Researchers in Saudi Arabia tested a new school program called Green Apple that teaches teenage girls about healthy eating and metabolism without emphasizing weight loss. The program was designed to be culturally appropriate and avoid making students feel bad about their bodies. The study included 105 girls from both rural and urban schools. The results showed that girls who participated in the program learned more about metabolic health and were less sedentary, especially in rural areas. Importantly, the program didn’t cause any negative effects on how girls felt about their bodies or their eating habits. This approach represents a shift away from traditional weight-focused health programs toward more inclusive, supportive health education.

The Quick Take

  • What they studied: Whether a school health program that focuses on how the body uses energy and nutrients (without emphasizing weight) could help teenage girls learn about metabolic health and stay more active, while keeping them feeling good about their bodies.
  • Who participated: 105 teenage girls in Saudi Arabia, average age 16 years old, from both rural villages and urban cities. Some girls received a basic two-session program, while others received an enhanced three-session version that included extra information about preventing metabolic diseases.
  • Key finding: Girls in both groups improved their knowledge about metabolic health. The group that received the enhanced program with extra disease-prevention content showed slightly more improvement (1.65 points) compared to the basic group (1.26 points). In rural areas specifically, girls became noticeably less sedentary after the program.
  • What it means for you: If you’re a teenager or parent concerned about health education, this suggests that teaching about nutrition and how the body works—without focusing on weight—can be effective and safe. It may help young people stay more active and understand their health better without creating anxiety about body image. However, this study was done in Saudi Arabia, so results may differ in other countries or cultures.

The Research Details

This was a quasi-experimental study, which means researchers assigned different groups of students to receive different versions of a health program but didn’t randomly assign individual students. Two classes in each school received either the basic Green Apple program (two sessions) or the enhanced version (three sessions). The researchers measured students’ knowledge, activity levels, and psychological well-being at three time points: before the program started, right after it ended, and one month later.

The program was delivered once per week over two weeks, with each session lasting about one class period. The Green Apple program teaches about energy metabolism (how the body uses food for energy), nutrient balance (eating different types of healthy foods), and where nutrients come from. The enhanced version added a third session specifically about preventing metabolic diseases like diabetes and heart disease.

The researchers used statistical methods to analyze whether the programs actually made a difference, accounting for the fact that students were grouped by class rather than randomly selected individually.

This research approach is important because it tests a program in real school settings with real students, rather than in a laboratory. The researchers specifically included rural girls, who often have less access to health education and resources. By measuring not just whether students learned, but also whether the program caused any harm (like making them worry too much about their bodies or eat in unhealthy ways), the study provides a more complete picture of whether this approach is actually safe and helpful.

Strengths: The study measured outcomes at multiple time points (baseline, immediately after, and one month later), which helps show whether benefits lasted. The researchers specifically looked for potential harms, not just benefits. They included both rural and urban students, which is important because rural areas are often overlooked in health research. Limitations: The sample size was relatively small (105 students), and students weren’t randomly assigned to groups, which means some differences between groups might have existed before the program started. The study only lasted about a month, so we don’t know if benefits continue longer. The study was done only in Saudi Arabia, so results may not apply to other countries or cultures.

What the Results Show

Both versions of the Green Apple program successfully improved students’ knowledge about metabolic health. Students in the enhanced program (with the extra disease-prevention content) showed an increase of 1.65 points on the knowledge test from the beginning to one month later, which was statistically significant. Students in the basic program showed an increase of 1.26 points, which was also statistically significant but slightly smaller.

Interestingly, when researchers compared the two groups directly, the difference between them wasn’t large enough to be considered statistically significant. This means both programs worked well, and adding the extra disease-prevention content didn’t produce dramatically better results than the basic program alone.

A notable finding emerged when researchers looked at rural versus urban schools separately. In rural schools, students who received the basic Green Apple program significantly reduced their sedentary behavior (sitting time) by about 3 hours per week. This reduction didn’t happen in urban schools or in the enhanced program group, suggesting that the basic program may be particularly effective at getting rural girls to move more.

Most importantly, neither program caused any negative effects. Students didn’t develop unhealthy attitudes about their bodies, didn’t show signs of disordered eating, and didn’t become more sedentary overall. This confirms that the weight-neutral approach is safe.

The study found that the weight-neutral approach successfully avoided the stigma and negative psychological effects that can come from weight-focused health programs. No students reported increased body image concerns or disordered eating symptoms. The program appeared to be culturally appropriate for Saudi female students, suggesting that tailoring health education to specific cultural contexts may be important for success.

This study builds on previous research showing that weight-neutral health programs can be effective. The Green Apple program had been tested before in urban settings, but this is the first time it was evaluated specifically with rural students. The findings align with global health recommendations that call for moving away from weight-focused approaches in schools, which can increase stigma and anxiety. The study adds to growing evidence that teaching about nutrition and metabolism without emphasizing weight loss can improve health knowledge and behavior.

The study only included 105 students, which is a relatively small number. Students weren’t randomly assigned to groups—entire classes received the same program—which means some differences between groups might have existed before the study started. The researchers did note that the enhanced intervention group was slightly younger on average (15.97 years) compared to the basic intervention group (17.00 years), which could have affected results. The study only followed students for one month after the program, so we don’t know if the benefits lasted longer. The study was conducted only in Saudi Arabia, so the results may not apply to other countries, cultures, or age groups. Finally, the study didn’t measure actual changes in metabolic health markers like blood sugar or cholesterol—only knowledge and behavior.

The Bottom Line

Based on this research, schools should consider implementing weight-neutral health programs like Green Apple that focus on nutrition, metabolism, and disease prevention. These programs appear to be effective at improving health knowledge and may increase physical activity, especially in rural areas. The evidence suggests these programs are safe and don’t cause the negative psychological effects sometimes seen with weight-focused approaches. Confidence level: Moderate. This is one study with a relatively small sample size, so more research is needed before making broad recommendations.

This research is most relevant for: teenage girls and their parents, school administrators and health teachers in rural and urban areas, health policymakers in Saudi Arabia and similar regions, and anyone interested in evidence-based health education that avoids weight stigma. The findings may be particularly important for rural communities where health education resources are limited. However, since the study was done in Saudi Arabia with a specific cultural context, people in other countries should be cautious about assuming the same results would occur in their communities.

Based on this study, students showed improved knowledge immediately after the program and maintained that improvement one month later. The reduction in sedentary behavior was also observed at the one-month follow-up. However, this study didn’t track students beyond one month, so we don’t know if these benefits continue for longer periods. To see lasting changes in health behaviors and outcomes, students would likely need ongoing reinforcement and support beyond the initial program.

Want to Apply This Research?

  • Track daily sedentary time (sitting time) in 30-minute blocks. Users can log when they’re sitting for activities like homework, eating, or screen time, and set a goal to reduce total sitting time by 30 minutes per day. This aligns with the study’s finding that the program reduced sedentary behavior, especially in rural areas.
  • Implement a ‘Movement Break’ feature that reminds users to stand up and move for 5 minutes every hour during school or study time. Users can log these movement breaks and earn badges for consistency. This directly supports the sedentary behavior reduction shown in the study.
  • Create a weekly ‘Metabolic Health Check-in’ where users answer 3-4 simple questions about their nutrition choices and activity level. Track knowledge improvement over time with monthly quizzes about metabolism and nutrient balance. Include a body image check-in to ensure the app maintains the weight-neutral, psychologically safe approach emphasized in the study.

This research describes a school-based educational program and should not be considered medical advice. The study was conducted in Saudi Arabia with teenage girls and may not apply to all populations, ages, or cultural contexts. While the program showed promise in improving health knowledge and reducing sedentary behavior without causing negative psychological effects, individual results may vary. Parents and educators should consult with qualified health professionals before implementing new health programs. This study measured knowledge and behavior changes but did not measure actual changes in metabolic health markers like blood sugar or cholesterol levels. Anyone with concerns about their health, nutrition, or body image should speak with a healthcare provider.