Fruit and vegetable consumption and obesity among adults in Saudi Arabia: a cross-sectional study

Background Obesity is a critical public health concern in the Gulf Cooperation Council (GCC) region (Saudi Arabia, Kuwait, the United Arab Emirates, Qatar, Bahrain and Oman), with Saudi Arabia having among the highest prevalence rates globally (23% adults obese, 45% overweight). These rates contribute to 27% of non-communicable disease (NCD) mortality and to an estimated US $19.3 billion in combined annual direct medical and productivity costs. Despite national targets to reduce obesity under Vision 2030, only about one in ten Saudi adults meets the recommended five daily servings of fruits and vegetables. Evidence on the relationship between fruit and vegetable consumption and obesity in this population remains limited. Objective To examine the association between fruit and vegetable consumption and body mass index (BMI) category among adults in Saudi Arabia, and to identify demographic factors associated with consumption patterns. Methods An exploratory cross-sectional study was conducted between December 2022 and (May 2023) using an online Food Frequency Questionnaire (FFQ) distributed via social media platforms to a non-probability convenience sample. The study included 641 adult participants (≥18 years) residing in Saudi Arabia. BMI was calculated from self-reported height and weight and classified into WHO BMI categories. Consumption frequencies were summed into monthly consumption frequency scores. Statistical analysis included descriptive statistics, Kruskal-Wallis and Mann–Whitney U tests, multiple linear regression, and multinomial logistic regression with BMI category as the outcome, using SPSS v24 ( α = 0.05). Results Of the 641 participants, who were mostly young (68.6% aged <35 years) and highly educated (78.6% held a bachelor’s or postgraduate degree), 635 had valid BMI data: 43.5% had normal BMI, 29.8% were overweight and 21.7% were obese. No statistically significant association was found between fruit consumption ( p = 0.14) or vegetable consumption ( p = 0.71) and BMI categories. Descriptively, median fruit consumption was highest among overweight participants (50 times/month) and marginally lower among normal-weight participants (47), with the lowest medians in the underweight (34) and obesity class I (40) groups; median vegetable consumption tended to be lower among obese participants (70–80 times/month) than among normal-weight individuals (88 times/month), although none of these differences reached statistical significance. Females consumed significantly more vegetables than males (median: 107 vs. 70 times/month, p < 0.001). Monthly income was the only significant predictor of fruit consumption ( β = −26.05, p = 0.03), while gender was the sole significant predictor of vegetable consumption ( β = −53.84, p < 0.001). In multinomial logistic regression adjusted for age group, gender, monthly income, education level, region and employment status ( n = 552), neither fruit nor vegetable consumption was associated with BMI category (all adjusted odds ratios ≈1.00 per one-unit increase in the monthly consumption frequency score; per 30-unit increase, equivalent to one additional item consumed daily: 0.90–1.02 for fruit and 0.96–1.01 for vegetables; p ≥ 0.31). Conclusion In this exploratory study, fruit and vegetable consumption was not associated with BMI category. Gender and income were associated with vegetable and fruit consumption, respectively. Findings are limited to young, highly educated adults recruited online and require confirmation in representative longitudinal studies.