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SPECIAL ARTICLE
Year : 2018  |  Volume : 6  |  Issue : 1  |  Page : 2-4

Obesity care: Urgent call for national standards in Saudi Arabia


Research & Studies Department, Health Affairs, Abha, Aseer Region, Kingdom of Saudi Arabia

Date of Submission13-Oct-2018
Date of Acceptance15-Oct-2018
Date of Web Publication13-Mar-2020

Correspondence Address:
Dr. Yahia M Al-Khaldi
Research & Studies Department, Health Affairs, PO Box 2653, Abha 61461, Aseer Region
Kingdom of Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/sjo.sjo_21_18

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  Abstract 


Obesity/overweight is very common health problems globally. In KSA, about three-quarter of population have either overweight or obesity. Obesity is known to be associated and complicated with other common health problems.. There is adequate evidence that obesity can be prevented and managed. Despite these facts, there were no standards for obesity care in Kingdom of Saudi Arabia (KSA)A. The objective of this paper is to present some standards for obesity care at different levels of health care in KSA.

Keywords: Care, national standards, obesity


How to cite this article:
Al-Khaldi YM. Obesity care: Urgent call for national standards in Saudi Arabia. Saudi J Obesity 2018;6:2-4

How to cite this URL:
Al-Khaldi YM. Obesity care: Urgent call for national standards in Saudi Arabia. Saudi J Obesity [serial online] 2018 [cited 2020 Sep 30];6:2-4. Available from: http://www.saudijobesity.com/text.asp?2018/6/1/2/280266




  Introduction Top


Obesity and overweight are very common health problems globally. In Kingdom of Saudi Arabia (KSA), about three-quarter of population have either overweight or obesity.[1],[2],[3] Obesity is associated and complicated with other common health problems (diabetes (DM) and hypertension (HTN), tumors, joints diseases, mental disorders, and sexual dysfunctions).[1]

There are strong and fair evidences that screening for obesity among (children,adolescents and adult) is a cost-effective and lifestyle modification has positive impact to control and treat obesity.[4],[5] Medical and surgical interventions are recommended when lifestyles cannot achieve the target weight loss.[5]

Despite these facts, there were no standards for obesity care in KSA.

The objective of this paper is to present some standards for obesity care at different levels of health care in KSA.

Rationales

Standardization of obesity care in KSA has been become mandatory for the following reasons[6],[7]:
  1. To unify all aspects of obesity care at all health sectors in KSA (system of care).
  2. To introduce safe and cost-effective care for all individuals wherever they are.
  3. To minimize variations of care for obese patients and reduce medical errors and malpractice.



  Definitions Top


Standards are statements of expected and accepted level of performance that made available prospectively to healthcare organization through formal mechanism and are useful for assessment/comparison of organization compliance (performance). They should be reliable, specific, valid, and measurable.[8]

Types of standards

There are three types of standards:
  1. Structures (e.g., availability of qualified team, equipment)
  2. Processes (e.g., checking body mass index (BMI) for all individuals above 12 years old)
  3. Outcomes (e.g; postoperative complications; good diabetes mellitus (DM) control after sleeve operation)


Levels of standards implementation

In this document, standards could be implemented and measured at four main levels:
  1. National level [Ministry of Health (MOH) and other high-authority organizations]
  2. Regional level (health directorates)
  3. Sector level (city or governorate)
  4. Organization level [clinics-primary health care center (PHCC), obesity unit at hospitals]


Standards at national level

The following standards are suggested at national level:
  1. There should be national program for obesity control with specific [objectives and key performance indicators (KPIs)].
  2. There should be national scientific committee for updating clinical guidelines of obesity.
  3. There should be a national committee for health professionals’ development and education.
  4. There should be national committee for health education and promotion.
  5. There should be national registry for obesity-related information.
  6. There should be national update policies and procedures manual for obesity care.


Standards at regional level

The following standards are suggested at regional level:
  1. There should be a regional obesity control program represented from all relevant sectors.
  2. There should be updated obesity clinical guideline.
  3. There should be an obesity control unit at public health departments.
  4. There should be an update policies and procedures manual for obesity care.
  5. There should be a well-structured health education program for community.
  6. There should be a well-structured training program for concerned health provisionals.
  7. There should be a regional registry for obesity-related information.
  8. There should be KPIs.


Standards at hospital level

The following standards are suggested at hospital level:
  1. There should be an obesity management unit.
  2. There should be an updated clinical guideline.
  3. There should be a qualified teamwork represented from all relevant units (endocrine, bariatric surgeon, cardiologist, expert anesthesiologist, nurse, health educator, social workers, nutritionist, and psychologist).
  4. There should be an update policies and procedures manual for obesity care.
  5. There should be a well-structured program for management of obesity including
    1. Action plan
    2. Health education materials and aids (booklet, posters, videotapes, etc.)
    3. Weight and height scale and BMI charts/growth charts
    4. Registers and records
    5. Drugs for obesity
    6. Appointment system
  6. There should be a well-structured training program for concerned health provisionals.
  7. There should be a well equipped bariatric surgery unit with all relevant tools and instrument.
  8. There should be KPIs.


Standards for process of care at hospital level

For obese people who will undergo bariatric surgery, they should be prepared through the following steps:
  1. Discussing with patient all types of surgical operations, benefits, and risks of each one of them.
    1. Informed consent should be signed by patient after detail explanation of procedure including benefits, risk, and long-term/short-term complications.
    2. Relevant investigations according to national guidelines should be performed by treating teamwork.
    3. Appropriated surgical procedures should be conducted by qualified physicians with valid license from Saudi Commission for Health Specificities (SCFHS) or equivalent body.
    4. Patients undergo bariatric surgery should stay at hospital for adequate time till they become fit to depend on themselves for ordinary daily activity.
    5. On discharge, the patient should be provide with a comprehensive medical report with clear instructions on how to care for themselves, including dieting, physical activity, drug use, and red flags.
    6. Patients should be given appointment within 1 to 2 weeks for follow-up visit.
    7. All relevant information about the operation should be documented in detail in patient file before discharge from hospital.
    8. Postoperative notes should include date, time of surgery, type of surgery, patient’s complaint and concern, mood status, side effects of drugs, vital sign, weight, BMI, wound status, and advice (about diet, exercise, relevant investigations).
    9. The patient should be given regular appointment with surgeon and family physician for at least the following 3 years.
    10. All the documents should be signed and stamped by treating physicians.


Standards of care at PHCC level

The following structures/resources should be available at PHCC level:
  1. Obesity clinic
  2. Updated clinical guidelines
  3. Qualified teamwork (family doctor, well-trained nurse, and health educator)
  4. Update policies and procedures manual for obesity care
  5. Well-structured program for management of obesity including
    1. Action plan
    2. Health education materials and aids (booklet, posters, videotapes, etc.)
    3. Weight and height scale and BMI charts/growth charts
    4. Registers and records
    5. Drugs for obesity
    6. Appointment system
  6. Well-structured training program for concerned health provisional
  7. Well-equipped obesity clinic with all relevant tools and instruments
  8. KPIs


Standards for processes of care at PHCC

  1. For all people attending PHCC, weight and height should be checked and BMI to be calculated and recorded in individual file at least once per year.
  2. All people should be informed about their weight status after calculating their BMI (underweight, normal, overweight, and obesity).
  3. For people with normal body mass index, they should be given health education about performing regular physical activity and intake well-balanced diet to keep their weight within normal.
  4. For overweight people, they should be given counseling about lifestyle changes and behavioral therapy with regular checkup every 6 to 12 months.
  5. For obese people, they should be informed about obesity, its risk, complications, and they should be referred for further assessment and management by a family physician accordingly.
  6. For obese people, they should be given adequate and well-structured counseling about
    1. Diet therapy
    2. Physical activity
    3. Drug therapy
    4. Surgical therapy
  7. For obese people, they should be referred to bariatric surgery for opinions and further care.



  Conclusion Top


Despite high prevalence of obesity in KSA, there are no standards of care.

To introduce safe and cost-effective health care for at risk and individuals with obesity in KSA, the present proposed standards could be revised and modified by the concerned and experts at high authorities including MOH, Central Board of Accreditation of Health Institutes, and Saudi Society of Obesity and to be implemented as soon as possible.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Memish ZA, El Bcheraoui C, Tuffaha M, Robinson M, Daoud F, Jaber S et al. Obesity and associated factors—Kingdom of Saudi Arabia, 2013. Prev Chronic Dis 2014;11:140236.  Back to cited text no. 1
    
2.
Al-Baghli NA, Al-Ghamdi AJ, Al-Turki KA, El-Zubaier AG, Al-Ameer MM, Al-Baghli FA. Overweight and obesity in the eastern province of Saudi Arabia. Saudi Med J 2008;29:1319-25.  Back to cited text no. 2
    
3.
Bin Horaib G, Al-Khashan HI, Mishriky AM, Selim MA, Alnowaiser N, Binsaeed AA et al. Prevalence of obesity among military personnel in Saudi Arabia and associated risk factors. Saudi Med J 2013;34:401-7.  Back to cited text no. 3
    
4.
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.  Back to cited text no. 4
  [Full text]  
5.
Alnaami MY. Prevention and control of obesity: An interprofessional system approach. Saudi J Obesity 2016;4:59-67.  Back to cited text no. 5
  [Full text]  
6.
Al-Khaldi YM. Bariatric surgery in Saudi Arabia: The urgent need for standards. Saudi J Obesity 2016;4:1.  Back to cited text no. 6
  [Full text]  
7.
Al-Khaldi YM. Abha statement and the upcoming hope to control obesity in Saudi Arabia. Saudi J Obesity 2016;4:57.  Back to cited text no. 7
  [Full text]  
8.
Kingdom of Saudi Arabia. Saudi Health Council. Saudi Central Board of Accreditation of Health Institutes. Manual standards for PHCC. 2011. pp 74-6.  Back to cited text no. 8
    




 

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