The global obesity epidemic, fueled by lifestyle changes and declining physical activity, is a significant public health challenge. In Saudi Arabia, obesity rates are among the highest worldwide, with projections indicating a prevalence of 57% in adults and 38% in children by 2035. Obesity poses significant health risks, including diabetes, cardiovascular diseases, and Metabolic dysfunction-associated steatotic liver disease, and imposes a substantial economic burden, with direct and indirect costs exceeding $19 billion annually. Timely intervention is crucial. The updated Saudi Guidelines for Obesity prioritize early diagnosis and management, emphasizing behaviour modifications, education, and the adoption of evidence-based pharmacologic and surgical options. Notable advancements in pharmacotherapy, such as GLP-1 receptor agonists like semaglutide, offer a ray of hope. They have been shown to not only reduce cardiovascular risk but also potentially benefit renal disease, halt the progression of MASLD, and improve mechanical complications related to obesity, particularly knee osteoarthritis, as well as numerous benefits beyond weight loss. The guidelines advocate for a multifaceted approach that incorporates public awareness campaigns, family-centered interventions, and advanced therapeutic strategies to mitigate the health and economic impacts of obesity. These comprehensive updates aim to improve population health and reduce obesity-related complications in Saudi Arabia.
Alsulami, S., Baig, M., Ahmad, T., Althagafi, N., Hazzazi, E., Alsayed, R., et al. (2023) Obesity Prevalence, Physical Activity, and Dietary Practices among Adults in Saudi Arabia. Frontiers in Public Health , 11, Article 1124051. https://doi.org/10.3389/fpubh.2023.1124051
WHO (2024) Obesity and Overweight. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
World Obesity Federation Global Obesity Observatory (2024) World Obesity Day Atlases | Obesity Atlas 2024. https://data.worldobesity.org/publications/?cat=22
Okati-Aliabad, H., Ansari-Moghaddam, A., Kargar, S. and Jabbari, N. (2022) Prevalence of Obesity and Overweight among Adults in the Middle East Countries from 2000 to 2020: A Systematic Review and Meta-Analysis. Journal of Obesity , 2022, Article ID: 8074837. https://doi.org/10.1155/2022/8074837
World Obesity Federation (2024) World Obesity Atlas 2023. https://www.worldobesity.org/resources/resource-library/world-obesity-atlas-2023
Al-Jawaldeh, A. and Abbass, M.M.S. (2022) Unhealthy Dietary Habits and Obesity: The Major Risk Factors Beyond Non-Communicable Diseases in the Eastern Mediterranean Region. Frontiers in Nutrition , 9, Article 817808. https://doi.org/10.3389/fnut.2022.817808
Lin, X. and Li, H. (2021) Obesity: Epidemiology, Pathophysiology, and Therapeutics. Frontiers in Endocrinology , 12, Article 706978. https://doi.org/10.3389/fendo.2021.706978
Alshaikh, A., et al. (2024) Clinical Practice Guideline for the Management of Overweight and Obesity in Adults in Saudi Arabia. International Journal of Clinical Medicine , 13, 590-649. https://www.scirp.org/journal/paperinformation?paperid=121881
Malkin, J.D., Baid, D., Alsukait, R.F., Alghaith, T., Alluhidan, M., Alabdulkarim, H., et al. (2022) The Economic Burden of Overweight and Obesity in Saudi Arabia. PLOS ONE , 17, e0264993. https://doi.org/10.1371/journal.pone.0264993
Hampl, S.E., Hassink, S.G., Skinner, A.C., Armstrong, S.C., Barlow, S.E., Bolling, C.F., et al. (2023) Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents with Obesity. Pediatrics , 151, e2022060640. https://doi.org/10.1542/peds.2022-060640
Ek, A., Brissman, M., Nordin, K., Eli, K. and Nowicka, P. (2023) A Long-Term Follow-Up of Treatment for Young Children with Obesity: A Randomized Controlled Trial. International Journal of Obesity , 47, 1152-1160. https://doi.org/10.1038/s41366-023-01373-7
Narzisi, K. and Simons, J. (2020) Interventions That Prevent or Reduce Obesity in Children from Birth to Five Years of Age: A Systematic Review. Journal of Child Health Care , 25, 320-334. https://doi.org/10.1177/1367493520917863
Iacobellis, G. (2022) Epicardial Adipose Tissue in Contemporary Cardiology. Nature Reviews Cardiology , 19, 593-606. https://doi.org/10.1038/s41569-022-00679-9
Shah, R.V., Anderson, A., Ding, J., Budoff, M., Rider, O., Petersen, S.E., et al. (2017) Pericardial, but Not Hepatic, Fat by CT Is Associated with CV Outcomes and Structure: The Multi-Ethnic Study of Atherosclerosis. JACC : Cardiovascular Imaging , 10, 1016-1027. https://doi.org/10.1016/j.jcmg.2016.10.024
Antoniades, C., Tousoulis, D., Vavlukis, M., Fleming, I., Duncker, D.J., Eringa, E., et al. (2023) Perivascular Adipose Tissue as a Source of Therapeutic Targets and Clinical Biomarkers. European Heart Journal , 44, 3827-3844. https://doi.org/10.1093/eurheartj/ehad484
Oikonomou, E.K., et al. (2021) Standardized Measurement of Coronary Inflammation Using Cardiovascular Computed Tomography: Integration in Clinical Care as a Prognostic Medical Device. Cardiovascular Research , 117, 2677-2690. https://pubmed.ncbi.nlm.nih.gov/34450625/
Oikonomou, E.K., Marwan, M., Desai, M.Y., Mancio, J., Alashi, A., Hutt Centeno, E., et al. (2018) Non-Invasive Detection of Coronary Inflammation Using Computed Tomography and Prediction of Residual Cardiovascular Risk (the CRISP CT Study): A Post-Hoc Analysis of Prospective Outcome Data. The Lancet , 392, 929-939. https://doi.org/10.1016/s0140-6736(18)31114-0
Koskinas, K.C., Van Craenenbroeck, E.M., Antoniades, C., Blüher, M., Gorter, T.M., Hanssen, H., et al. (2024) Obesity and Cardiovascular Disease: An ESC Clinical Consensus Statement. European Heart Journal , 45, 4063-4098.
Marso, S.P., et al. (2016) Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes. The New England Journal of Medicine , 375, 311-322. https://pubmed.ncbi.nlm.nih.gov/27295427/
Marso, S.P., Bain, S.C., Consoli, A., Eliaschewitz, F.G., Jódar, E., Leiter, L.A., et al. (2016) Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. New England Journal of Medicine , 375, 1834-1844. https://doi.org/10.1056/nejmoa1607141
Lincoff, A.M., Brown-Frandsen, K., Colhoun, H.M., Deanfield, J., Emerson, S.S., Esbjerg, S., et al. (2023) Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes. New England Journal of Medicine , 389, 2221-2232. https://doi.org/10.1056/nejmoa2307563
Knop, F.K., Aroda, V.R., do Vale, R.D., Holst-Hansen, T., Laursen, P.N., Rosenstock, J., et al. (2023) Oral Semaglutide 50 mg Taken Once per Day in Adults with Overweight or Obesity (OASIS 1): A Randomised, Double-Blind, Placebo-Controlled, Phase 3 Trial. The Lancet , 402, 705-719. https://doi.org/10.1016/s0140-6736(23)01185-6
Frías, J.P., Davies, M.J., Rosenstock, J., Pérez Manghi, F.C., Fernández Landó, L., Bergman, B.K., et al. (2021) Tirzepatide versus Semaglutide Once Weekly in Patients with Type 2 Diabetes. New England Journal of Medicine , 385, 503-515. https://doi.org/10.1056/nejmoa2107519
(2022) A Phase 3, Randomized, Double-blind, Placebo-Controlled Study to Investigate the Effect of Tirzepatide on the Reduction of Morbidity and Mortality in Adults with Obesity. https://clinicaltrials.gov/study/NCT05556512
Marx, N., Federici, M., Schütt, K., Müller-Wieland, D., Ajjan, R.A., Antunes, M.J., et al. (2023) 2023 ESC Guidelines for the Management of Cardiovascular Disease in Patients with Diabetes. European Heart Journal , 44, 4043-4140.
Vrints, C., Andreotti, F., Koskinas, K.C., Rossello, X., Adamo, M., Ainslie, J., et al. (2024) 2024 ESC Guidelines for the Management of Chronic Coronary Syndromes: Developed by the Task Force for the Management of Chronic Coronary Syndromes of the European Society of Cardiology (ESC) Endorsed by the European Association for Cardio-Thoracic Surgery (EACTS). European Heart Journal , 45, 3415-3537. https://doi.org/10.1093/eurheartj/ehae177
Alswat, K., Aljumah, A.A., Sanai, F.M., Abaalkhail, F., Alghamdi, M., Al Hamoudi, W.K., et al. (2018) Nonalcoholic Fatty Liver Disease Burden—Saudi Arabia and United Arab Emirates, 2017-2030. Saudi Journal of Gastroenterology , 24, 211-219. https://doi.org/10.4103/sjg.sjg_122_18
Alqahtani, S.A., Broering, D.C., Alghamdi, S.A., Bzeizi, K.I., Alhusseini, N., Alabbad, S.I., et al. (2021) Changing Trends in Liver Transplantation Indications in Saudi Arabia: From Hepatitis C Virus Infection to Nonalcoholic Fatty Liver Disease. BMC Gastroenterology , 21, Article No. 245. https://doi.org/10.1186/s12876-021-01828-z
Polyzos, S.A., Goulis, D.G., Giouleme, O., Germanidis, G.S. and Goulas, A. (2022) Anti-obesity Medications for the Management of Nonalcoholic Fatty Liver Disease. Current Obesity Reports , 11, 166-179. https://doi.org/10.1007/s13679-022-00474-0
Nevola, R., Epifani, R., Imbriani, S., Tortorella, G., Aprea, C., Galiero, R., et al. (2023) GLP-1 Receptor Agonists in Non-Alcoholic Fatty Liver Disease: Current Evidence and Future Perspectives. International Journal of Molecular Sciences , 24, Article 1703. https://doi.org/10.3390/ijms24021703
Zelber-Sagi, S. and Moore, J.B. (2024) Practical Lifestyle Management of Nonalcoholic Fatty Liver Disease for Busy Clinicians. Diabetes Spectrum , 37, 39-47. https://doi.org/10.2337/dsi23-0009
Newsome, P.N., Sanyal, A.J., Engebretsen, K.A., Kliers, I., Østergaard, L., Vanni, D., et al. (2024) Semaglutide 2.4 mg in Participants with Metabolic Dysfunction-Associated Steatohepatitis: Baseline Characteristics and Design of the Phase 3 Essence Trial. Alimentary Pharmacology & Therapeutics , 60, 1525-1533. https://doi.org/10.1111/apt.18331
Newsome, S.A., Kliers, I., et al. (2024) Phase 3 ESSENCE Trial: Semaglutide in Meta-Bolic Dysfunction-Associated Steatohepatitis (MASH). Presented at the Liver Meeting®, American Association for the Study of Liver Diseases. https://www.prnewswire.com/news-releases/essence-phase-3-trial-results-demonstrating-statistically-significant-and-superior-improvements-with-semaglutide-2-4-mg-in-people-with-mash-presented-at-aasld-2024--the-liver-meeting-302310474.html
Karjoo, S., Auriemma, A., Fraker, T. and Bays, H.E. (2022) Nonalcoholic Fatty Liver Disease and Obesity: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2022. Obesity Pillars , 3, Article ID: 100027. https://doi.org/10.1016/j.obpill.2022.100027
Dandgey, S. and Patten, E. (2023) Psychological Considerations for the Holistic Management of Obesity. Clinical Medicine , 23, 318-322. https://doi.org/10.7861/clinmed.2023-0146
Al Nasser, K.A., Alsaffar, Y.K. and Al Hazmi, A.N. (2024) Correlation between Obesity and Mental Health Status in Riyadh, Saudi Arabia. Cureus , 16, e53976.
Castelnuovo, G., Pietrabissa, G., Manzoni, G.M., Cattivelli, R., Rossi, A., Novelli, M., et al. (2017) Cognitive Behavioral Therapy to Aid Weight Loss in Obese Patients: Current Perspectives. Psychology Research and Behavior Management , 10, 165-173. https://doi.org/10.2147/prbm.s113278
Alshaikh, A., Aljedai, A., Alfadda, A., Alrobayan, A., Bawahab, A., Ouf, S.A., et al. (2022) Clinical Practice Guideline for the Management of Overweight and Obesity in Adults in Saudi Arabia. International Journal of Clinical Medicine , 13, 590-649. https://doi.org/10.4236/ijcm.2022.1312045
Cornier, M.A. (2022) A Review of Current Guidelines for the Treatment of Obesity. https://www.ajmc.com/view/review-of-current-guidelines-for-the-treatment-of-obesity
Alhabeeb, W., Kinsara, A.J., Bakhsh, A., Tash, A., Alshammary, A., Almasood, A., et al. (2024) A Saudi Heart Association Position Statement on Obesity and Cardiovascular Disease. Journal of the Saudi Heart Association , 36, 263-300. https://doi.org/10.37616/2212-5043.1391
Aronne, L.J., Sattar, N., Horn, D.B., Bays, H.E., Wharton, S., Lin, W.Y., et al. (2024) Continued Treatment with Tirzepatide for Maintenance of Weight Reduction in Adults with Obesity: The Surmount-4 Randomized Clinical Trial. JAMA , 331, 38-48.
Wadden, T.A., Chao, A.M., Machineni, S., Kushner, R., Ard, J., Srivastava, G., et al. (2023) Tirzepatide after Intensive Lifestyle Intervention in Adults with Overweight or Obesity: The SURMOUNT-3 Phase 3 Trial. Nature Medicine , 29, 2909-2918. https://doi.org/10.1038/s41591-023-02597-w
Garvey, W.T., Frias, J.P., Jastreboff, A.M., Le Roux, C.W., Sattar, N., Aizenberg, D., et al. (2023) Tirzepatide Once Weekly for the Treatment of Obesity in People with Type 2 Diabetes (SURMOUNT-2): A Double-Blind, Randomised, Multi-Centre, Placebo-Controlled, Phase 3 Trial. Lancet , 402, 613-626.
Alsheikh, A., Alshehri, A., Alzahrani, S., Jammah, A.A., Alqahtani, F., Alotaibi, M., et al. (2023) Evaluating the Clinical Effectiveness and Safety of Semaglutide in Individuals with Uncontrolled Type 2 Diabetes. Real-World Evidence from Saudi Arabia: The Observational, Multicenter, 15-Month EVOLUTION Study. Diabetes Therapy , 15, 473-485. https://doi.org/10.1007/s13300-023-01516-z
Alsheikh, A., Alshehri, A., Alzahrani, S., AlJammah, A., Alqahtani, F., Alotaibi, M., et al. (2024) Oral Semaglutide Effectiveness and Safety in Real World Practice; the Revolution Study. Diabetes Epidemiology and Management , 14, Article ID: 100209. https://doi.org/10.1016/j.deman.2024.100209
Alshehri, A., AlFaris, N., Al Qahtani, A.M., Shams, M. and Yahia, M. (2023) Clinical Effectiveness of Liraglutide 3.0 Mg and Impact of Weight Loss in Improving Obesity‐related Comorbid Conditions in King Fahad Medical City, Kingdom of Saudi Arabia: A Real-World Experience. Clinical Obesity , 13, e12594. https://doi.org/10.1111/cob.12594
Lim, R., Beekley, A., Johnson, D.C. and Davis, K.A. (2018) Early and Late Complications of Bariatric Operation. Trauma Surgery & Acute Care Open , 3, e000219. https://doi.org/10.1136/tsaco-2018-000219
Ding, L., Fan, Y., Li, H., Zhang, Y., Qi, D., Tang, S., et al. (2020) Comparative Effectiveness of Bariatric Surgeries in Patients with Obesity and Type 2 Diabetes Mellitus: A Network Meta-Analysis of Randomized Controlled Trials. Obesity Reviews , 21, e13030. https://doi.org/10.1111/obr.13030
Roomy, M.A., Hussain, K., Behbehani, H.M., Abu-Farha, J., Al-Harris, R., Ambi, A.M., et al. (2024) Therapeutic Advances in Obesity Management: An Overview of the Therapeutic Interventions. Frontiers in Endocrinology , 15, Article 1364503. https://doi.org/10.3389/fendo.2024.1364503
American Society for Metabolic and Bariatric Surgery (2019) ASMBS Endorsed Procedures and FDA Approved Devices. https://asmbs.org/resources/endorsed-procedures-and-devices/
Mechanick, J.I., Apovian, C., Brethauer, S., Garvey, W.T., Joffe, A.M., Kim, J., et al. (2019) Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures—2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, the Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists. Endocrine Practice , 25, 1-75. https://doi.org/10.4158/gl-2019-0406
AlEnazi, S., AlAjlan, R., AlKhalaf, H., Abolfotouh, M., Alharbi, O., Alfawaz, R., et al. (2023) Prevalence of Obesity among Children and Adolescents in Saudi Arabia: A Multicenter Population-Based Study. Saudi Journal of Medicine & Medical Sciences , 11, 19-25. https://doi.org/10.4103/sjmms.sjmms_417_22
AlQurashi, A.A., Kusuma, D., AlJishi, H., AlFaiz, A. and AlSaad, A. (2021) Density of Fast Food Outlets around Educational Facilities in Riyadh, Saudi Arabia: Geospatial Analysis. International Journal of Environmental Research and Public Health , 18, Article 6502. https://doi.org/10.3390/ijerph18126502
Syed, N.K., Syed, M.H., Meraya, A.M., Albarraq, A.A., Al-kasim, M.A., Alqahtani, S., et al. (2020) The Association of Dietary Behaviors and Practices with Overweight and Obesity Parameters among Saudi University Students. PLOS ONE , 15, e0238458. https://doi.org/10.1371/journal.pone.0238458
Alghadir, A.H., Gabr, S.A. and Iqbal, Z.A. (2015) Television Watching, Diet and Body Mass Index of School Children in Saudi Arabia. Pediatrics International , 58, 290-294. https://doi.org/10.1111/ped.12834