Journal of Biology and Today's World

Weight Lowering Medications to Alter Morphological Indices: A Cross-Sectional Study among Saudi Females

Tabinda Hasan^* and Kavitha Ganesh ^*Correspondence: Tabinda Hasan, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia, Email:

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Introduction

Obesity has become a large health problem globally and a major risk factor for number of diseases [1]. Saudi Arabia has a high percentage of overweight patients according to a study conducted in 2013. It showed that over 3.6 million (28.7% of population) Saudi adult were obese. Prevalence of obesity in women was 33.5% while for men it was 24.1% [2].

In 2015, the guidelines provided by the Ministry of Health for obesity management suggested obese adults to use Orlistat and Metformin as conditional recommendations in addition to dieting and physical activity, although in many countries, including Saudi Arabia, metformin use for weight loss is considered off-label [3]. Inclusion of other drugs that have been approved by US Food and Drug Administration (FDA) will be postponed due to the lack of data of their usage specifically in Saudi Arabia. There are limited studies on regular practices of weight-loss among Saudis especially with the aid of weight lowering medication. Therefore, we will conduct a cross-sectional study by distributing self-administered questionnaires to Saudi females in multiple setting. The survey will include questions concerning previous or current use of weight-reducing drugs and whether they suffered from any side effects from these drugs.

The purpose of this study is to estimate the prevalence of using medication for weight loss among Saudi females, given that obesity is significantly more common among females in Saudi Arabia [2,4]. We aimed to estimate the prevalence of using weight lowering medications among Saudi females, determine the most common types of medication used for weight loss, determine the most frequently self-reported side effects caused by weight lowering drugs, assess the attitude, awareness and knowledge toward using weight lowering medication among Saudi females and investigate the associations between using weight lowering medication and other factors such as age, marital status, educational level, income, and body mass index. We anticipate that our data will be the base for future research on obesity treatments and drugs in Saudi Arabia.

Materials and Methods

Study design

Our study was carried out using descriptive cross-sectional questionnaire study. The questionnaire have constructed after reviewing the literature. After questionnaire validation, we did the pilot study and made minor modifications according to the participants responses.

Study setting/location

A convenience sampling method was adopted to distribute the surveys. We distributed paper surveys in multiple setting in different regions of Riyadh city (e.g. Almaarefa colleges, Prince Sultan University, hospitals, diet centers, gyms), whereas electronic surveys was spread using social media applications.The study conducted during March-May 2018-19.

Study population

Female Saudi nationality total responses were 1208.

Ethical consideration

After approval of the institutional ethical review committee; an informed verbal consent of study subjects was obtained with assurance of confidentiality and anonymity of the data.

Data collection

A structured questionnaire was used to collect the following data: Firstly, sociodemographic characteristics, for example, age group, gender, nationality, marital status, profession, educational level, income. Secondly, it included health-related questions such as height, current weight, and current health status. In addition to weight lowering practices questions, for example, methods used to lose weight, reasons to reduce weight. In addition, weight lowering medications associated questions including taking drugs with diet or exercise, type of medication, period of using medication, estimate of weight change, side effects suffered from medication. Lastly, questions on the knowledge about weight lowering drugs such as knowing the advantages and disadvantages from using weight lowering medication, other indications for these drugs, general drug interaction with food or other drugs.

Data cleaning and analysis

Data were analyzed using SPSS (IBM Corp. Released 2011). Univariate descriptive statistics performed to summarize and present data. Categorical variables reported as count and percentage, whereas continuous variables reported as mean and standard deviation. We compared participants’ responses on using weight lowering medications with number of nominal and ordinal variables such as age group and marital status, in addition to continuous variables such as BMI. Cross tabulation and Chi-square tests were used to determine the association between categorical variables (nominal, ordinal) and categorical outcomes. Quantitative data were described as means after testing of normality by Kolmogorov- Smirnov test. BMI showed not follow normal distribution, so we used non-parametric Kruskal-Wallis which doesn’t require normality condition to compare means within groups. “P value ≤ 0.05” was considered to be statistically significant.

Results

As illustrated in Figure 1, the total number of participants was 1208 (Electronic: 916, Paper: 292). After applying inclusion and exclusion criteria, we included 820 participants (electronic: 647, paper: 173). As seen in Table 1, the majority of participating females were in age group 19-25, followed by age group 26-35. The least age group reported was elderly more than 56 (Figure 2). 62.7% of females were single, while 28.4% were married (Figure 3). Furthermore, 53.6% were students, 19.1% were housewives. Most of the participants had bachelor's degree (72.2%) followed by high school 16.5%, diploma and higher education was in similar percentage 4.5% (Figure 4). According to monthly income, 30% of participants had 10000-20000 Saudi Riyal as family monthly income followed by 28.4% for 5000-10000 Saudi Riyal, the lowest percentage was for who had monthly income less than 5000 Saudi Riyal.

Table 1: Demographic characteristics.

Figure 1: Total number of participants before and after exclusion.

Figure 2: Percentages of participants’ age group.

Figure 3: Percentages of participants’ marital status.

Figure 4: Percentages of participants’ educational level.

In general, Body Mass Index (BMI) of participants followed a skewed normal distribution; where the highest percentage (40.8%) was for normal BMI (18.6-24.9) then began to decrease as BMI increased as it showed in Figure 5. There were numbers of factors that may have association with BMI such as age, marital status, educational level, and income. Table 2 demonstrated the p-value for age group and marital status to be equal to 0.000. Moreover, the p-value for monthly income was equal to 0.045. On the other hand, educational level had no significant p-value with BMI in our study.

Table 2: Cross tabulation showing frequency and relationship between BMI with demographic characteristics (age, marital status, educational level, income).

Figure 5: Percentages of BMI.

Notably, 22.4% of participants didn’t want to lose weight. As illustrated in Table 3, diet and exercise were the main methods used by participants to lose weight (64.1%, 61.5% respectively). In addition, the most common reasons to lose weight as reported by participants were to enhance appearance (70.3%), to improve physical fitness (46.5%), and for health reasons (27.8%); given that all percentages in Table 3 were from the total number of participants.

Table 3: Frequency Table of questions about try, methods and reasons for weight loss.

Furthermore, the prevalence of using weight lowering medication among Saudi females was 21.3% (Figure 6). The number of respondents who used drugs to lose weight along with diet reached 111 people, 86 of them with exercise and 75 with both diet and exercise. Table 4 showed that there is no relationship between weight change and taking drugs with diet (p-value 0.168), also with exercise (p-value 0.203), although people who used drugs with either diet, or exercise or both had 73.6% probability to lose weight. Further, the p-value for periods of using drugs with weight change was equal to 0.000.

Table 4: Cross tabulation showing frequency and relationship between patterns of using drugs for weight loss with weight change.

Figure 6: Prevalence of drug usage among Saudi females.

Lowering weight using medications was found to be significantly associated with age and marital status (p-value .000); however, there was no significant p-value between educational level and income with using drugs to lose weight. Table 5 and Figure 7 illustrated that highest number of drug users were among age group 19-25, followed by 26-35. On the other hand, married females consumed more anti-obesity drugs than others. In addition to that participants with monthly income around 5000- 10000 Saudi Riyal were using drugs more than other groups.

Table 5: Cross tabulation showing frequency and relationship between using weight lowering drugs and age, marital status, educational level, income.

Figure 7: Relationship between age and drug use for weight loss.

Further, there was a statistically significant difference in BMI between the different drug usage p=0.000. From Figure 8 we deduced that the probability of using drugs increased when BMI increased. In addition, the average BMI for drug users was 30.29, whereas the average for non-drug users was 24.68.

Figure 8: Relationship between BMI and drug use for weight loss.

Table 6 and Figure 9 showed the most common drugs used for weight loss to be Orlistat 46(26.4%), Metformin 36(20.7%), and Fibers PGX 13(7.5%). 17.8% of participants reported using other drugs such as Sibutramine, dietary supplements, and natural products. Furthermore, 25.9% of the participants who were consuming weight lowering medication did not know the type of medication they were using; given that all percentages for drugs used were calculated out of the total number of participants.

Table 6: Most common used drugs, periods for drug use, weight change.

Figure 9: Most common used drugs for weight loss.

Additionally, Table 6 showed the longest period for using drugs for weight loss was from 1 to 2 months, followed by taking drugs for less than 1 month (23%) and for 3 to 4 months (19.5%), respectively. Likewise, 27.6% of females who took medications lose 4 to 6 kilograms. Notably, there was 4% who gained weight from using weight lowering medications.

As illustrated in Figure 9, the most-frequently self-reported side effects from weight lowering medications were oily spotting (25.9%), headache (19.5%), diarrhea (17.2%), nausea (16.7%) and insomnia (16.1%). 28.7% of participants reported no side effects while they took the medications; where the percentages were calculated out of the total number of respondents. Table 7 showed drugs and their most-frequently reported side effects. Orlistat had oily spotting as most stated side effect, while metformin had nausea then oily spotting and diarrhea.

Table 7: Frequency of self-reported side effects of weight lowering medications.

Lastly, we found that 68.3% of total respondents knew the advantages and disadvantages of using weight lowering drugs, 25.4% knew that there are other indications for these drugs, 37.1% knew general interactions for weight lowering drugs, as provided in Table 8. However, there was no strong statically association between having knowledge about weight lowering medication drug use. In Table 9, those who have more knowledge about drugs were less-likely to consume them. Participants who took medications were 29% likely to not know the advantages and disadvantages for these medications.

Table 8: Questions about weight lowering medications knowledge.