Knowledge, Attitude and Practices of Parents Towards Obesity in Children in Aseer Region, Southern of Saudi Arabia

Abstract

Background: Childhood obesity represents a critical global health concern, with steadily rising prevalence and significant implications for long-term physical and psychological well-being. In Saudi Arabia, the problem is particularly acute, with national data showing high obesity rates among children and adolescents, attributed to sedentary lifestyles and poor dietary habits. Understanding parental influence is vital in addressing this growing epidemic.

Objective: This study aimed to assess the knowledge, attitudes, and practices (KAP) of parents regarding childhood obesity in the Aseer Region of Saudi Arabia and to identify demographic factors associated with parental knowledge levels.

Methods: A cross-sectional, web-based survey was conducted for a period of 3 months targeting parents of children aged 18 or younger years living in the Aseer Region. A structured questionnaire assessed sociodemographic data and parental KAP regarding childhood obesity. Descriptive statistics and chi-square tests analyses were used for data analysis, with significance set at p < 0.05.

Results: A total of 907 parents participated. While 92.8% recognized that children can be obese and 96.8% acknowledged lack of physical activity as a risk factor, only 67% were familiar with Body Mass Index (BMI), and 80.6% identified genetics as a contributing factor. Despite generally positive attitudes 93.5% agreed that high intake of sweets and fried foods increases obesity risk unhealthy practices were prevalent: 85.1% of children snacked between meals, 73.8% ate while using screens, and 48.7% exceeded three hours of screen time daily. Maternal education (p = 0.001) and employment status (p = 0.048) were significantly associated with higher parental knowledge levels. Positive correlations were also found between knowledge, attitude, and practice scores (p < 0.001).

Conclusion: Although parents in the Aseer Region demonstrated high awareness and favorable attitudes, their practices often failed to reflect this knowledge. These findings highlight the need for culturally tailored interventions that support parents in translating awareness into healthier behaviors for their children. Strategies should particularly focus on screen time management, mindful eating, and support for less-educated and non-working mothers.

Introduction

Childhood obesity is a significant global health issue, with rising prevalence rates that contribute to long-term health risks such as type 2 diabetes, cardiovascular disease, and psychological challenges.^1,2 Once considered primarily an adult issue, obesity now affects a large proportion of children, resulting in substantial health and economic burdens. In Saudi Arabia, childhood obesity is particularly concerning, as recent data indicate that approximately 20% of Saudi males aged 5–9 and 24% aged 10–14 are obese. Among females, these rates reach 40% and 41% for those aged 5–9 and 10–14, respectively.³

The Kingdom of Saudi Arabia, like many other nations, has witnessed a concerning rise in childhood obesity rates, with lifestyle changes and urbanization being major contributing factors.⁴ The Aseer region, located in the southwestern part of Saudi Arabia, has unique demographic and cultural characteristics, including traditional dietary patterns and varying levels of physical activity that are influenced by geographical and familial settings.⁵ These distinct features may shape parental knowledge, attitudes, and behaviors toward childhood obesity, as parents play a crucial role in managing and influencing their children’s health-related behaviors.

Parental knowledge and attitudes regarding childhood obesity significantly impact children’s health outcomes, as parents are responsible for making decisions about food choices, physical activities, and other lifestyle factors. Studies have shown that increased parental awareness and understanding of obesity-related risks are associated with more proactive measures in promoting healthy habits among children.^6–9 However, limited data are available on parental knowledge and perceptions related to childhood obesity in the Aseer region, particularly regarding how cultural and environmental factors might influence these attitudes and practices.

This study aims to fill this knowledge gap by evaluating the knowledge, attitudes, and behaviors of parents regarding childhood obesity in the Aseer region. By identifying parental perceptions and associated factors, this research provides insights into the potential areas for intervention and awareness programs to address the childhood obesity epidemic effectively. The findings of this study can support the development of targeted educational programs to enhance parental knowledge and encourage healthier family lifestyles, ultimately aiming to reduce childhood obesity prevalence in Saudi Arabia.

Methodology

Study Design

This descriptive, cross-sectional study was conducted in the Aseer Region of Southern Saudi Arabia for a period of 3 months. The study aimed to assess the knowledge, attitudes, and practices (KAP) of parents regarding childhood obesity and to identify factors associated with parental knowledge levels.

Study Population and Sampling

The target population included parents (both mothers and fathers) of children aged 18 or younger residing in the Aseer Region. Eligibility criteria included being a Saudi resident in Aseer, having at least one child in the specified age range, and being able to read and respond to the survey in Arabic. Parents without children or those unwilling to provide informed consent were excluded.

A sample size of 385 participants was calculated using the Sample size calculator¹⁰ with a 5% margin of error, 95% confidence level, and an estimated response distribution of 50%. To ensure greater statistical power and account for incomplete responses, the final sample included 907 respondents.

Survey Instrument and Design

Data were collected using a self-administered, structured online questionnaire developed by the research team after reviewing previous studies on parental KAP toward childhood obesity.¹¹ The questionnaire was developed in Arabic, the primary language of the participants, and comprised five sections:

1. Sociodemographic information (eg, age, education, employment, income).
2. Parental knowledge (10 items): Assessed awareness of obesity-related risk factors and health consequences. Responses were “Yes”, “No”, or “Don’t Know.” Correct answers were scored as 1, and incorrect/“Do not Know” as 0. Total scores were categorized into high or low knowledge based on the median cutoff.
3. Attitudes (15 items): Rated using a 3-point Likert scale (Agree, Neutral, Disagree).
4. Practices (6 items): Assessed lifestyle behaviors such as meal frequency, screen time, physical activity, and parental supervision.
5. Children’s habits (eg, screen time, activity type, eating patterns).

The questionnaire’s internal consistency was tested, yielding a Cronbach’s alpha of 0.783, indicating acceptable reliability.

Recruitment and Data Collection

Participants were recruited via social media platforms, including WhatsApp parenting groups, Twitter, and Facebook pages targeting families in the Aseer Region. The survey link, created using Google Forms, included a clear description of the study’s purpose and eligibility. Each respondent provided informed electronic consent before participation.

To minimize duplicate entries, the survey restricted responses to one per IP address, and timestamps were monitored for suspicious patterns. No personally identifying information was collected to ensure confidentiality.

Data Analysis

Data were exported from Google Forms and analyzed using IBM SPSS Statistics, Version 25.0. Descriptive statistics (frequencies and percentages) were used to summarize participant demographics and KAP responses. Chi-square test was also done to examine associations between categorical variables.

Ethical Approval

Ethical approval was obtained from the Research Ethics Committee at King Khalid University (Approval Number: ECM#2022-107). All procedures complied with the principles outlined in the Declaration of Helsinki. Participation was voluntary, and participants were informed of their right to withdraw at any point without penalty.

Results

A total of 907 parents participated in the study. The demographic analysis showed diverse characteristics among respondents. Fathers had a mean age of 41.6 ± 13.9 years, while mothers averaged 36.8 ± 12.6 years. Education levels were generally high, with 58% of fathers and 62.3% of mothers holding a university degree. Employment rates differed significantly by gender, with 93.1% of fathers working compared to 49.3% of mothers. Monthly family income varied, with 41.5% of families reporting an income between 10,000–20,000 SR. Regarding family health history, 47.7% reported a family history of obesity, and 39% reported a history of chronic diseases. Detailed demographic information is provided in Table 1.

Table 1 Demographic Characteristics of Parents in the Aseer Region

Knowledge Domain

The findings indicate that parents in the Aseer region generally have a high level of knowledge about childhood obesity. An overwhelming majority (92.8%) were aware that children could be obese, and 67% of respondents were familiar with the concept of Body Mass Index (BMI). Awareness of specific risk factors was also high, with 96.8% recognizing lack of exercise, 96.7% citing inactivity, and 95.7% identifying poor nutrition as contributors to childhood obesity. Notably, 80.6% of parents acknowledged genetic predisposition as a factor in obesity, although this awareness was slightly lower than that for lifestyle-related risk factors.

In terms of health consequences, most parents were aware of the link between obesity and various health risks. Specifically, 91.5% recognized that obesity is a risk factor for diabetes, 89.4% for heart disease, and 87.5% for high blood pressure. Additionally, 96.1% of parents agreed that regular aerobic exercise is essential for weight management in children. The internal consistency for the knowledge items was supported by a Cronbach’s alpha of 0.764, indicating acceptable reliability. Table 2 and Figure 1 provide a summary of parental knowledge regarding childhood obesity, illustrating the distribution of knowledge levels across various obesity-related factors.

Table 2 Parental Knowledge of Childhood Obesity

Figure 1 Overall Parents knowledge level for obesity in children, Aseer region, Saudi Arabia.

Attitude Domain

Parents exhibited predominantly positive attitudes toward preventing childhood obesity. Most parents (93.5%) agreed that high consumption of sweets, carbonated drinks, fried foods, and ice cream increases the risk of obesity. Additionally, 91.3% believed that physical education classes can play a critical role in reducing obesity risk, while 90.3% acknowledged that prolonged screen time and physical inactivity contribute to weight gain in children. The data further indicate that parents view obesity as a preventable condition, with 88.6% believing it can be prevented, and 88.8% supporting regular fruit and vegetable intake to reduce obesity risk.

Interestingly, although parents generally exhibited positive attitudes toward obesity prevention, some misconceptions persisted. For instance, 21.8% of parents believed that “obese children are healthy”, suggesting that a subset of parents might not fully understand the health implications of obesity. The attitude domain achieved strong reliability, with a Cronbach’s alpha of 0.783. Detailed responses for each attitude item are provided in Table 3.

Table 3 Parental Attitudes Toward Childhood Obesity

Practice Domain

While parental knowledge and attitudes toward obesity were generally positive, the reported practices revealed areas for improvement. A significant proportion of parents (85.1%) reported that their children frequently ate between meals, and 73.8% allowed their children to eat while using screens. Such behaviors could contribute to excessive caloric intake and distracted eating habits, potentially leading to weight gain.

Regarding physical activity, sedentary behaviors appeared prevalent among children in the sample. Nearly half (44.7%) of children’s primary activities involved sedentary pastimes such as video gaming, and 48.7% of children spent more than 3 hours per day on screens. These findings align with broader trends linking prolonged screen time to higher obesity risk. Encouragingly, 59% of parents reported actively engaging with their children during meals, demonstrating a commitment to meal supervision. However, 46.1% of parents used food as a reward, which may promote unhealthy relationships with food and contribute to overeating. Figure 2 illustrates the distribution of parental practices related to child dietary habits, screen time, and meal supervision, with further details in Table 4.

Table 4 Parental Practices Regarding Child Diet, Screen Time, and Meal Supervision

Figure 2 Distribution of parental practices related to child dietary habits, screen time, and meal supervision.

Factors Associated with Parental Knowledge

The study found that certain demographic factors were significantly associated with parental knowledge levels. Maternal education emerged as a key factor, with university-educated mothers more likely to have higher knowledge scores (91.3%) than those with secondary education (80.7%), a difference that was statistically significant (p =0.001). Employment status also influenced knowledge, with 89.1% of working mothers demonstrating high knowledge compared to 84.1% of non-working mothers (p =0.048). These findings are consistent with previous studies indicating that higher educational attainment and employment status can positively impact health awareness. A detailed analysis of factors associated with parental knowledge is presented in Table 5.

Table 5 Factors Associated with Parental Knowledge of Childhood Obesity

Children’s Eating Habits and Behaviors

In addition to examining parental knowledge, attitudes, and practices, the study also analyzed children’s eating habits and behaviors. A substantial portion (49.1%) of children were both breastfed and formula-fed during infancy, while 30.8% were exclusively breastfed and 20.2% were formula-fed. Most children had three meals per day (48%), with an additional 34.2% consuming four or more meals daily. Additionally, screen time during meals was common, with 73.8% of parents reporting that their children ate while using screens.

In terms of children’s favorite activities, sedentary pastimes dominated, with video gaming identified as the preferred activity for 44.7% of children. Other popular activities included general play (35%) and football (12.3%). Additionally, 48.7% of parents reported that their children’s daily screen time exceeded 3 hours, highlighting a high prevalence of sedentary behaviors. Further details on children’s eating habits, meal frequency, and screen time behaviors are provided in Table 6.

Table 6 Children’s Eating Habits, Meal Frequency, and Screen Time Behaviors

Discussion

This study evaluated the knowledge, attitudes, and practices (KAP) of parents in the Aseer region regarding childhood obesity. The results reveal an encouraging level of awareness and favorable attitudes among most parents; however, notable behavioral gaps remain. While a majority of parents demonstrated strong knowledge of obesity risk factors including poor nutrition, lack of physical activity, and sedentary behavior, this knowledge did not consistently translate into healthy lifestyle practices at home. These findings underscore the complex and multifaceted nature of obesity prevention, particularly within the cultural and environmental context of the Aseer region.

The Aseer region presents a unique backdrop for studying childhood obesity. Located in the mountainous southwestern part of Saudi Arabia, Aseer is characterized by traditional lifestyles, extended family systems, and a mix of rural and urban populations.¹² Local dietary patterns, often rich in carbohydrates and animal fats, combined with limited access to organized recreational facilities, may contribute to sedentary behaviors among children. Moreover, family-oriented social structures may reinforce longstanding beliefs about body image, potentially leading to an underestimation of obesity risks or normalization of excessive weight in children. These factors make the Aseer region particularly relevant for targeted interventions that reflect the realities of daily life in this community.

The majority of parents showed substantial awareness of childhood obesity, with over 90% recognizing key risk factors such as lack of exercise, inactivity, poor diet, and genetic predisposition. This aligns with other studies in Saudi Arabia and globally that demonstrate increasing awareness of childhood obesity and its associated health risks among parents.^13–15 The high awareness of physical inactivity and poor dietary habits as obesity risk factors suggests that parents are aware of lifestyle influences on weight. However, only 80.6% acknowledged the role of genetics, indicating a potential knowledge gap regarding the multifactorial nature of obesity. Addressing this gap may help parents understand the broader influences on childhood obesity beyond lifestyle choices.

Parental attitudes toward childhood obesity were generally positive, with nearly all parents supporting the importance of physical activity, healthy eating, and limiting screen time. Notably, 93.5% agreed that high consumption of sweets, fried foods, and sugary drinks increases obesity risk, and 91.3% believed that physical education is essential for preventing obesity. These attitudes reflect a growing recognition among parents of the importance of healthy lifestyle practices for their children, aligning with findings in other regions.^16–18 However, the belief that “obese children are healthy” held by 21.8% of parents suggests that some may still have misconceptions about obesity’s impact on children’s health. Educating parents about obesity’s potential long-term health effects could help address this perception.

Despite high awareness and positive attitudes, some parental practices reveal concerning behaviors that may contribute to childhood obesity. For example, 85.1% of children ate outside of regular meals, and 73.8% ate while using screens. These behaviors can foster unhealthy eating habits and contribute to excessive caloric intake, underscoring the need for targeted interventions to reduce screen time during meals and promote mindful eating practices. Additionally, nearly half of the children had over 3 hours of screen time daily, which could exacerbate sedentary behaviors and lead to weight gain. These findings are consistent with prior studies showing that prolonged screen time is a significant risk factor for obesity.^19–21

Encouragingly, 59% of parents reported actively engaging with their children during meals, suggesting a high level of parental involvement. However, the practice of using food as a reward, reported by 46.1% of parents, raises concerns as it may reinforce unhealthy relationships with food and foster overeating. Interventions that provide parents with alternative reward systems and strategies for encouraging healthy eating habits may help reduce reliance on food-based rewards.

This study found that maternal education and employment significantly influenced parental knowledge levels. University-educated mothers were more likely to have higher knowledge scores compared to those with only secondary education (p =0.001). Working mothers also had higher knowledge scores than non-working mothers (p =0.048). These findings align with research indicating that higher educational attainment and employment status positively impact health awareness and knowledge.^22–24 These results suggest that targeted educational programs for less-educated and non-working mothers could help address disparities in knowledge and support healthier lifestyles for children across different socioeconomic backgrounds. It is crucial to understand the current investigation’s limits, nevertheless. The use of an online survey may have introduced selection bias, favoring parents with internet access and potentially higher education levels. Also, the reliance on self-reported data is subject to recall bias and may not accurately reflect actual behaviors.

The public health implications of these findings are clear. First, family-based education programs should be developed and delivered through schools, clinics, and digital platforms, with content tailored to the cultural values of the Aseer community. Second, schools should be empowered to reinforce these messages through mandatory physical education, healthy cafeteria options, and parental engagement. Third, media campaigns should work to dismantle common misconceptions such as the belief that obesity is primarily genetic and promote behavior-focused solutions. Finally, mobile health (mHealth) tools, such as apps or SMS reminders, could serve as low-cost, scalable solutions to guide and support parents in implementing healthier home routines.

Like any study, this research has limitations. The use of a web-based survey may have introduced selection bias, as participants with higher educational attainment and internet access may be overrepresented. Additionally, self-reported data are subject to recall and social desirability bias, which could influence the accuracy of responses. Despite these limitations, the large sample size and focus on a culturally distinct region enhance the relevance and value of the findings.

Conclusion

This study contributes valuable insight to the existing literature on childhood obesity by focusing on the Aseer Region of Saudi Arabia, a culturally distinct and underrepresented area in public health research. It demonstrates that while parental knowledge and attitudes toward childhood obesity are generally high, there is a clear gap between awareness and the implementation of healthy practices. The study’s findings support global trends while also revealing unique regional patterns, such as the overemphasis on genetic causes of obesity and the normalization of excessive screen time.

By identifying significant associations between knowledge levels and sociodemographic factors particularly maternal education and employment, the study highlights key areas for targeted intervention.

Nonetheless, the study has limitations. The use of a web-based, self-reported survey may have introduced selection bias, favoring more educated or digitally literate participants. Additionally, behavioral responses may be influenced by social desirability or recall bias. Despite these limitations, the large sample size and focus on a regionally specific population enhance the reliability and relevance of the findings.

In light of the results, several practical recommendations emerge. For parents, greater emphasis should be placed on reducing screen time, avoiding the use of food as a reward, and modeling healthy eating and activity habits. Schools should reinforce physical education and collaborate with families on health education initiatives. Health authorities are encouraged to develop culturally tailored campaigns and mobile health tools that support behavior change at home, with special attention to engaging less-educated and non-working mothers. By addressing both knowledge and behavior, such efforts can more effectively combat childhood obesity and promote long-term health for Saudi children.

Acknowledgments

The author extends his appreciation to the Deanship of Scientific Research at King Khalid University for funding this work through large group Research Project under grant number: RGP2/378/44

Disclosure

The author reports no conflicts of interest in this work.

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