ASSESSING THE LIFESTYLE (PHYSICAL ACTIVITY LEVELS, SEDENTARY BEHAVIOUR AND EATING HABITS) OF OMANI ADOLESCENT GIRLS: A MIXED METHODS STUDY

Abstract

Background: Rising body mass index (BMI) in the world population is a serious global health issue of 21st century. Epidemiology and management of high BMI have been the themes of many studies. In the Arab world, including in Oman where this study is based, the prevalence of obesity and inactivity emerged late but is accelerating rapidly, particularly among the youth. The aim of this study is to bridge the research gap that exists regarding Omani adolescent girls’ lifestyle and their association with body weight status by studying the diet and activity habits of this population using a mixed method approach. To date, this is the first study of its kind from Oman. Methods: An explanatory sequential mixed methods study was conducted to assess the lifestyle characteristics (physical activity level, sedentary behaviour, and eating habits) among Omani girls aged 15–18 years, and to understand their perceptions related to this lifestyle. A total of 421 female students were randomly selected from two schools in Ibri, Oman, to participate in this study. A validated online ATLS questionnaire (N = 421), diet diary and pedometer (n = 59) and focus groups (n = 16) were used as data collection instruments. Ethical approvals were granted by the Queen Margaret University (QMU) ethics committee and Oman Ministry of Education (MOE). Informed consent was obtained from the participants and their parents and the confidentiality of the collected data maintained. Results: The prevalence of overweight was 21% and obesity 14% among this sample of Omani female adolescents. The average footstep tally of the participants (n=59) was 5,755 footsteps per day against the recommended 10,000–11,700 with significant differences between BMI groups. The pedometer data indicated that normal weight participants scored mean footstep counts of 6,625 per day, while it was 6,094 in the overweight girls, falling further to 5,755 for their obese peers. The majority of the participants (56%) who maintained diet diaries were normal reporters, while misreporters were 44%. After excluding the misreporters, the energy intake (EI) of the diet diary cohort was lower than the recommended value of 2400 Kcal/day. The overweight participants were significantly more likely to consume French fries/ chips (82%) and cake/ doughnuts (74%) than the other BMI groups, while the obese participants consumed more sweets (61%) and fast food (42%). The participants perceived environmental and sociocultural factors, rapid modernisation and acculturation of Omani society, lack of encouragement from family, friends, and teachers, as well as lack of self-motivation and role models as barriers to physical activity. Even though they perceived fast food as unhealthy, they were attracted to these due to the taste and advertisements. The study also found that increased digital screen-time, sleeping less, and missing breakfast were other factors that positively correlated with inactivity and increased the BMI among Omani female adolescents. Conclusion: The current study establishes a positive correlation between the overweight and obesity in Omani teenage girls and their physical inactivity and nutritional habits. While the current results are similar to those from other parts of the world, there are also factors that are specific to the region such as the climate and culture that makes the problem complex. The trend for BMI to rise with age among teenagers raises apprehension that it may continue in their adulthood. Urgent action needs to be taken by adolescent girls in Oman, their parents, and higher authorities at Oman ministries of education and health to improve the nutritional habits and physical activity of this age group. Specific culture-sensitive suggestions are provided in this thesis to meet these challenges. Key words: adolescent girls, obesity, overweight, BMI, Arab, Oman, school children, lifestyle, physical activity, dietary habits, sedentary behaviour, fast food, sleep, Ibri