A SAUDI GUIDELINE UPDATE

1. Obesity –
A Saudi guideline update
By Dr Syed Saifuddin

3. KSA 3rd in world obesity ranking
ARAB NEWS | Published — Saturday 6 August 2016
• Lancet has placed the Kingdom in the third position in the
world, after Malta and Swaziland, in terms of obesity and
laziness, triggering warnings from Saudi experts.
• The British medical journal has put the ratio of laziness
and obesity in the Kingdom at 86 percent, which is one of
the main causes of diseases like diabetes — a disease
afflicting 25 percent of the Saudi population.
• Staying awake at night , eating just for fun and just before
sleep

4.  In Saudi Arabia, obesity has become one of the most common health problems
affecting people of both sexes and all age groups.
 According to epidemiological studies and surveys, obesity was found to affect
more than one quarter while overweight affects about one-third of the adults in
Saudi Arabia.
Magnitude of obesity in Kingdom of
Saudi Arabia

5. GUIDELINES DEVELOPMENT PROCESS
 This Guideline is based on the work of the
Saudi Arabian Society of Metabolic and
Bariatric Surgery (SASMBS).
 SASMBS has established a guideline
adoption group (GAG) to work on adopting
evidence-based clinical practice guideline for
the prevention and management of obesity
in Saudi Arabia.
 The Saudi Journal of Obesity is the official
publication of SASMBS

6. TARGET USERS OF THE GUIDELINE
 This guideline is intended for the use of healthcare
professionals at all levels, including physicians,
nurses, dietitians, psychologists, and
physiotherapists.

7. HOW TO USE THE GUIDELINE
 The goal of the guideline is to provide health care
professionals with the tools to effectively prevent and
manage overweight and obesity among children and
adults. The guideline consists of the following parts:
 The first part deals with primary prevention of obesity in
children, young people, and adults ; the guideline
provided information on preventing overweight and
obesity through lifestyle modification program, focusing on
recommendations for healthy diet, physical activity and
periodical medical examination.

8.  The second and the third part deal with weight
management in children and adults. The guideline
introduced two algorithms to be followed for assessment
and management of obesity and overweight. The
assessment is based on body mass index (BMI) for age
percentiles for children and BMI and waist circumference
for adult, in addition to a set of laboratory investigation to
assess for underlying causes, risk factors, and
comorbidities.

9.  The fourth part discussed the pharmacological
management of obesity; it briefly presented a list of
medications used for pharmacological treatment.
 The last part deals with surgical management of obesity
(bariatric surgery); it described briefly the indications for
considering bariatric surgery as part of obesity
management. It described briefly the common types of
bariatric surgery highlighting their potential acute and
chronic complications.

10. PRIMARY PREVENTION OF OBESITY
 For all age groups, assess diet, physical activity and
sedentary behaviors annually.
 Children above 5 years and adults –
 Follow the 5-2-1-0 message every day:
5 = Encourage intake of daily 5 rations of fruits
and vegetables
2 = Encourage eating with the child in a
sociable atmosphere without distractions,
separate eating from other activities and keep
recreational screen time to <2 hour,
1 = Include at least 1 hour or more of active play
every day
0 = Skip sugar-sweetened beverages and drink
more water every day.

11. THE EAT WELL PLATE GUIDELINES

12. GUIDELINES FOR PHYSICAL ACTIVITY
 Adults
• Provide physical activity advice appropriate to specific individual
situations. Focus on activities that can fit easily into their everyday life
and are tailored to their individual preferences and circumstances.
Attention should be given to pregnant women, postnatal weight
retention, menopause or when stopping smoking.
• Inform the individuals about the benefits of physical
activity on reducing the risk of cardiovascular
disease (CVD) and type 2 diabetes, even without
evident weight reduction.
• Encourage adults to do at least 30 minutes of
moderate intensity physical activity on 5 or more
days a week.

13. ADULTHOOD OBESITY MANAGEMENT

14. ADULTHOOD OBESITY MANAGEMENT
Clinical and laboratory assessment of overweight
and obesity
 History and a general physical examination to
assess obesity, overweight, and obesity related risks
and to exclude secondary causes of obesity
 Measure body mass index (BMI)
 Measure waist circumference (WC) (males with WC
≥102 cm and females with WC ≥88 cm are at high
risk of many complications)
 Request/conduct laboratory tests when appropriate
as blood sugar levels, LFT, FLP, TFT, cortisol levels,
Sleep studies …

19. PHARMACOTHERAPY
 Medications for obesity have traditionally fallen into
two major categories: appetite suppressants
(anorexiants) and gastrointestinal fat blockers.
 Appetite-suppressing medications have primarily
targeted three monoamine receptor systems in the
hypotha lamus: noradrenergic, dopaminergic and
serotonergic receptors.
 Gastrointestinal fat blockers reduce the absorption
of selective macronutrients， such as fat, from the
gastroi ntesti nal tract.

23. ADULTHOOD OBESITY MANAGEMENT

25. Al-Shehri FS, Moqbel MM, Al-Khaldi YM,Al Shahrani AM, Abu-Melha WS,
Alqahtani AR, et al. Prevention and management of obesity: Saudi
guideline update. Saudi J Obesity 2016;4:25-40.