A Mixed Methods Study of Childhood Feeding and Growth in Saudi Arabia

Childhood obesity is on the rise in Saudi Arabia with the latest national prevalence approximately 30% for children (below 18 years) and 9% for preschoolers. The burdens of obesity are numerous from financial cost on society to physical and psychological comorbidities. Maternal views about childhood obesity have not been examined in the Saudi Arabian literature. This study used a sequential explanatory mixed methods design to examine maternal perceptions about their children’s weight, feeding styles, and assessment of their children’s eating behaviors in the eastern province of Saudi Arabia. The translation procedure examined the cultural appropriateness and fidelity of the Arabic version of the Child Feeding Questionnaire (CFQ) and Child Eating Behavior Questionnaire (CEBQ). The quantitative phase examined whether Saudi mothers’ feeding styles and children’s eating behaviors were associated with children’s anthropometrics and family socioeconomic factors. The qualitative phase examined maternal perceptions of their children’s weight, feeding styles and children’s eating behaviors. The mixed phase examined the relationship between children’s weight status and maternal perceptions, feeding practices and children’s eating behaviors. The translation procedure underwent six stages, showed acceptable internal consistency, agreement and scale-content validity index scores of the Arabic CFQ and CEBQ. In the quantitative phase, 223 mothers and their preschoolers were recruited from 7 schools in the eastern province. Children’s anthropometrics found combined overweight and obesity was 11.8%. Combined overweight and obesity in mothers was 64.3%. Statistical analyses revealed the significant correlates with children’s body mass index (BMI) percentiles were perceived mothers’ and children’s weight, concern about children’s weight and pressure to eat (CFQ). From the CEBQ, enjoyment of food, satiety responsiveness, slowness in eating, and emotional overeating were significantly correlated with children’s BMI percentile. Themes identified related to maternal feeding styles and attitudes included strategies for food management, discrepant views between parents, and use of electronics during meals. Mothers strategies differed based on their employment status, with employed mothers relying on others to manage some of their children’s meals. Discrepant views between parents focused on fathers bringing home sweets for the children despite the mothers’ desire to limit such items.Doctor of Philosoph