Zuair Areeg, Alhowaymel Fahad M, Jalloun Rola A, Alzahrani Naif S, Almasoud Khalid H, Alharbi Majdi H, Alnawwar Rayan K, Alluhaibi Mohammed N, Alharbi Rawan S, Aljohan Fatima M, Alhumaidi Bandar N, Alahmadi Mohammad A
Department of Community Health Nursing, Taibah University, Janadah Bin Umayyah Road, Medina, 42353, Saudi Arabia, 966 594800400.
Department of Nursing Science, Shaqra University, Shaqra, Saudi Arabia.
JMIR Pediatr Parent. 2025 Jan 24;8:e67213. doi: 10.2196/67213.
Obesity rates among Saudi adolescents are increasing, with regional variations highlighting the need for tailored interventions. School-based health programs in Saudi Arabia are limited and often emphasize weight and body size, potentially exacerbating body image dissatisfaction. There is limited knowledge on the feasibility of non-weight-centric educational programs in Saudi Arabia and their effects on health behaviors and body image.
This study aimed to (1) assess the prevalence of obesity using BMI-for-age z score (BAZ) and fat percentage among Saudi adolescents; (2) evaluate key health behaviors, cardiovascular fitness, and health literacy; and (3) assess the feasibility and impact of a low-intensity, non-weight-centric educational intervention designed to improve knowledge of macronutrients and metabolic diseases, while examining its safety on body image discrepancies.
A quasi-experimental, pre-post trial with a parallel, nonequivalent control group design was conducted among 95 adolescents (58 boys and 37 girls; mean age 16.18, SD 0.53 years) from 2 public high schools in Medina City, Saudi Arabia. Participants were randomly assigned to either the weight-neutral Macronutrient + Non-Communicable Diseases Health Education group or the weight-neutral Macronutrient Health Education group. Anthropometry (BAZ and fat percentage), cardiovascular fitness, physical activity, and eating behaviors were measured at baseline. Independent t tests and χ² tests were conducted to compare group differences, and a 2-way mixed ANOVA was used to evaluate the effect of the intervention on macronutrient knowledge and body image discrepancies. A total of 69 participants completed the postintervention assessments.
The prevalence of overweight and obesity based on BAZ was 37.9% (36/95), while 50.5% (48/95) of participants were classified as overfat or obese based on fat percentage. Students with normal weight status were significantly more likely to have had prior exposure to health education related to metabolic diseases than students with higher weight status (P=.02). The intervention significantly improved macronutrient-metabolic knowledge (F1,64=23.452; P<.001), with a large effect size (partial η²=0.268). There was no significant change in students' body image from pre- to postintervention (P=.70), supporting the safety of these weight-neutral programs. The intervention demonstrated strong feasibility, with a recruitment rate of 82.6% and a retention rate of 72.6%.
This study reveals a high prevalence of obesity among Saudi adolescents, particularly when measured using fat percentage. The significant improvement in knowledge and the nonimpact on body image suggest that a non-weight-centric intervention can foster better health outcomes without exacerbating body image dissatisfaction. Region-specific strategies that prioritize metabolic health and macronutrient education over weight-centric messaging should be considered to address both obesity and body image concerns in adolescents.
沙特青少年的肥胖率正在上升，地区差异凸显了采取针对性干预措施的必要性。沙特阿拉伯的校本健康项目有限，且往往侧重于体重和体型，这可能会加剧对身体形象的不满。关于非以体重为中心的教育项目在沙特阿拉伯的可行性及其对健康行为和身体形象的影响，相关知识有限。
本研究旨在（1）使用年龄别体重指数（BAZ）和体脂百分比评估沙特青少年的肥胖患病率；（2）评估关键健康行为、心血管健康状况和健康素养；（3）评估一项低强度、非以体重为中心的教育干预措施的可行性和影响，该干预旨在提高对宏量营养素和代谢性疾病的认识，同时考察其对身体形象差异的安全性。
在沙特阿拉伯麦地那市的2所公立高中对95名青少年（58名男孩和37名女孩；平均年龄16.18岁，标准差0.53岁）进行了一项类实验性的前后试验，采用平行、非等效对照组设计。参与者被随机分配到非体重相关的宏量营养素+非传染性疾病健康教育组或非体重相关的宏量营养素健康教育组。在基线时测量人体测量指标（BAZ和体脂百分比）、心血管健康状况、身体活动和饮食行为。进行独立t检验和χ²检验以比较组间差异，并使用双向混合方差分析来评估干预对宏量营养素知识和身体形象差异的影响。共有69名参与者完成了干预后评估。
根据BAZ，超重和肥胖的患病率为37.9%（36/95），而根据体脂百分比，50.5%（48/95）的参与者被归类为脂肪过多或肥胖。体重正常的学生比体重较高的学生更有可能之前接触过与代谢性疾病相关的健康教育（P = 0.02）。干预显著提高了宏量营养素-代谢知识（F1,64 = 23.452；P < 0.001），效应量较大（偏η² = 0.268）。从干预前到干预后，学生的身体形象没有显著变化（P = 0.70），这支持了这些非体重相关项目的安全性。该干预显示出很强的可行性，招募率为82.6%，保留率为72.6%。
本研究揭示了沙特青少年中肥胖的高患病率，尤其是使用体脂百分比测量时。知识的显著提高以及对身体形象无影响表明，非以体重为中心的干预措施可以促进更好的健康结果，而不会加剧对身体形象的不满。应考虑采取针对特定地区的策略，将代谢健康和宏量营养素教育置于以体重为中心的信息之上，以解决青少年的肥胖和身体形象问题。
