Saudi Arabia: How combatting obesity through a system-based approach can save lives

As the world deals with constant health threats like new variants of COVID-19 or monkeypox, obesity and excess weight remains the number one leading risk factor for death and disability in Saudi Arabia and the Gulf Cooperation Council (GCC) countries. 

Overweight and obesity are a major global epidemic that has grown substantially. Worldwide, obesity rates nearly tripled since the 1970’s and there are currently more than 2 billion individuals with overweight and obesity worldwide.  As highlighted in the 2020 Obesity book, the global obesity epidemic presents a major challenge to developing human capital acquisition, national wealth accumulation, and the goals of boosting shared prosperity.

Overweight and obesity together constitute both a disease and a biological risk factor linked to numerous noncommunicable diseases (NCDs).  The prevalence of all NCDs—such as diabetes, cardiovascular diseases, and cancers—has also increased substantially in recent decades. Diabetes prevalence alone has increased by 99% in the last decade in Saudi Arabia, rising from 1.4 million cases in 2009 to 2.7 million in 2019. This is especially concerning when most Saudis are young, and the prevalence rates will likely increase as the population ages if no action is taken.

A new report entitled, “Overweight and Obesity in Saudi Arabia,” by the Saudi Health Council, in collaboration with the World Bank, provides a comprehensive assessment of overweight and obesity in KSA  through several in-depth analyses with the objective of providing new evidence and generating knowledge to support the government in achieving their national goals and objectives.

“The report highlights many of the existing accomplishments in KSA and will help to advance progress in the kingdom based on the best global experiences and evidence to date. Both policymakers and researchers will find it useful for building on the areas identified in the book, that will encourage collaboration on reversing the trend of overweight and obesity in Saudi Arabia, other countries in the region, and beyond," said Dr. Nahar Alaezmi, Secretary General of the Saudi Health Council, and one of the editors of the report.

Overweight and obesity rates are rapidly increasing in KSA, especially among boys.  While historically adult women had higher rates of overweight/obesity than adult men in KSA, a noticeable reversal in trend occurred in the early 2000s with the young boys leading the prevalence rates of overweight/obesity compared to girls. More alarmingly, one-third of all children and adolescents (aged 5–19) had overweight or obesity in 2016, which is twice the global average of 18%.

Overweight and obesity rates aren’t just a major health threat, but an economic one.  They take a large economic toll in society. The impact of overweight/obesity directly costs a total of US$3.8 billion in Saudi Arabia, equal to 4.3% of total health expenditures the country (2019). This is largely driven by type 2 diabetes costs. Additionally, overweight and obesity-attributable absenteeism and presenteeism costs a total of US$15.5 billion, equal to 0.9% of GDP in 2019.

Increased obesity in Saudi Arabia has been commensurate with lifestyle changes, such as increased consumption of ultra-processed foods and sugar-sweetened-beverages (SSBs) . Approximately 65–70% of food and beverages sold in Saudi Arabia are either processed or ultra-processed, which contribute around 17–20% of caloric intake in Saudi Arabia.  Furthermore, almost 70% of the population aged 15 years and older don’t meet standard global physical activity guidelines. Our analysis shows that achieving a 20% reduction on overweight and obesity can avert an estimated 60,000 and 110,000 deaths for women and men, respectively, by 2050.

While the issue of obesity is complex and some of its risk factors are beyond the control of individuals, several innovative evidence-based interventions do exist. The new report showcases the strong commitment and policy responses by the Saudi government to address the rising problem of obesity in the country—particularly among youth. KSA already implemented many innovative policies, including a 50% tax on SSBs. The report also identifies the remaining challenges and opportunities as well as provides recommendations

One such opportunity is to transform the food system to benefit both public health and the environment. Current food systems around the world are not sustainable and cause significant damage to public health and the environment.  Production of ultra-processed foods and SSBs contributes significantly to water use and carbon emissions. A shift toward healthier diets with fewer animal products and less food waste can help achieve health goals.

Saudi Arabia has the capacity and resources to catalyze the collective action to transform its food system. The report recommends a food systems approach to nutrition- and obesity-related policies  in Saudi Arabia, with the design of a Saudi Arabia–specific nutrient profiling model to serve as a unified tool for all nutrition related policies such as taxation, front of package labeling, and advertising restrictions among others.

Now is the time to build on KSA’s momentum for a food system transformation for itself and the GCC, and to help achieve better health for people and our planet, while also achieving many of the UN’s SDG goals.