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overweight and obesity are defined as abnormal or excessive fat accumulation that may impair health .
obesity represents a rapidly growing threat to the health of populations in an increasing number of countries .
at least 2.8 million adults die each year as a result of being overweight or obese .
in addition , 44% of the diabetes burden , 23% of the ischaemic heart disease burden , and between 7% and 41% of certain cancer burdens are attributable to overweight and obesity .
obesity comorbidities include coronary heart disease , hypertension and stroke , certain types of cancer , non - insulin - dependent diabetes mellitus , gallbladder disease , dyslipidemia , osteoarthritis and gout , and pulmonary diseases , including sleep apnoea .
the move towards high - energy diet and an inactive life style has turned obesity from a developed - world event into a global epidemic [ 35 ] .
obesity prevalence rates , as well as food intake habits , vary by demographic and socioeconomic groups [ 69 ] . in 2008 , the who estimated that at least 500 million adults ( greater than 10% ) are obese , with higher rates among women than men and more than 1.4 billion adults , 20 and older , were overweight .
of the 500 million over weights , over 200 million men and nearly 300 million women were obese .
about 35% of adults aged 20 and over were overweight , and 11% were obese .
about 65% of the world 's population lives in countries where overweight and obesity kills more people than underweight .
a combination of excessive food energy intake and a lack of physical activity are thought to explain most cases of obesity
. a limited number of cases are due primarily to genetics , medical reasons , or psychiatric illness [ 12 , 13 ] . in contrast , increasing rates of obesity at a societal level are felt to be due to an easily accessible and palatable diet , increased reliance on cars , and mechanized manufacturing [ 15 , 16 ] .
the growth and prosperity , however , have brought marked changes in the lifestyle of people .
most eating habits are less healthful and the level of physical activity is very low .
therefore , the purpose of this study was to assess the burden of the problem in hail region , ksa .
data regarding obesity were collected as a part of a comprehensive survey that included 5000 saudi civilians living in hail region northern saudi arabia , during the period from october 2012 to december 2013 .
the sample size was calculated to obtain confidence level of 95% and confidence interval of 1.38 .
participants were selected from 30/105 primary health care ( phc ) centers by simple random method .
the primary care program in saudi arabia is a leading program in the developing countries that has accomplished respectable success within a few years of its establishment .
the ministry of health ( moh ) provides phc services throughout hail region comprising 105 centers .
participants were recruited to the local phc in each area before one week of the campaign . on campaign day , all responding individuals were included up to the target of 5000 participants .
the purpose of the survey was to estimate the prevalence of chronic kidney disease in the area .
data were collected by the doctors of the team utilizing a standard questionnaire , which included demographic information and previously diagnosed diseases ( hypertension , diabetes , and others ) .
diagnosis of hypertension was based on observation of blood pressure levels > 140/90  mmhg .
diagnosis of diabetes in this survey was based on the information provided by the participant of being under treatment for diabetes due to a previous well - established diagnosis then confirmed with new blood glucose estimation .
bmi was calculated from measured height and weight and classified as normal weight ( < 25  kg / m ) ; overweight ( 2530  kg / m ) ; and obese ( 3035  kg / m ) , morbid obesity ( > 36 
data management was done using statistical package for social sciences ( spss version 16 ) .
spss was used for analysis and to perform the pearson chi - square test for statistical significance ( p value < 0.05 ) .
the mean age of the study population was 43.5  18.7 years with 44.6  20.2 for males and 42.3  16.9 for females .
moreover , the prevalence of males was 56.2% and the prevalence of females was 71% . when categorizing obesity , 37.3% , 15.3% , and 11% were categorized as overweight , obese , and with morbid obesity , respectively .
moreover , increased weight categories were strongly linked to females and this was found to be statistically significant ( p < 0.0001 ) , as indicated in figure 1 . 

however , the peaks for all obesity categories were at middle age 4155 years ( p < 0.05 ) , followed by age range 2640 years , as indicated in figure 2 . furthermore , of the 2452 obese persons , 746/2452 ( 30.4% ) and 781/2452 ( 32% ) were hypertensive and diabetic patients , respectively .
these findings show strong association between obesity and hypertension or diabetes , both showed statistically significant differences ( hypertension p < 0.01 and diabetes p < 0.001 ) , as indicated in figure 3 . in regard to the relationship between normal wt and hypertension or dm in different age ranges , it was observed that dm is increasing among older age ranges , hence , hypertension was observed more frequent among younger age ranges , as indicated in figure 4 .
the prevalence of overweight and obesity was highest in the americas ( 62% for overweight in both sexes and 26% for obesity ) and lowest in south east asia ( 14% overweight in both sexes and 3% for obesity ) .
the increased consumption of fast foods and sugar - dense beverages ( e.g. , sodas ) as well as the extensive use of cars , elevators , escalators , and remotes in recent years has dramatically increased the burden of obesity in ksa .
thus the increased prevalence rate of obesity in the present study indicates the magnitude of the problem in relation to daily life - style . according to forbes , saudi arabia ranks 29 on a 2007 list of the fattest countries with a percentage of 63.5% of its citizens being overweight ( bmi > 25 ) , which is similar to our findings in this study ( 63.6% ) .
however , some studies from saudi arabia have showed lower prevalence rates than forbes report and our findings in the current study . according to epidemiological studies and surveys ,
obesity was found to affect more than one quarter while overweight affects about one - third of adults in saudi
four studies that were conducted among four different age groups in saudi arabia revealed the following findings .
overweight among adult males and females was ( 30.7% and 28.4% , resp . ) , while obesity among adult males and females were ( 14% and 23.6% , resp . ) .
the prevalence of overweight among adults population was 36% and the prevalence of obesity among the adult population was 35.6% .
prevalence of overweight and obesity among children and adolescents 518 years was 23.1% and 11.3% , respectively .
prevalence of overweight and obesity among females of childbearing age was 31.5% and 21% , respectively .
the prevalence of overweight and obesity among college students were 21.8% and 15.7% , respectively .
data regarding these studies were collected many years before and since there is a global fast increase in obesity and in ksa in particular , the elevated increase in the prevalence rates is expected due to strong dependent on factors that increase the risk of obesity among saudi civilians . in a study that involved a cross - sectional survey of 2,250 saudi male soldiers aged between 20 and 60 years residing in a military city in northern saudi arabia conducted in 2004 , over 82% of the subjects were either overweight or obese . in a study ( 20092011 ) to measure the prevalence of obesity among military personnel in ksa , it was reported that 40.9% of the participants were overweight , 29% obese , and 42.4% had central obesity . in a study form saudi arabia , the percent of different categories of body composition in healthy saudi adults and its relationship with fitness scoring .
the percent of the prevalence of underweight , normal weight , overweight , obesity class i , obesity class ii , and obesity class iii was 2.91 ( n = 13 ) , 33.81 ( n = 139 ) , 35.27 ( n = 145 ) , 19.46 ( n = 80 ) , 6.32 ( n = 26 ) , and 2.18 ( n = 9 ) , in this order .
the study concluded that the prevalence of obesity , percent body fat , and poor fitness was high in the study population with significant gender differences .
public awareness programmes , including exercise and diet habits change , are necessary at mass scale to cope with the growing burden of obesity . however , increased rates of obesity in hail region over the other parts of saudi arabia are previously reported , as the prevalence of obesity ranged from 33.9% in hail to 11.7% in jizan .
dietary behaviors varied across gender and bmi groups , with males preferring dining out , eating fast foods , and carbonated beverages as compared to females who preferred dining with family , snacking on potato chips , chocolates , cakes , sweets , and drank more caffeinated beverages .
snacking was inversely associated with overweight and obesity ( p = 0.05 ) while drinking caffeinated beverages was positively linked ( p = 0.043 ) . skipping breakfast ( p = 0.006 ) , low consumption of fruits ( p = 0.012 ) , and frequent restaurant visits ( p = 0.027 )
were significantly associated with prevalence of high bmi% . in this study , increased weight categories were strongly linked to females and this was found to be statistically significant ( p < 0.0001 ) . in all who regions ,
in the who regions for africa , eastern mediterranean , and south east asia , women had roughly doubled the obesity prevalence of men .
moreover , many studies from ksa indicated that the prevalence of obesity among females was significantly higher than for males [ 3032 ] .
the results of the current study showed a strong association between obesity and hypertension or diabetes , which showed a statistically significant difference ( hypertension p < 0.01 and diabetes p < 0.001 ) , when compared to nonhypertensives or nondiabetics .
the relationship between obesity and hypertension or / and diabetes is well established in several studies [ 33 , 34 ] . in a study from ksa to assess the effect of overweight and obesity on diabetes and hypertension , the prevalence of obesity among diabetics and hypertensive patients was 46% and 54% , respectively . in conclusion ,
overweight and obesity are prevalent in hail , ksa , and should be considered a serious public health problem .
practicable solutions include health education regarding the right food choices and encouraging physical exercise among all age groups for both genders .
background . obesity contributes significantly to morbidity and mortality rates worldwide . 
 we , therefore , aimed to provide epidemiological data on the prevalence of obesity in hail , kingdom of saudi arabia ( ksa ) . methodology . 
 data were collected during cross - sectional survey which included 5000 saudi selected from 30 primary health care centers ( phcs ) in hail region . results . 
 the overall prevalence of obesity in hail was 63.6% . 
 moreover , the prevalence of males was 56.2% and the prevalence of females was 71% . 
 conclusion . 
 obesity is prevalent in the hail region which necessitates urgent interventions including health education .