Alberti, la fortificación como un sistema construido

The participants described their individual personal sedentary activities and how they believed this contributed to their overall health, fitness and obesity levels. Overall, this comprehension and perception was shown through two specific subcategories: time spent watching television and time spent gaming. Hence, it has been stipulated quite conclusively that these two individual activities alongside other personal lifestyle factors are what contribute most to low levels of fitness and increased obesity. In the words of one of the participants (PR5):

“Yes, I like watching television. I like watching comedies, horrors and actions. I feel comfortable when I’m in front of the T.V. ….in addition I enjoy playing video games a lot, I spend quite a lot of time playing than spending time outdoors doing any physical activity under the hot weather".

The view posited above shows the impact time spent viewing television and or playing video games had on the participant’s energy intake and energy expenditure. However, not all participants felt that exercise was a strategy to curb weight gain, as PR2 stated:

“I am between the two views. I think that sometimes doing a lot of exercise can help you lose some weight but maybe also sometimes this will not help you as well, and you can still get fat.”

This view does present the need for a review of the existing interventions directed at changes in sedentary behaviour and food choices especially as the consumption of snacks between meals was found to be high among the participants during sedentary activities because it is readily available at any time.

Knowledge of the Relationship between Time Spent Watching TV and Diet for Managing Weight/Obesity

The amount of time spent watching television for children and adolescents is not exclusive to any specific country, as it has become increasingly popular throughout the world (Dietz and Gortmaker, 2001). However, the current study focuses purely on school children attending the same primary school in Madinah, Saudi Arabia, and the findings from the qualitative data have distinguished that a substantially large percentage of time is spent engrossed in sedentary activities among the participants in comparison to undertaking physical activities. This could lead to an increase in overweight children and a decrease in fitness levels. Thus, the percentage of overweight children will ultimately increase and fitness levels will decrease. One participant stated, “I spent roughly between 2-4 hours watching TV, but it can be different depending on the days”.

154 Similarly, another participant (PR2) mentioned:

“I watch television sometimes for more than two hours every day. Sometimes it may be different but I think this is average”;

and one more participant (PR11) stated: “Probably, um, nearly 3 hours every day I think.”.

In accordance with this theme, a different student (PR14) added that:

“I like watching different programmes like comedy and action mostly. Each programme is half an hour and I watch about 8 to 10 different programmesper day”.

Consequently, it is evident that more time is spent watching television than in participating in physical activities. To expand on this the participant (PR14) affirmed that:

“I do not do any form of activities either in school but sometimes I play games outside which involve running and playing at home. I would say about an hour or just under.”

This again is an indicator the participants do not engage much in physical activity and these patterns reflect individual values and beliefs and involve what, how much, and when an individual chooses to eat and spend time on exercise. This supports Farghaly and colleagues’ (2007) findings that health education and physical education programmes are recommended to promote healthy life styles and dietary habits among school children.

However, this range of more than 2 hours (Farghaly et al., 2007) was not shown throughout the respondents, as one stated, “sometimes a little longer than an hour if something I like is on TV” in addition they hold a positive view around diet:

“I think diets work. This can be done by making a record of what you have eaten throughout the week and sticking to a daily plan.”

While this may sound positive, the ability for the interviewee to keep a record of their diet is considered unrealistic. Therefore, there are children within the study group who do not necessarily just watch television every time, although many who do not state that they would do more gaming than watching TV.

Perception of the Relationship of Time Spent Playing Video Games and Obesity Reduction Video gaming has increased in popularity throughout the world in modern times (Sherry et al., 2006) and this is also true with respect to Saudi Arabia. Students aged between 9 and 16 are commonly found to spend their free time playing video games, as the qualitative data findings signify. As affirmed by one of the interviewees (PR5): “I enjoy playing video games a lot, and I think that I spend a lot of time playing games.” While another participant (PR3) gave an insight into the time spent playing games: “I play them all the time, I play them on my phone” and another respondent stated that, “maybe roughly around three hours every

155

day”. However, another student (PR5) noted that they can spend an excessive amount of time

on gaming each day, “just over 5 hours” and “about 5 hours or so because time goes by quick

when I’m playing a game; I get too involved in the game”. Moreover, a different example by

PR7 was: “so I would say in total about three hours; on weekends I play on my iPad a lot more.”

Based on the participants’ responses it is clear that excess time is now spent on electronic devices and video games which is associated with a range of adverse outcomes (Tobin and Grondin 2009, Thorne et al., 2014). Hence the capacity for video gaming to increase total screen-time and promote high levels of inactivity is evident. It is worth considering that, whether video games have a positive or negative impact (or both) on gamers, the fact remains that based on the interview responses, it can be assumed that this scenario is a reflection of what is happening on a wider scale; the amount of time spent on gaming is high and it leads some to become dependent thereby increasing their sedentary time.

Nevertheless, additional education into the detrimental effects of unrestricted sedentary activities has been shown to be a possibility for developing upon current awareness and knowledge, as most students acknowledged the requirement to reduce their gaming hours. For instance: “too much; I spend the whole day [gaming]”, was one statement, while another answer was said in jest to define the excessive amount of gaming: “I would say that I’m

usually playing video games about 24 hours a day!”

As a result, it can be deduced that although the respondents are focusing more on sedentary activities than physical ones, they remain aware of obesity prevention techniques.

Accordingly, youngsters within Saudi Arabia struggle to refrain from excessive sedentary lifestyles, as the extreme hot weather can keep people indoors, while modern lifestyles are usually focused around visual entertainment, such as television, movies and video gaming (Al Hazzaa, 2004). Moreover, Saudi Arabian families often hire house maids or nannies to look after the children of the house, which means it is not the parents who commonly shape the youngster’s attitudes towards exercise (Al Hazzaa, 2004). Therefore, for a true measure of implementation, it would be imperative to develop the Ministry of Education (MOE) for future development in schools, and the understanding of the house maids and workers who frequently interact with the children in their domestic life.

156

As has been determined through the previous subheadings, many students who participated in the qualitative interviews presented inadequate dietary habits, insufficient physical activity within their daily lives, and too much sedentary time, which resulted in obesity and a lack of fitness and health.

However, it needs to be duly noted and analysed that the participants possessed the knowledge and awareness in obesity prevention. Just as the PR15 stated that:

“I think if one eats less of the right food type that will help in weight loss, or if you follow a

specific healthy diet recommended by the doctor it may also help with weight management.”

Thus, it would be feasible to initiate further prevention and intervention techniques among the target population. This particular theme of awareness is further presented using three individual sub-themes: perception of diets to reduce weight; belief in exercise to help lose weight; and suggested solutions for losing weight.

4.10.2.3.1. Perceptions of Diets to Reduce Weight

Overall, defined and restrictive diets were also understood to be helpful in improving a person’s weight. This sentiment can be seen from a variety of statements that were presented that constitute this common theme through the answers. For instance, “Yes; I think all diets work for different people”, was one particular answer. Likewise, another participant stated:

“eat less and you would lose weight, or if you create some sort of plan or record of what you eat every day”.

“I think it is possible to make a diet work if you follow it regularly”, was a different answer

that adhered to the common theme, and “because diets take time and you have to stop eating

fast food and drinking soft drinks because they have a lot of sugar”, was also noted from a

separate student. Despite the positive views held, there are others that are unsure of the benefits of eating a healthy diet, as confirmed in the submission made by PR16:

“I don’t know. It depends on the type of diet. Mostly when on a diet you would cut down on a

lot of the food you eat and what you eat but sometimes that doesn’t work”.

The vast majority of students within the interview understood that personal diet plays a vital part in the balance of a person’s weight and fitness. Therefore, overall, diet was perceived to be most beneficial in reducing weight.

All the participants interviewed stated that they believed and understood that exercise was greatly beneficial in the process of helping a person lose weight and maintain a sufficient level of fitness. Just as one of the respondents (PR3) said:

157

“I think doing exercises twice per week or more would help one lose weight. I don’t mean

taking part in short distance running or exercise but I mean spending long time exercising like an hour or so”.

This was one specific response that showed the common knowledge of beneficial exercise. Additionally, another respondent stated that: “by doing exercise on a weekly basis, such as going to the gym, sports and running and doing activities [it would be possible to lose weight]”. It was even mentioned in terms that would highlight that most students would perceive exercise to always be beneficial: “if you do it a lot I am sure it will stop you getting fat. I think everyone knows that”. This was the same with regard to the answer: “I think it would help as you would stay active” .

This showed that, taking part in daily physical exercise was significantly low among participants and they recognised that involvement in a moderate physical activity regularly has health benefits. As judged by the girls in the present study, physical exercise should be encouraged among the girls in schools and there is a need for a physical education programme to be adopted as early as possible so as to build up this healthy habit.

In addition, the participants were knowledgeable of the fact that a balance is required for any individual between healthy physical activity and healthy eating, as one would not work without the other (Haskell et al., 2007):

“I think that if the person eats unhealthy foods and is also doing exercises, it will not work; but if the person is eating healthy foods along with exercising, then it will work.”

Likewise, another student stated, “exercise can help you lose some weight but maybe also sometimes this will not help you as well, and you can still get fat”. As a consequence, it was

possible to denote a variety of potential solutions for weight loss from this general understanding.

It was clearly evident that a great percentage of the students did not adhere to their own recommendations of healthy dietary habits or quality physical activity. However, it was possible to draw from the information provided that the participants had awareness of potential solutions for weight loss and methods to decrease obesity. One statement made (PR1) suggested that: “organise meal times, and then secondly by doing exercises regularly”,

whilst another stated a healthy solution is “where the person eats fruit, vegetables and nuts”.

Additionally, “reducing the amount of food you are eating” was also emphasised as an

effective way to assist in weight loss. Accordingly, another respondent (PR6) said that it would be beneficial to “make a list of what you are going to eat during the week and keep a record of what you eat.”

158

In accordance with what an individual should do to improve his/her health and decrease the chances of obesity, there were also restrictive measures to which a person would need to adhere. Hence, one student stated that “eating fewer takeaways” was a way to reduce weight,

whilst another individual noted, “stop drinking soft drinks, because they have a lot of sugar”.

In the same manner, a different participant (PR16) mentioned: “It’s necessary to cut down on

takeaway foods and sweets and things that aren’t good for you.”