The puzzle of self-reported weight gain in a month of fasting (Ramadan) among a cohort of Saudi families in Jeddah, Western Saudi Arabia

Nutrition Journal The puzzle of self-reported weight gain in a month of fasting (Ramadan) among a cohort of Saudi families in Jeddah, Western Saudi Arabia Balkees Abed Bakhotmah 0 0 Department of Nutrition & Food Sciences, College of Home Economy, King Abdulaziz University , P. O. Box 53100, Jeddah 21583 , Saudi Arabia Methods: A Cross-section study using a pre-designed questionnaire to identify the local pattern of expenditure on food consumption, dietary habits during Ramadan and correlate that to self-reported weight gain after Ramadan in a representative cohort of Saudis living in Jeddah. It was piloted on 173 nutrition students and administered by them to their families. Results: A total of 173 Saudi families were interviewed. One out of 5 indicated that their expenditure increases during Ramadan. Approximately two thirds of the respondents (59.5%) reported weight gain after Ramadan. When asked about their perspective explanations for that: 40% attributed that to types of foods being rich in fat and carbohydrates particularly date in (Sunset meal) 97.7% and rice in (Dawn meal) 80.9%. One third (31.2%) indicated that it was due to relative lack of physical exercise in Ramadan and 14.5% referred that to increase in food consumption. Two thirds (65.2%) of those with increased expenditure reported weight gain. Conclusion: Surprisingly weight gain and not weight loss was reported after Ramadan by Saudis which indicates timely needed life-style and dietary modification programs for a population which reports one of the highest prevalence rates of diabetes. Fasting; Weight changes; Ramadan; Muslims; Saudi Arabia - Background At least, one billion of the total Muslims population which amounts to 1.5 billion [1]. on earth refrain from eating or drinking from sunrise (Sohor)to sunset (Ifttar) during the holy month of Ramadan [2]. Ramadan is the ninth lunar month of the Islamic calendar and it will meet month of August in 2011. The fast periods in Ramadan varies from country to country and from season to season with an average length of 12 hours [2]. In Ramadan all Muslims -except children, elderly, travelers, sick and/or unable- are expected to abstain from food and drink from early dawn to sunset [3]. Among disabled individuals with acute or chronic diseases, most diabetic patients preferred to fast but certain diabetics can be exempted from fasting [4]. Although religious fasting is often a time of great spiritual growth, it can also be a time of great improvement to ones physical health and perhaps to lose weight. Most kinds of different religious fasts, and not only Ramadan fast, have this potential as forms of dietary modification [2]. During Ramadan most Muslims change their life style [3], sleep hours [5], physical activities [6], food consumption, meals frequencies and dietary habits for different reasons [2,7-10]. Fasting has been the subject of numerous scientific investigations [2,7] and [8]. The general opinion is that fasting has a potential non-pharmacological intervention for improving health and increasing longevity [7]. There are no adverse effects of Ramadan fasting on the heart, lung, liver, kidney, eyes, hematologic profile, endocrine and neuropsychiatric functions [7]. However, the majority of health-specific findings related to Ramadan fasting are mixed and sometimes contradicting [3]. The likely causes for these heterogeneous findings are the differences between studies in the following: 1) the amount of daily fasting time; 2) the percentage of subjects who smoke, take oral medications, and/or receive intravenous fluids; and 3) the subjects typical food choices and eating habits [2]. For the last reason this study was conducted to find out the perceptions of a cohort of Saudi females and their families about their expenditure on foods during Ramadan, changes in life style, dietary behaviour/ habits, meals frequencies, foods preferences, preparation of foods and its relation to body weight in view of the published literature which indicate that body mass index (BMI) may or may not decrease in response to Ramadan fasting [11-14]. It is assumed that such variation may be related to quality and quantity of foods ingested by Muslims in various countries and sub-cultures [15]. Cultures and sub-cultures differ in their socio-economic backgrounds and dietary habits in Ramadan. Most of studies published were conducted on small group of young volunteers and aimed to find out the bio-chemical, anthropometric and physiological changes under standardized strict conditions and did not approach it at a public level from all aspects including the previously mentioned factors. Understanding of the previous patterns in Ramadan will hopefully lead to better health promotion, behavior and nutrition modification programs among various communities particularly those with high prevalence rates of obesity-related type 2 diabetes such as Saudi Arabia. Methods This is a cross sectional descriptive study which was performed on a cohort of Saudi females nutrition students and their families living in Jeddah city, Western Saudi Arabia. It was hypothesized that body weight will increase after Ramadan as a result of changes in life style by Saudi families which include increase in sugary and fatty foods consumption, increase in meals frequency and decrease in physical activities. In Ramadan, most Saudis have 2 main meals (Sohor before dawn and Ifttar after sunset prayers) and another 3 smaller ones (at sun-set, after night prayers i.e. Taraweh and at midnight before Sohor). The sample was a convenient sample. The studied group was primarily a group of 173 final year undergraduate nutrition female students who were invited to participate in filling answers to a pre-designed questionnaire. The study was conducted on Ramadan of 2008 (1429H). Students were requested to involve their parents. In case of death of both or one of parents, two mature members of the family above 20 years of age can be involved in filling the answers related to whole family food consumption pattern and to verify the accuracy of data given. Verbal informed consents were obtained after the study had been explained to them in native language. Students were living across Jeddahs city in almost all the districts. This wide comprehensive distribution of the studied clusters enhanced the representation of all the socio-economic groups of Greater Jeddahs communities which embraces more than 2.5 million inhabitants. Training and overall supervision of the interviewers were carried out by the author (BB). For the purpose of study weight gain was simply defined as a gain of more than 3 kilograms after completing a full month of Ramadan fasting by healthy participants who were female residents in Jeddah city i.e. sick and/or travelers were excluded. In addition, nonSaudi, those who do not weigh themselves regularly or those who declined to participate were also excluded. Questionnaire was explained and ad (...truncated)