A working group of the Ministry of Health of the Kingdom of Saudi Arabia in collaboration with McMaster University, Canada has used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach (which describes evidence quality and strength of the recommendation) to recommend clinical practice guidelines on weight management.
Across the world, physical inactivity and the spectrum of overweight and obesity are increasingly becoming more prevalent across all age groups. In India, reports abound about the prevalence of obesity among children. The rising incidence of ‘lifestyle diseases’ like hypertension and diabetes mellitus among the young and the middle-aged populations is a cause for concern for the civil society in India and consequently the Armed Forces too.
The guidelines in the Journal article have included recommendations for the nonpharmacological, pharmacological, and surgical management of overweight and obese adults (defined as those with Body mass index (BMI) 25–29.9 kg/m2 and 30 kg/m2, respectively).
Lifestyle interventions rather than usual medical care alone for overweight and obesity have been recommended. These lifestyle interventions involve promoting healthy lifestyle habits such as eschewing tobacco, abstinence from alcohol, getting ‘adequate’ daily exercise, dietary counseling, and interventions. A conditional recommendation has been made on intensive lifestyle interventions in place of the usual or minimal care in overweight and obese adults. These interventions involve more extreme dietary, physical, and behavioral counseling, delivered by a multidisciplinary team of nutritionists, physicians, behavioral therapists, and exercise trainers.
An intuitive recommendation that is part of the guidelines is for physical activity rather than no physical activity! It has also been recommended that physical activity is essential in addition to diet rather than diet alone. The guidelines have also recommended individualized counseling interventions rather than generic educational pamphlets, which is the usual modus operandi in public health interventions for dealing with the obesity epidemic. The guidelines have suggested orlistat in obese and overweight adults, and using bariatric surgery in obese adults (BMI ≥40 or ≥35 kg/m2 with comorbidities).
While these guidelines may have been developed by a ministerial task force specifically for Saudi Arabia, their recommendations hold true for any organization intent on focusing on mounting an evidence-based response to the obesity epidemic that threatens the populations.