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BMC Public Health
Published in: BMC Public Health 1/2015

Open Access 01-12-2015 | Research article

Do routinely measured risk factors for obesity explain the sex gap in its prevalence? Observations from Saudi Arabia

Authors: Fatima Garawi, George B Ploubidis, Karen Devries, Nasser Al-Hamdan, Ricardo Uauy

Published in: BMC Public Health | Issue 1/2015

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Abstract

Background

The prevalence of adult obesity is higher in women than men in most countries. However, the pathways that link female sex with excess obesity are still not fully understood. We examine whether socioeconomic and behavioural factors may mediate the association between sex and obesity in the Saudi Arabian setting where there is female excess in obesity.

Methods

We performed a mediation analysis using a cross-sectional, national household survey from Saudi Arabia with 4758 participants (51% female). A series of multivariable regression models were fitted to test if socioeconomic position, physical activity, sedentary behaviour, diet, and smoking mediate the association between sex and obesity (BMI >=30). The findings were confirmed using causal mediation analysis.

Results

Women in this sample were roughly twice as likely as men to be obese (crude OR 1.9; 95% CI 1.6-2.3). The odds ratio remained significantly higher for women compared to men in models testing for mediation (OR range 1.95–2.06). Our data suggest that indicators of socio-economic position, physical activity, sedentary behaviour, diet, and smoking do not mediate the sex differences in obesity.

Conclusions

Our analysis shows that most commonly measured risk factors for obesity do not explain the sex differences in its prevalence in the Saudi context. Further research is needed to understand what might explain the female excess in obesity prevalence. We discuss how data related to the lived experience of Saudi men and women may tap into underlying mechanisms by which the sex difference in obesity prevalence are produced.
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Literature
1.
Finucane MM, Stevens GA, Cowan MJ, Danaei G, Lin JK, Paciorek CJ, et al. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 91 million participants. Lancet. 2011;377:557–67.PubMedPubMedCentral
2.
Bobrow KL, Quigley MA, Green J, Reeves GK, Beral V. Persistent effects of women’s parity and breastfeeding patterns on their body mass index: results from the Million Women Study. Int J Obes (Lond). 2013;37:712–7.
3.
Brooks R, Maklakov A. Sex differences in obesity associated with total fertility rate. PLoS One. 2010;5:1–4.
4.
Wells JCK, Marphatia AA, Cole TJ, McCoy D. Associations of economic and gender inequality with global obesity prevalence: understanding the female excess. Soc Sci Med. 2012;75:482–90.PubMed
5.
Garawi F, Devries K, Thorogood N, Uauy R. Global differences between women and men in the prevalence of obesity: Is there an association with gender inequality? Eur J Clin Nutr. Advance online publication 11 June 2014; doi: 10.1038/ejcn.2014.86.
6.
Pickett KE, Kelly S, Brunner E, Lobstein T, Wilkinson RG. Wider income gaps, wider waistbands? An ecological study of obesity and income inequality. J Epidemiol Community Health. 2005;59:670–4.PubMedPubMedCentral
7.
Monteiro CA, Conde WL, Lu B, Popkin BM. Obesity and inequities in health in the developing world. Int J Obes Relat Metab Disord. 2004;28:1181–6.PubMed
8.
McLaren L. Socioeconomic status and obesity. Epidemiol Rev. 2007;29:29–48.PubMed
9.
Monteiro CA, Moura EC, Conde WL, Popkin BM. Socioeconomic status and obesity in adult populations of developing countries: a review. Bull World Health Organ. 2004;82:940–6.PubMed
10.
Wardle J, Waller J, Jarvis MJ. Sex differences in the association of socioeconomic status with obesity. Am J Public Health. 2002;92:1299–304.PubMedPubMedCentral
11.
Bull F, Chey TS, Bergman P, Hipp D. The international prevalence study on physical activity: results from 20 countries. Int J Behav Nutr Phys Act. 2009;6:21.PubMedPubMedCentral
12.
Owen CG, Nightingale CM, Rudnicka AR, Cook DG UE, Whincup PH. Ethnic and gender differences in physical activity levels among 9-10-year-old children of white European, South Asian and African-Caribbean origin: the Child Heart Health Study in England (CHASE Study). Int J Epidemiol. 2009;38:1082–93.PubMedPubMedCentral
13.
Guthold R, Ono T, Strong KL, Chatterji S, Morabia A. Worldwide variability in physical inactivity: a 51-country survey. Am J Prev Med. 2008;34:486–94.PubMed
14.
Al-Nuaim AR, Al-Rubeaan K, Al-Mazrou Y, Al-Attas O, Al-Daghari N, Khoja T. High prevalence of overweight and obesity in Saudi Arabia. Int J Obes Relat Metab Disord. 1996;20:547–52.PubMed
15.
Al-Othaimeen AI, Al-Nozha M, Osman AK. Obesity: an emerging problem in Saudi Arabia: analysis of data from the National Nutrition Survey. East Mediterr Health J. 2007;13:441–8.PubMed
16.
Al-Nozha MM, Al-Mazrou YY, Al-Maatouq MA, Arafah MR, Khalil MZ, Khan NB, et al. Obesity in Saudi Arabia. Saudi Med J. 2005;26:824–9.PubMed
17.
Al-Hamdan N. The WHO stepwise approach to NCD surveillance, Saudi Arabia standard report. Geneva: WHO; 2005.
18.
Osman AK, Al-Nozha MM. Risk factors of coronary artery disease in different regions of Saudi Arabia. East Mediterr Health J. 2000;6:465–74.PubMed
19.
Alhowaish AK. Economic costs of diabetes in Saudi Arabia. J Fam Community Med. 2013;20:1–7.
20.
Hnoosh A, Vega-Hernández G, Jugrin A, Todorova L. Direct medical costs of diabetes-related complications in Saudi Arabia. Value Health. 2012;15:A178.
21.
Kilpi F, Webber L, Musaigner A, Aitsi-Selmi A, Marsh T, Rtveladze K, et al. Alarming predictions for obesity and non-communicable diseases in the Middle East. Public Health Nutr. 2014;17(5):1078–86.PubMed
22.
23.
Heslehurst N, Simpson H, Ells LJ, Rankin J, Wilkinson J, Lang R, et al. The impact of maternal BMI status on pregnancy outcomes with immediate short-term obstetric resource implications: a meta-analysis. Obes Rev. 2008;9:635–83.PubMed
24.
25.
26.
Mabry RM, Reeves MM, Eakin EG, Owen N. Evidence of physical activity participation among men and women in the countries of the Gulf cooperation council: a review. Obes Rev. 2010;11:457–64.PubMed
27.
28.
29.
Al-Hamdan N, Saeed A, Kutbi A, Choudhry AJ, Nooh R. Characteristics, risk factors, and treatment practices of known adult hypertensive patients in Saudi Arabia. Int J Hypertens. 2011;2010:168739.PubMedPubMedCentral
30.
Ledoux TA, Hingle MD, Baranowski T. Relationship of fruit and vegetable intake with adiposity: a systematic review. Obes Rev. 2011;12:e143–50.PubMed
31.
Armstrong T, Bull F. Development of the world health organization global physical activity questionnaire (GPAQ). J Public Health. 2006;14:66–70.
32.
33.
Ainsworth BE, Haskell WL, Herrmann SD, Meckes N, Bassett DR, Tudor-Locke C, et al. 2011 compendium of physical activities: a second update of codes and MET values. Med Sci Sports Exerc. 2011;43:1575–81.PubMed
34.
Imai K, Keele L, Tingley D, Yamamoto T. Unpacking the black box of causality: learning about causal mechanisms from experimental and observational studies. Am Polit Sci Rev. 2011;105(4):765–89.
35.
Hicks R, Tingley D. Causal mediation analysis. Stata J. 2011;11:609–15.
36.
Imai K, Keele L, Tingley D. A general approach to causal mediation analysis. Psychol Methods. 2010;15:309.PubMed
37.
StataCorp. Stata survey data reference manual release 13. 1985–2013.
38.
39.
40.
MacKinnon DP, Krull JL, Lockwood CM. Equivalence of the mediation, confounding and suppression effect. Prev Sci. 2000;1:173–81.PubMedPubMedCentral
41.
Musaiger AO. Overweight and obesity in the Eastern Mediterranean Region: can we control it? East Mediterr Health J. 2004;10:789–93.PubMed
42.
Salam AA. Nuptiality and fertility in Saudi Arabia: Aan appraisal of census data. Middle East Fertil Soc J. 2013;18:147–53.
43.
Al-Hreashy FA, Tamim HM, Al-Baz N, Al-Kharji NH, Al-Amer A, Al-Ajmi H, et al. Patterns of breastfeeding practice during the first 6 months of life in Saudi Arabia. Saudi Med J. 2008;29:427–31.PubMed
44.
Baker JL, Gamborg M, Heitmann BL, Lissner L, Sorensen TI, Rasmussen KM. Breastfeeding reduces postpartum weight retention. Am J Clin Nutr. 2008;88:1543–51.PubMed
45.
Fell DB, Joseph K, Armson BA, Dodds L. The impact of pregnancy on physical activity level. Matern Child Health J. 2009;13:597–603.PubMed
46.
Garawi F, Thorogood N. The female excess in obesity in Saudi Arabia. London, UK: Poster presented at the meeting of the British Sociological Association; 2014.
47.
Baglar R. “Oh God, Save Us from Sugar”: an ethnographic exploration of diabetes mellitus in the United Arab Emirates. Med Anthropol. 2013;32:109–25.PubMed
48.
Donnelly TT, Al Suwaidi J, Al Bulushi A, Al Enazi N, Yassin K, Rehman AM, et al. The influence of cultural and social factors on healthy lifestyle of Arabic women. Avicenna, 2011;3:1–13.
49.
Kivimäki M, Batty GD, Hublin C. Shift work as a risk factor for future type 2 diabetes: evidence, mechanisms, implications, and future research directions. PLoS Med. 2011;8:e1001138.PubMedPubMedCentral
50.
Antunes L, Levandovski R, Dantas G, Caumo W, Hidalgo M. Obesity and shift work: chronobiological aspects. Nutr Res Rev. 2010;23:155–68.PubMed
51.
Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999–2008. JAMA, J Am Med Assoc. 2010;303:235–41.
52.
Van Dyck D, Cardon G, Deforche B, Owen N, De Bourdeaudhuij I. Relationships between neighborhood walkability and adults’ physical activity: how important is residential self-selection? Health Place. 2011;17:1011–4.PubMed
53.
Al-Nakeeb Y, Lyons M, Collins P, Al-Nuaim A, Al-Hazzaa H, Duncan MJ, et al. Obesity, physical activity and sedentary behavior amongst British and Saudi Youth: a cross-cultural study. Int J Environ Res Public Health. 2012;9:1490–506.PubMedPubMedCentral
54.
55.
World Bank. 2013. Opening doors: gender equality and development in the Middle East and North Africa. Washington DC: World Bank. doi: 10.1596/978-0-8213-9763-3. License: Creative Commons Attribution CC BY 3.0.
56.
Field AE, Cheung L, Wolf AM, Herzog DB, Gortmaker SL, Colditz GA. Exposure to the mass media and weight concerns among girls. Pediatrics. 1999;103:e36.PubMed
57.
Musaiger AO, Shahbeek NE, Al-Mannai M. The role of social factors and weight status in ideal body-shape preferences as perceived by Arab women. J Biosoc Sci. 2004;36:699–707.PubMed
58.
Rasheed P. Perception of body weight and self-reported eating and exercise behaviour among obese and non-obese women in Saudi Arabia. Public Health. 1998;112:409–14.PubMed
59.
Thomas J, Khan S, Abdulrahman AA. Eating attitudes and body image concerns among female university students in the United Arab Emirates. Appetite. 2010;54:595–8.PubMed
60.
Khraif RM. Fertility in Saudi Arabia: levels and determinants. XXIV General Population Conference, Salvador, Brazil, 18–24 2001.
61.
62.
Shah NR, Braverman ER. Measuring adiposity in patients: the utility of body mass index (BMI), percent body fat, and leptin. PLoS ONE [Electronic Resource]. 2012;7:e33308.
63.
Prince S, Adamo K, Hamel M, Hardt J, Gorber S, Tremblay M. A comparison of direct versus self-report measures for assessing physical activity in adults: a systematic review. Int J Behav Nutr Phys Act. 2008;5:56.PubMedPubMedCentral
64.
Schoenborn CA Marital Status and Health, United States 1999–2002. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics 2004.
65.
Sobal J, Rauschenbach B, Frongillo EA. Marital status changes and body weight changes: a US longitudinal analysis. Soc Sci Med. 2003;56:1543–55.PubMed
66.
Al-Shehri F, Moqbel M, Al-Shahrani A, Al-Khaldi Y, Abu-Melha W. Management of obesity: Saudi clinical guideline. Saudi J Obes. 2013;1:18.
Metadata
Title
Do routinely measured risk factors for obesity explain the sex gap in its prevalence? Observations from Saudi Arabia
Authors
Fatima Garawi
George B Ploubidis
Karen Devries
Nasser Al-Hamdan
Ricardo Uauy
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2015
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-015-1608-6

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