ORIGINAL ARTICLE

Year : 2018  |  Volume : 6  |  Issue : 2  |  Page : 49-52

Riyadh Obesity Forum Proceedings (December 1–2, 2018), Day 1 Theme: Magnitude of the problem and interventions to prevent and control obesity

Mohammed Alnaami¹, Khalid Alrubeaan², Ayoub Aljawaldeh³, Fahad Bamehriz⁴, Ahmed Alghamdi⁵, Abdulaziz Al Othman⁶, Meshal Al Aqeel⁷, Hazzaa Alhazzaa⁸, Khalid Al Omari⁹, Nasreen Alfaris¹⁰, Adnan Mofti^11
1 Chairperson − Scientific and Organizing Committee − SASMBS, Kingdom of Saudi Arabia
² Head of Academic Affairs and Research Center − SBAHC, and Former Director − Diabetic Center KSU
³ WHO Regional Nutrition Advisor
⁴ Director of Minimally Invasive Surgery Fellowship Program − KSU
⁵ National Leader of the Optional Health Care System
⁶ President of the Saudi Society for Clinical Nutrition
⁷ Consultant Psychiatrist and Psychotherapist (KSAU-HS)
⁸ Head, Lifestyle and Health Research Center − PNU
⁹ General Supervisor of Obesity and Endocrinology Program − KFMC
¹⁰ Director of the Fellowship Program for Obesity Medicine − KFMC
¹¹ President − SASMBS

Correspondence Address:
Prof. Mohammed Alnaami
The Saudi Commission for Health Specialties (SCFHS) 6591 Samahah Street – Al Safarat District, Riyadh 12511-3158
Kingdom of Saudi Arabia

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/2347-2618.331872

Forum aims and objectives − Mohammed Alnaami

1. developing opportunity to experience the best public health practices globally
2. empowering the Kingdom of Saudi Arabia (KSA) health professionals to collaborate, innovate and help shape the future of KSA public health landscape
3. creating the largest platform in the KSA for innovative ideas and approaches to prevention and proper management practices, policies, and research that encourage further collaborations across multiple sectors and professions (Health in All Policies)
4. inspiring setting to start new research, strategies, best practices, and innovation
5. interactive networking and knowledge exchange forum at the KSA, GCC, Regional, Arab, and International level to identify, discuss, and troubleshoot current public health issues across a range of disciplines and sectors for integrated comprehensive care of obesity
6. supporting and nurturing the next generation of healthcare leaders;
7. engaging global and diverse voices, ideas, vision, initiatives, and actions toward combating obesity;
8. Strengthen and transform the global effort to combat obesity and influence decision-making at national level; and
9. building multidisciplinary networks to promote a national public health activity within the frame of 2030 KSA vision.

1. identify challenges and related solutions, trends, emerging issues, and gaps;
2. explore the current status of obesity prevention and management evidence, research, policy, and practice;
3. effective evidence-based education programs and health-promotion practices;
4. evaluate strategies for knowledge and skill translation; and
5. develop and access a network of colleagues and partners for initiating or expanding obesity prevention and management initiatives.

1. Establish a national obesity control committee "Experts’ Panel" within the structure of the National Center for Disease Prevention and Control that is interprofessional, authorized, and independent, with the following responsibilities:
   1. Lead and administer the project with bylaws
   2. Set the components and resources of the obesity prevention and control system
   3. Collect and study available data and research in obesity prevention and control
   4. Setting standards, policies, guidelines, best practices, interventions, and programs that
   5. promote the vision of the project
   6. Preparation and implementation of national strategies in this field
   7. Develop programs for continuous education and training for relevant professions and other stakeholders
   8. Monitoring and evaluating the system as a whole
   9. Establish international networking and disseminate successful experiences and research in this field
2. Build healthy environment and implement collaborative interprofessional anti-obesity programs
3. Develop assessment methods and tools, establish adequate measurements criteria, and make use of assessment and monitoring results for further improvement
4. Use media, schools and universities, primary healthcare and community centers as conduits for dissemination of research and successful results in this field
5. Increase availability of healthy food and pure water, decrease consumption of sugars and saturated fat in the community, and promote physical activity throughout life
6. Provide state-of-the-art health care for overweight and obese individuals from primary care centers, through tertiary care facilities, to highly specialized bariatric centers
7. Participate in national and international campaigns and programs

Obesity and diabetes epidemic in Saudi Arabia − Khalid Alrubeaan

1. Alert policy makers in Saudi Arabia to consider the implementation of preventive lifestyle interventions that include weight control programs
2. For preventing metabolic syndrome, policy makers should consider the promotion of a healthy diet and physical activity in the planning of future healthcare strategies in Saudi Arabia

Proposed priority areas of action and suggested interventions to prevent obesity − Ayoub Aljawaldeh

1. Saudi Food and Drug Authority engaged in implementation of the healthy food strategy to promote public health by reducing food content of sugar, salt, saturated, and trans-fat. They signed a pledge with nine global companies to reduce sugar, salt, and fat in their products. Other national companies started to follow.
2. Nutrition information to consumers, including implementing fact-based nutrition labeling and promoting healthy diets and lifestyles, were implemented. Big efforts by Ministry of Health for Public awareness of front of pack labeling.
3. Launched “Calories Display Regulation” in menus of restaurants, bakeries, cafeterias, ice-cream stores, fresh fruit stores, coffee and sweet shops to be mandatory by January 1, 2019.
4. Menus will be inspected by Ministry of Municipal and Rural Affairs (MOMRA).
5. Issued a Regulation to eliminate Trans-Fats: Code No (GSO 2483), which should not exceed 2% and 5% of total fat as follows: 2% in oil and fat products such as margarine and 5% in the fat component in other food products.
6. Review the regulation Code No (GSO 2362/2014) for salt in bread which stated that salt should not exceed 1.8% by dry weight. A draft regulation Code No (GSO 05 FDS 5008/2017) to regulate salt in bread and cereal products from Emirates Authority for Standardization and Metrology (ESMA). Salt limits in bread in the UAE to 0.5 g.
7. Fact-based nutrition: Public awareness of community was created through provision of sufficient nutrition information. Traffic light labeling was suggested for all food products.
8. Sin Taxes sugar sweetened beverages and soft drinks: Two tax excise by General Authority for zakat (GAZT): A tax rate of (50%) for soft-drink beverages. A tax rate of 100% for energy drinks.
9. National public awareness and motivational communication were implemented for physical activity, including mass media campaigns for physical activity behavioral change.
10. Saudi strategies on the prevention and management of obesity were developed. The Saudi guidelines on the prevention and management of obesity were prepared. Formal and on the job training were organized to build staff capacity. More than 175 scientific lectures and workshops for the health technicians and physicians were conducted on obesity management. Approximately, 5878 health practitioners participated in training activities.
11. Development and production of Information, Education, and Communication (IEC) materials: Around 300,000 health awareness content and 230 rollup were distributed at regions in KSA. Screening campaigns for obesity were conducted in public places 116 early detection and screening locations in 20 health regions. Around 36,731 visitors were screened and intensively educated on obesity and its related risk factors.
12. Health education materials were distributed to all participants. National surveys on obesity and risk factors were conducted HIS Couple researches in obesity under the topic were published (Knowledge and training needs of primary healthcare physicians regarding obesity management in Saudi Arabia). Ministries of Health and Education implemented initiative for obesity control project through School Development of a practical “Calories Guideline” to reduce weight (1200–2200 kcal).
13. TOT guideline training for practitioners at all regions in KSA Health Program for adopting
14. physical activities and active life style among students Rashaka.

Bariatric education and training − Fahad Bamehriz

1. Increase of obesity-related topics teaching in health professions undergraduate curricula
2. Expose residents (graduate health professions) to more obesity training and practice
3. Create more fellowship programs in the KSA to educate and train graduates in bariatric subspecialties, for example, surgery, medicine, psychology/psychiatry, nutrition, exercise, etc.
4. Provide more outreach programs to transfer experiences of bariatric surgery and other specialties from urban to less-urbanized and rural areas

How to build obesity care pathway: A future model − Ahmed Alghamdi

1. Establish wellness programs run and followed by the health institute (hospital/cluster) within the catchment area.
2. Pathway development
3. Privileging system (accreditation)
4. Establish the one stop clinic (OSC) to service as multidisciplinary approach
5. Establish and utilize in the service the following initiative:
   1. Step down and post discharge services
   2. Length of stay initiatives such as preoperative blood management protocol, pain management protocol, and enhance recovery after surgery (ERAS) protocol
6. Create bundled care management with known KPI and set of clinical outcome based on time from procedure performance and final desired results. The idea is toward accountable care system, starting with episode cost payment given in retrospective fashion. This payment is only given after clinical outcome of interest is achieved. For example, laparoscopic sleeve gastrectomy, after 1 year with 55% of excess weight reduction and no leakage or malabsorption complications.

Dieting and nutritional support for the management of obesity − Abdulaziz Al Othman

1. Establish policies guidelines and procedures that involving all aspects of medical management
2. Improve quality of prevention and management of obesity and enhance better life style including healthy nutrition and physical activities
3. Collaborate with other health societies and related professional to improve quality of services

Psychological evaluation and management in obesity − Meshal Al Aqeel

1. Recruit and train more bariatric psychiatrists/clinical psychologists
2. Involve clinical psychologist in the bariatric multidisciplinary team
3. Introduce more bariatric cognitive behavioral therapy (CBT) programs

Obesity, physical activity, and sedentary behaviors among Saudi Children and Adolescents: It is time for action − Hazzaa Alhazzaa

1. Promoting physical activity
2. Reducing sedentary behaviors
3. Improving sleep and dietary habits among Saudi youth population, especially more so among young females

Role of the multidisciplinary team (MDT) on obesity management − Khalid Al Omari

1. MDT to be mandatory for the following cases:
   1. Body mass index (BMI) more than 50
   2. Severe heart failure
   3. Uncontrol diabetes mellitus (DM)
   4. Type 1 DM and poor control status with frequent diabetic ketoacidosis (DKA)
   5. Uncertain type of DM
   6. Patient requiring wheelchair or any aids due to shortness of breathing (SOB)
   7. Mood disorders like severe depression or patients with substances abuse
   8. Severe gastroesophageal reflux disease (GERD) with Barrett disease
   9. Severe renal impairment with glomerular filtration rate (GFR) less than 30
   10. Chronic liver disease with portal hypertension (HTN)
   11. Patient with frequent thromboembolic disorders or at a risk of bleeding
   12. All revisional surgeries
2. MDT should be held regularly
3. MDT members should include: medical, surgical, psychologist and/or psychiatrist, nutritionist, anesthesiologist

Advances in the medical management of obesity and its complications − Nasreen Al-Faris

1. To include metabolic surgery as a treatment for T2DM in patients with a BMI of 35 and above; and to consider metabolic surgery as a treatment for patients with T2DM who cannot achieve adequate glycemic control despite of being on antidiabetes drugs with a BMI 30–35.
2. To make more pharmacotherapy for obesity available in the country; and to take the initiative to make pharmacotherapy available through government initiatives rather than depending on industry to make these important interventions available.
3. To support the mandate of inclusion of obesity education at all levels: medical school, residency, and fellowship training.

Update on surgical management of obesity − Adnan Mofti

1. At present time, bariatric surgery remains the only effective method to treat morbid obesity and its comorbidities on relatively a reasonable save and cost-effective out comes. However, the available facilities of bariatric and metabolic surgeries can only accommodate 1% to 2% of the burden of the morbid obesity and its comorbidities.
2. It is of paramount importance to focus the efforts and resources to prevent obesity to start with to reduce its ever-increasing prevalence.
3. Encouragement and enforcement of life style changes and practices among the communities from infancy to advanced age toward health life.