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  Table of Contents 
Year : 2020  |  Volume : 23  |  Issue : 10  |  Page : 1356-1367

Association between parental negligence in feeding and social activity of obese adults among jazan population

1 Department of Prosthetic Dental Sciences, College of Dentistry, Jazan University, Jazan, KSA
2 Department of Preventive and Community Dentistry, College of Dentistry, Jazan University, Jazan, KSA

Date of Submission11-Oct-2019
Date of Acceptance09-Apr-2020
Date of Web Publication12-Oct-2020

Correspondence Address:
Dr. K A Mattoo
Department of Prosthetic Dental sciences, College of Dentistry, Near Mohammad Bin Nassar Hospital, Shwajara, Jazan
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/njcp.njcp_553_19

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Background: Neglectful feeding and physical activity (PA) practices by parents are associated with development of adulthood obesity. The Arab world has reported an alarming increase of adulthood obesity and childhood neglect by parents, yet have not studied the association between the two variables. Aims: The objectives of this study were to evaluate two parental negligence parameters (feeding style and social activity) associated with adulthood obesity and to identify the level of parental negligence on a customized parent neglect scale. Methods: In total 450 adult subjects 18-30 were screened for body mass index (BMI) values. 240 subjects fulfilling the criteria for the study were divided into two groups normal weight (N Gp) (n = 150) and overweight/obese (Ov/Ob Gp) (n = 90) groups. A questionnaire was formulated through a dual moderator focus group discussion, which was then tested in a prepilot and a pilot study (qualitative) to determine its validity (content and criterion) and reliability (repeated measurement) before distributing to the parents of both groups. Physical activity and screen time were also recorded for the subjects and their parents. Chi square test for association/difference between two categorical variables and Pearsons correlation coefficient for BMI correlation were employed. Results: Parenting parameters like maternal age, consanguineous marriage, breastfeeding duration, formula food introduction, and maternal smoking were significantly different between studied groups. Higher physical inactivity was observed among parents (father/mother 53%) and subjects (80%). The higher amount of screen time (73% ≥ 60-100 h/week) was found in the Ov/Ob Gp that significantly differed with the other group. Maternal BMI was positively related to the subjects BMI. Parents of obese subjects were found negligent in feeding style and very negligent for social activity on a parent neglect scale as compared to the parents of the normal weight subjects. Conclusion: Parents are responsible for developing healthy eating habits and competitive social behavior among their children. Parents need to practice the same to influence changes in their children during their early childhood, as well as when their children grow into adults. Negligent parenting in the studied parameters were found to increase the risk of developing adulthood obesity and should be considered as a potential marker for adult obesity.

Keywords: Body mass index, child negligence, feeding practices, parenting style, screen time

How to cite this article:
Mattoo K A, Shubayr M. Association between parental negligence in feeding and social activity of obese adults among jazan population. Niger J Clin Pract 2020;23:1356-67

How to cite this URL:
Mattoo K A, Shubayr M. Association between parental negligence in feeding and social activity of obese adults among jazan population. Niger J Clin Pract [serial online] 2020 [cited 2020 Dec 4];23:1356-67. Available from:

   Introduction Top

Obesity, historically a medical condition, but now a recognized disease, is also a globally declared federal public health problem whose roots are originated from American states and spread to developing and underdeveloped nations with a major health liability on their regimes and population. While the economically prospering oil producing nations of the middle east have reported a steep rise in childhood overweight/obesity (Ov/Ob) (25–40%), as well as adulthood Ov/Ob (32–50%) during the present decade,[1],[2] obesity is not sparing even the poorest African nations. Although, heredity determines about 40–70% of the obese aetiology, the role of the environment plays a significant role in the remaining of the affected individuals. The environment provided to the growing child during his childhood is directly or indirectly the outcome of parenting. Neglectful parenting during childhood not only has shown an association, but is also now considered as a predictor of adulthood obesity.[3] Higher chances for developing adulthood obesity in neglected (dirty) children than average groomed children has been reported.[4] Psychological maltreatment during early childhood like child negligence[5] and sexual abuse[6] have been associated with increased risk of developing obesity in adulthood. Obesity in such cases of parental negligence has been described as an adaptation to being a victim of childhood abuse.[7] Corporal punishment by parents (physical abuse) has been significantly found associated with negative outcomes that includes its relation to the development of eating disorders.[8] While parents do not neglect their children intentionally, personal problems does impede one's ability to adequately provide ideal childcare. In relation to adult obesity, studies have isolated three forms of parental neglect is a scientific term and cannot be changed to negligency which is an english term. here we are referring to scientific terminology therefore the sentence has to parental neglect: medical neglect, supervisory neglect, and care neglect.[9] Parents not only control but are also accountable for developing a lifestyle of their children. Parental feeding style and physical activity have been stated to be associated with their children being overweight or obese.[10] Advancement or recession of obesity from childhood to adulthood largely depends on habits (eating, activity, social interaction) that are cultivated within a child. While some habits can be enforced through proper child education by parents, others like physical activity need to be practiced by parents to influence a child. The mother as a poor role model increases risk of the child to develop obesity.[11] Also, physically inactive parents, especially inactive mother increases the chance of producing physically inactive children.[12]

Saudi Kingdom is a world's largest petrol exporter with less population, but a disadvantaged geographic location. Child maltreatment was under reported (sensitive issue) until the year 2000, when the government recognized and installed child protection centers across its major hospitals. As per the hospital-based child safety centers of the Saudi National family safety registry (NFSR), within a space of three years between 2010 and 2012, about 1450 child abuse cases were registered with 511 (35%) cases classified as suffering from parental neglect.[13] Male subjects have been reported to suffer more neglect. Independent research in 2016 (n = 16,939) among students aged 15 to 19 years, showed 53% of participants having experienced negligence by parents.[14] Coincidentally, during the present decade the prevalence of obesity in Saudi Arabia has been accounted to have gone drastically high (40 and 50%).[1] Parts of the kingdom like Jazan province also are known to have extensive use of Khat (Catha edulis – Khat),[15] and substance abuse is considered a form of parental negligence.[16] This boosted conductance of the present study. As parent neglect encompasses extensive issues, the present study was focused on determining the existence of parental neglect (if any) in their feeding style and social activity which falls in the realm of supervision and care neglect.[9]

We hypothesized that parents of obese subjects in Saudi population are negligent in developing healthy feeding habits and social activity among their off springs than the parents whose off springs have normal weight. This study was objectively aimed to explore the differences in the feeding style and social activity between parents of normal weight and overweight/obese adult subjects. In doing so, the study also aims to analyze the prevalence of obesity and relative parenting practices of Saudi population. The level of parental negligence for both parameters was estimated on a scale that was custom designed for the study. The development of a scaled questionnaire as a measuring tool was also intended to encourage further research in determining parental neglect as Saudi culture and laws do not allow previously validated methods of identifying parental neglect like observing the home environment of the suffering child.

   Materials and Methods Top


This research project was duly approved by the college and the university research committee that conducts all human and animal studies in accordance with the ethical principles and standards of the Helsinki Declaration. All participants (eligible adult subjects and their respective parents) were briefed about the purpose of the study and after assuring about the confidentiality of their relevant information, a written informed consent was taken from them.

Study design

This comparative case control study was done in the southern province of the Kingdom of Saudi Arabia, between the year 2017 and 2018. All eligible subjects were students (more than 18 years) of various colleges affiliated to different universities in this region. They represented the gross population as admission to various universities is proportionally done according to the population distribution of 14 different provinces. The study adopted a qualitative approach to analyze the parental feeding style and social activity, whereas a quantitative approach was used to analyze the time spent by the subjects and their respective parents on individual physical activity (PA) and the screen time (ST). A qualitative study was preferred because the study was aimed to explore and analyze the differences in feeding style and social activity between parents of normal weight and overweight subjects.

Sample selection and grouping: In the first phase of the study, a total of 450 students between the age of 18-30 years were randomly screened by qualified and experienced physicians for body mass index values (BMI) during three different surveys (pre pilot, pilot, and final). From these a sample of 240 subjects was selected and divided into two groups. Selection was based on specific eligibility criteria for subjects and their respective parents. For a subject the eligibility criteria included being a Saudi National, one or more brother/sister with a corresponding BMI value, both biological parents alive and living together since birth, no history of systemic disturbance or any potential illness during the childhood, no history of chronic drug use, no history of recent marriage or pregnancy of the subject and no history of being underweight/overweight or obese since birth. Any subject who was the lone child of his parents or sudden weight gain history were also excluded. These criteria were laid to ensure that the progression of gaining weight was due to the mileu (environment) provided to the subject by their parents. The inclusion criteria for parents were that they should be cooperative and willing to reveal personal information for the study, no history of familial obesity, parents not divorced or living separately, no history of chronic illness/chronic drug use by either of the parent and no history of substance abuse by either father or mother. The reason for excluding the above mentioned criterion was to ensure that weight gain was not due to systemic or physiological conditions and was purely as a result of parental influence.

The primary criterion for allocation of subjects into respective groups was their respective BMI value. On the basis of the BMI values, optimum number of subjects that fulfilled the requirement of efficiency, representativeness, reliability and flexibility for each group was decided to be 150 subjects in the normal weight group (N Gp) and 90 subjects (proportional allocation) in the overweight/obese (Ov/Ob Gp) (±5% accuracy, an alpha of 0.05 (95% confidence interval)). Sample design for the subject of N Gp was random sampling (probability sampling) with replacement, whereas sample design for Ov/Ob Gp was judgement sampling (judgement depend on choosing BMI values of each subject).

Operational definition: In the context of the present study, parental “neglectful feeding” was operationally defined as the parent's inaction or inattention to control, monitor, and restrict adverse feeding practices, including the compulsion of feeding culture thereby providing a feeding environment that promotes weight gain. Parental “neglectful physical activity” was operationally defined as the parent's inaction or inattention to model, promote, train and monitor his child's minimum requisite's to maintain physical well-being. For ease to understand the chosen adult participants are referred to as subjects and their respective father and mother as parents. As we investigated parenting practices about the subject who is either normal or obese, the term child whenever used is in context to the subject when he was a child.

Data collection and analysis: Assessment of various demographic, socioeconomic, personal and family variables, including parent neglect regarding feeding and social activity was done using a questionnaire whose reliability and validity was examined and tested in earlier prepilot and pilot studies.[17] The questionnaire (28 questions closed rating scale type) assessed parent's negligence regarding feeding style in six domains, namely responsibility perception (Internal reliability (IR) (Cronbachα) 0.90, Test retest reliability (TRR) - 0.816), feeding control (IR-0.819, TRR-0.80), feeding culture (IR-0.88, TRR-0.812), feeding environment (IR-0.915, TRR-0.90), monitoring (IR-0.734, TRR-0.798) and feeding restrictions (IR-0.770, TRR-0.812) while social activity was measured using a set of 9 questions (IR-0.795, TRR-0.754). The extent of time spent on physical activity and screen time was also recorded. Questions were modified according to the socio-cultural conditions and available sports facilities in the region. The questionnaire was translated into Arabic language (local) and then translated back into English according to the “translation/back-translation method” by two professional experienced bilinguals. Once the filled questionnaires were collected, they were reviewed, coded, studied and then relevant data analysis was completed using the statistical package of social science (SPSS-25.0) software. Mean values ± standard deviation (median with interquartile range) for continuous variables while relative and absolute frequencies for qualitative variables were calculated. Chi square test was employed to test for the association and or the difference between two categorical variables while BMI correlation was done using Pearson's correlation coefficient. As certain parameters of parental negligence were measured at a nominal level, the use of Chi square test (nonparametric) was preferred. The same test was also preferred to prevent any effect on the study if the data obtained was not normally distributed, since the test is a distribution free tool. All P values were two sided and taken equal to or less than 0.001 levels. For determining the level of each domain on a parent negligence scale, the level of each item was determined by using the formula (highest point in the scale-lowest point on the scale/the number of levels used.[18]

   Results Top

Subjects of both groups were chosen from a random sample of 450 young adults aged between 18 and 30 years. A total of 90 subjects were graded as either overweight or obese, showing a prevalence of 20.4%. Out of 450 subjects, 240 subjects (150 N Gp and 90 Ov/Ob Gp) fulfilled the criteria for this study. Tests of normality were done for data distribution and the results are shown in [Table 1]. While descriptive statistics were expressed in mean and standard deviation, analysis for statistical significance of quantitative variables was done using the median. Sociodemographic comparison of the two groups is presented in [Table 2]. Average BMI value for the subject in N Gp was 22 and in the Ov/Ob Gp it was 29. Results show that higher frequency in parameters like parental BMI, parental literacy, father's occupation among Ov/Ob Gp. In total 81.1% of the parents in Ov/Ob Gp claimed that the subject had gained most of the weight in intermediate/secondary school (grade 7 - 12/ age 13 - 19 years). Association and significance of the environmentally modulated variables investigated in both groups are illustrated in [Table 3]. Parenting factors like duration of breastfeeding, introduction of supplemental food, maternal age at the time of birth, maternal smoking, consanguineous marriage and parents' opinion about a subjects' weight illustrated statistically significant differences at P < 0.001, between the two groups. Father's age at subjects's birth (P = 0.005), paternal smoking (P = 0.462) and parent's substance abuse (P = 0.195); however showed no significant differences. Parameters associated with the subject like the subject being active during school, subjects sleeping hours/day and subject's physical activities per week were statistically significant. BMI values of mother displayed correlation with the subjects BMI (P < 0.001) while fathers BMI (P = 0.368) showed no correlation.
Table 1: Tests of normality

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Table 2: Comparative Sociodemographic characteristics of the studied groups (Normal weight (N Gp) and Overweight/Obese (Ov/Ob Gp))

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Table 3: Frequency distribution and significance of association of various environmentally modulated parental variables associated with obesity

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The relative differences in frequency and their association between the extent of time spent on physical activity and screen time by respective parents and the subjects between the two groups are illustrated in [Table 4]. Subjects and their respective parents in N Gp spent more time on physical activity than the parents of subjects in the Ov/Ob Gp. Differences of all studied individuals (father, mother, and subjects) were statistically significant at P < 0.001 showing a positive correlation between the physical activity and the BMI of the individual. The differences between the subjects of the two groups for the parameter of screen time was statistically significant at P < 0.001, thereby showing an association between time spent on screen time and the BMI of the subject. Parents screen time was insignificant between two groups.
Table 4: Frequency distribution and significance of association for the amount of time spent on physical activity and screen time with the subjects and their parents

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The comparative level of parental neglect for feeding style and social activity is illustrated in [Table 5]. Between two groups, the parents of subjects in Ov/Ob Gp in three domains of feeding style (responsibility perception, feeding control, feeding environment) were found negligent while only one domain (feeding culture) was diligent. Except feeding culture, the differences between the two groups in all domains were statistically significant at P < 0.001. When all the domains were summed to provide a total score for the feeding style the parents of subjects in N Gp (m = 20.52) scaled level of diligence, while the feeding style of parents in Ov/Ob Gp (m = 15.12) represented negligent on the parental neglect scale. The social activity score for parents of N Gp and for parents of Ov/Ob Gp on the neglect scale represented neutral and very negligent respectively. Differences in overall scores for feeding style and social activity were significant statistically at P < 0.001.
Table 5: Relative comparison of parent negligence in terms of feeding style and social activity on a parent negligence scale in the studied groups

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   Discussion Top

This study employed a comparative analytical approach that provided insight into two types of commonly recognized risk factors associated with obesity. The highlights of the present study are the differences in parenting practices between two groups. Jazan province has much of its cultural influence associated with dependence on agriculture and consumption of high fiber diet, both being unfavorable to the development of obesity. This study demonstrates a prevalence of 20% adult obesity among the Jazan population, while early study has reported 12% of childhood obesity,[19] although the studied age is different. Our results are in agreement with the fact that obesity is more prevalent in families with low-education level and low socioeconomic status.[20] Parents with low literacy also possess poor health literacy, therefore their ability to understand the nutrition value of food is undermined. These two parameters in the context of this study are significant because they are consistent predictors of adult obesity and are also associated with parental negligence.[21] Early discontinuation of breastfeeding with early introduction of supplemental food (96.7% <5 months) was observed more in the nurturing habits of the parents in Ov/Ob Gp. Differences in both parameters were significant between two groups, suggesting their possible association with the BMI of the offspring. Decline of breastfeeding in the Arab region has been reported to be far below than the most conservative WHO recommendations as studied by El Mouzan,[22] who noted that 51.4% (n = 4260) of infants were given bottle feeding by 1 month of age and 90% (n = 4787) by 6 months of age. Energy dense formula food when introduced early in infancy hampers child's self-regulation over energy intake in later life. In a study on adolescents who were breastfed for 9 months or longer were found to have reduced the odds (odds ratio (OR)=0.54; 95% confidence interval (CI)=0.35–0.83) of experiencing negligence by parents as compared with those who were breastfed for <9 months.[23] Parenting factors like consanguineous marriage and parent's respective age at the time of the birth of the subject have never been investigated in relation to development of adulthood obesity. Saudi Arabia practices marriage at an early age and according to earlier studies, 65% of marriages in general have been found to be consanguineous in nature.[24] We observed more of such marriages (88.9%) in the Ov/Ob GP with significant differences between the two groups. This study also supports the view that maternal smoking during pregnancy increases the risk of the child to develop obesity.[25] Parent's smoking in general, irrespective of smoking during or after pregnancy, and parental substance abuse (drugs, alcohol) results to care negligence by parents as parental dependence on such things affects care of the growing child.[26]

Parental neglect and its relation to feeding and social activity:Parenting has been classified as one of the four specific styles; authoritative, authoritarian, indulgent, neglectful.[27] Negligence on the part of parents was investigated for feeding style and social activity. Feeding style was studied under six domains and in principal the questionnaire investigated various aspects of each domain that influence eating habits and behaviour like, parental responsibility perception, feeding control, culture, environment, monitoring, and restrictions.[17],[28],[29] Except feeding culture, all other domains of parental feeding style differed significantly between two groups. Parents of normal weight showed less negligence than parents of overweight subjects across all domains except feeding culture. Our findings on feeding control by parents are in agreement with earlier studies who found that parents of overweight children had less feeding control.[30],[31] When the combined scores for feeding style on a parent negligence scale were done, the parents of the N Gp (20.51) were termed as diligent as compared to parents of the Ov/Ob Gp (15.12) which was considered as negligent according to the scale. The first domain in the feeding style investigates their perception of obesity since studies have found that parental denial of recognizing their child being obese increases the child's risk to develop adulthood obesity[32] which falls in the realm of care negligence.[9] Parental monitoring of feeding involves many aspects of dietary intake and developing of eating healthy foods. Parents have the responsibility of monitoring the types of fruits consumed by his child, and alternatively provide other vitamin rich supplements if he shows reluctance. Failure to do so by the parents qualifies to be medical negligence.[33] Parents of subjects in the Ov/Ob Gp were found to be negligent in providing a proper feeding environment while scoring less for restrictions on feeding of their child as compared to the parents in the normal weight group. Both domains are considered as parental negligence in supervision (supervisory neglect) where a parent or a caregiver does not provide adequate and/or proper food to the child.[34] As eating is a learned behavior, the role of parents in developing eating habits are achieved through proper supervision and care. Same habits continue to be practiced by the child in his adulthood and therefore are considered significant in the prevention of adulthood obesity. Parental negligence (both supervisory and care) that is associated with the feeding style generated from various individual domains in this study includes monitoring of breakfast eating by their children, daily interactions during meals, providing home cooked food and variety in home cooking. Parental negligence in such issues leads to their children eating outside which indirectly results in less intake of fiber rich food. Breakfast skipping by both parents has been associated with breakfast skipping by children and has been associated with an increase of 18-116% to child becoming overweight.[35] Eating a single fast food meal per week outside tends to increase BMI by 0.8 kg/m2.[36] Parents also are responsible for developing self regulation eating ability in their children. Across various feeding cultures, parents tend to practice providing food for their children based on environmental cues (like dinner time) rather than their children feeling hungry. Such parenting practices have been found to be associated with children's self regulation ability of the food.[37] Parental feeding styles in relation to obesity have been found to be of four different types; emotional feeding, instrumental feeding, encouragement feeding, and controlled feeding. All four types have been found to make the child a poor regulator of his own energy intake and therefore should be avoided.[38]

Increasing the competitive nature in their children is the responsibility of every parent. Social interactions are bound to motivate people of all ages. This study investigated two forms of activity, social and physical of parents as well as the subjects (when he was a child and existing physical activity). On the scale of social activity, the parents of normal weight group scored a mean of 3.18 (neutral) while the parents of overweight group scored a mean of 1.62 (very negligent) in our study. For physical activity, both parents (Father 53%, Mother 53% inactive) and the subject (80% inactive) in the Ov/Ob Gp differed significantly from parents and subjects of the N Gp. The prevalence of physical inactivity level has been studied in Saudi Arabia and according to a review of 8 studies by Al Hazzaa,[39] the rate of inactivity ranged from 43.3% to 99.5%. Body fat and physical activity are inversely related. The absence of outdoor activity (≤2 h on non-school days) increases the risk of obesity.[40] The relation between parental negligence and social activity can be established by certain known facts. Parents are a role model for their children irrespective of gender. A mother who is a poor role model significantly increases obesity risk for her children.[11] Parents must know that familial influence has a significant impact on exercise participation of their children. Genetic studies have shown that maximum heritability that has been found is that for the degree of inactivity (51-56%).[41] A study by Fasting et al.,[42] suggests that parental weight gain during their offspring's childhood constitutes an important risk factor for offspring becoming overweight later in life. Parents' behaviour related to food preference or physical activity might provide social cues for their children's behaviour. When children become adults, they bring parental attitudes with them as studies have shown these traits to persist beyond childhood and adolescent years,[43],[44] which explains the association between parents and the adult offspring's in our study.

There has been a decline in physical activities across all ages. There are various components of a sedentary lifestyle which are interlinked to each other. Screen time that includes the time spent on various types of screens (television, mobile, computer, laptop) is one such component of sedentary lifestyle that displaces the time spent on physical activity. Although, we did not find any association for screen time between the parents, studies on parenting practices, have shown evidence that parental self-efficacy and parents own TV time are associated with children's screen time.[45] As far as screen time of the subjects in both groups is concerned, the results show that about 72% of the subjects in the Ov/Ob Gp were spending more than 60 hours per week (average of 8 h/day) as compared to only 13% in the N Gp. Parents are supposed to intervene when their children get involved in unhealthy activities. Evidence of parental negligence is reflected by the way they provide a living environment for their children. Parents are responsible to limit TV and video viewing by their children, besides also keeping televisions out of their bedrooms. A study by Gentile et al., reported that children used to skip family meals while they were watching TV in their personal rooms.[46] This also justifies the relation of investigating feeding and physical activity since they are interdependent. For every additional hour of television watching per day, the prevalence of obesity has been reported to increase by 2%.[47] The mechanism by which increased screen time imparts obesity involves displacing free time physical activity, consuming more calories (higher fat diets), and displace or disturb sleep patterns.[48] Whether parental long working hours amount to parental negligence or not is a matter of future studies, but studies on long working hours of mothers has been found to have significant association for children becoming overweight. Father's working hours (55 h per week or more) has been also shown to strengthen the effect of mothers.[49] Parental absence from home directly affects their ability to supervise and take care of their children.

In the context of the above results, sedentary behavior associations in the kingdom of Saudi arabia include the presence of housemaid (58.8% with severely obese),[50] insufficient knowledge and education available for healthy lifestyle maintenance, nominal requirement of school exercise sessions per week by the ministry of education (1 per week for boys and none for girls),[51] limited access to physical activity, especially for Saudi women and conservative sociocultural and religious norms.[1] The results are also evident from the national survey data which reported that physical inactivity in Saudi women increased from 84.7% in 1996 to 98.1% in 2011 while in men there has been an increase from 43.3% to 93.9% during the same period.[52]

Mechanism of parental negligence in developing obesity: Individuals who suffer from parental negligence tend to develop altered psychological states that affects energy balance through change in behavior and hormonal balance. The pathway that links psychological states and obesity is the hypothalamus pituitary adrenocortical system which responds to stressful situations by alteration of cortisol hormone.[53] Increased cortisol blood levels promote lipid accumulating enzymes in the visceral fat of the body. Parental negligence induces stress, which in turn induces overeating or stress induced eating that is naturally and physiologically abnormal.[54] Changes in metabolic system and regulation of energy by the brain are also induced by stress hormones.

Strength and limitations of the study: Parental negligence is a complex issue besides being a highly sensitive issue in a country where governance is conservative and follows religious principles. This study is perhaps the first study done in the region which made it necessary to take a qualitative approach where the emphasis was more on identifying, complementing and providing an explanation for such behavior. The main feature of the study is also the development of a scale as a research tool to measure parental negligence in feeding style and social activity. Although the data collection were cost efficient, the study is limited by its non ability of findings to be generalized to the study population or a particular community. Another limitation of the study is that the subject's parents were asked to recall the information regarding nurturing and parenting that was performed earlier in life. Owing to the limitations of time and finance, the study was conducted on a small sample of the population which adds to its limitations.

   Conclusion Top

This comparative study was done on a cross sectional sample (scores obtained at a single point of time) of the saudi population to evaluate the differences in feeding style and social activity (including physical activity) between normal weight and overweight/obese subjects (including respective parents). The study also identified various levels of parental negligence in feeding style and social activity on a customized parent negligence scale. Since the study was performed on a population whose culture is even quite different from other parts of the kingdom of Saudi Arabia, therefore inferences to the entire population cannot be derived. The study revealed significant differences between the two groups in nurturing (breastfeeding, formula food introduction, maternal smoking during pregnancy, parenting (early maternal age, consanguineous marriage, perception), physical activity (father, mother and subject), and screen time (subject). The study also reveals that parents of overweight/obese subjects were found to be very negligent on the social activity scale, negligent for individual domains (responsibility perception, feeding control) of feeding style and overall feeding style. Except feeding culture the differences in the levels of negligence between parents of both groups were significantly different. Further studies to investigate the relative association between parental negligence and child feeding/physical activity among Saudi population can throw a light on the overall effect of these two variables in the development of obesity.

Financial support and sponsorship

This study was financially supported by the 7th research program of Deanship of Scientific Research, College of Dentistry, Jazan University.

Conflicts of interest

There are no conflicts of interest.

   References Top

Abdul Rahim HF, Sibal A, Khader Y, Hwalla N, Fadhil L, Alsiyabi H, et al. Health in the Arab world: Aview from within 2 non-communicable diseases in the Arab world. Lancet 2014;383:356-67.  Back to cited text no. 1
Alhaqwi A, Alnasir M, Ahmed N, Masaudi E, Alotaibi S, Hamad B. Obesity and overweight in a major family practice center, central region, Saudi Arabia. Saudi J Obes 2015;3:12-5.  Back to cited text no. 2
Noll JG, Zeller MH, Trickett PK, Putnam FW. Obesity risk for female victims of childhood sexual abuse: A prospective study. Pediatrics 2007;120:e61-7.  Back to cited text no. 3
Johnson WF, Huelsnitz CO, Carlson EA, Roisman GI, Englund MM, Miller GE,et al. Childhood abuse and neglect and physical health at midlife: Prospective, longitudinal evidence. DevPsychopathol 2017;29:1935-46.  Back to cited text no. 4
Sharley V, Ananias J, Rees A, Leonard E. Child neglect in Namibia: Emerging themes and future directions. Br J Soc Work 2019;49:983-1002.  Back to cited text no. 5
Ramirez JC, Milan S. Childhood sexual abuse moderates the relationship between obesity and mental health in low-income women. Child Maltreat 2016;21:85-9.  Back to cited text no. 6
Levine JA, McCrady-Spitzer SK, Bighorse W. Obesity and sexual abuse in American Indians and Alaska natives. J Obes Weight Loss Ther 2016;6:e119.  Back to cited text no. 7
Afifi TO, Sareen J, Fortier J, Taillieu T, Turner S, Cheung K,et al. Child maltreatment and eating disorders among men and women in adulthood: Results from a nationally representative United States sample. Int J Eat Disord 2017;50:1281-96.  Back to cited text no. 8
Knutson JF, Taber SM, Murray AJ, Valles N, Koeppl G. The role of care neglect and supervisory neglect in childhood obesity in a disadvantaged sample. J Pediatric Psychol 2010;35:523-32.  Back to cited text no. 9
French SA, Harnack L, Jeffery RW. Fast food restaurant use among young women in the Pound of Prevention study: Dietary, behavioral, and demographic correlates. Int J Obes Relat Metab Disord 2000;24:1353-9.  Back to cited text no. 10
Martin-Biggers J, Quick V, Byrd-Bredbenner C. Development of an obesity risk score for mothers of young children. FASEBJ 2017;31:960.3-960.3.  Back to cited text no. 11
Lin X, Eaton CB, Manson JE, Simin L. The genetics of physical activity. Curr Cardiol Rep 2017;19:119.  Back to cited text no. 12
Health Ministry. The National Family Safety Registry Report, 2011.  Back to cited text no. 13
Al-Eissa MA, Saleheen HN, AlMadani S, AlBuhairan FS, Weber A, Fluke JD, et al. Determining prevalence of maltreatment among children in the Kingdom of Saudi Arabia. Child Care Health Dev 2016;42:565-71.  Back to cited text no. 14
Alsanosy RM, Mahfouz MS, Gaffar AM. Khat chewing habit among school students of Jazan Region, Saudi Arabia. PLoS One 2013;8:e65504  Back to cited text no. 15
Elwyn L, Smith C. Child maltreatment and adult substance abuse: The role of memory. J Soc Work Pract Addict 2013;13:269-94.  Back to cited text no. 16
Mattoo KA, Moaleem M, Shubayr M. Assessing the validity and reliability of a questionnaire to identify existence of parental neglect in terms of developingfeeding styleand social activity in obese adult Saudi population. J Med Sci and Clin Res 2018;6:377-83.  Back to cited text no. 17
Norman G. Likert scales, levels of measurement and the “laws” of statistics. Adv Health Sci Educ Theory Pract 2010;15:625-32.  Back to cited text no. 18
El-Hazmi MAF, Warsy AS. A comparative study of prevalence of overweight and obesity in children in different provinces of Saudi Arabia. J Trop Pediatr 2002;48:172-7.  Back to cited text no. 19
Gunstad J, Paul RH, Spitznagel MB, Cohen RA, Williams LM, Kohn M, et al. Exposure to early life trauma is associated with adult obesity. Psychiatry Res 2006;142:31-7.  Back to cited text no. 20
Rogosch FA, Dackis MN, Cicchetti D. Child maltreatment and allostatic load: Consequences for physical and mental health in children from low-income families. Dev Psychopathol 2011;23:1107-24.  Back to cited text no. 21
El Mouzan MI, Al Omar AA, Al Salloum AA, Al Herbish AS, Qurachi MM. Trends in infant nutrition in Saudi Arabia: Compliance with WHO recommendations. Ann Saudi Med 2009;29:20-3.  Back to cited text no. 22
Kremer KP, Kremer TR. Breastfeeding is associated with decreased childhood maltreatment. Breastfeed Med2017;13:18-22.  Back to cited text no. 23
Sebai ZA. Health in Saudi Arabia. Vol1, 2nd ed. Riyadh: Tihama Publication; 1985.  Back to cited text no. 24
Vik T, Jacobsen G, Vatten L, Bakketeig LS. Pre- and post-natal growth in children of women who smoked in pregnancy. Early Hum Dev 1996;45:245-55.  Back to cited text no. 25
Wolitzky-Taylor K, Sewart A, Vrshek-Schallhorn S, Zinbarg R, Mineka S, Hammen C, et al. The effects of childhood and adolescent adversity on substance use disorders and poor health in early adulthood. J Youth Adolesc 2017;46:15-27.  Back to cited text no. 26
Maccoby EE, Martin JA. Socialization in the context of the family: Parent-child interaction. In: Mussen PH, Hetherington, editors. Handbook of Child Psychology: V.4, Socialization, Personality and Social Development. New York: Wiley 1983. p. 53-6.  Back to cited text no. 27
Hanson NI, Neumark-Sztainer D, Eisenberg ME, Story M, Wall M. Associations between parental report of the home food environment and adolescent intakes of fruits, vegetables and dairy foods. Public Health Nutr 2005;8:77-85.  Back to cited text no. 28
Neumark-Sztainer D, Story M, Perry C, Casey MA. Factors influencing food choices of adolescents: Findings from focus-group discussions with adolescents. J Am Diet Assoc 1999;99:929-37.  Back to cited text no. 29
Wardle J, Saskia S, Carol AG, Lorna R, Robert P. Parental feeding style and the inter-generational transmission of obesity risk. Obes Res 2002;10:453-62.  Back to cited text no. 30
Faith MS, Berkowitz RI, Stallings VA, Kerns J, Storey M, Stunkard AJ. Parental feeding attitudes and styles and child body mass index: Prospective analysis of gene-environment interaction Pediatrics 2004;114:e429-36.  Back to cited text no. 31
Mason SM, Bryn Austin S, Bakalar JL, Boynton-Jarrett R, Field AE, Gooding HC, et al. Child maltreatment's heavy toll: The need for trauma-informed obesity prevention. Am J Prev Med2016;50:646-9.  Back to cited text no. 32
Gray J, Cadieux A, Sweeney B, Beck AR, Edgar S, Eneli I, et al. Medical neglect and pediatric obesity: Insights from tertiary care obesity treatment programs. Childrens Health Care 2017;46:246-64.  Back to cited text no. 33
Yang M, Maguire JK. Predictors of basic needs and supervisory neglect: Evidence from the Illinois families study. Child. Youth Serv. Rev 2016;67:20-6.  Back to cited text no. 34
Okada C, Tabuchi T, Iso H. Association between skipping breakfast in parents and children and childhood overweight/obesity among children: Anationwide 10.5-year prospective study in Japan. Int J Obes 2018;42:1724-32.  Back to cited text no. 35
Smethers AD, Roe LS, Sanchez CE, Zuraikat FM, Keller KL, Rolls BJ. Both increases and decreases in energy density lead to sustained changes in preschool children's energy intake over 5-¯days. Physiol Behav2019;204:210-8.  Back to cited text no. 36
Potter C, Ferriday D, Griggs RL, Hamilton-Shield JP, Rogers PJ, Brunstrom JM. Parental beliefs about portion size, not children's own beliefs, predict child BMI. Pediatr Obes2018;13:232-8.  Back to cited text no. 37
Steinsbekk S, Barker ED, Llewellyn C, Fildes A, Wichstrøm L. Emotional feeding and emotional eating: Reciprocal processes and the influence of negative affectivity. Child Dev 2018;89:1234-46.  Back to cited text no. 38
Al Hazzaa HM. Prevalence of physical inactivity in Saudi Arabia: Abrief review. East Mediterr Health J 2004;10:663-70.  Back to cited text no. 39
Zhang J, Zhang Y, Jiang Y, Sun W, Zhu Q, Ip P, et al. Effect of sleep duration, diet, and physical activity on obesity and overweight elementary school students in Shanghai. J Sch Health 2018;88:112-21.  Back to cited text no. 40
Zhang X, Speakman JR. Genetic factors associated with human physical activity: Are your genes too tight to prevent you exercising?. Endocrinology 2019;160:840-52.  Back to cited text no. 41
Fasting MH, Nilsen TI, Holmen TL, Vik T. Changes in parental weight and smoking habits and offspring adiposity: Data from the HUNT-study. Int J Pediatr Obes 2011;6:e399-407.  Back to cited text no. 42
Simonen RL, Perusse L, Rankinen T, Rice T, Rao DC, Bouchard C. Familial aggregation of physical activity levels in the Quebec Family Study. Med Sci Sports Exerc 2002;34:1137-42.  Back to cited text no. 43
Rossow I, Rise J. Concordance of parental and adolescent health behaviors. Soc SciMed 1994;38:1299-305.  Back to cited text no. 44
Bleakley A, Jordan AB, Hennessy M. The relationship between parents' and children's television viewing. Pediatrics 2013;132:e364-71.  Back to cited text no. 45
Gentile DA, Berch ON, Choo H, Khoo A, Walsh DA. Bedroom media: One risk factor for development. Dev Psychol2017;53:2340-55.  Back to cited text no. 46
Anderson PM, Butcher KE. Childhood obesity: Trends and potential causes. Future Child 2006;16:19-45.  Back to cited text no. 47
Taheri S. The link between short sleep duration and obesity: We should recommend more sleep to prevent obesity. Arch Dis Child 2006;91:881-4.  Back to cited text no. 48
Li J, Kaiser T, Pollmann-Schult M, Strazdins L. Long work hours of mothers and fathers are linked to increased risk for overweight and obesity among preschool children: Longitudinal evidence from Germany. J Epidemiol Community Health2019;73:723-9.  Back to cited text no. 49
Rasheed P. Perception of body weight and self-reported eating and exercise behaviour among obese and non-obese women in Saudi Arabia. Public health 1998;112:409-14.  Back to cited text no. 50
Mahfouz AA, Shatoor AS, Khan MY, Daffalla AA, Mostafa OA, Hassanein MA,et al. Nutrition, physical activity, and gender risks for adolescent obesity in south western Saudi Arabia. Saudi J Gastroenterol 2011;17:318-22.  Back to cited text no. 51
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AlQuaiz AM, Kazi A, Tayel S, Shaikh SA, Al-Sharif A, Othman S, et al. Prevalence and factors associated with low bone mineral density in Saudi women; Acommunity based survey. BMC Musculoskeltal Disord 2014;15:5.  Back to cited text no. 52
Hewagalamulage S, Lee TK, Clarke IJ, Henry BA. Stress, cortisol, and obesity: Arole for cortisol responsiveness in identifying individuals prone to obesity. Domest Anim Endocrinol 2016;56:S112-20.  Back to cited text no. 53
Ebrahimi F, Urwyler SA, Schuetz P, Mueller B, Bernasconi L, Neyer P,et al. Effects of interleukin-1 antagonism on cortisol levels in individuals with obesity: Arandomized clinical trial. Endocr Connect 2019;8:701-8.  Back to cited text no. 54


  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]


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