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Awareness and Practice of Diabetic Patients about Obesity in Saudi Arabia Cross-Sectional Study

Journal of Research in Medical and Dental Science
eISSN No. 2347-2367 pISSN No. 2347-2545

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Research - (2022) Volume 10, Issue 4

Awareness and Practice of Diabetic Patients about Obesity in Saudi Arabia Cross-Sectional Study

*Correspondence: Mohammed H Karrar lsharif, Department of Basic Medical Science, College of Medicine, Prince Sattam Bin Abdulaziz University, Al Kharj, 11942, Saudi Arabia, Email:

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Abstract

Obesity is a serious public health issue linked to the occurrence of diabetes type 2. However, only a few studies have examined how type 2 diabetics (T2D) patients perceive obesity. In this study, we want to see how T2D patients in Saudi Arabia feel about obesity and what they do about it. T2D patients were examined for their understanding of how obesity impacts their disease and worries. In addition to their habits, such as weight-loss activities and eating habits, in a cross-sectional study done in Saudi Arabia. A total of 421 T2DM patients were included. A total of 234 (55.6%) were obese, and 187 (44.4%) were non-obese. Patients' ages ranged from 18 to 80 years, with a mean age of 40.2 ± 16.5 years old. This research will aid public policymakers in developing a more effective evidence-based and informed communication strategy. As a result, adequate efforts must be made to raise awareness of obesity and its repercussions, and the availability of exact information is critical to such efforts' success.

Keywords

Obesity, Awareness, Type 2 diabetes, Public health

Introduction

Obesity and overweight are defined as an abnormal or excessive buildup of fat that can be damaging to one's health. The body mass index (BMI) is a basic weight-forheight metric that's frequently used to determine whether or not a person is overweight or obese. It is computed by multiplying a person's kilogram weight by his squared height (kg/m2) [1]. Obesity, like hypertension and atherosclerosis, is a chronic condition. Obesity is caused by an energy imbalance between the energy absorbed in food and the energy expended in physical activity [2]. Each disease with an increased risk due to obesity can be divided into one of two pathophysiological groups. An increase in fat mass causes the first group of disabilities. Obesity stigma and the behavioral responses it causes, osteoarthritis, and sleep apnea are among them— the dangers connected with metabolic alterations caused by excess fat fall under the second category. Diabetes mellitus, gallbladder disease, hypertension, cardiovascular disease, and several cancers linked to obesity are among them [2]. Type 2 diabetes is caused due to insensitivity of insulin receptors witch located on lipocytes (fat cells). Type 2 diabetes affects more than 95% of patients with diabetes. Fatness and poor physical are the primary causes of this type [3].

According to the World Health Organization (WHO), Saudi Arabia has the second-highest diabetes rate in the Middle East and ranks seventh globally. According to estimates, around 7 million people have diabetes, and almost 3 million have pre-diabetes [4]. Overweight people accounted for 36.9% of the population. In Saudi Arabia, men are significantly more likely than women to be overweight (42.4 percent vs. 31.8 percent) [5]. Patients with T2DM who lost weight had better control of their hyperglycemia. Due to the importance of patient awareness and understanding of the management of obesity and T2DM, it is necessary to analyze patient attitudes and behaviors about obesity and related disorders [6]. All previous studies ensure the strong relationship between obesity and DM 2, which leads us to question further the knowledge and awareness of diabetic patients regarding obesity and its effect on their diabetes status. Lifestyle modifications such as losing weight and normalizing the patient's BMI can improve the condition and reduce mortality and morbidity. In this study, we aim to evaluate the awareness and knowledge of diabetic patients concerning Obesity.

Aim and Objectives

Aim

Type 2 diabetes is one of the chronic diseases that Saudi society suffers from; the Saudi Ministry of Health carries out many periodic awareness and guidance campaigns throughout the year that contribute to raising the levels of knowledge and awareness about health practices for people with type 2 diabetes, and what is not There is no doubt that obesity is linked to many diseases, including type 2 diabetes patients, so this study is based on evaluating the level of obesity and the levels of knowledge and awareness health practices in patients with type 2 diabetes.

Objectives

✓ Assessment of the level of knowledge and the assessment of obesity in patients with type 2 diabetes.
✓ Knowing the level of obesity in patients with type 2 diabetes.
✓Assessment of the knowledge of patients with type 2 diabetes onset of high blood pressure.
✓ Assessing the awareness of patients with type 2 diabetes on the correct practices to track their health.
✓ Knowing the unhealthy practices of type 2 diabetes patients.

Methodology

Study design, population and site

A quantitative cross-sectional study of 421 Diabetic patients. An electronic questionnaire was distrusted among patients with Type 2 diabetes mellitus in Saudi Arabia for both genders. The questionnaire was designed in English following a review of the published literature and consultation with experts and then was translated into Arabic. The questionnaire used in the previous study and well-structured and divided into four sections. The first part was about the personal information which included gender, age, educational level, medical illness status, weight & height . The second half focused on understanding obesity, appropriate body weight, BMI thresholds, and obesity risk factors and causes. The final segment examined the individuals' attitudes toward obesity and T2DM, as well as their willingness to reduce weight, change their diet, and exercise. The final portion enquired about their weight loss regimen (if any), eating habits, and weight, blood pressure, and blood glucose level measurements, among other things.

The study was conducted with type 2 diabetic patients between January and March 2022, asking about their behavior and practice regarding obesity. A research board review was obtained from the health and science disciplines research ethics committee at Prince Sattam bin Abdulaziz University (SCBR-06-2022). Consent was obtained from the participants in the survey.

Data collection

An electronic questioner distributed by social media to the Patient with type 2 diabetes. The questionnaire includes age, BMI, and questions about their lifestyle, exercise, and weight loss methods. It also includes questions if they have hypertension or not and how many times they measure their blood pressure and body weight. Also, we ask them about their knowledge of the relationship between obesity and diabetes and other diseases.

Data analysis

After the data was extracted, it was reviewed, coded, and fed into the IBM SPSS version 22 statistical program (SPSS, Inc. Chicago, IL). Two-tailed tests were used for all statistical analyses. A statistically significant P value was less than 0.05. All variables, including diabetic patients' socio-demographic and clinical data, were subjected to descriptive analysis based on frequency and percent distribution. Crosstabulation was used to compare obese and non-obese patients for all obesity-related factors, including awareness regarding obesity, patients’ Behaviour, practice, and self-monitoring. Relations were tested using the Pearson chi-square test and exact probability test for small frequency distributions.

Results

A total of 421 T2DM patients were included. A total of 234 (55.6%) were obese, and 187 (44.4%) were nonobese. Patients' ages ranged from 18 to 80 years, with a mean age of 40.2 ± 16.5 years old. The exact 69.8% of patients were males, and 53.2% had a university education. A total of 21.4% had hypertension, 20.7% were current smokers, while 72.4% were non-smokers. There was a significant difference between obese and non-obese patients regarding age, gender and education level (Table 1).

Bio-demographic data Obesity p-value
Total Obese Non-obese
No % No % No %
Age in years
< 30 147 34.90% 52 22.20% 95 50.80% 0.001*
30-49 160 38.00% 112 47.90% 48 25.70%
50+ 114 27.10% 70 29.90% 44 23.50%
Gender
Male 294 69.80% 187 79.90% 107 57.20% 0.001*
Female 127 30.20% 47 20.10% 80 42.80%
Educational level
Below secondary 105 24.90% 76 32.50% 29 15.50% 0.001*
Secondary 92 21.90% 43 18.40% 49 26.20%
University / above 224 53.20% 115 49.10% 109 58.30%
Diagnosed with HTN
Yes 90 21.40% 56 23.90% 34 18.20% 0.153
No 331 78.60% 178 76.10% 153 81.80%
Smoking
Current smoker 87 20.70% 42 17.90% 45 24.10% 0.109
Ex-smoker 29 6.90% 13 5.60% 16 8.60%
Non-smoker 305 72.40% 179 76.50% 126 67.40%
P: Pearson X2 test
*P<0.05 (significant)

Table 1: Bio-demographic data of T2DM patients, Saudi Arabia.

Table 2 shows awareness regarding obesity among T2DM patients, Saudi Arabia. The exact 38% of obese patients know the difference between obesity and overweight compared to 75.9% of non-obese patients (P=0.001). Also, 50.4% of obese patients know the normal blood glucose level versus 61.5% of the non-obese group (P=.023). Knowing the ideal body weight was detected among 28.6% of the obese group compared to 46% of the non-obese group (P=0.001). Additionally, 26.5% of obese patients know how to measure body weight versus 41.2% of non-obese patients (P=0.001). As for risk factors of obesity, the most known among obese patients were hypertension (62.8%), followed by DM (62.4%) and high cholesterol levels. The most known for non-obese were DM (63.6%), followed by high cholesterol (52.4%), and HTN (35.3%). Considering causes of obesity, the most reported by obese patients were lack of exercise (70.1%) and high calories intake (64.5%) compared to 73.3% and 72.2% for non-obese, respectively; P=0.009.

Awareness about obesity Obesity p-value
Obese Non-obese
No % No %
Obesity and overweight are different?
Yes 89 38.00% 142 75.90% 0.001*
No 145 62.00% 45 24.10%
Do you know the normal blood glucose level?
Yes 118 50.40% 115 61.50% .023*
No 116 49.60% 72 38.50%
What is the normal blood glucose level?
100-140 77 65.30% 79 68.70% 0.214
140-200 26 22.00% 16 13.90%
70 -100 15 12.70% 20 17.40%
Do you know the ideal body weight?
Yes 67 28.60% 86 46.00% 0.001*
No 167 71.40% 101 54.00%
What is the ideal body weight?
<18.5 6 9.00% 4 4.70% .215$
18.5-24.9 45 67.20% 72 83.70%
25-29.9 9 13.40% 6 7.00%
30-34.9 5 7.50% 3 3.50%
>35 2 3.00% 1 1.20%
Do you know how to measure body weight?
Yes 62 26.50% 77 41.20% 0.001*
No 172 73.50% 110 58.80%  
If someone is obese, what could this obesity lead to?
DM 146 62.40% 119 63.60% 0.001*
HTN 147 62.80% 66 35.30%
CVD 84 35.90% 59 31.60%
High cholesterol 113 48.30% 98 52.40%
Joint pains/arthritis 68 29.10% 41 21.90%
None of the above 21 9.00% 27 14.40%
Which of the following lead to obesity ?
Slow metabolism 66 28.20% 66 35.30% 0.009*
High-calorie intake 151 64.50% 137 73.30%
Lack of exercise 164 70.10% 135 72.20%
Family history 117 50.00% 82 43.90%
Others 1 0.40% 8 4.30%
P: Pearson X2 test
$: Exact probability test
* P<0.05 (significant)

Table 2: Awareness of fat and non-fat patients about obesity among type 2 diabetic patients, Saudi Arabia.

Table 3 illustrated the Behaviour of fat & non-fat diabetic patients about obesity, Saudi Arabia. A total of 59% of obese patients are willing to reduce weight compared to 50.3% of non-obese while 36.9% of non-obese think there is no need versus 4.7% of obese patients (P=0.001). The most reported reason for weight reduction among obese was to avoid further complications (84.1%) versus 78.7% for non-obese patients. Also, 62.4% of obese patients need to consult a physician to reduce weight versus 46% of the non-obese group (P=0.001). About 16.2% of obese patients think that Diabetes and obesity are not related versus 5.9% of the non-obese group (P=0.001). Additionally, 97.9% of obese patients believe having the appropriate awareness of their illness and management can land them over a controllable state compared to 90.4% of the non-obese group (P=0.001).

Behaviour Obesity p-value
Obese Non-obese
No % No %
Would you lose weight?
Yes 138 59.00% 94 50.30% 0.001*
No 85 36.30% 24 12.80%
No need 11 4.70% 69 36.90%
If yes, then choose one or more of the following motives
Social/relatives’ pressure 34 24.60% 17 18.10% 0.413
Avoid further complications 116 84.10% 74 78.70%
To do daily work more efficiently 53 38.40% 39 41.50%
To fit my social environment 66 47.80% 52 55.30%
Would you talk to a doctor to lose your weight?
Yes 146 62.40% 86 46.00% 0.001*$
No 88 37.60% 101 54.00%
Do you believe the overweight person should reduce his/her weight?
Yes 223 95.30% 172 92.00% 0.16
No 11 4.70% 15 8.00%
In your opinion, is it important for the diabetic patient to reduce his/her weight?
Very Important 189 80.80% 159 85.00% 0.001*
No need to lose weight 7 3.00% 17 9.10%
name="RANGE!A22">Diabetes and obesity are not related 38 16.20% 11 5.90%
Do you believe having appropriate awareness of your disease can land you in a controllable state?
Yes 229 97.90% 169 90.40% 0.001*$
No 5 2.10% 18 9.60%
P: Pearson X2 test
$: Exact probability test
* P<0.05 (significant)

Table 3: The behaviors of fat and non-fat patients about obesity among type 2 diabetic patients, Saudi Arabia.

Table 4 shows behaviors of fat and non-fat diabetic patients about obesity, Saudi Arabia. A total of 83.4% of obese patients reported previous trials to reduce weight compared to 67.9% of non-obese patients (p=0.001). The most applied options among obese patients were exercise (81%) versus 72.4% for nonobese then following a dietary system (77.4% vs. 64.6%, respectively; P=0.001). Exercises were daily among 11.4% of obese patients compared to 23.9% of nonobese (P=0.009). About 88.7% of obese patients tried dietary systems to reduce weight versus 82.7% of nonobese.

Practice Obesity p-value
Obese Non-obese
No % No %
Did you try to reduce your weight?
Yes, often 112 47.90% 67 35.80% 0.001*
Yes, occasionally 83 35.50% 60 32.10%
Never tried 31 13.20% 19 10.20%
No need 8 3.40% 41 21.90%
If yes, which of the following choices have you tried to lose weight?
Gym exercises 158 81.00% 92 72.40% 0.001*
Weight-reducing medication 87 44.60% 25 19.70%
Avoiding meals 113 57.90% 49 38.60%
Dietary system 151 77.40% 82 64.60%
If you said yes to gym exercise, how often do you exercise?
always 18 11.40% 22 23.90% 0.009*
sometimes 140 88.60% 70 76.10%
Did you try a diet/regime to lose weight?
Yes 173 88.70% 105 82.70% 0.123
No 22 11.30% 22 17.30%
P: Pearson X2 test
* P<0.05 (significant)

Table 4: Behaviors of fat and non-fat diabetic patients about obesity, Saudi Arabia.

Table 5 explains Self-assessment behaviors of fat and non-fat diabetic patients, Saudi Arabia. A total of 50% of obese patients checked their blood pressure compared to 33.2% of non-obese patients (0.001). Additionally 64.5% of obese patients checked their blood glucose levels versus 41.6% of the non-obese group (P=0.001). Furthermore, about 71.1% of the obese patients checked their weight versus 74.9% of non-obese patients, which was weekly among 40.2% of the obese group versus 19.8% of non-obese (P=0.001).

Self-assessment Obesity p-value
Obese Non-obese
No % No %
I check my blood pressure….?
always 9 3.80% 11 5.90% 0.001*
Many times / week 48 20.50% 23 12.30%
2 times / week 41 17.50% 7 3.70%
1 time / week 19 8.10% 21 11.20%
Never 117 50.00% 125 66.80%
I check my blood glucose level….?
always 31 13.20% 36 19.30% 0.001*
Many times / week 48 20.50% 20 10.70%
2 times / week 52 22.20% 13 7.00%
1 time / week 20 8.50% 7 3.70%
Never 83 35.50% 111 59.40%
I check my weight ….?
always 11 4.70% 16 8.60% 0.001*
Weekly 94 40.20% 37 19.80%
Monthly 59 25.20% 87 46.50%
Never 70 29.90% 47 25.10%
P: Pearson X2 test
* P < 0.05 (significant)

Table 5: Self-assessment behaviors of fat and non-fat diabetic patients, Saudi Arabia.

The Figure 1 shows that 67.4% of participants with a secondary level of education showed willing to reduce their weight compared to 58.9% of those with a university level of education and 36.2% of others with below secondary level of education with recorded statistical significance (P=0.001).

Medical-Dental-willingness

Figure 1:The relationship between education level and the willingness to reduce weight.

The Figure 2 shows that 65.4% of female participants showed willing to reduce their weight compared to 50.7% of male participants with recorded statistical significance (P=0.001).

Medical-Dental-weight

Figure 2:The relationship between gender and the willing to reduce weight.

The Figure 3 shows that 41.5% of young aged participants (< 30 years) checked their weight monthly, while 47.5% of those aged 30-49 years checked their weight weekly and 43.9% of old aged patients (50 years / more) never checked their weight with recorded statistical significance (P=0.001).

Medical-Dental-check

Figure 3:The relationship between participants’ age and how often they check their weight.

The Figure 4 shows that 23.3% of female participants practice exercise daily while 76.7% do it a few times a week compared to 13.7% and 86.3% of male participants, respectively, with no statistical significance (P=.076).

Medical-Dental-frequency

Figure 4:The relationship between frequency of exercise and participants’ gender.

Discussion

Recently, obesity has been a challenging public health problem worldwide due to its association with diabetes, hypertension and other health problems linked to metabolic syndrome. (1) Obesity trend in developing countries is upward to changes in lifestyle with more urbanization, which affects all public issues with a higher risk of the diseases related to overweight and obesity [2,3]. Type 2 diabetes and obesity are associated with insulin resistance as a majority of obese persons, despite having insulin resistance [4].

The WHO reported that Kuwait, Bahrain, Saudi Arabia, and UAE are today among the highest ten countries internationally regarding obesity prevalence. In Saudi Arabia, the obesity prevalence is 35.2% [5]. Similarly, in the UAE, obesity prevalence among school children was estimated to be 16.9% among females compared to 16.5% among males [6].

The current study aimed to assess the behaviors of type 2 diabetic patients regarding obesity in Saudi Arabia. The study results showed that non-obese patients were in the young age group (<30 years) with high education levels. The vast majority of obese patients (more than three-quarters) were males. As for patients’ awareness regarding obesity, non-obese patients were more aware regarding the difference between overweight and obesity than obese patients. Also, many non-obese patients know the normal blood glucose level, the ideal body weight, and the know-how to measure body weight. These findings were consistent with Saleh Fs et al. [7] in Bangladesh, who found that nearly all the respondents (99%) have no idea regarding the meaning of obesity. Also, more than half of the patients ignore the normal blood glucose level (59%) and ideal body weight (59%). Besides, Akbar Q et al. [8] reported similar findings where more than half the T2DM patients cannot differentiate between obesity and overweight.

Additionally, 39.1% of obese patients ignore ideal body weight while they know the measurement. High-calorie consumption and poor physical activity were considered causes of obesity by most patients (63.3% and 62.4%, respectively). All these findings were consistent with other studies that concluded the lack of diabetic patients’ awareness regarding obesity [7,9,10].

The study also showed that about two-thirds of the obese diabetic patients know about DM and HTN as a risk factor for obesity, and nearly half of them reported high cholesterol levels. As for causes, the most known obese cases were lack of exercise, high calories intake, and family history of obesity. Obirikorang Y et al. [9] reported that the most reported causes and risk factors of obesity among diabetic patients were poor diet (76.9%), hypertension (81.8%), and diet modification (86.7%), respectively.

Additionally, more than half of the obese diabetic patients are willing to reduce their weight, while one-third of the non-obese think there is no need. The main reported reasons behind their willingness were fear of more complications and their appearance in society. This can be explained by the fact that obese patients may experience more complications with high restrictions in their daily life activities due to obesity and its related health consequences [8] Reported that fat diabetic patients showed higher readiness to lowering weight compared to non-fat patients and were stimulated by health and social reasons. Also, in the current study, obese patients showed a higher tendency for consulting a doctor to reduce weight, which is consistent with their willingness to improve their self-esteem and avoid dangerous complications. Most diabetic patients believe that having a proper understanding of their disease can help them to get a controllable state. It is important for an obese person with diabetes to lose weight. This can be reflected in their behaviour and practice in dealing with overweight or obesity status. A study conducted by Bolarinde S et al. [11] revealed that more than threequarters (76.64%) of obese patients had adequate knowledge of Overweight / Obesity and weight control programs, and 69.5% established good attitudes toward weight control. Also, about one third (37.5%) of the respondent had a high level of active participation in weight reduction events.

As for patients practice, the current study showed that 83.4% of obese patients reported previous trials to reduce weight compared to 67.9% of non-obese patients (p=0.001). The most applied options among obese patients were exercise (81%) versus 72.4% for nonobese then following a dietary system (77.4% vs. 64.6%, respectively; P=0.001). Exercises were daily among 11.4% of obese patients compared to 23.9% of nonobese (P=0.009). About 88.7% of obese patients tried dietary systems to reduce weight versus 82.7% of nonobese. Many studies assessed post diabetes diagnosis lifestyle changes, behavior modifications and physical activity. Schneider et al. [12] reported that diabetic patients with a recent diagnosis were more likely to increase their physical activity. Also, Penn et al. found that the diagnosis is a motivational issue for diabetic cases to exercise and track a healthy diet [13]. Findings by Chong et al. estimated modifications in participants' lifestyles after being diagnosed with DM [6]. Though patients’ awareness alone is insufficient for lifestyle modification, as revealed, other factors, including attitude and incentives, are also important. For example, in this study, most respondents showed the frequent measurement of their weight, blood glucose level, and blood pressure [15-19].

Conclusion

Obesity is considered one of the major factors that countered diabetes as known, especially diabetes type 2, due to its strong relation and insulin resistance besides other affective factors. In this study, we investigated the behavioral and consciousness of diabetes type 2 in the existence of obesity or not, measuring the behavior and the actions toward obesity due to the fact obesity is a challenging issue abroad diabetes. About half of these categories realised the strong association and were willing to take action. Also, less than half know the difference between obesity and overweight. The present study looks into obesity in diabetic patients in greater depth, examining more aspects such as previous obesity behavior. Health issues related to the glycemic index. This research will aid public policymakers in developing a more effective evidence-based and informed communication strategy. As a result, enough efforts must be made to raise awareness of obesity and its repercussions. The availability of precise information and the availability of accurate information is critical to the success of such endeavors.

Limitations and Recommendations

This study only focused on a limited time and area, which could have restricted the generalization of the findings. In addition, even though the sample was collected from all of the country's major areas, sample sizes in various regions differed, which might be a limitation of the current study. Another limitation of this study was the low responses. Also, the sample could be biased since we did not use a random sampling method to enrol the participants.

We recommend setting plans that improve the behaviors and practices of T2DM patients regarding obesity. Also, interventions are required to provide patients with the tools they require to manage their condition effectively. Further research is recommended on a large scale to address the poor behaviors and practices of T2DM patients regarding obesity.

Acknowledgement

This publication was supported by the Deanship of Scientific Research at Prince Sattam bin Abdulaziz University, Alkharj, Saudi Arabia.

Funding

This study has not received any external funding.

Authors Contributions

This work was performed in collaboration with all authors. They designed the study, collected and processed questionnaires, created the manuscript, and approved the final version of the manuscript.

Conflict of Interests

The authors declare that there are no conflicts of interest.

Data and Materials Availability

All data associated with this study are present in the paper.

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Author Info

1College of Medicine, Prince Sattam Bin Abdulaziz University, Al Kharj 11942, Saudi Arabia
2Nutrition Department, Lancare Clinics, Riyadh, 13213, Saudi Arabia
3Department of Basic Medical Science, College of Medicine, Prince Sattam Bin Abdulaziz University, Al Kharj, 11942, Saudi Arabia
 

Citation: Abdulsalam Saud Alharbi, Abdulrahman K Alenezi, Abdulhakim Alqahtani, Mansour N Alsuliman, Moaath Fahad Alharbi, Talal Z Alruwaili, Meshari M Hader, Mohammed H Karrar Alsharif, Awareness and Practice of Diabetic Patients about Obesity in Saudi Arabia Cross-Sectional Study, J Res Med Dent Sci, 2022, 10 (4):112-120.

Received: 01-Apr-2022, Manuscript No. JRMDS-22-61268; , Pre QC No. JRMDS-22-61268 (PQ); Editor assigned: 04-Apr-2022, Pre QC No. JRMDS-22-61268 (PQ); Reviewed: 18-Apr-2022, QC No. JRMDS-22-61268; Revised: 22-Apr-2022, Manuscript No. JRMDS-22-61268 (R); Published: 29-Apr-2022

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