**Association Between Smoking Hookahs (Shishas) and Higher Risk of Obesity: A Systematic Review of Population-Based Studies**

#### **Reem Baalbaki, Leila Itani, Lara El Kebbi, Rawan Dehni, Nermine Abbas, Razan Farsakouri, Dana Awad, Hana Tannir, Dima Kreidieh, Dana El Masri and Marwan El Ghoch \***

Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, P.O. Box 11-5020 Riad El Solh, Beirut 11072809, Lebanon; reembaalbaki1998@gmail.com (R.B.); l.itani@bau.edu.lb (L.I.); larakebbe@gmail.com (L.E.K.); rawan-dehni@hotmail.com (R.D.); nermine.abbas7@gmail.com (N.A.); razane.fa@hotmail.com (R.F.); dana\_awad@outlook.com (D.A.); hana.tannir@bau.edu.lb (H.T.); d.kraydeyeh@bau.edu.lb (D.K.); dana.masri@bau.edu.lb (D.E.M.)

**\*** Correspondence: m.ghoch@bau.edu.lb; Tel.: +9611300110 (ext. 2332)

Received: 28 May 2019; Accepted: 14 June 2019; Published: 16 June 2019

**Abstract:** The American Heart Association has published a scientific statement on the e ffect of hookah smoking on health outcomes; nevertheless, hookah smoking continues to be popular worldwide, especially among the young. Recent reports mention a potential link between hookah smoking and obesity; however, uncertainties still surround this issue. The aim of the current study was to conduct a systematic review to clarify whether hookah smoking is associated with a higher risk of obesity among the general population. This study was conducted in compliance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, and data were collated by means of a meta-analysis and a narrative synthesis. Of the 818 articles retrieved, five large-population and low-bias studies comprising a total of 16,779 participants met the inclusion criteria and were reviewed. All included studies reported that, regardless of gender, hookah smoking increases the risk of obesity among all ages and observed an association between the two after a correction for several confounders or reported a higher prevalence of obesity among hookah smokers. This was confirmed by the meta-analysis. Therefore, hookah smoking seems to be associated with a higher risk of obesity. Public health policymakers should be aware of this for the better managemen<sup>t</sup> of obesity and weight-related comorbidities.

**Keywords:** obesity; hookah; overweight; shisha; abdominal obesity; weight management; treatment
