JMIR Publications

ABSTRACT

Background:

Obesity rates among Saudi adolescents are on the rise, with regional variations underscoring the need for tailored interventions. Existing school-based health programs in Saudi Arabia are limited and often focus on weight and body size, which can inadvertently exacerbate body image dissatisfaction and disordered eating behaviors. To date, no known study has delivered an obesity prevention program specifically targeting Saudi rural students.

Objective:

This study aimed to evaluate the feasibility and impact of a low-intensity, non-weight-centric educational intervention – Green apple- designed to enhance knowledge of macronutrients, Metabolic Non communicable diseases (MNCDs), and sedentary behavior while assessing its safety regarding body image discrepancies and disordered eating symptoms.

Methods:

This quasi-experimental study included 105 participants from urban and rural schools in Saudi Arabia, were four classes assigned to an intervention group (macronutrients education + MNCDs education) or a control group (macronutrients education only). Assessments were conducted at three time points: baseline, post-intervention, and one-month follow-up. Linear mixed-effects models were utilized to evaluate the effects of intervention type and school type on knowledge, sedentary behavior, body image discrepancy, and disordered eating symptoms.

Results:

Intervention significantly improved MNCDs knowledge at both post-intervention (p < 0.001) and follow-up (p < 0.001) in urban schools, with delayed but significant improvements in rural schools at follow-up (p = 0.03). The intervention reduced sedentary behavior, particularly in rural schools (p = 0.017). Promising trends were observed in decreasing body image discrepancy and disordered eating symptoms, particularly in urban schools (p = 0.007). No significant adverse effects on body image or disordered eating symptoms were noted, underscoring the program's safety.

Conclusions:

The Green Apple program demonstrates the potential of weight-neutral, culturally tailored interventions in improving metabolic health literacy, reducing sedentary behavior, and supporting positive psychosocial outcomes among Saudi rural female adolescents. These findings highlight the need for scaling such programs to address adolescent health challenges in non-Western contexts.