Smartphone use and its association with body image distortion and weight loss behaviours among adolescents in Saudi Arabia

Multinomial logistic regression analysis to estimate odds ratios (ORs) and 95% CIs for the associations of the duration of smartphone use with BID and weight loss behaviors. Table 3 presents the results of a multinomial logistic regression analysis aimed at estimating the parameters for different categories of smartphone use duration (in minutes per day). The reference category is “Duration of smartphone use (1–120 min/d),” and the table provides odds ratios (O.R) and their corresponding 95% confidence intervals (CIs) for each variable in relation to the reference category. The table is divided into three sections, each representing a different range of smartphone use duration: 121–180 min/d, 181–300 min/d, and ⩾ 301 min/d. Looking at the first level of smartphone use duration (121–180 min/day), the odds ratio for “Males” is 1.026. This means that, compared to the reference category (1–120 min/day), males have 1.026 times higher odds of the event (BID) occurring within the same level of smartphone use duration (121–180 min/day). Participant’s schooling, perceived stress level and BMI showed statistically significant association after Bonferroni correction for multiple testing (Table 4).

4. Discussion

The global number of smartphone users has quickly expanded over the last decade [19]. Nowadays, the smartphone has evolved into a key screen device for accessing different media material, such as social media (e.g., Instagram and Facebook), videos (e.g., YouTube and Netflix), games, and music [20]. Smartphones also improve social contact and enable quick information searches. According to several studies, excessive smartphone usage among teenagers is connected with depression, insufficient and low-quality sleep, and issues with social interactions [12, 13]. Adolescent smartphone use is expected to be connected with mental health and related behavior since this period is sensitive to psychological and behavioral development [21]. Unfortunately, little is known regarding the links between smartphone usage and other psychological effects and health behaviors, such as BID and unhealthy weight reduction attempts. This study aimed to determine the connections between smartphone use patterns with BID and weight loss behaviors among Saudi teenage smartphone users.

The most common content types accessed by the teenage smartphone users in our study were social networking services or forums (31.8%) and videos, movies, or music (23.8%), followed by chatting, messaging, or emails (11.6%) and educational or informational searches (11.3%) than games (10.2%), web novels (6.7%), in addition to Shopping or other activities (4.7%). Liu et al. [23] found that the new social media TikTok considerably impacts the value judgment system that guides people, resulting in serious social problems. Alkhateeb et al. [24] found that regular smartphone use for lengthy periods was related to a significant risk of addiction.

The duration of smartphone use was significantly associated with the perceived stress level and the presence of depressive symptoms. Students with middle perceived stress levels (51.4%) and no depressive symptoms (68.9%) used smartphones 121–180 min/d. Prolonged smartphone use (301 min/d) was significantly associated with social networking services or forum content ( P = 0.00, 37.4%). One study found a strong negative relationship between smartphone addiction and total health-related quality of life (HRQoL) and its subdomains: physical and psychological well-being, and school environment, but not with autonomy, family, friends, or social support. Moreover, significant differences in gender, hours spent on smartphones on weekdays and weekends, frequency of weekend smartphone usage, and total HRQoL and its subdomains were detected when comparing the smartphone addiction and non-addiction groups [25].

Modest smartphone use (1–120 min/d) was significantly found in students with normal weight ( P = 0.00, 71.9%); however, aerobic physical activity weight loss strategy ( P = 0.00, 30.9%) was correlated with prolonged smartphone use (301 min/d). According to current findings, children and adolescents who watched music videos and played appearance-focused computer games (such as those in which players change the clothes and hairstyle of a female character to match the male character’s perfect date) were more likely to suffer from body satisfaction. Several recent smartphone-accessible online games are centered on looks, presenting visuals of realistic-looking game characters (or avatars) with unrealistic, and idealized body forms [26, 27]. Kwon et al. [18] recently found that when compared to modest smartphone use (1–120 min/d), prolonged smartphone use (301 min/d) was strongly linked with body image distortion and incorrect weight loss techniques in both sexes after adjusting for categories of information accessed. When the duration of smartphone use was considered, it was observed that smartphones for music, videos, movies, webtoons or web novels, and games were positively connected to body image distortion in men compared to using smartphones for informational or educational purposes content. The use of cell phones primarily for talking, messaging, or email and smartphones primarily for social networking services or forums was favorably associated with muscle-strengthening and aerobic physical activity in males. The use of cell phones primarily for talking, texting, or email, as well as smartphones primarily for social networking services or forums, was positively related to weight loss attempts and the adoption of incorrect weight loss tactics among girls. In addition, Kaewpradub et al. [28] investigated the relationship between secondary school students’ internet use, body image, and eating habits. They found that the average (standard deviation) age of the participants was 15.7 (1.9) years, with 246 men (39.7%) and 374 women (60.3%). Using the web and social networks for body image and dietary behavior content was connected to lower body image satisfaction but increased unhealthy dietary attitudes, binge eating, purging, laxatives/diuretics, and desire for muscularity, as well as eating behaviors associated with obesity risk. According to Rodgers et al. [29] and Park et al. [30], adolescents with internet addiction symptoms are more likely to have over-perception of body weight and body image avoidance (i.e., behavioral avoidance of situations in which one’s body shape is conspicuous). In another study problematic smartphone use was associated with obesity in children and adolescents in Shanghai [31]. Evidence from 50 studies in 17 countries indicates that social media usage leads to body image concerns, eating disorders/disordered eating and poor mental health via the mediating pathways of social comparison, thin/fit ideal internalisation, and self-objectification [32]. Results from a sample of 84 adolescents showed that adolescents tend to rely on the frequency of smartphone use when reporting on the time they spent with the smartphone. Traced duration of smartphone use as well as time distortion, i.e., over-estimation, are significant predictors of Problematic smartphone use [33]. In our study, compared to the reference category (1–120 min/day), males have 1.117 times higher odds of the event (BID) occurring within the same level of smartphone use duration (121–180 min/day). Participants schooling, perceived stress level and BMI showed statistically significant association after Bonferroni correction for multiple testing. Our findings are supported by the recent studies conducted in Korean Adolescents further suggesting that over-dependency on smartphones strongly reduces the quality of life and positive health behavior in adolescence [34, 35]. Findings from a recent Canadian study highlight the importance of ear of Missing Out (FoMO) and self-regulation in understanding problematic smartphone use [36]. Advances in artificial intelligence (AI) could pave the way for better personalization and novel approaches of digitization in mental health care of young people [37]. Smartphone-based conversational agents can deliver psychologically driven intervention and support, thus increasing psychological well-being over time. Mobile-based conversational agents have the potential to deliver engaging and effective Acceptance Commitment Therapy interventions. A recent U.S. study tested the potential of an automated conversational agent named Kai.ai to deliver a self-help program based on Acceptance Commitment Therapy tools for adolescents, aimed to increase their well-being [38]. Another scoping review found a large heterogeneity of methods and findings in AI studies in child psychiatry. Overall, the largest gap identified in this scoping review is the lack of randomized controlled trials, as most studies available were pilot studies and feasibility trials [39]. More high-quality longitudinal studies and mechanistic research are needed to clarify the role of sleep and of type of Mobile Phones/Wireless devices use (e.g. social media) on mental health trajectories in children and adolescents [40]. Fojnica et al. implemented artificial neural network (ANN) for diagnosing pulmonary tuberculosis progression and dynamics. This artificial neural network is a promising method for predicting diagnosis and possible treatment routine for tuberculosis disease [41]. Another paper presents the development of an Expert System for the classification of metabolic syndrome (MetS). Two-layer feedforward Artificial Neural Network (ANN) with sigmoid transfer function was used for MetS classification [42]. Granulo et al. used the telemetry system for diagnosis of Asthma and Chronic obstructive pulmonary disease (COPD). Developed telemetry system was implemented using Android, Java, MATLAB and PHP technologies [43]. Findings of the review indicate that, AI algorithms and deep learning can be rendered as accurate, hence showing possibility to be used as a diagnostic tool now and in the future [44]. Thus, AI has completely changed the traditional medical model, significantly improved the level of medical services, and ensured health in all aspects. It is yet to be seen how future development prospects of medical AI will impact the human population in tackling the rising challenges such as infectious pandemics, chronic diseases and elderly population [45].

The cross-sectional nature of this study cannot confirm the causality association between the compared variables. The self-reported responses could over or underestimate the results. However, the data included adolescents of age groups between 10–19 years in different regions of Saudi Arabia and an extensive analysis has been made is the strength of our study.

5. Conclusion

Despite the limitations, the findings of this study contribute to the existing body of knowledge about the associations of smartphone usage patterns with BID and weight loss behaviors among Saudi adolescents. Prolonged smartphone use was found to be prevalent among adolescent smartphone users in Saudi Arabia. The most common content types of smartphone use among study participants were social networking services or forums and videos, movies, or music, followed by chatting, messaging, or emails and educational or informational searches, then games, web novels, or Shopping or other activities. The factors associated with the duration of smartphone use were School, Gender, Income, parental residence, and parental educational level. The duration of smartphone use was significantly associated with the perceived stress level and the presence of depressive symptoms. Prolonged smartphone use was significantly associated with social networking services or forum content. Modest smartphone use was significantly found in students with normal weight. However, aerobic physical activity weight loss strategy was correlated with prolonged smartphone use. Because smartphone access to a wide range of digital information has become increasingly easy, incorporating digital literacy instruction into health promotion activities is necessary to assist teens in particular assessing and understanding the messages they encounter on digital platforms. Adequate parental advice is required to assist teenagers in developing healthy smartphone usage practices. Digital platform companies may also consider adopting more social responsibility for the information generated and delivered on their networks, boosting its beneficial effect.