1. OBESITY

2. Dr. Rasmieh Alzeidan Cardiac Sciences Department
OBESITY
Dr. Rasmieh Alzeidan Cardiac Sciences Department

3. Outlines Definition of Obesity
Prevalence of obesity among Middle East and GCC countries
Prevalence of obesity in King Saud University employees and their families
Obesity indices

4. Definitions
Obesity is a multifactorial disease; genetic, metabolism environmental, and BehRFs.
WHO Defined the Obesity as : an excessive fat accumulation in the body, and simply obesity is an imbalance between energy intake (food) and energy expenditure (physical activity)

5. Introduction…..conted
Obesity is strongly associated with co-morbidity & mortality:
Diabetes
Coronary artery disease
Peripheral artery disease
Stroke
Hypertension
Hyperlipidemia
Arthritis
Obstructive sleep apnea
Pulmonary disease
PCOS/infertility
Dysmenorrhea
Pregnancy complications
Gallbladder disease
GERD
Skin infections
Urinary incontinence
Depression
Eating disorders
Social stigma
Some types of cancers
Increase in all causes mortality

6. Obesity indices (BMI) WC: 102cm (40in)M &88cm (34.5in) F WHR:
WHO classification
BMI (kg/m2)
Co-morbidity risk
Underweight
< 18.5
Low
Normal weight
Average
Overweight
Increased
Obese
Moderate
Morbid obese
>35
Sever to
Very sever
(BMI)
WC:
102cm (40in)M
&88cm (34.5in) F
WHR:
0.95 M& 0.88 F
WHtR:
0.5 (M&F)

7. Gulf Cooperation Council Countries (GCC)
Obesity trends among Arab Nations
Obesity %
Overweight %
Country
Female
Male 23 11 54 43
Morocco 67
Lebanon 46 77
Egypt
Jordan
Gulf Cooperation Council Countries (GCC) 26 19 57 58
Oman 44 30 73 70
Saudi Arabia 74 71
UAE 52 37 81 78
Kuwait
Black color means low prevalence of overweight and obesity and red is the highest and Saudi Arabia almost has the second highest level after Kuwait
data source :Global status report on non-communicable disease 2011

8. Obesity trends among Arab Nations
Black color means low prevalence of overweight and obesity and red is the highest and Saudi Arabia almost has the second highest level after Kuwait
data source :Global status report on non-communicable disease 2011

9. Obesity trends among Arab Nations
Black color means low prevalence of overweight and obesity and red is the highest and Saudi Arabia almost has the second highest level after Kuwait
data source :Global status report on non-communicable disease 2011

10. Obesity trends among Arab Nations con’t
KSA has been reported to have the second highest prevalence of overweight and obesity ranging from 35% - 60% after Kuwait (Musaiger, 2011).
A recent systematic review projects that by 2030 among populations of nine Middle Eastern countries (Bahrain, Egypt, Iran, Jordan, KSA, Kuwait, Lebanon, Oman, and Turkey), the Kuwaiti population is expected to have the highest prevalence of overweight and obesity (around 90%), followed by Saudis (80%) (Kilpi et al., 2013).

11. Methodology Cross-sectional survey using WHO STEPwise Q’aire
4500 participants (employees & their families), above 18years old and non-pregnant woman
Duration: between July 2013-June 2014

12. Methodology…..cont’d 1st phase: Screening for ClinRFs& BehRFs
Anthropometric Measurements( HT, WT, waist/ hip circumferences, & BP).
Biochemical tests (lipid profile, FBG, HBA1c)
Calculating CVR score using the Framingham scale to identify low risk <10%, intermediate 10-<20%, and high risk >20% group.
2nd phase:
Intervention and management of those participants identified with intermediate and high risk score.

13. Results: king Saud University EMPLOYEES & their families
Saudis n (%)
Non-Saudis n (%)
Total number
3062 (68)
1438(32)
Employees
1694(55)
1021(71)
Families
1366(45)
418 (29)
Male
1155(38)
841(58 )
Female
1907(62)
597(42)
Age
39±13
41±12
BMI ≥ 25 kg/m2
69%
76%
Highlighted figures are the highest prevalence level

14. Results: king Saud University EMPLOYEES & their families
Highlighted figures are the highest prevalence level

15. Results Obesity in KSU employees and their families
Non Saudis Female 56% obese based on WHtR and 67% in Male

16. Results…..cont’d Obesity indices The whole study cohort 1633 (36%)
BMI
>30 kg/m2
WC, AO>
102cm (M)& 88cm (F)
WHR, AO>
0.95 (M)&
0.88 (F)
WHtR
AO >0.5
The whole study cohort
1633 (36%)
1118 (25%)
1607( 36%)
2672 (59%)
Saudis n=3062
1126 (37%)
731 (24%)
936 (31%)
1689 (55%)
Non-Saudis n=1438
507 (35%)
387 (27%)
671 (47%)
983 (68%)

17. Results…..cont’d "keep your waist circumference
to less than half your height“
Take home message
Ref: Ashwell et al (2012)>Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta-analysis

18. Prevalence of ClinRFS

19. Results Obesity &CVRFs…..cont’d
Saudis population n=3062
Obese
Normal
OR (95% CI) P
Hypertension n(%)
Male
212(31)
39(8)
3.9( )
<0.0001
Female
307 (35)
54 (5)
5.6( )
Diabetes
173(25)
78(17)
1.6( )
0.001
298 (34 )
51 (5)
5.6( )
IFG
228(33)
26(6)
6.4 ( )
286 (33)
51(5.0)
5.5 ( )
Hypercholesteremia
294(43)
119 (26)
1.8( )
405(42)
345(34)
1.1( )
0.09
Low HDL-C
347(50)
152(33)
1.7( )
184(21)
101 (10)
1.8 ( )
TC/HDL-C
289 (42)
94 (20)
2.2( )
158 (18)
68 (7)
2.3 ( )

20. Non-Saudis population n=1438
Results Obesity &CVRFs…..cont’d
Non-Saudis population n=1438
Obese
Normal
OR (95% CI) P
Hypertension n(%)
Male
203 (35)
30 (12)
2.9 ( )
<0.0001
Female
114 (34)
21 (8)
4.2( )
Diabetes
144 (25)
20 (8)
3.1( )
84 (25)
12 (5)
5.4( )
IFG
225 (38)
75 (10)
1.3 ( )
0.08
110 (33)
39 (15)
2.1 ( )
Hypercholesteremia
246 (42)
84 (33)
1.3( )
0.11
144 (43)
56 (22)
2.1 ( )
0.0001
Low HDL-C
361 (62)
130 (51)
1.2 ( )
0.14
95 (28)
49 (19)
1.5( )
0.038
TC/HDL-C
288 (49)
95 ( 37)
1.3 ( )
0.05
86 (26)
26 (10)
2.6 ( )
Non Saudis Female 56% obese based on WHtR and 67% in Male

21. Discussion
Some of the reasons behind high prevalence of overweight and obesity in Saudi Arabia are:
Massive improvement in wealth leading to changes in demographic and socio-economic status, globalization, access to domestic helper, automobile-car, office work and urbanization (84%).
High rate of insufficient physical activity due to hot climate, cultural norms, no designated leisure places, crowded city and air pollution.
Unhealthy dietary pattern; low fruit/veg. intake, wide range of global fast-food chains, influence of westernized food and diet.

22. Implications for practice
Substantial evidence from our study supports the important role of lifestyle interventions programme; physical activity and healthy diet not only in preventing CVRFs, but also reducing the chronic disease complications. Our recommendations to policy/decision makers therefore are :
To encourage screening approach e.g. at contract renewal to cover ClinRFs ( lipid profile , FG, HBA1C)
To follow up the sub-clinical diseases ( borderline results)

23. Implications to practice…cont’d
To add a dietitian clinic to the employees clinics (3)
To encourage the physical activity among University employees through longer lunch break, provision of recreation centers, week-end group walking/running in the university campus.
To encourage healthy dietary pattern through provision of healthy food in the canteen, health promotion programme and nutrition education.

24. Limitations of study
Cross-sectional study
In specific category of population (generalizability)