Management of Obesity in Saudi Arabia During the Era of COVID-19: A Clash of Two Pandemics.

TO THE EDITOR: 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% (1). Unfortunately, coronavirus disease 2019 (COVID‐19) has arisen as an additional challenge, shifting focus and valuable resources to managing this emerging threat.

In Saudi Arabia, 58% of the population is 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 the risk of developing a more severe complicated infection (3).

On February 27, 2020, the first response to the pandemic by the Kingdom was to swiftly suspend all pilgrimage to Makkah and Madinah. The first case of COVID‐19 was confirmed on March 2, 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. However, these measures, which were taken to contain the infection, were not without consequences. Key challenges that were specific for obesity care included reduced access to health care resources, isolating patients, limiting 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 canceled or postponed and that free‐of‐charge home delivery for pharmacotherapy for obesity was enabled. After the lockdowns were lifted on May 31, 2020, individuals with BMI ≥ 40 kg/m2 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 some of the day‐to‐day struggles that our patients have been 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 be neither 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.

Disclosure

NA serves as a consultant for Novo Nordisk and Johnson and Johnson. However, this disclosure did not influence the content of this manuscript.