The Kingdom of Saudi Arabia is witnessing fast and progressive developments in healthcare provision and delivery. These include the three programmes from Vision 2030: the Quality of Life Programme (QoL), the National Transformation Programme (NTP), and the Health in All Policies (HiAP) strategy. The HiAP strategy is a cross-sectoral strategy that aims to address the social determinants of health in the Kingdom. Together, these programmes comprise various goals for the health and wellbeing of the population. The provision of healthy foods, the performance of more physical activity, and the modification of the public environment are just some of the main goals of the aforementioned programmes.
One success story from the Ministry of Health (MOH) and governmental action is the control and management of the COVID-19 pandemic. Rapid and effective actions were taken by the health authorities and the concerned governmental sectors starting from lockdowns, enforcement of wearing face masks and social distancing in public places, and a mass vaccination campaign.
“We call for a similar multi-sectoral prevention and management approach against other common causes of death such as injuries from road traffic accidents and non-communicable diseases such as obesity, diabetes mellitus, hypertension, ischemic heart disease, cerebrovascular accidents among others,” the World Obesity Federation said.
Obesity, however, is the most prevalent chronic disease in the Kingdom. It has been linked to multiple complications including type 2 diabetes mellitus, obstructive sleep apnoea, hypertension, and ischemic heart disease, and can have substantial consequences on the psychosocial life of individuals living with obesity. A recent study in BMJ Global Health estimated that in 2019, the economic impact of overweight and obesity in the Kingdom of Saudi Arabia totalled US$19.2 billion. This is the equivalent of 2.4% of the Kingdom’s GDP in that year. Worryingly, if current trends continue, the same study estimated that by 2060 costs will rise four-fold to US$78.09 billion, the equivalent to 4.2% of GDP.
Despite these economic, social and health consequences, the prevalence of obesity in the Kingdom of Saudi Arabia continues to increase at alarming rates and is approaching 33% in adults, and between 10-20% in children and adolescents.
Obesity prevention initiatives
Several initiatives and programmes have been proposed to prevent and control this rise of obesity in the Kingdom. Examples of such initiatives include the Saudi Food and Drug Authority (SFDA) policies to reduce the content of sugar, salt, saturated and trans-fat, and the mandatory display of caloric content of foods overseen by the Ministry of Municipality and Rural Affairs (MOMRA). Taxation of sugary beverages by the General Authority for zakat (GAZT) have also been implemented with a tax rate of 50% for soft drinks and a tax rate of 100% for energy drinks. Another prominent initiative was the implementation of Rashaqah (fitness), a joint programme between the MOH and the Ministry of Education (MOE), which addresses the provision of healthy canteen food, structured regular exercise sessions and screening for overweight and obesity among students.
Moreover, the MOH produced the Obesity Prevention & Control Strategy 2020-2030 by Weqaya (prevention) at the Public Health Authority (PHA), which was recently established replacing the former Center for Disease Control (CDC-MOH). Under the PHA, a Committee to Combat Obesity has been established with the mandate to coordinate inter-professional education and training and manage a collaborative practice among the various sectors to help in the refinement and implementation of the various strategies and programmes to prevent and manage obesity. All of this is in addition to the several obesity prevention and management guidelines, publications, reports, conferences, workshops, and symposia that address the subject of overweight and obesity prevention and management across all age groups.
“Unfortunately, at this time, most of these strategies and programmes are lacking implementation toolkits and actions. This is a challenge that needs special consideration and further work by the government and other concerned stakeholders and actors,” the World Obesity Federation said.
Implementation
Recently, the Saudi Society for Metabolic and Bariatric Surgery (SASMBS) in collaboration with the World Obesity Federation (WOF) took the initiative to discuss and address issues related to the implementation of obesity prevention and management strategies and programmes, including barriers and opportunities. This was achieved through a virtual roundtable workshop shared and attended by key experts in obesity prevention and management and other relevant stakeholders.
The main conclusions and recommendations of this workshop included:
- Use momentum around Vision 2030 to push for implementation of obesity efforts and employ the use of KPIs to do so.
- Use evidence of the economic impact of obesity to encourage action.
- Allocate budgets to obesity so that stakeholders and sectors can focus on implementation and invest in the monitoring and evaluation of all programmes and policies.
- Unify all parties – including the MOH, SASMBS and the Public Health Authority – so that going forward there is one set of obesity and bariatric guidelines that everyone follows.
- Mandate all parts of the healthcare sector to implement existing guidelines.
- Encourage insurance companies to cover the full range of obesity treatment in line with existing guidelines. This was achieved through the Medical Insurance Council and will be effective in 2022.
- Empower individuals with obesity to seek out care earlier and promote patient education.
- Increase training and education on the use of obesity medication.
- Increase capacity within primary care to deliver low-level interventions and follow-up care.
- Improve public health messaging around obesity and the maintenance of a healthy lifestyle.
- Recognize obesity as a chronic disease, not just a risk factor for other diseases, starting with a position statement from
the “Public Health Authority” and/or the “SASMBS” (similar to the 2017 World Obesity Federation position statement). - Adopt the National Bariatric Registry initiative by Sultan Ben Abdul-Aziz Humanitarian City to improve the quality of research on bariatric surgery and to create a wide spectrum national registry that covers all disciplines.
“We believe that action on the above recommendations, with support from the Government and other interested parties, will help ensure better care is available to those living with obesity. We must build on the momentum channelled thus far, and continue our efforts,” the World Obesity Federation said.
