key: cord-266380-lu6hj3a2
authors: Alfaris, Nasreen
title: Management of obesity in Saudi Arabia during the era of COVID‐19: A clash of two pandemics
date: 2020-10-01
journal: Obesity (Silver Spring)
DOI: 10.1002/oby.23055
sha: 
doc_id: 266380
cord_uid: lu6hj3a2

Obesity remains one of the world’s most challenging pandemics. The Kingdom of Saudi Arabia carries one of the highest burdens of obesity with a prevalence of 35 %. Unfortunately, . COVID‐19 has arisen as an added challenge shifting focus and valuable resources to managing this emerging threat. In Saudi Arabia, 58% of the population are under the age of 35 years, and only 3.2% are over the age of 65 years, but unfortunately, the burden of obesity in the Kingdom poses a risk of developing a more severe complicated infection.

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In Saudi Arabia, 58% of the population are under the age of 35 years, and only 3.2% are over the age of 65 years, 2 but unfortunately, the burden of obesity in the Kingdom poses a risk of developing a more severe complicated infection. 3 On February 27,2020 the first response to the pandemic by the Kingdom was with the swift suspension of all pilgrimage to Makkah and Madinah .The first case of COVID-19 was confirmed on March 2 nd , 2020, and as of September 21,2020 , there were 6,093,601 tests performed with 330,246 confirmed cases and 4,512 deaths. 4

The country's Ministry of Health (MOH) created a mobile phone application and website inquiring about symptoms and history of contacts, and a royal decree with a directive that all foreigners are entitled to free testing and treatment regardless of their visa status resulted in an active testing campaign for all migrant workers in their neighborhoods and residences. But these measures taken to contain the infection were not without consequences. Key challenges that were specific for obesity care, included reduced access to healthcare resources, isolating patients, limiting their physical activity, and causing disruptions in eating habits with irregular mealtimes, frequent snacking, more processed meals, and increased anxiety and depression.

To tackle these challenges the MOH in Saudi Arabia utilized all resources to establish obesity telemedicine clinics and as a result, physicians were able to ensure that outpatient visits for obesity were not cancelled or postponed and free-of-charge home delivery for pharmacotherapy for obesity was enabled. After the lockdowns were lifted on May 31,2020, individuals with a BMI ≥ 40 kg/m 2 were instructed to continue working remotely.

Despite these measures, the pandemic resulted in the magnification of obesity stigma.

Jokes and memes about weight gain during lockdown, the reemergence of stigmatizing images of individuals with obesity, and the pressure to utilize the time during lockdown to lose weight, are

This article is protected by copyright. All rights reserved some of the day-to-day struggles that our patients are being subjected to. This is particularly destructive in a culture where BMI is a measure of social acceptance and blame is laid on individuals with obesity. Furthermore, individuals with obesity were being pressured to utilize the time of lockdown to lose weight. Failure to do that, may have resulted in further isolation after the lockdowns and curfews were lifted resulting in devastating consequences including adapting unhealthy eating behaviors, anxiety, depression and worsening of their disease. 5 At a time when the focus is only the immediate COVID-19 pandemic, our patients with obesity should not be lost, nor forgotten. It is important to understand the unique risks our patients with obesity are facing during these challenging times and to establish a strategy for caring for patients with obesity during epidemics.

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Obesity stigma as a barrier to healthy eating behavior