Nearly Three in Ten Adults Obese in Saudi Town, With Sleep, Smoking and Inactivity Key Factors

Nearly three in ten adults living in the Saudi governorate of Hawtat Bani Tamim have obesity, according to the first city-level study of the condition in this community, and the strongest adjusted associations point to age, education, sleep duration, smoking, physical inactivity and hypertension. The cross-sectional survey, published in Frontiers in Public Health, measured body mass index directly in 384 residents and used survey-weighted logistic regression to identify which sociodemographic and lifestyle factors were independently linked to obesity. The findings give local health planners in the Riyadh Region their first population-specific estimates, filling a gap that national surveys cannot address because obesity patterns vary considerably across Saudi communities.

The study, led by Mohammed Omar Musa Mohammed of Prince Sattam Bin Abdulaziz University, found an overall obesity prevalence of 28.9 percent, defined as a body mass index of 30 kg/m² or higher under World Health Organization criteria. That figure sits within the range of 24.7 to 39.5 percent reported across different Saudi regions in earlier surveys, and above the 23.1 percent national estimate for adults aged 15 and older recorded by the General Authority for Statistics in 2024. The authors note the result is comparable to estimates from several Gulf Cooperation Council countries but remains higher than the global average reported by the WHO.

Data collection took place between September and October 2025, a period the researchers deliberately chose because moderate spring temperatures of 18 to 32 degrees Celsius minimize seasonal distortion of physical activity and dietary patterns. Participants were adults aged 18 or older who had lived in the governorate for at least six months. Pregnant women, people who were bedridden, those with physical disabilities preventing accurate measurement, temporary residents, and individuals with severe cognitive or psychiatric impairments were excluded. Of 420 eligible adults approached, 36 declined or were excluded for incomplete data, leaving 384 participants in the final analysis.

The sampling design was unusually detailed for a single-governorate study. Hawtat Bani Tamim, home to an estimated 41,854 people in 2022, was divided into four administrative sub-districts proportional to population size. Thirty residential clusters were then selected with probability proportional to size, twelve households were drawn from each cluster by systematic random sampling, and one eligible adult per household was chosen by simple random sampling. The target sample of 384 was calculated using the standard proportion-estimation formula with a 50 percent assumed prevalence, a 95 percent confidence level and a 5 percent margin of error, a deliberately conservative choice that maximizes the required sample size when no reliable local prevalence estimate exists.

Measurements followed the WHO STEPS protocol for noncommunicable disease risk factor surveillance, using the official Arabic version of the questionnaire. Weight was recorded to the nearest 0.1 kilogram on a calibrated Seca 874 digital scale with participants in light clothing and no shoes, and height to the nearest 0.1 centimeter on a portable Seca 213 stadiometer with the head positioned in the Frankfurt plane. Hypertension was classified by standardized blood pressure measurement, with a systolic reading of at least 140 mmHg, a diastolic reading of at least 90 mmHg, or current antihypertensive medication defining a positive case. Because the questionnaire did not ask about previously physician-diagnosed hypertension, self-reported history was not used for classification.

In the survey-weighted multivariable model, which adjusted for sampling weights, clustering and stratification, several factors stood out. Compared with participants aged 60 or older, those aged 51 to 60 had more than twice the odds of obesity (odds ratio 2.40, p < 0.001), and those aged 41 to 50 had 45 percent higher odds (OR 1.45, p = 0.001). Men had higher odds than women (OR 1.20, p = 0.007), a notable reversal of national trends in which Saudi women show higher obesity rates. Education showed the largest effect: participants with secondary schooling or less had more than four times the odds of obesity compared with those holding higher-education degrees (OR 4.18, p = 0.008), and university graduates also had elevated odds (OR 2.81, p = 0.035).

Behavioral and health variables also carried independent associations. Short sleep, defined as three to five hours per day, raised the odds of obesity by 25 percent (OR 1.25, p = 0.021), a link the authors connect to established mechanisms in which sleep deprivation increases ghrelin, decreases leptin, disrupts glucose metabolism, reduces insulin sensitivity and elevates cortisol, promoting hunger, fatigue and abdominal fat storage. Smokers had 30 percent higher odds than non-smokers (OR 1.30, p = 0.008), a relationship the researchers treat cautiously because nicotine suppresses appetite yet heavy use and smoking cessation have both been linked to weight gain and central fat accumulation, and the cross-sectional design cannot disentangle these dynamics. Physically inactive participants had 60 percent higher odds than highly active ones (OR 1.60, p = 0.005), while moderate activity appeared protective (OR 0.75, p = 0.028). Participants without hypertension had 67 percent lower odds than those with hypertension (OR 0.33, p < 0.001).

Several factors that might have been expected to matter showed no independent association after adjustment, including place of residence, marital status, occupation and most dietary variables. In the unadjusted analysis, obesity prevalence did differ significantly by marital status, smoking status and vegetable intake, but these differences did not survive multivariable adjustment, which the authors interpret as evidence of confounding. One counterintuitive result deserves particular caution: participants reporting high vegetable consumption had higher adjusted odds of obesity (OR 2.34, p = 0.013). The authors explicitly warn that this should not be read as vegetables causing obesity; reverse causality is plausible, since people with obesity may increase vegetable intake as part of weight-management efforts, and total energy intake and overall dietary patterns were not measured.

The study’s limitations shape how the findings should be read. As a cross-sectional survey, it cannot establish cause and effect or temporal sequence, so all reported associations are correlations rather than causal effects. Physical activity, sleep and diet were self-reported, exposing results to recall and social desirability bias. Variables such as genetic predisposition, psychosocial factors, detailed socioeconomic indicators and total caloric intake were not measured, leaving room for residual confounding. The sample was not enlarged to account for a design effect because no prior estimates of the intracluster correlation coefficient existed for the setting, potentially reducing precision, and no post-hoc pairwise comparisons followed the significant overall chi-square tests in the bivariate analysis. Documentation of equipment calibration and inter-observer reliability for anthropometric measurements was also limited.

Even with those caveats, the authors argue the results carry practical weight for public health planning in Hawtat Bani Tamim and similar smaller Saudi communities, where localized epidemiological data have been scarce. The combination of high prevalence, a strong education gradient and adjusted links to inactivity, short sleep and hypertension suggests that community-based programs promoting regular physical activity, adequate sleep, health education and integrated cardiometabolic screening could be prioritized, particularly for groups with higher observed odds. The findings also align with Saudi Vision 2030 health objectives and Sustainable Development Goal 3 on noncommunicable disease prevention. The authors call for longitudinal studies with objective measures of activity and sleep, comprehensive dietary assessment tools such as 24-hour dietary recalls or food frequency questionnaires, and culturally tailored intervention trials to clarify the temporal pathways this snapshot survey could only hint at.

Subject of Research: Obesity prevalence and associated risk factors among adults in Hawtat Bani Tamim, Saudi Arabia

Article Title: The prevalence and risk factors associated with obesity among adults in Hawtat Bani Tamim: a cross-sectional study

Article References: Mohammed, M. O. M. (2026). The prevalence and risk factors associated with obesity among adults in Hawtat Bani Tamim: a cross-sectional study. Frontiers in Public Health, 14, Article 1877282. https://doi.org/10.3389/fpubh.2026.1877282

Image Credits: AI Generated

DOI: 10.3389/fpubh.2026.1877282

Keywords: obesity, Saudi Arabia, cross-sectional study, body mass index, physical inactivity, sleep duration, hypertension, WHO STEPS, logistic regression, public health, education level, smoking