Obesity – A Saudi guideline

update

By Dr Syed Saifuddin

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

· 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

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

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.

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.

· 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.

· 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.

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 fruitsand vegetables 2 = Encourage eating with the child in asociable atmosphere without distractions,separate eating from other activities and keeprecreational screen time to <2 hour, 1 = Include at least 1 hour or more of active playevery day 0 = Skip sugar‑sweetened beverages and drinkmore water every day.

THE EAT WELL PLATE GUIDELINES

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 physicalactivity on reducing the risk of cardiovasculardisease (CVD) and type 2 diabetes, even withoutevident weight reduction.

• Encourage adults to do at least 30 minutes ofmoderate intensity physical activity on 5 or moredays a week.

ADULTHOOD OBESITY MANAGEMENT

ADULTHOOD OBESITY MANAGEMENT

Clinical and laboratory assessment of overweightand 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 …

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.

ADULTHOOD OBESITY MANAGEMENT

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.