In the Kingdom of Saudi Arabia (KSA), obesity (defined as body mass index (BMI) of ≥30 kg/m2) and overweight (defined as BMI of 25-29.9 kg/m2) represent an alarming threat for population health based on their high prevalence.

Both genders are affected, with some differences existing, where obesity is more prevalent among females, while overweight is higher among males.

The high prevalence is a real concern; especially since obesity and overweight are well known risk factors for several life-threatening conditions including type 2 diabetes, coronary artery disease, hypertension, and certain cancers, in addition to impaired quality of life.

Obesity and its comorbidities are multifactorial (including genetic, environmental, psychological, social, and cultural factors), requiring multiple approaches to population management in various settings with input from a range of stakeholders.

 To promote healthy lifestyle in the community and decreasing the number of overweight and obese patients in the whole region of Al Qassim by following these objectives:

1.           Screening for all overweight and obese patients in the different communities in Al Qassim Region.
2.           Promote awareness about obesity and its complications.
3.           Promote awareness about social and psychological issues related to obesity.
4.           Reduce the burden of obesity on all health care services.
5.           Reduce the family and community’s financial burdens of treating obesity complication.
6.           Provide an access to the dietary and physiotherapy services for all obese patients.
7.          Design a standard pathway of Obesity PHC Managements and proper referral system to secondary and Tertiary Managements such as Health Coaching, Aggressive Medical Management and Surgical Managements (e.g. Bariatrics).

1. Patients or population are categorized depending on their BMI into levels.

Patient Segmentation:( Target Population)

2. With the following segmentation: 

Level 0

• Patient level 0 obesity Visit Primary care facilities for health education (By a Health Coach or Medically inclined staff).
• The patient will be discharged when he/she remains within target (BMI less than  25) for at least 6 months.

Level 1

•  Patient level 1 obesity Visit Primary care facilities for health education by health coach or medical staff If the patient didn’t achieve the goal:
•  Patient who did not achieve at least 5% percent reduction in weight within 6 months, they will be refer to Essential plus services.
•  If a patient reached target BMI <25 and has comorbidities, they will refer back to Primary Health Care.

Level 2

• Patient level 2 obesity: Patient will refer to secondary care/Essential plus services (Obesity clinic).       
•  If  the patient failed to achieve the goal (Patient who did not achieve at least 5% reduction in weight within 6 months), Physicians refer to Secondary or Tertiary facilities for bariatric surgery.

Level 3

• Patient level 3 Morbid obesity. Patients are recommended to visit specialized centers for possible bariatric surgery according to medical assessments and plan for managements.
• The BMI 25-29.9 overweight (with or without comorbidities)
• Patients should be seen in PHC center for lifestyle modifications.
• Failure of lifestyle modification 4-6 months or BMI ≥ 30, Refer to obesity clinic.
• The BMI from 30-39.9 obesity class 1 & 2 (with or without complications), Patient will be refer to obesity clinic.
• Screening & Assessment for any patient with BMI >40 with or without complications/comorbidities
•  Patients should be counselled for bariatric surgery at the level of PHC center by family medicine consultant (TBC).
•  If the patient accepts to undergo for Bariatric surgery, He/She will be refer immediately to Bariatric surgery. 
•  If patient refused the surgery, Patient will be refer to obesity clinic.

1) subjective assessments
By :

A. History taking and assessing the readiness of the patient 
B.focus on getting the patient past history of chronic diseases and any previous attempts for weight loss interventions 
C.the patient family history for obesity 
D.history of using any medications  
E.Surgical history 
F.psychological and social history 

2)Objective assessment 
By:
Clinical examination and labs investigation

Obesity Therapy-Al Qassim HealthCare Delivery

   Pharmacologic Treatment Picture  

 Consider bariatric surgery:

• In adults with clinically morbid obesity (BMI ≥40 kg/m2). It is the most effective treatment; it leads to durable weight loss and improvement of comorbidities.
• In adults with BMI ≥35 kg/m2 with or without comorbidities.
• In adults with BMI ≥30 kg/m2 with or without comorbidities failed to achieve weight reduction on Anti-Obesity medications.

•            Psychiatric clinic, physiotherapy therapy clinic, endocrine clinic, sleep medicine clinic, Diabetes Clinic or dietary clinics.

• If the patient achieves weight loss by ≥ 5% after 6 months.
• If a patient did not achieve weight loss through weight loss medications by ≥5% after 3 months.
• If there are any safety or tolerability issues at any time.
• Then, alternative medication(s) or treatment approaches should be considered.
• If the Patients complete 2 years of follow up post bariatric surgery, then refer to Primary Health Care or Team Base Care.

•           To be seen initially by their family physician in PHC (TBC) for assessment and control any risk factors “comorbidities” before their surgery (DM, HTN, DLP, Asthma).

•        Should be seen in the Hospital for further follow up (obesity surgery clinic/internal medicine/DM clinic/endocrine clinic) for 2 years then follow up with obesity clinic if needed.

Link to obesity toolkit and policy