AWM: Eating Frequency and Patterns (2013)


Al-Rethaiaa AS, Fahmy AE, Al-Shwaiyat NM. Obesity and eating habits among college students in Saudi Arabia: A cross-sectional study. Nutr J 2010; 9: 39.

PubMed ID: 20849655
Study Design:
Cross-Sectional Study
D - Click here for explanation of classification scheme.
Quality Rating:
Positive POSITIVE: See Quality Criteria Checklist below.
Research Purpose:
  • To determine the prevalence of overweight and obesity in a sample of male college students in the Kingdom of Saudi Arabia (KSA)
  • To determine the relationship between the students' body weight status and composition and their eating habits.
Inclusion Criteria:

Male students in College of Health Sciences at Rass, Qassim University, KSA during the spring semester of 2009.

Exclusion Criteria:

None specified, chosen by stratified random sampling method by department and class year.

Description of Study Protocol:


  • Stratified random sampling of male students in the College of Health Sciences at Rass, Qassim University, KSA 
  • Those who signed written consent were allowed to participate.


Cross-sectional study

Blinding used

Implied with measurements


Not applicable

Statistical Analysis

  • Chi-square tests
  • SPSS version 17
  • Statistically significant if P value <0.05. 
Data Collection Summary:

Timing of Measurements

Participants completed a questionnaire and all measurements at baseline

Dependent Variables

  • Height measured with Digital Physician Scale, MDW-250L, Adam Equipment Company Ltd, UK
  • Weight measured with BF500 Omron Body Composition monitor, bioelectrical impedance device
  • Body mass index (BMI) calculated
  • Body fat percentage (BF%) measured with BF500 Omron Body Composition monitor, bioelectrical impedance device; levels were defined as: low less than 8%, normal 8-19.9%, high 20-24.9%, very high ≥25%
  • Visceral fat level (VFL) measured with BF500 Omron Body Composition monitor, bioelectrical impedance device; levels were defined as normal one to nine, high 10-30.

Independent Variables

Eating habits assessed through answers to questions on eating, drinking, and smoking habits questionnaire.

Control Variables

Description of Actual Data Sample:
  • Initial N: 357 male students
  • Attrition (final N): None reported
  • Age: 20.4±1.3 years
  • Ethnicity: Saudi
  • Other relevant demographics: Not reported
  • Anthropometrics:
    Variable Total

    Weight (kg)


    Height (cm)


    BMI (kg/m2)


    Body Fat percentage


    VFL (1-30)

  • Location: Rass, Qassim University in the Al-Qassim province of Saudi Arabia.


Summary of Results:

 Key Findings

Prevalence of Obesity, Body Fat Percentages, and Visceral Fat Levels

BMI Categories Total (Percent)
Normal N=18 (5.0%)
Overweight N=205 (57.4%)
Obese N=56 (15.7%)
 Obese grade 1 N=41 (11.5%)
 Obese grade 2 N=12 (3.4%)
 Obese grade 3 N=3 (0.8%)
  • 41.7% of students had normal body fat (BF), 16.7% had high BF, and 38.4% had very high BF
  • 78.2% had normal visceral fat (VF), 21.8% had high VF
  • Correlation among BMI, BF% and VFL were direct and significant (P<0.001)
  • Body fat exceeded normal limits in all overweight and obese subjects as well as 30.7% of subjects with a normal BMI.

Eating Habits

  • 63.5% of students reported irregular meal consumption
  • 31.7% of students reported snacking daily
  • 46.8% of students reported eating friend foods at least three times per week
  • Dates were eaten at least three times per week by 60.5% of students
  • 32.2% of students rarely ate vegetables
  • 40.3% of students rarely ate fruit (excluding dates)
  • 66.4% of students reported sharing meals with their family daily
  • 59.7% of students reported they were aware of the types of food they should eat in order to have balanced nutrition.

Correlation between BMI category and eating habits [Total(Percent)]

Question  Possible Answers Normal
(BMI 18.5-24.9) 
(BMI 25-29.9) 
(BMI 30+) 
Total (Percent)  P value 
How often do you take snacks apart from regular meals? 

A) Daily  72 (20.2%)  19 (5.3%) 19 (5.3%) 113 (31.7%) 0.018
B) Three to four times per week  55 (15.4%)  19 (5.3%) 6 (1.7%) 89 (24.9%)
C) Once or twice a week  43 (12.0%)  22 (6.2%) 15 (4.2%) 85 (23.8%)
D) Rarely  35 (9.8%)  18 (5.0%) 16 (4.5%) 70 (19.6%)
How often to you eat with family?
A) Daily  141 (39.5%)  52 (14.6%) 34 (9.5%) 237 (66.4%) 0.005
B) Three to four times per week  49 (13.7%) 15 (4.2%) 8 (2.2%) 75 (21.0%)
C) Once or twice a week  13 (3.6%) 10 (2.8%) 9 (2.5%) 36 (10.1%)
D) Rarely 2 (0.6%)  1 (0.3%) 5 (1.4%) 9 (2.5%)


Correlations between VFL categories and eating habits [Total(Percent)]

Question  Answer Levels Normal VFL  High
Total (%) P value
How often do you eat dates? 
A) Daily  N=110 (30.8%) N=19 (5.3%) N=129 (36.1%)  0.013
B) Three to four times per week  N=71 (19.9%) N=16 (4.5%) N=87 (24.4)  
C) Once or twice a week  N=48 (13.1%) N=20 (5.6%) N=68 (19.0%)  
D) Rarely  N=50 (14.0%) N=23 (6.4%) N=73 (20.4%)  
How often to you eat with family?
A) Daily  N=186 (52.1%) N=51 (14.3%) N=237 (66.4%)  0.007
B) Three to four times per week  N=65 (18.2%) N=51 (14.3%) N=75 (21.9%)  
C) Once or twice a week  N=24 (6.7%) N=12 (3.4%) N=36 (10.1%)  
D) Rarely N=4 (1.1%) N=5 (1.4%) N=9 (2.5%)  


Author Conclusion:

In short, our findings showed high rates of overweight and obesity among male college students in KSA. Furthermore, BF% was elevated among more students, increasing the obesity prevalence by more than two times when used for defining adiposity rather than BMI.

In contrast, the majority of the students possess normal VFL. High VFL's were encountered only in the extremely overweight and obese participants and, thus, can be used as a warning indicator for life-threatening healthy problems associated with obesity such as diabetes and heart attack. Irregular and infrequent meals together with low vegetable and fruit intake were the most common unhealthy eating habits of the participants.

Eating with family and frequent snacking were found to have a negative effect on BMI. Furthermore, VFL was inversely correlated with the frequency of both eating with family and dates' consumption. The university and college arenas represent the final opportunity for nutritional education of a large number of students.

Our findings suggest the need for strategies and coordinated efforts at all levels (family, university, community, and government) to reduce the tendency of overweight and obesity among college students and to promote healthy eating habits in our youth.

Funding Source:
No funding provided
Reviewer Comments:

Funding source was not mentioned in the article. I emailed the corresponding author for that information and here was the response: 

Dear Kim Bandelier,

Thank you for the e-mail. Concerning your question about the funding source for our study on obesity and eating habits among college students in Saudi Arabia, I would like to inform you that it was not-for-profit study. I would be more than happy to provide you with any further information you need.
Abdallah S. Al-Rethaiaa, PhD
College of Health Sciences in Arrass
Qassim University
Kingdom of Saudi Arabia 

Quality Criteria Checklist: Primary Research
Relevance Questions
  1. Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies) N/A
  2. Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about? Yes
  3. Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice? Yes
  4. Is the intervention or procedure feasible? (NA for some epidemiological studies) N/A
Validity Questions
1. Was the research question clearly stated? Yes
  1.1. Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified? Yes
  1.2. Was (were) the outcome(s) [dependent variable(s)] clearly indicated? Yes
  1.3. Were the target population and setting specified? Yes
2. Was the selection of study subjects/patients free from bias? Yes
  2.1. Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study? Yes
  2.2. Were criteria applied equally to all study groups? Yes
  2.3. Were health, demographics, and other characteristics of subjects described? Yes
  2.4. Were the subjects/patients a representative sample of the relevant population? Yes
3. Were study groups comparable? N/A
  3.1. Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT) N/A
  3.2. Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline? N/A
  3.3. Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.) N/A
  3.4. If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis? N/A
  3.5. If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.) N/A
  3.6. If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")? N/A
4. Was method of handling withdrawals described? N/A
  4.1. Were follow-up methods described and the same for all groups? N/A
  4.2. Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.) N/A
  4.3. Were all enrolled subjects/patients (in the original sample) accounted for? N/A
  4.4. Were reasons for withdrawals similar across groups? N/A
  4.5. If diagnostic test, was decision to perform reference test not dependent on results of test under study? N/A
5. Was blinding used to prevent introduction of bias? Yes
  5.1. In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate? N/A
  5.2. Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.) N/A
  5.3. In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded? Yes
  5.4. In case control study, was case definition explicit and case ascertainment not influenced by exposure status? N/A
  5.5. In diagnostic study, were test results blinded to patient history and other test results? N/A
6. Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described? Yes
  6.1. In RCT or other intervention trial, were protocols described for all regimens studied? N/A
  6.2. In observational study, were interventions, study settings, and clinicians/provider described? Yes
  6.3. Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect? N/A
  6.4. Was the amount of exposure and, if relevant, subject/patient compliance measured? N/A
  6.5. Were co-interventions (e.g., ancillary treatments, other therapies) described? N/A
  6.6. Were extra or unplanned treatments described? N/A
  6.7. Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups? N/A
  6.8. In diagnostic study, were details of test administration and replication sufficient? N/A
7. Were outcomes clearly defined and the measurements valid and reliable? Yes
  7.1. Were primary and secondary endpoints described and relevant to the question? Yes
  7.2. Were nutrition measures appropriate to question and outcomes of concern? Yes
  7.3. Was the period of follow-up long enough for important outcome(s) to occur? N/A
  7.4. Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures? Yes
  7.5. Was the measurement of effect at an appropriate level of precision? Yes
  7.6. Were other factors accounted for (measured) that could affect outcomes? No
  7.7. Were the measurements conducted consistently across groups? N/A
8. Was the statistical analysis appropriate for the study design and type of outcome indicators? Yes
  8.1. Were statistical analyses adequately described and the results reported appropriately? Yes
  8.2. Were correct statistical tests used and assumptions of test not violated? Yes
  8.3. Were statistics reported with levels of significance and/or confidence intervals? Yes
  8.4. Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)? N/A
  8.5. Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)? No
  8.6. Was clinical significance as well as statistical significance reported? Yes
  8.7. If negative findings, was a power calculation reported to address type 2 error? N/A
9. Are conclusions supported by results with biases and limitations taken into consideration? Yes
  9.1. Is there a discussion of findings? Yes
  9.2. Are biases and study limitations identified and discussed? Yes
10. Is bias due to study's funding or sponsorship unlikely? Yes
  10.1. Were sources of funding and investigators' affiliations described? Yes
  10.2. Was the study free from apparent conflict of interest? Yes