Is the prevalence of overweight/obesity overestimated among Saudi children and adolescents?

Sir,

I refer to the distinguished study by Al-Hussaini et al.[1] published recently in The Saudi Journal of Gastroenterology. The authors conducted a cross-sectional study among Saudi school children and adolescents to provide the most recent estimate of childhood obesity and determine the trend in childhood obesity over the past two decades. On using the World Health Organization (WHO) body mass index (BMI) percentile standards, the authors found that the overall prevalence of overweight and obesity was 13.4% and 18.2%, respectively. When compared with the WHO-based national prevalence rate of obesity reported in 2004 (≈9.3%), the obesity rate was found to have doubled over a 10-year period.[1]

However, I presume that the findings of Al-Hussaini et al.[1] did not reflect the actual prevalence of overweight and obesity among Saudi school children and adolescents. Although the authors mentioned a few study limitations, the following methodological limitation is additionally relevant. It is worthy to mention that there are many BMI percentile standards used to define overweight/obesity in the pediatric clinical settings, notably Center for Disease Control standards, WHO standards, and country-specific standards. Evaluation of these standards showed that country-specific standards could address overweight/obesity in children and adolescents more faithfully than other standards.[2] Indeed, the clinical employment of national standards in certain populations revealed unique patterns of BMI percentiles curves compared to other standards. Hence, these national standards were considered as an important tool for investigators and pediatricians in monitoring the overweight/obesity changes over time and for comparing different regions.[34]

In the Kingdom of Saudi Arabia, L, M, and S parameters as well as Z scores were calculated for weight, height, and BMI for school-aged children and adolescents[5] and they were launched in 2016 for more precise assessment of growth and nutrition in research institutions and clinical fields. Towards this, the conduction of a large-scale study employing the national BMI percentile standards could better estimate the actual prevalence of overweight/obesity among Saudi school children and adolescents.

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