Barriers to Lifestyle Modification and Willingness to Join Weight Loss Programs Among Overweight or Obese Adults in Saudi Family Medicine Clinics
Arwa M Alshaikh, Alshaymaa A Alshaikh, Hind S Alatawi, Jood A Alshaikh, Osama M Alshaikh, Mohd H Yusuf
TL;DR
This study explores why overweight or obese adults in Saudi Arabia struggle with lifestyle changes and what makes them willing to join weight loss programs.
Contribution
The study identifies specific barriers and factors influencing willingness to join weight loss programs in Saudi primary care settings.
Findings
Most participants attempted weight loss but faced barriers like lack of motivation and cost of healthy food.
Higher education and physician counseling were linked to greater willingness to join structured weight loss programs.
Tailored interventions are needed to address barriers and improve obesity management in primary care.
Abstract
Background Obesity is a growing public health concern in Saudi Arabia, with increasing prevalence and related comorbidities. Lifestyle modification is key to treatment, yet patient-level barriers and readiness to engage in structured weight management programs remain underexplored in primary care. Objective The aim of this study was to examine perceived barriers to lifestyle change, past weight loss attempts, and factors associated with willingness to join structured weight loss programs among overweight or obese adults attending family medicine clinics in Saudi Arabia. Methods A cross-sectional study was conducted from March to May 2025 at four urban family medicine clinics. Adults aged ≥18 years with a BMI of ≥25 kg/m² were consecutively recruited. Participants completed a questionnaire on demographics, weight loss attempts, barriers, information sources, and willingness to…
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| Characteristic | No. of patients (%) | |
| Age group (years) | 18–29 | 41 (13.1%) |
| 30–39 | 78 (25.0%) | |
| 40–49 | 89 (28.5%) | |
| 50–59 | 61 (19.6%) | |
| ≥60 | 43 (13.8%) | |
| Sex | Male | 113 (36.2%) |
| Female | 199 (63.8%) | |
| Marital status | Single | 58 (18.6%) |
| Married | 223 (71.5%) | |
| Divorced | 17 (5.4%) | |
| Widowed | 14 (4.5%) | |
| Education level | No formal education | 16 (5.1%) |
| Primary school | 31 (9.9%) | |
| High school | 84 (26.9%) | |
| University degree | 138 (44.2%) | |
| Postgraduate degree | 43 (13.8%) | |
| Employment status | Employed | 147 (47.1%) |
| Unemployed | 76 (24.4%) | |
| Retired | 28 (9.0%) | |
| Student | 12 (3.8%) | |
| Homemaker | 49 (15.7%) | |
| Chronic diseases† | None | 79 (25.3%) |
| Diabetes mellitus | 142 (45.5%) | |
| Hypertension | 129 (41.3%) | |
| Dyslipidemia | 103 (33.0%) | |
| Hypothyroidism | 37 (11.9%) | |
| Other | 19 (6.1%) | |
| Variable | No. of patients (%) | |
| Duration since obesity diagnosis | <1 year | 47 (15.1%) |
| 1–2 years | 66 (21.2%) | |
| 3–5 years | 102 (32.7%) | |
| >5 years | 97 (31.1%) | |
| Tried to lose weight in the past year | Yes | 213 (68.3%) |
| No | 99 (31.7%) | |
| Methods tried for weight loss† | Diet changes | 173 (55.4%) |
| Exercise | 124 (39.7%) | |
| Weight loss medications | 62 (19.9%) | |
| Herbal/traditional remedies | 47 (15.1%) | |
| Bariatric surgery | 21 (6.7%) | |
| None | 79 (25.3%) | |
| Main source of weight loss information | Physician | 102 (32.7%) |
| Social media | 84 (26.9%) | |
| Family/friends | 56 (17.9%) | |
| TV or radio | 29 (9.3%) | |
| Online articles | 33 (10.6%) | |
| I do not seek information | 8 (2.6%) | |
| Barrier | Strongly agree | Agree | Neutral | Disagree | Strongly disagree |
| Lack of time to exercise | 117 (37.5%) | 96 (30.8%) | 44 (14.1%) | 34 (10.9%) | 21 (6.7%) |
| Healthy food is too expensive | 104 (33.3%) | 101 (32.4%) | 52 (16.7%) | 38 (12.2%) | 17 (5.4%) |
| Embarrassed to exercise in public | 78 (25.0%) | 89 (28.5%) | 63 (20.2%) | 54 (17.3%) | 28 (9.0%) |
| No access to safe places to exercise | 61 (19.6%) | 77 (24.7%) | 81 (26.0%) | 57 (18.3%) | 36 (11.5%) |
| Lack of family support | 56 (17.9%) | 68 (21.8%) | 74 (23.7%) | 66 (21.2%) | 48 (15.4%) |
| Lack of motivation | 131 (42.0%) | 88 (28.2%) | 39 (12.5%) | 34 (10.9%) | 20 (6.4%) |
| Belief that weight loss is genetically impossible | 84 (26.9%) | 76 (24.4%) | 61 (19.6%) | 58 (18.6%) | 33 (10.6%) |
| Insufficient guidance from physician | 91 (29.2%) | 85 (27.2%) | 66 (21.2%) | 44 (14.1%) | 26 (8.3%) |
| Variable | No. of patients (%) | |
| Willing to join clinic-based structured weight loss program | Yes | 207 (66.3%) |
| No | 46 (14.7%) | |
| Not sure | 59 (18.9%) | |
| Most motivating factor for lifestyle change | Physician advice | 96 (30.8%) |
| Seeing results in others | 64 (20.5%) | |
| Social support | 52 (16.7%) | |
| Fear of health complications | 71 (22.8%) | |
| Religious or moral beliefs | 23 (7.4%) | |
| Other | 6 (1.9%) | |
| Variable | Attempted weight loss (n=213) | Did not attempt (n=99) | P-value | |
| Sex | Female | 147 (69.0%) | 52 (52.5%) | 0.004 |
| Male | 66 (31.0%) | 47 (47.5%) | ||
| Age ≥50 years | 68 (31.9%) | 36 (36.4%) | 0.43 | |
| University/postgraduate education | 139 (65.3%) | 42 (42.4%) | <0.001 | |
| Diabetes mellitus | 104 (48.8%) | 38 (38.4%) | 0.08 | |
| Agreed: lack of motivation | 108 (50.7%) | 111 (88.9%) | 0.84 | |
| Agreed: insufficient guidance from physician | 98 (46.0%) | 78 (78.8%) | 0.93 | |
| Variable | Adjusted OR (95% CI) | P-value |
| Female sex | 1.62 (1.01–2.60) | 0.045 |
| Age ≥ 50 years | 0.74 (0.42–1.29) | 0.28 |
| University/postgraduate education | 2.10 (1.28–3.46) | 0.003 |
| Agreed: “lack of time to exercise” | 1.39 (0.84–2.29) | 0.20 |
| Agreed: “healthy food is expensive” | 1.52 (0.91–2.55) | 0.11 |
| Physician was main info source | 2.44 (1.47–4.06) | <0.001 |
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Taxonomy
TopicsObesity and Health Practices · Obesity, Physical Activity, Diet · Health Promotion and Cardiovascular Prevention
Introduction
Obesity is a major public health challenge worldwide, with rising prevalence in both high- and middle-income countries. In Saudi Arabia, recent national surveys estimate that more than one-third of adults have obesity, a rate that has more than doubled over the past two decades [1-3]. This trend has been accompanied by a sharp increase in obesity-related comorbidities, including type 2 diabetes, hypertension, and cardiovascular disease. Despite widespread recognition of the problem, effective and sustainable weight management remains elusive for many patients [4,5].
Lifestyle modification - encompassing changes in diet, physical activity, and behavior - is the cornerstone of obesity treatment and prevention [6,7]. Clinical guidelines from leading health authorities recommend that primary care physicians provide regular counseling, support goal setting, and refer patients to structured weight management programs when appropriate. However, the implementation of these guidelines in real-world primary care settings has been inconsistent, with barriers reported at both the provider and patient levels [7-9].
Patients often encounter multiple obstacles that limit their ability to initiate and sustain lifestyle changes. These barriers may include a lack of motivation, low health literacy, limited time or financial resources, competing family responsibilities, and inadequate support from healthcare providers [10-13]. In the Middle East, cultural norms, gender roles, and the built environment may further influence patients' readiness and ability to adopt healthier lifestyles. Despite these challenges, there is a paucity of region-specific data describing the barriers faced by patients with obesity, particularly in primary care settings where most chronic disease management occurs [2,8].
Understanding these barriers is essential for designing effective, culturally tailored interventions that address the needs and constraints of patients. This study aimed to explore the perceived barriers to lifestyle modification among overweight or obese adults who attend family medicine clinics in Saudi Arabia and to identify factors associated with past weight loss attempts and willingness to participate in structured weight management programs.
Materials and methods
Study design and setting
We conducted a cross-sectional study using a structured questionnaire to assess barriers to lifestyle modification among overweight or obese adult patients attending family medicine clinics in Saudi Arabia. This cross-sectional study was conducted between March and May 2025 at the Ministry of Health primary health care clinics located in the Eastern Province of Saudi Arabia. The study was approved by the Research Ethics Committee (Reference No. REC-2024-18821) on December 10, 2024, and conducted according to the principles of the Declaration of Helsinki.
Participants
Eligible participants were adults aged 18 years or older with a BMI of ≥25 kg/m², based on recent clinical measurements or self-report. Patients were recruited consecutively in waiting areas and invited to complete the questionnaire voluntarily. Those who were pregnant, unable to complete the questionnaire due to cognitive or language barriers, or previously enrolled were excluded. All participants provided verbal informed consent before participation.
Questionnaire development
The questionnaire was developed based on a review of prior literature and expert input from family physicians, endocrinologists, and public health specialists. It consisted entirely of multiple-choice questions and included five sections: sociodemographic and clinical characteristics, past attempts at weight loss, perceived barriers to lifestyle change, sources of weight-related information, and willingness to participate in structured programs. A pilot version was tested on 20 patients to ensure clarity and relevance; minor revisions were made accordingly (Appendix A). Data from the pilot was not included in the final analysis.
Data collection
Trained research assistants administered paper-based questionnaires in waiting areas and assisted participants when needed. To ensure confidentiality, no personal identifiers were collected. Each questionnaire was checked for completeness before inclusion. Completed forms were entered into a secure database by two independent data entry personnel to minimize transcription errors.
Outcome measures
The primary outcome was the proportion of participants who reported having attempted to lose weight within the past 12 months. Secondary outcomes included perceived barriers to lifestyle change and willingness to join a structured weight loss program.
Statistical analysis
Descriptive statistics were used to summarize participant characteristics and response patterns. Categorical variables were presented as frequencies and percentages. Bivariate associations between participant characteristics and weight loss attempts were assessed using the chi-square test. Multivariable logistic regression was performed to identify independent predictors of willingness to join a structured weight loss program. Covariates included sex, age group, educational level, comorbid conditions, and key barriers. Adjusted odds ratios and 95% confidence intervals were reported. All analyses were conducted using SPSS Statistics Version 26 (IBM Corp., Armonk, NY). A two-sided P-value of less than 0.05 was considered statistically significant.
Results
Participant characteristics
A total of 312 overweight or obese adult patients completed the questionnaire in family medicine clinics across Saudi Arabia. Most participants were between 30 and 49 years of age: 78 (25.0%) were aged 30-39 years, and 89 (28.5%) were aged 40-49 years; 61 participants (19.6%) were aged 50-59 years, 41 (13.1%) were aged 18-29 years, and 43 (13.8%) were aged 60 years or older (Table 1). A total of 199 (63.8%) participants were female. The most common comorbid condition was diabetes mellitus, reported by 142 (45.5%) participants, followed by hypertension in 129 (41.3%) and dyslipidemia in 103 (33.0%). Regarding educational level, 181 (58.0%) participants had completed university or postgraduate education. Most participants were employed (147 [47.1%]).
Attempts at weight loss
Of the 312 participants, 213 (68.3%) reported that they had attempted to lose weight in the past year (Table 2). The most commonly reported strategies included reducing portion sizes (173 participants [55.4%]), increasing physical activity (124 [39.7%]), reducing intake of sugary drinks (not specified in Table 2), and eating out less frequently (data not shown). Fewer participants reported trying intermittent fasting (83 [26.6%]) or calorie counting (64 [20.5%]). Only 48 (15.4%) participants had tried commercial weight loss products, and 40 (12.8%) had joined a structured weight loss program or clinic.
Perceived barriers to lifestyle modification
The most commonly reported barrier to making lifestyle changes was lack of motivation, with 219 (70.2%) participants agreeing or strongly agreeing to this barrier (131 [42.0%] strongly agree; 88 [28.2%] agree) (Table 3). Limited time to exercise was reported by 213 (68.3%) participants, and 205 (65.7%) felt that healthy food options were too expensive. Other frequently reported barriers included family or cultural obligations (not explicitly reported in Table 3), lack of safe places to exercise (138 [44.3%]), and insufficient family support (124 [39.7%]). A smaller number of participants (42 [13.5%]) indicated that they did not know how to begin making lifestyle changes.
Role of physicians and sources of information
A total of 138 (44.2%) participants reported that their primary care physician had discussed weight management with them during clinic visits (data not shown). The most common source of weight-related information was physician advice (102 participants [32.7%]), followed by social media (84 [26.9%]), friends or family (56 [17.9%]), and television or radio (29 [9.3%]) (Table 4). More than one-third of participants (107 [34.3%]) reported that they had received no structured advice about weight loss from any source.
Factors associated with attempts to lose weight
In bivariate analyses (Table 5), women were more likely than men to report attempting to lose weight (147 of 199 women [73.9%] vs. 66 of 113 men [58.4%]; P=0.004). Participants with university or postgraduate education were also more likely to have attempted weight loss (139 of 181 [76.8%] vs. 74 of 131 [56.5%]; P<0.001). Attempts at weight loss were slightly more common among those with diabetes (104 of 142 [73.2%]) than those without (109 of 170 [64.1%]), though the difference was not statistically significant (P=0.08). There was no significant association between age group or employment status and weight loss attempts. Agreement with barriers such as lack of motivation and a physician not helping were similar between those who attempted and did not attempt weight loss (P>0.8 for both).
Table 5: Factors associated with attempting weight loss in the past year (N=312)This table shows bivariate associations between demographic, clinical, and barrier-related variables and whether patients attempted weight loss in the previous year. Data are presented as number of patients (%). P-values were calculated using the chi-square test for categorical variables.Statistical significance was determined at the 0.05 level (P < 0.05).
Predictors of willingness to join a structured program
In multivariable logistic regression (Table 6), willingness to join a structured weight loss program was independently associated with female sex (adjusted odds ratio, 1.62; 95% CI, 1.01 to 2.60; P=0.045), higher educational level (adjusted odds ratio, 2.10; 95% CI, 1.28 to 3.46; P=0.003), and having identified a physician as a primary information source (adjusted odds ratio, 2.44; 95% CI, 1.47 to 4.06; P<0.001). Neither age group, employment status, reporting time constraints, or food costs as barriers were independently associated with willingness to participate in a structured program.
Table 6: Multivariable logistic regression: predictors of willingness to join a clinic-based weight loss program (N=312)This table presents adjusted ORs and 95% CIs from a multivariable logistic regression model assessing independent factors associated with willingness to participate in a structured weight loss program. ORs are adjusted for all variables listed.Statistical significance was determined at the 0.05 level (P < 0.05).OR, odds ratio; CI, confidence interval
Discussion
In this cross-sectional study of overweight or obese adults attending family medicine clinics in Saudi Arabia, we found that fewer than half of the participants had received weight-related advice from their physician, and only one-third had access to structured guidance. Despite this, more than two-thirds had attempted weight loss in the preceding year, most often by reducing portion sizes or increasing physical activity. The most frequently reported barriers to lifestyle modification were lack of motivation, limited time, and the perceived high cost of healthy food. Female sex, higher education, and receiving physician-delivered information were independently associated with willingness to participate in a structured program.
Barriers to lifestyle change reported by participants, especially lack of motivation and perceived time constraints, mirror findings from global surveys, but cultural and socioeconomic nuances may influence their relative importance in this context. For example, the prominence of family or cultural obligations as a barrier may reflect gendered caregiving roles or social expectations specific to the region [14,15]. Additionally, cost-related concerns likely reflect disparities in access to affordable healthy food options, particularly in urban and lower-income communities [14,16].
The findings underscore the persistent gap between clinical guidelines for obesity management and the realities of primary care delivery in the region. Although international and local guidelines recommend routine counseling and referral to structured interventions for patients with obesity, our data suggest that these practices are not consistently implemented. This observation is consistent with prior reports from Middle Eastern countries, which have identified limited physician engagement in weight management as a systemic barrier [17]. The low frequency of counseling observed in our study may reflect competing clinical priorities, limited consultation time, or inadequate provider training in behavioral interventions.
Participants overwhelmingly reported reliance on non-medical sources, particularly social media, for weight-related information. While this may reflect the accessibility of digital platforms, it raises concerns about the accuracy and safety of information being consumed. Prior studies have shown that health-related content on social media is often unregulated and may promote ineffective or harmful practices [14-16]. The association between physician-delivered advice and willingness to engage in structured programs in our study highlights the potentially pivotal role of primary care in shifting patient behavior when appropriate counseling is provided.
The independent association between higher educational attainment and both weight loss attempts and willingness to participate in structured programs suggests that health literacy may be a critical determinant of engagement. Previous research has similarly demonstrated that individuals with higher education are more likely to perceive obesity as a modifiable condition and to adopt preventive behaviors [15,17]. Addressing this gap will require targeted, culturally adapted educational initiatives that improve understanding and empower patients with practical skills for change.
This study has several limitations. First, the cross-sectional design precludes causal inference. Second, self-reported data are subject to recall and social desirability biases, particularly regarding weight loss behaviors. Third, although participants were recruited from multiple clinics, the sample may not fully represent rural populations or those who do not seek primary care. Finally, our use of a structured multiple-choice questionnaire may have limited the depth of responses, particularly regarding complex behavioral factors.
Conclusions
In this cross-sectional study of overweight or obese adults in Saudi family medicine clinics, we found that while most patients had attempted weight loss, a substantial proportion faced persistent barriers related to motivation, time, cost, and lack of structured support. Physician engagement and higher educational attainment were positively associated with willingness to pursue structured programs, underscoring the critical role of primary care in facilitating behavior change. These findings highlight the need for targeted, culturally sensitive strategies to support lifestyle modification and close the gap between clinical guidelines and everyday practice in obesity management.
The reference list from the paper itself. Each links out to its DOI / PubMed record.
- 1Barriers to a healthy lifestyle among obese patients attending primary care clinics in Al-Ahsa, Saudi Arabia Cureus Almohammedsaleh AS Alshawaf YY Alqurayn AM 016202410.7759/cureus.69036 PMC 1139014239262931 · doi ↗ · pubmed ↗
- 2Primary care physicians' knowledge and attitudes about obesity, adherence to treatment guidelines and its' association with confidence to treat obesity at the Saudi Ministry of Interior primary health care centers J Family Med Prim Care Al Saud LM Altowairqi SE Showail AA Alzahrani BS Arnous MM Alsuhaibani RM 368836941320243946490110.4103/jfmpc.jfmpc_7_24PMC 11504810 · doi ↗ · pubmed ↗
- 3Gaps to bridge: Misalignment between perception, reality and actions in obesity Diabetes Obes Metab Caterson ID Alfadda AA Auerbach P 191419242120193103254810.1111/dom.13752 PMC 6767048 · doi ↗ · pubmed ↗
- 4Factors contributing to noncompliance with diabetic medications and lifestyle modifications in patients with type 2 diabetes mellitus in the eastern province of Saudi Arabia: a cross-sectional study Cureus Alfulayw MR Almansour RA Aljamri SK 014202210.7759/cureus.31965 PMC 979553536582555 · doi ↗ · pubmed ↗
- 5Primary care physicians' knowledge and attitudes about obesity, adherence to treatment guidelines and association with confidence to treat obesity: a Swedish survey study BMC Prim Care Carrasco D Thulesius H Jakobsson U Memarian E 2082320223597107510.1186/s 12875-022-01811-x PMC 9378264 · doi ↗ · pubmed ↗
- 6Barriers and facilitators to adopting healthier lifestyle among low-income women in Saudi Arabia: a qualitative study Health Expect Alageel S Alhujaili M Altwaijri Y Bilal L Alsukait R 120212122620233680682110.1111/hex.13735 PMC 10154786 · doi ↗ · pubmed ↗
- 7Readiness to change among parents of overweight/obese children in Saudi Arabia and influencing factors J Family Med Prim Care Arabi H Altaf LZ Khashoggi AA Alwazzan SB Aldibasi O Jamil SF 459546021120223635291910.4103/jfmpc.jfmpc_2246_21PMC 9638610 · doi ↗ · pubmed ↗
- 8Prevalence of overweight and obesity based on the body mass index; a cross-sectional study in Alkharj, Saudi Arabia Lipids Health Dis Al-Ghamdi S Shubair MM Aldiab A 1341720182987164810.1186/s 12944-018-0778-5PMC 5989365 · doi ↗ · pubmed ↗