What works to address inequalities in primary care: Development of Living Evidence Maps using machine learning.

Adolescent obesity represents a global public health emergency, with prevalence more than doubled over the past three decades and all projections indicating continued escalation (, ). Adolescence is a critical period during which obesogenic behaviors (e.g., physical inactivity, poor diet, excessive sedentary time, and inadequate sleep) are established and consolidated, with serious consequences that extend into adulthood (). In the Gulf Cooperation Council (GCC) countries, the burden of adolescent obesity is particularly severe. In 2023, the World Health Organization (WHO) reported that among school-age children and adolescents (aged 5–19), GCC countries recorded the highest prevalence of overweight globally in 2016, with Saudi Arabia, Kuwait, Qatar, and the United Arab Emirates each reporting adult obesity rates more than double the global average (). Driven by rapid urbanization, economic transitions, and profound shifts in lifestyle patterns, a systematic review of school-age children and adolescents in GCC countries confirmed that the region faces one of the highest pediatric obesity burdens worldwide (). In the case of Saudi Arabia specifically, a recent multicenter population-based study reported an obesity prevalence of 49.7% among those aged 2–19 years, foregrounded by escalating trends over the past two decades (). Sociodemographic factors, including sex and school type, significantly modulate body mass index (BMI) and PA profiles among Saudi adolescents (), while physical inactivity in particular has been identified as a central and modifiable driver of this trajectory (). Multiple obesity-related risk behaviors co-occur among physically inactive adolescents. Sedentary behavior, poor dietary habits, and insufficient sleep operate independently yet synergistically to promote adiposity and cardiometabolic dysfunction (, ). Understanding why adolescents do or do not engage in regular PA requires the use of a robust theoretical lens. Social Cognitive Theory (SCT), proposed by Bandura (1986), offers one of the most comprehensive and empirically validated frameworks for conceptualizing health behavior (). SCT posits that behavior arises from the reciprocal interaction among personal cognitive factors, behavioral patterns, and environmental influences, termed reciprocal determinism (). Its core constructs, namely self-efficacy, outcome expectations, observational learning, social support, and behavioral capability, have been consistently identified as predictors of PA engagement and obesity prevention across adolescent populations (). Systematic reviews confirm that SCT-based interventions targeting these constructs produce meaningful improvements in PA engagement and weight-related outcomes in adolescents (). Although the current study does not directly measure SCT constructs, SCT serves as a conceptual lens for interpreting between-group behavioral differences and informing the discussion of potential mechanisms. Despite the substantial research on adolescent obesity in Saudi Arabia and GCC countries, a critical gap persists. Prior studies have largely described lifestyle behaviors at the population level or examined general correlates of obesity without systematically comparing the full behavioral risk profile of physically active versus physically inactive adolescents using a validated instrument (, ). Critically, no attempts have been made to incorporate the Arab Teens Lifestyle Study (ATLS) questionnaire, a validated, culturally appropriate tool for Arab adolescents, within a theoretically informed framework to compare obesity-related risk behaviors between physically active and physically inactive adolescents in Saudi Arabia. The novelty of the current study lies in three aspects: the use of a group-comparative design targeting the full behavioral risk profile simultaneously; the application of the ATLS in this specific comparative context; and the use of SCT as conceptual framework for interpreting behavioral differences, which advances beyond descriptive epidemiological approaches by providing a theoretically grounded basis for understanding potential mechanisms and informing intervention design. This oversight limits the evidence base for targeted interventions to encourage physically inactive Saudi adolescents to engage in PA. Accordingly, the current study aimed to compare obesity-related risk behaviors among physically active and physically inactive male Saudi adolescents, drawing on SCT as a conceptual framework.