Klaus Gebel

Background The prevalence of childhood obesity has substantially increased in the Gulf Cooperation Council countries, including Saudi Arabia. The Rashaka initiative is a Saudi national school-based multicomponent intervention that was introduced in the school year 2016–2017 to address childhood overweight and obesity. This study aims to examine the effect of the Rashaka initiative on students’ body mass index (BMI) for two academic years (2016–2017 and 2018–2019) and to analyse predictors of BMI change. Methods Secondary data for this pre–post study was provided by the Ministry of Health for 38 026 students from 89 intermediate and secondary schools that implemented the initiative in Makkah City, Saudi Arabia. It was analysed using non-parametric tests and multiple regressions at a 5% level of significance. Results Over 2 y of implementation, BMI was reduced significantly across the schools (p < 0.001). Based on the regression modelling, school gender and education stage were found to be the only significant predictors of BMI change. Girls and intermediate schools had greater BMI reductions than boys and secondary schools (p < 0.001 and p = 0.031). Conclusions This study provides tentative evidence for the effectiveness of the Rashaka intervention in Makkah City. In addition, our study has identified that the Rashaka initiative may require modification to improve its effect on boys and students in secondary schools.