JMIR Publications

ABSTRACT

Background:

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.

Objective:

This study aimed to (1) assess the prevalence of obesity using Body Mass Index (BMI) 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 effect on body image discrepancies.

Methods:

A quasi-experimental, pre-post trial with a parallel, non-equivalent control group design was conducted among 95 adolescents (mean age 16.18 ± 0.53 years) from two public high schools in Madina City, Saudi Arabia. Participants were randomly assigned to either the Macronutrient + NCDs Health Education group or the Macronutrient Health Education group. Anthropometry (BMI and fat percentage), cardiovascular fitness, physical activity, and eating behaviors were measured at baseline and post-intervention. The intervention consisted of two educational sessions focusing on macronutrients and metabolic diseases for the experimental group, while the control group received sessions focused solely on macronutrient education, with no emphasis on weight or body size. Independent t-tests and Chi-square tests were conducted to compare group differences, and a two-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 post-intervention assessments.

Results:

The prevalence of overweight and obesity, based on BMI, was 37.9%, while 50.5% 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 compared to their overweight or obese peers (p = 0.022). The intervention significantly improved macronutrient-metabolic knowledge, F(1, 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 post-intervention (p = .70), suggesting that the non-weight-centric approach did not increase body image discrepancies. The intervention demonstrated strong feasibility, with a recruitment rate of 82.6% and a retention rate of 72.6%.

Conclusions:

This study reveals a high prevalence of obesity among Saudi adolescents, particularly when measured using fat percentage. The significant improvement in knowledge and the potential positive impact 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.