Year : 2014 | Volume
: 2 | Issue : 2 | Page : 49--53
Towards an integrated national obesity control program in Saudi Arabia
Yahia M Al-Khaldi1, Fahad S Al-Shehri1, Abdullah S Aljoudi2, Shamsun Nahar A Khalil Rahman3, Waleed S Abu-Melha4, Mohammed A Mashour4, Abdullah M Al-Shahrani1,
1 Department of Family Medicine and Public Health, General Directorate of Health Affairs, Aseer Region, Dammam, Saudi Arabia
2 Department of Family and Community Medicine, University of Dammam, Dammam, Saudi Arabia
3 Department of Family and Community Medicine, King Khalid University, Abha, Saudi Arabia
4 Department of Preventive Medicine and Home Care, Armed Forces Hospital, Southern Region, Saudi Arabia
Fahad S Al-Shehri
Department of Family Medicine, General Directorate of Health Affairs, Aseer Region, Abha, Code 61461, P.O. Box 2653
Obesity is one of the common health problems in Saudi Arabia. It affects almost one third of adult population and one tenth of children and adolescents. In order to prevent and control obesity among Saudi population, it is mandatory to have national program with definite objectives and strategies. The aim of this paper is to identify priorities for integrated strategies to prevent and control obesity and to define roles and responsibilities of various stakeholders including individuals, families, community, organizations and agencies in KSA as the first step in a process to develop integrate national program to prevent obesity.
|How to cite this article:|
Al-Khaldi YM, Al-Shehri FS, Aljoudi AS, Khalil Rahman SA, Abu-Melha WS, Mashour MA, Al-Shahrani AM. Towards an integrated national obesity control program in Saudi Arabia.Saudi J Obesity 2014;2:49-53
|How to cite this URL:|
Al-Khaldi YM, Al-Shehri FS, Aljoudi AS, Khalil Rahman SA, Abu-Melha WS, Mashour MA, Al-Shahrani AM. Towards an integrated national obesity control program in Saudi Arabia. Saudi J Obesity [serial online] 2014 [cited 2019 Dec 11 ];2:49-53
Available from: http://www.saudijobesity.com/text.asp?2014/2/2/49/147342
Studies conducted during the past two decades in Saudi Arabia have shown that obesity affects all age groups of both genders from both urban and rural areas. At least one out of three adults, one out of five adolescents and one out of ten children are suffering from obesity in KSA. ,,,,, The epidemiological studies concluded that the two risk factors which significantly contribute to dramatic increase of obesity are imbalanced food intake and lack of physical activity. [7-12] Most of the above studies concluded that obesity could be prevented and controlled through dealing with the above two risk factors by establishment of an national program.
The determinants of obesity are complex and varied and it is important to recognize that no single intervention is likely to prevent obesity in the population. Actions to prevent obesity need to be taken in multiple settings and incorporate a variety of approaches and involve a wide range of stakeholders. This requires intervention at all levels of society, from communities through to governments, private organizations and nongovernmental organizations. It is generally accepted that comprehensive and coordinated interventions which support and facilitate physical activity and healthy diets in the context of a social-determinants-of-health approach represent the best way forward for obesity prevention. 
The overall aim of the paper is to identify priorities for integrated strategies to prevent and control obesity and to define roles and responsibilities for various stakeholders including individuals, families, community, organizations and agencies in KSA as the first step in a process to develop integrate national program to prevent obesity.
ROLES OF INDIVIDUALS
In the new era, health organizations reinforce that health is the responsibility of an individual rather than the responsibility of different health organizations. Individuals should know that obesity is an indicator of disease and is associated with serious and complicated health problems such as diabetes, hypertension, heart diseases, and malignancies.  It is not enough for individuals to just know the different grades of obesity but they should regularly check their weight and calculate their body mass index. To maintain healthy weight status, individuals should spend 45-60 minutes of regular physical activity at least 5 days/week. Act ivies such as walking, running, cycling, bicycle are different physical activity options that could be practiced. 
All individuals should know that having an unbalanced diet is the leading cause of obesity.
They must understand that a food items with high calories such as rice, dates, creams, chocolates, soft drinks, fast food, sweets, full cream (milk, cheese, Laban, Zabadi) should be taken in low amounts while vegetables, fruits should be consumed daily. They should know how to read food labels and what they mean.
ROLES OF FAMILY AND COMMUNITY
Family is considered the functional and structural unit of the society.  The average number of Saudi family is about seven members.  In Saudi Arabia, it has been observed that most of families eat together particularly lunch and dinner. Saudi diets are rich in carbohydrate, fat and protein which contribute to obesity and overweight as mentioned in many national and regional studies. ,,,,, Families can play a vital role in both directions (weight gain and weight control) through preparing food at home. In this regard, many recommendations should be considered;
The varieties of food should be available in acceptable amounts representing all food groups particularly fruits and vegetables which were found to be ignored by many individuals ,,,,,Cooking of food should be undertaken using olive oil, skimmed milk, low amount of saltEach member of the family should use his/her own plate instead of eating together from a large plateSoft drinks such as Pepsi/Cola should be replaced by water or fresh juices that are sugar free.All members should eat slowly and grind and chew the food wellAll family members should not watch TV while eatingAll family members should eat salad, fruits, vegetables dailyAll family members should know that eating sweets frequently is unhealthy habit which leads to many health problems including obesity, caries and dyslipidemia.
Regarding physical activity, many barriers were reported to do such activity among Saudis.
These barriers included time, lack of facilities and climate. , However, family members can overcome such barriers by utilizing any available resources such as walking on ground floor, large rooms in the house and using machines designed for physical activity at home.
Roles of Ministry of Education (Schools and Colleges)
There is fair evidence that school based interventions such as diet or physical activities could prevent overweight and obesity. 
In Saudi Arabia, there are 1000 of schools and 100 of colleges in which there are more than seven million students and 900,000 employees.  Students spend about six hours a day in schools and colleges. Most of the time is spent for studying with short breaks for snacks which are very rich in calories but lack in fruit and vegetables (fast food, soft drinks and hot drinks). Most schools particularly boys schools give their students at least one session of sport as part of their weekly timetable. However, most activities run in schools lack relevant resources such as suitable playground, instruments and tools for different games except for football and volleyball. In girls' schools, sport is still not practiced for social and cultural reasons. As a result of all the above mentioned factors, students in Saudi Arabia start to develop lifestyles that make them overweight and obese as reported by many national and regional studies. ,,,,, Schools and colleges need to play their role in health promotion and prevention of obesity, it is mandatory to provide them with essential with essential resources relevant to different sport, to allocate adequate time to practice sport (at least 3 h/week) in addition to cafeteria at schools and colleges should prepare and present healthy food for the students under the direct supervision of school health department.
Curriculum of schools and colleges should contain some subjects about the roles and importance of healthy diet and regular physical activities in the prevention and control of obesity. Other important roles of school and colleges include screening for overweight/obesity, conducting academic interventional research in addition to giving frequent health education for students regarding the magnitude, risk and prevention of obesity.
ROLES OF MUNICIPALITY
In Saudi Arabia, Ministry of Municipality (MOM) and relevant affairs are responsible for issuing rules, regulations, supervising the activities of restaurants, cafeteria, bakeries and markets all over the country. It is observed that food preparation, storage and presentation in these places were not complying with MOM regulations. It was observed that most of the oils used for cooking were saturated and used for long time without change. The other important observation was providing the customers with large amount of food that exceeds the their actual needs.
In this regard, many recommendations could be implemented to have healthy restaurants, cafeteria and bakeries in Saudi Arabia. Steps needed to be taken are:
Updating the current rules and regulations regarding license for opening restaurants, cafeterias and bakeries in order make such activities more healthyAllocating some corners in restaurants/supermarkets for food items of low fat and low calories in order to help obese patients to choose food that meet their needsEnsure that the above places do their activities according to the rules and regulations through direct supervision and accountabilityCreation of pedestrian tracks in all cities overall Saudi Arabia to enable people to practice different physical activities as walking and running.
ROLE OF MINISTRY OF HEALTH AND OTHER HEALTH SECTORS
Ministry of Health (MOH) is responsible for introducing and supervising health care services at all levels for Saudi community. MOH introduces health care services for more than two thirds of the population while other governmental and private sector introduce health services for the remaining one third. There are more than 2,090 Primary Health Care Center (PHCCs) and 300 hospitals over KSA.  Many other health sectors in KSA have introduced different health services for their employees and their families. These sectors include Ministry of Defense, Ministry of National Guard, Ministry of Higher Education, Ministry of Interior, and private sectors. 
Roles of primary health care / family practice centers
Primary care and family practice centers are the cornerstone of introducing health promotion and health education services for the community in general and for that at high risk such as overweight and obesity.  Health care professionals at primary health care (PHC) and family practice centers can play the following vital roles in prevention and management of patients at risk of overweight and obesity as every person visits health care setting at least 4 times a year.  The following recommendations could be implemented at PHC/family phicion level in KSA.
Obesity and being overweight should be considered as a health priorityTeamwork at PHC/FPC should introduce health education program about obesity at community level including danger/risk/prevention and complications of obesityPHC/FPC should implement screening program to detect overweight/obesity as early as possible particularly for those 18 years and above and those at high risk of obesityPhysicians at PHC/FPC should manage overweight and obese patients through introducing dietary and lifestyles counseling/prescribing drugs used in obesityPHC doctors/FP should coordinate with hospital regarding referring obese patients for secondary and tertiary care if indicated (secondary causes and bariatric surgeryPHC could coordinate with schools and colleges to conduct health education sessions about prevention of overweight and obesity.
Roles of Hospitals
Hospitals in Saudi Arabia are the second and third lines of health care. There are three types of hospitals (secondary, tertiary and specialized). To manage overweight and obesity based on evidence and cost effective approach, the following recommendations should be implemented at hospital level:
Obesity clinics should be established at general and central hospitals over the KSAObesity care team should be assembled in each general hospital and consists of internist (preferred to be endocrinologist), pediatrician, nurse, dietician)The team is responsible for accepting obesity cases referred from PHC/FPC, manage cases at hospital level and referring patients if indicated to high care levelObesity care team should be formed in each central hospital and consists of endocrinologist, bariatric surgeon, nurse, dietician, sociologist, psychologist and anesthesiologist)The team is responsible for management cases referred from obesity clinics at general hospitalsTeam in hospitals could conduct training sessions for health professionals caring for obesity at PHCC/FP settings.
Roles of Academia, Reseaech Centers and Societies
In Saudi Arabia, there are many societies and academic institute such as Saudi Arabian society of Metabolic and Bariatric surgery, Hypertension Society, Diabetes Society, Obesity Chair at King Saud University and Non-communicable Diseases Department in Ministry of Health. At university level, there are more than 30 medical and paramedical colleges all over KSA.  These organization can play vital roles in management of obesity through development of health professionals caring for obesity. The following roles could be played by these institutions/organization:
Releasing up-to-date clinical guidelines for management of obesityConducting training course for developing different health professionals in order to enable them to manage obesity at all health care levelsReleasing patient health information booklets/pamphlets to educate the community about obesityConduct and support research in the field of obesityPublish journals and magazine in the field of obesityEstablish national standards at all levels regarding (structures/processes and outcomes of obesity)Conduct and supervise scientific meetings/forums and symposium on obesityEstablish postgraduate studies in the field of obesity and bariatric surgeryGraduate some specialists who can contribute in prevention and management obesity such as health educators, nutritionist and medical psychologist.
ROLES OF OTHER SECTORS
Prevention and management of overweight and obesity is not merely the responsibility of the above mentioned sectors. Many other sectors could play vital roles in this regard.
Ministry of trade and industry
Ministry of trade and industry are responsible for importing and supervising the manufacture foods/drinks in Saudi Arabia. Those authorities should ensure that all food items are safe for human use and each item of food should have labels indicating its contents of calories/fat/protein.
Ministry of information
Ministry of information (MOI) can play its roles through its different agencies and media such as Radio/TV/journals which can give health education programs in collaboration with scientific societies. MOI, should restrict advertising and propaganda directed at young people concerning unhealthy dietary habits and behaviors (drinking Cola, Intake different sweeteners and fast foods).
Ministry of Islamic affairs endowments, call and guidance
In Saudi Arabia, There are thousands of mosques (Masjid) in which millions of people preforms their five prayers daily and Jumaa Prayer weekly. At these holy places short talks about obesity by health professional could be conducted frequently in coordination with Islamic Affairs in all regions particularly during major national/international health events and during Hajj and Omra seasons.
ROLES OF GENERAL PRESIDENCY OF YOUTH WELFARE
In Saudi Arabia, General Presidency of Youth Welfare is responsible for youth sector all over the country. Under this umbrella, there are more than 155 sport clubs in different regions of KSA with many and different games including football, volleyball, basketball, tennis hand ball and others. Through these clubs, thousands of young individuals participate in different competitive games in order to win medals and cups. However, the contributions of these sport settings for the benefits of community is very limited as most of these settings are in the big cities, restricted to be utilized by young and registered people which limit their use by most of the people living in remote areas and small cities. These settings could be utilized efficiently by public if expanded to cover all cities, governorates, big villages and towns, districts in addition to providing all facilities to enable all age groups, both genders to practice their favorite sport which can help them to have healthy life styles and may lead to acceptable body weight and low prevalence of obesity.
ROLE OF PRIVATE SECTORS
Private health sectors can contribute significantly in prevention and treatment of obesity not only by producing drugs and materials used in bariatric surgery but by other means such as sponsorship of academic activities in addition to financial funding of producing health education materials and research.
Other activities include supporting journals and making free subscriptions for institutes and health professionals caring for obesity. Private commercial sector can also contribute by allocating some place in malls/supermarkets for scientific activities such as exhibitions, educational session during national and international health events particularly "World Day of Obesity."
Obesity in KSA is a major health problem with serious complications. The long term solutions should concentrate on control and prevention rather than treatment and cure.
Integrated approach might be the only sustainable solution. As highlighted in this paper, integrated effort from all sectors, individuals and professionals should be united in one national program to implement the practical solutions. In order to make the national program more effective, it should practical, community and evidence based.
|1||Al-Nozha MM, Al-Mazrou YY, Al-Maatouq MA, Arafah MR, Khalil MZ, Khan NB, et al. Obesity in Saudi Arabia. Saudi Med J 2005;26:824-9.|
|2||Al-Othaimeen AI, Al-Nozha M, Osman AK. Obesity: An emerging problem in Saudi Arabia. Analysis of data from the National Nutrition Survey. East Mediterr Health J 2007;13:441-8.|
|3||Al-Malki JS, Al-Jaser MH, Warsy AS. Overweight and obesity in Saudi females of childbearing age. Int J Obes Relat Metab Disord 2003;27:134-9.|
|4||El Mouzan MI, Al Herbish AS, Al Salloum AA, Al Omar AA, Qurachi MM. Regional variation in prevalence of overweight and obesity in Saudi children and adolescents. Saudi J Gastroenterol 2012;18:129-32.|
|5||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.|
|6||El Mouzan MI, Foster PJ, Al Herbish AS, Al Salloum AA, Al Omer AA, Qurachi MM, et al. Prevalence of overweight and obesity in Saudi children and adolescents. Ann Saudi Med 2010;30:203-8.|
|7||Mahfouz AA, Shatoor AS, Khan MY, Daffalla AA, Mostafa OA, Hassanein MA. Nutrition, physical activity, and gender risks for adolescent obesity in Southwestern Saudi Arabia. Saudi J Gastroenterol 2011;17:318-22.|
|8||Al-Rethaiaa AS, Fahmy AE, Al-Shwaiyat NM. Obesity and eating habits among college students in Saudi Arabia: A cross sectional study. Nutr J 2010;9:39.|
|9||Amin TT, Al-Sultan AI, Ali A. Overweight and obesity and their relation to dietary habits and socio-demographic characteristics among male primary school children in Al-Hassa, Kingdom of Saudi Arabia. Eur J Nutr 2008;47:310-8.|
|10||Al Qauhiz NM. Obesity among Saudi female university students: Dietary habits and health behaviors. J Egypt Public Health Assoc 2010;85:45-59.|
|11||Al-Hazzaa HM. Rising trends in BMI of Saudi adolescents: Evidence from three national cross sectional studies. Asia Pac J Clin Nutr 2007;16:462-6.|
|12||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.|
|13||Gortmaker SL, Swinburn BA, Levy D, Carter R, Mabry PL, Finegood DT, et al. Changing the future of obesity: Science, policy, and action. Lancet 2011;378:838-47.|
|14||Guh DP, Zhang W, Bansback N, Amarsi Z, Birmingham CL, Anis AH. The incidence of co-morbidities related to obesity and overweight: A systematic review and meta-analysis. BMC Public Health 2009;9:88.|
|15||Scottish Intercollegiate Guidelines Network (SIGN). Management of Obesity National Clinical Guideline. http://www.sign.ac.uk/2010. p. 12-3.|
|16||Al-Gelban KS, Al-Khaldi YM, Diab MM. Family Medicine: A Practical Approach. 2 nd ed. traford puplisher Trafford Publisher; 2006. p. 10-3.|
|17||Khoja TA, Farid SM, Al-Ansari L, Al-Hamdan N, Al-Bader A, Abdel-Rahim I, et al. Saudi Arabia Family Health Survey. Riyadh: Ministry of Health Saudi Arabia; 1996. p. 15.|
|18||Amin TT, Suleman W, Ali A, Gamal A, Al Wehedy A. Pattern, prevalence, and perceived personal barriers toward physical activity among adult Saudis in Al-Hassa, KSA. J Phys Act Health 2011;8:775-84.|
|19||Al-Nozha MM, Al-Hazzaa HM, Arafah MR, Al-Khadra A, Al-Mazrou YY, Al-Maatouq MA, et al. Prevalence of physical activity and inactivity among Saudis aged 30-70 years. A population-based cross-sectional study. Saudi Med J 2007;28:559-68.|
|20||Waters E, de Silva-Sanigorski A, Hall BJ, Brown T, Campbell KJ, Gao Y, et al. Interventions for preventing obesity in children. Cochrane Database Syst Rev 2011;CD001871.|
|21||Ministry of Health. Health Statistical Year Book. Kingdom of Saudi Arabia: Ministry of Health; 2010. p. 124-264.|