5
No 114 30.5
2. Is there a need for additional information or instruction concerning
physical activity for students of your age?
Yes 256 68.4
No 118 31.6
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The dietary preferences of the study participants are detailed in Table 2. The data indicates that a considerable proportion of the respondents (35.3%) incorporate salty foods or munchies into their daily routines. The majority (222, or 59.4%) consume such items on a weekly basis, while a minority (20, or 5.3%) abstain from their consumption entirely. 55 individuals (14.7%) do not consume milk products, 202 individuals (54%),
on occasion, do so, and 117 individuals (31.3%) consume them once or more daily on a weekly basis. Furthermore, 204 (54.5%) of the students exhibit a weekly consumption pattern of sugary foods, with 145 (38.8%) consuming such items once or more daily and 25 (6.7%) abstaining entirely from their consumption. Significantly, 82 (21.9%) of the participants consume fatty foods on a daily basis, whereas 228 (61%) do so at least once per week, and 64 (17.1%) abstain from their consumption. Additionally, it is worth noting that a mere 53 students (14.2%) consume fast-food restaurant treats on a weekly basis, while 259 students (69.3%) consume them between one and three times per week and 62 students (17.1%) abstain entirely. Additionally, the research demonstrates that 69 (18.4%) of the respondents incorporate high-fiber foods into their diet at least once per day, 206 (55.1%) do so occasionally, and 99 (26.5%) abstain entirely. Furthermore, 75 participants (20.1%) consume breakfast daily, while 172 (47%) consume breakfast on a regular basis and 127 (34%) do not consume breakfast at all. In conclusion, while 82 (21.9%) of the respondents consume energy drinks on a daily basis, 239 (63.9%) abstain from drinking, 53 (14.2%) do not consume energy drinks at all.
1.3.3 Knowledge, Attitudes, Skills
Table 2 presents the findings that throughout the study year, instruction on the advantages of increasing fruit and vegetable consumption was limited to 142 students (or 38%). While 162 (43%) disagreed, 212 (56.7%) agreed that a balanced diet can promote health and well-being. 201 students (53.7%) were not instructed in class on how to maintain a healthy weight, compared to 135 students (36.1%). 176 (47.1%) of the sample received education regarding the potential dangers of consuming fat, sugar, or sodium, compared to 198 (52.9%) who did not. 125 (33.4%) students were instructed in the development of a fitness regimen, compared to 249 (66.6%) who were not. 126 (33.6%) of the sample was educated on community physical activity, whereas 248 (58.6%) did not receive such instruction. A majority of the participants, 219 individuals (58.6%), indicated that they did not receive any form of physical activity education in the classroom; however, 155 individuals (41.4%) did. A significant number of participants, 142 (38%), obtained information regarding nutrition and healthful diet through online sources or social media. This was followed by 119 (31.8%) parents or guardians and 3 (0.8%) teachers and other school personnel.
1.3.4 Role of the Media and Advertising on Weight
According to Table 2, 234 (62.6%) participants reported seeing a few sugar-sweetened drink billboards, whereas 140 (37.5%) reported seeing many. Among the students, 219 (58.6%) have seen few sugar-sweetened drink ads online or on social media, while 155 (41.4%) have seen many.
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1.3.5 School Health Services
Table 2 illustrates that 68.4% of students expressed interest in receiving more diet information, whereas only 30.5% did not. Similarly, 68.4% of students agreed to want more physical activity information, while 31.6% did not.
1.4 Associations: Chi-square
Table 3: Crosstabulation for the OW/OB and non-OW/OB students with
sociodemographic Factors.
Demographical
Factors
Category
Adolescent
Overweight/obesity
No
Yes
n(%)
n=374
P.value
Type of school
Private
113
22
135
(41.2%)
(22%)
(36.1%)
Public
161
78
239
(58.8%)
(78%)
(63.9%)
<0.001
Grade
10th
grade
111
43
154
(40.5%)
(43%)
(41.2%)
11th
grade
74
30
104
(27%)
(30%)
(27.8%)
12th
grade
89
27
116
(32.5%)
(27%)
(31%)
Age
15
years
114
36
150
(41.6%)
(36%)
(40.1%)
16
years
74
34
108
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34
Nationality
Saudi
191
(69.7%)
65
(65%)
256
(68.4%)
Non-Saudi
83
(30.3%)
35
(35%)
118
(31.6%)
0.382
Father Education Level
< university
67
(24.5%)
47
(47%)
114
(30.5%)
≥ University
207
(75.5%)
53
(53%)
260
(69.5%)
Mother Education Level
[unreadable]
[unreadable]
Student living conditions
Single career
16
(5.8%)
18
(18%)
34
(9.1%)
Both
258
82
340
<0.001
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35
Financial Level
< middle
38 (13.9%) 25 (25%) 63 (16.8%)
236 (86.1%) 75 (75%) 311 (83.2%)
0.018
Sleeping hours
< 8 Hrs.
127 (46.4%) 44 (44%) 171 (45.7%)
147 (53.6%) 56 (56%) 203 (54.3%)
0.726
Mode of commuting to school
Private car
215 (78.5%) 90 (90%) 305 (81.6%)
Other
59 (21.5%) 10 (10%) 69 (18.4%)
0.010
History of Chronic
Disease
Yes
34 (12.4%) 17 (17%) 51 (13.6%)
No
240 (87.6%) 83 (83%) 323 (86.4%)
0.206
Table 4. Crosstabulation of OW/OB and non-OW/OB students and their responses
to the research questionnaires
Questionnaire Category
answer Overweight & Obese Total P- value
No N=177 Yes N=100 N=374
2.1 Dietary behaviors
1. How often did you eat salty foods or snacks during the past seven days?
Never eating 13 (4.7%) 7 (7%) 20 (5.3%)
Sometimes during the week 159(58%) 63(63%) 222(59.4%)
Once and more, daily 102(37.2%) 30(30%) 132(35.3%) 0.352
Never consuming 38(14.3%) 17(17%) 55(14.7%) 0.130
2. How often did you drink or eat milk products in the past seven days?
3. During the past seven days, how often did you eat foods high in sugar, such as cookies, cakes, and pastries?
Never eating 14(5.1%) 11(11%) 25(6.7%)
Sometimes during the week 152(55.5%) 52(52%) 204(54.5%) 0.064
Once and more, daily 95(34.7%) 22(22%) 117(31.3%)
108(39.4%) 27(27%) 135(38.8%)
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4. During the past seven days, how often did you eat high-fat foods, such as fried foods?
Never eating
47(17.2%)
17(17%)
64(17.1%)
Sometimes
during the
week
167(60.9%)
)
61(61%)
228(61%)
Once and
more, daily
60(21.9%)
22(22%)
82(21.9%)
0.999
5. During the past seven days, how often did you eat at least one meal or snack from a fast-food restaurant?
Never eating
43(15.7%)
19(19%)
62(16.6%)
Sometimes
during the
week
191(69.7%)
68(68%)
259(69.3%)
Once and
more, daily
40(14.6%)
13(13%)
63(14.2%)
0.724
6. During the past seven days, how often did you eat breakfast?
Never eating
70(25.5%)
29(29%)
99(26.5%)
Sometimes during the
week
153(55.8%)
53(53%)
206(55.1%)
Almost every
day
129(47.1%)
43(43%)
172(46%)
0.353
7. During the past 30 days, how often did you eat breakfast?
Never eating
95(34.7%)
32(32%)
127(34%)
Sometimes
during the
week
50(18.2%)
25(25%)
75(20%)
Almost every
day
59(21.5%)
23(23%)
82(21.9%)
0.353
8. How often have you consumed energy drinks in the past seven days?
Never drinking
182(66.4%)
57(57%)
239(63.9%)
Sometimes
during the
week
59(21.5%)
23(23%)
82(21.9%)
Almost every
day
50(18.2%)
25(25%)
75(20%)
0.113
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38
week
Once and
more, daily
33(12%)
20(20%)
53(14.2%)
2.2 Weight behaviors
1. During the past 12
months, were you weighed
or measured?
Yes
217(79.2%)
)
81(81%)
298(79.7%)
0.773
No
57(20.8%)
19(19%)
76(20.3%)
2. How do you describe
your weight?
underweight
69(25.2%)
2(2%)
71(19%)
About the right
weight
152(55.5%)
11(11%)
163(43.6%)
<0.001
Overweight or
obese
53(19.3%)
87(87%)
140(37.4%)
3. During the past 30 days, did you vomit or take laxatives to lose weight or to keep from gaining weight? (Q13)
Yes
17(6.2%)
9(9%)
26(7%)
No
257(93.8%)
91(91%)
348(93%)
4. During the past 30 days, did you take any pills, powders, or liquids
without a doctor's advice to gain weight?
Yes
16(5.8%)
1(1%)
17(4.5%)
No
258(94.2%)
99(99%)
357(95.5%)
0.050
5. During the past 30 days, did you exercise, play
sports, or do other physical activity to lose weight?
Yes
123(44.9%)
66(66%)
189(50.5%)
No
151(55.1%)
34(34%)
185(49.5%)
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39
weight or keep from
gaining weight past 30 days, have you taken any diet pills, powders, or liquids
without a doctor's advice to lose weight or prevent weight gain?
Yes
7(2.6%)
5(5%)
12(3.2%)
No
267(97.4%)
95(95%)
362(96.8%)
0.317
2.3 Knowledge, Attitudes, Skills
1. During this school year, were you taught the benefits of eating more fruits and vegetables in any of your classes?
Yes
106(38.7%)
36(36%)
142(38%)
0.718
No
168(61.3%)
64(64%)
232(62%)
0.718
2. During this school year, were you taught in any of your classes that healthy eating can help you be healthy and strong?
Yes
156(56.9%)
56(56%)
212(56.7%)
0.906
No
118(43.1%)
44(44%)
162(43.3%)
0.906
3. During this school year, were you taught how to
maintain a healthy weight in any of your classes?
4. During this school year, were you taught how to
to prepare or store food in
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any of your classes safely?
5. During the school year,
were you taught in any of
your classes about the
risks of eating too many
foods high in fat, sugar, or
salt?
Yes 128(46.7%) 48(48%) 176(47.1%)
No 146(53.3%) 52(52%) 198(52.9%)
0.907
6. During this school year,
were you taught how to
develop a physical fitness
plan for yourself in any of
your classes?
Yes 89(32.5%) 36(36%) 125(33.4%)
No 185(67.5%) 64(64%) 249(66.6%)
0.537
7. During this school year,
were you taught in any of
your classes about
opportunities for physical
activity in your
community?
Yes 91(33.2%) 35(35%) 126(33.7%)
No 183(66.8%) 65(65%) 219(58.6%)
0.805
8. During this school year,
were you taught the
benefits of physical
activity in any of your
classes?
Yes 113(41.2%) 42(42%) 155(41.4%)
No 161(58.8%) 58(58%) 219(58.6%)
0.906
2.4 Role of the Media and Advertising
1. During the past 30 days, A lot
103(37.6%) 37(37%) 140(37.4%)
0.917
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how many advertisements
for sugar-sweetened
drinks did you see on
billboards?
Few
)
171(62.4%)
)
63(63%)
234(62.6%)
3. In the past 30 days, how
many advertisements for
sugar-sweetened drinks
have you seen on the
Internet or social media?
A lot
115(42%)
40(40%)
155(41.4%)
0.813
Few
159(58%)
60(60%)
219(58.6%)
*Using a 95% confidence interval, a p-value of 0.05 or less indicated a significant association
1.4.2.1 Dietary behaviors
The chi-square test results pertaining to the dietary behaviors of overweight and obese (OW/OB) students are displayed in Table 4. No significant associations among independent variables and OW/OB students were identified in the study. Nevertheless, intriguing revelations emerged from the findings. As an illustration, 30% of OW/OB pupils consume salty foods on a daily basis or more, whereas 7% never consume them.63% of OW/OB pupils consume them on occasion. In addition, milk consumption was analyzed, and it was discovered that 22% of OW/OB pupils consume milk daily, while 17% never do so and 52% do so occasionally. In the same way, only 17% of
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OW/OB students never consume fattening foods, while 22% consume them once or
twice per week and 61% consume them occasionally.
Additionally, the findings revealed that 13% of OW/OB students consume fast food
munchies on a daily basis, with 68% doing so occasionally throughout the week. A
mere 19% never consume them. The consumption of vegetables and fiber was also
assessed. 29% of OW/OB students never consume vegetables or foods high in fiber,
compared to 53% who do so occasionally and 18% who do so once or more daily. An
examination of breakfast consumption revealed that 32% of OW/OB pupils do not
consume breakfast at all, 25% consume it occasionally, and 43% consume it nearly
every day. In the final section of the study, energy drink consumption was analyzed; it
was discovered that 20% of OW/OB students are regular consumers of energy drinks,
23% are occasional consumers, and 57% never consume them. An added
bonus, the study found that 91% of OW/OB students did not try to shed weight or avoid
gaining weight by purging or using laxatives. But nine of the kids admitted to
participating in such behavior.
Just one student out of a hundred actually used weight-gain pills, supplements, or
liquids without a prescription, while the other 99 percent strictly avoided doing so.
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Finally, 95% of OW/OB students avoided using diet pills, powders, or liquids without a doctor's prescription to maintain a healthy weight. All told, five kids accomplished this.
1.4.2.3 Abilities, Attitudes, and Knowledge
the findings of a chi-square test assessing the knowledge, attitudes, and abilities pertaining to the determinants of obesity and overweight among students are displayed in Table 4. None of the independent variables were found to be associated with BMI.
Furthermore, a substantial proportion of overweight or obese pupils did not receive education on healthy eating practices, according to the study. In particular, 64% of these students were not instructed on the advantages of increasing their consumption of fruits and vegetables, and 44% were not made aware of the correlation between a healthy diet and the maintenance of good health. 62% were not instructed in the proper methods of preparing and storing food safely, and 63% were not provided with any guidance regarding weight maintenance. 52% of these pupils also required education regarding the dangers associated with consuming foods high in fat, sugar, or sodium. In addition, it was found that 64% of overweight or obese students were not provided with any instruction on how to formulate a personal physical fitness regimen, 65% were not informed about the availability of physical activity opportunities in their locality, and 58% were not educated on the advantages of engaging in physical activity.
1.4.2.4 Function of Advertising and Media
The findings of a chi-square test examining the influence of media and advertising on the overweight/obesity (OW/OB) status of students are displayed in Table 4. No OW/OB was determined to have a substantial relationship with the independent variables.. 37% of OW/OB students reported seeing numerous advertisements for sugar-sweetened beverages on billboards, whereas 63% reported seeing few. In a similar vein,
forty percent of OW/OB students reported seeing advertisements for sugar-sweetened beverages on billboards, whereas 63% reported seeing few. In a similar vein,
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beverages on social media or the Internet, whereas sixty percent reported seeing very few.
1.5 Multinomial regression
Table 5: Logistic regression analysis of OW/OB and non-OW/OB students with sociodemographic factors and weight behavior
Questionnaire Category Answer Adjust OR (95% CI) Significant
Type of schools Private Public (Reference) -0.773 (0.186-1.143) 0.095
Father Education Level < university ≥ University(Reference) 0.494 (0.717-3.758) 0.242
Mother Education Level < university ≥ University(Reference) -0.679 (0.379-1.90) 0.690
Students living conditions Single parent/ other Both(Reference) 1.737 1.803-17.904 0.003
Financial Level < middle ≥ Middle(Reference) 1.006 (0.379-1.90) 0.021
Mode of commuting to school Other Private car(Reference) -2.064 0.001
About the right weight 0.003
Overweight or
obese(Reference)
play sports or
exercise do other
types of physical
activity Q14
Yes
No(Reference)
-0.713
0.999-4.162
0.050
Yes
No(Reference)
-3.254
0.003-0.488
0.012
*Reference group is non-OW/OB
Table 5 shows the results of a multinomial logistic regression study. Statistically related characteristics with OW/OB pupils (Tables 3 and 4) were the focus of this study's examination of their influence. Among these factors were the kids' social position, the way they commuted to school, the socioeconomic level of their parents, the sort of school they attended, and the students' living situations with their parents. The reference group did not consist of OW/OB students. An examination of the factors influencing students' OW/OB revealed that only "students' living conditions" and "financial level" were considerably relevant. It was also shown that OW/OB pupils were much more likely to use a certain form of transportation to go to school.
One study found that compared to kids whose parents live together, those whose parents live apart had a higher probability of becoming OW/OB. There is a p-value of 0.003 and
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an odds ratio of 1.737 (95% CI: 1.162-6.441). More students from low-income
households are overweight or obese than students from middle-class or higher-income
families. The odds ratio is 1.006 (95% CI: 1.162-6.441) when the p-value is 0.0219.
Further factors influencing OW/OB pupils include mode of transportation. The results
show that students who use school transportation or other forms of transportation, such
walking, to go to school are less likely to become OW/OB compared to those who use
private cars. The p-value is less than 0.001, and the odds ratio is 2.064 (95% CI: 0.037-0.297). Students' tendency to be overweight or obese is significantly correlated with
how they perceive their own weight. With an odds ratio of 4.650 and a p-value less than
0.001 (95% CI: 0.002-0.049), there is a statistically significant difference between the
chance of pupils who self-identify as underweight and those who are overweight or
obese.
Likewise, there is a reduced likelihood of overweight or obesity among students who
self-identify as being at a healthy weight, as indicated by an odds ratio of 3.254 and a
p-value of less than 0.001 (95% CI 0.003-0.488). Furthermore, the findings indicate that
students who engage in physical activity have a reduced likelihood of developing OW/OB in
comparison to those who do not. This is associated with an odds ratio of 0.713 and a
p-value of 0.050 (95% CI 0.003-0.488).
In conclusion, the likelihood of students becoming OW/OB is diminished when they
abstain from consuming weight gain tablets, powders, or liquids without consulting a
physician, as opposed to those who do so. A p-value of 0.012 corresponds to an odds
ratio of 3.254 (95% CI: 0.003-0.488).
As a result
2. Comparative aspect:
A total of 27 individuals were interviewed; nine were from School A, nine from School
B, and nine from School C. Multiple themes surfaced during the analysis of the interviews. The initial motif pertained to the canteen of the educational institution, encompassing the provision of nutritious fare, appealing presentation, and affordable pricing. The second theme concerned the deficiency in school health services that contributes to the obesity of students (lack of awareness regarding the dangers of obesity, school responsibility and physical activity implementation, and accessibility of treatment plans).
2.1 Themes analysis related, which was the assessment of the school canteen about the availability of healthy food and unhealthy choices:
Theme 1.1: Availability of healthy food :
The majority of those polled felt that the existing cafeteria cuisine requires to be reconsidered and supplanted with an increased number of healthy, beneficial options.
They also suggested using marketing clips to attract students' attention, such as videos and publications promoting nutritious food, and having an outside party monitor the school's food quality on an ongoing basis.
"The contractor for the school canteen and the productive family in the school provide the fryer, pastries, some sugary juices, and sweetened juices" (teacher 4, secondary school A).
"The canteen is laden with sugars and carbohydrates, both of which contribute to obesity; these items are impoverished and unhealthy, and are not deemed valid" (teacher 8, secondary school B).
"The canteen does not carry fruits, which are preferred by some students as a snack" (teacher two, secondary school C).
48
Theme 1.2: Presentation in an attractive way:
As many participants mentioned, the healthy food in the school's canteen needs
to be attractively presented to the students so they are excited to buy it.
"Food should be provided in colorful containers so we can be motivated to buy
it" (teacher, six secondary school C).
"The factor that most affects children's nutrition is the media and advertising."
(teacher seven secondary school A).
"Offering mixed fruit topped with yogurt would be a beneficial suggestion; it
promotes health and may appeal to certain students who favor the canteen" (secondary school C, teacher 2).
"I am aware that many students on a diet prefer brown bread to white bread,
but it is not available at our school cafeteria" (teacher one from secondary school B).
"Providing appliances in the canteen, such as a toaster for toasting bread, would be a
beneficial addition (Teacher Seven, Secondary School A)."
"Although the provision of fruit and vegetables in the canteen is commendable, it
would be more optimal if fruit salads were offered or vegetable salads were substituted
for fruit salads on alternate days. This would prevent the monotony of eating the same
food every day (teacher one, secondary school A)."
"The availability of nutritious cuisine in school cafeterias is infrequent. Certain
pupils consume sandwiches stuffed with potato crisps and mayonnaise, among other
similar items (Teacher six, secondary school C)."
'We are in a new digital age. It would be exciting to start doing healthy advertising. (teacher six secondary school C).'
Theme 1.3: Reasonable price:
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49
One factor which popped up while deciding on a cuisine choice was the cost. However,
there isn't a consensus posture on this because notwithstanding parents' assertions that
eating well is more expensive than ingesting fewer nourishing meals, the latter is
selected.
"Canteen main courses, including pastries and croissants, should not exceed two SR" (teacher three, secondary school A).
"'Certain pupils' personal money does not surpass two to three SAR; therefore, they are unable to purchase this food item for three SAR for a sandwich (teacher five secondary school C)."
"Activating the community partnership in the Ministry of Education by providing healthy meals for students, calculating calories offered at nominal prices or free" (teacher one secondary educational institution B).
"'Students are not interested in health programs that educate them about the dangers of obesity,' according to teacher eight of secondary school C."
"The services are restricted to conventional methods of raising awareness, and there is no supplementary initiative to promote a healthy food culture" (teacher three, secondary school B).
2.2 Themes analysis related to identifying the gap needs among female students about school health services related to obesity
Theme 2.1: Weakness of awareness of obesity risk:
The majority of respondents agreed that we must prioritize education and awareness. Their concerns centered on the absence of targeted and appealing methods to execute the awareness campaign.
"Students are not interested in health programs that educate them about the dangers of obesity," according to teacher eight of secondary school C.
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50
"The parents' and students' lack of interest" (teacher number five, secondary school A).
Theme 2.2: Physical activity practice and school role:
Gyms, walking places, public parks, and social care facilities are essential resources that
students require, according to several participants. Their theory is that the obesity
epidemic is worsened because people do not have easy access to exercise facilities and
green spaces.
"The school lacks a fitness center and a designated area for student sports" (Teacher four, Secondary School A).
"The walkway is important, and there is no one in the school." (Secondary school instructor C).
"In practical application, physical activity does not exist; it is purely theoretical" (Teacher No. 9 at Secondary School B).
"The school does not have a designated area for physical activity; the school environment should be modified to accommodate the age of the students" (Teacher Two, Secondary School B).
"Encourage them by making an incentive at the end of each term to the student who successfully reduces weight can be an effective strategy to promote physical behaviors among the students" (teacher eight students in secondary school C).
"The student needs to maintain and encourage physical activities inside and
outside the school, but we do not have as the families do not fully collaborate with
schools" (teacher six secondary educational institution A).
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participation by all students, ensure that physical education teachers are well qualified" (teacher three secondary educational institutions B).
and appropriately trained" (teacher three secondary educational institutions B).
"Beyond of school hours, there is an absence of sports clubs that encourage
students to participate symbolically" (teacher number five, secondary school A).
"Inadequate financial and human support, deteriorating, outdated, and unfit facilities,
and a dearth of contemporary sports equipment" (teacher one, secondary school C).
"Increase sports classes regularly in schools with prepared halls and a proper
environment and the work of exhibitions inside and outside schools to encourage
exercise" (teacher six secondary educational institution A).
"Another barrier that hinders physical activity has been emphasized by the
participants. Physical activity among community members, especially young adults,
was frequently impeded by the exorbitant cost of gym memberships."
"The cost of going to the gym is high." (Secondary school instructor C).
"The cost of going to the gym is excessive." (Eighth-grade secondary school B instructor).
Theme 2.3: Accessibility of treatment plan:
The participants expressed concern about the lack of support for obese children in
schools and the difficulty for them to access appropriate healthcare owing to
overcrowding in primary care clinics and insufficient resources at specialist clinics.
School nurses and other health professionals should be employed by schools to ensure
the well-being of both kids and faculty, according to one participant.
"There is no plan to detect an obese student, and there is no clear follow-up
with obese students in the early stages to refer them to an age-appropriate
dietary pattern with a specialist, make the necessary analyses before starting any diet, and
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provide free weight loss nutritional programs for obese students" (teacher five secondary school C).
"NO free subscriptions and low-calorie meals supporting students with obesity to help them lose weight" (teacher eight secondary school A).
"MOH examines specific levels each year, and no yearly program to evaluate all students" (teacher one secondary school B).
"We need to focus on Increasing self-evaluation among students, maintaining the proper weight and cooperating with parents more with schools" (teacher three secondary school C).
"Absent of school nurse to maintain consciousness of evaluation and encourage to decrease weight among overweight and obese students" (teacher seven secondary school C).
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ConclusionError: Reference source not found