Published date: Dec 31 2024

Journal Title: Dubai Diabetes and Endocrinology Journal

Issue title: Dubai Diabetes and Endocrinology Journal (DDE): Volume 30 Issue 1-2

Pages: 19 - 36

DOI: 10.18502/ddej.v30i1-2.17931

Rita NawarAmerican Academy of Cosmetic Surgery Hospital, Dubai

Rahila BhattiGenesis Healthcare Clinic, Dubai

Fatih Tangitangi_fatih@lilly.comGulf Medical Affairs, Eli Lilly and Company, Dubai

Soniya RaiGulf Medical Affairs, Eli Lilly and Company, Dubai

Tatjana IsailovicGulf Medical Affairs, Eli Lilly and Company, Dubai

Swarna KhareEli Lilly and Company, Bracknell

Esther ArtimeValue Evidence and Outcomes, Eli Lilly and Company, Alcobendas

Victoria HigginsMetabolic Franchise, Adelphi Real World, Bollington

Andrea LeithMetabolic Franchise, Adelphi Real World, Bollington

Fatheya Al AwadiDubai Hospital, Dubai

Background: Limited evidence exists on the impacts of obesity in the United Arab Emirates (UAE). Real-world evidence is required to support obesity-related healthcare decision-making in the UAE.

Materials and Methods: The Adelphi Real World Obesity Disease Specific Programme^TM is a multicountry , cross-sectional survey with retrospective data capture including physicians directly involved in chronic weight management and people living with obesity (PwO) presenting to them in a real-world clinical setting. UAE data were collected between April and August 2022. Physicians completed online questionnaires reporting demographics and clinical characteristics for eligible PwO (aged ≥18 years participating in a weight management plan and/or presenting with a body mass index [BMI] ≥30 kg/m²). PwO voluntarily completed questionnaires reporting out-of-pocket costs and patient-reported outcomes: Work Productivity and Activity Impairment Questionnaire (WPAI), Short Form 36 v2 Health Survey (SF-36v2), Jenkins Sleep Evaluation Questionnaire ( JSEQ). Analyses were descriptive.

Results: 41 physicians identified 201 PwO; 49% were male and 65% were of Middle Eastern origin. Mean age, BMI, and median time since obesity diagnosis were 39.1 years, 33.7 kg/m², and 11.5 months, respectively. PwO (n = 84) reported a mean of 7.4% monthly household income spent on medicine for weight and weight-related health conditions. Mean WPAI was 35.3% activity impairment and 37.5% overall work impairment due to obesity. Generally, SF-36v2 scores were <47, indicating impairment, and mean JSEQ score was 3.6.

Conclusion: PwO in the UAE had a high level of complications and measurable negative obesity-related impacts. These data may contribute to improving obesity awareness and management in the UAE.

Keywords: obesity, burden of disease, health related quality of life, work productivity and activity impairment, UAE

[1] Lobstein T, Brinsden H, Neveux M. World obesity atlas 2022. London: World Obesity Federation; 2022. Accessed February 2, 2024. https://s3-eu-west-1.amazonaws.com/wof-files/ World_Obesity_Atlas_2022.pdf

[2] World Health Organization. Obesity and overweight fact-sheets. 2024. Accessed September 27, 2023. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight

[3] Vats MG, Mahboub BH, Al Hariri H, Al Zaabi A, Vats D. Obesity and sleep-related breathing disorders in Middle East and UAE. Can Respir J. 2016;2016:9673054.

[4] Al Heialy S, Hachim MY, Hachim IY, Bin Naeem K, Hannawi H, Lakshmanan J, et al. Combination of obesity and co-morbidities leads to unfavorable outcomes in COVID-19 patients. Saudi J Biol Sci. 2021;28(2):1445–1450.

[5] Burki T. European Commission classifies obesity as a chronic disease. Lancet Diabetes Endocrinol. 2021;9(7):418.

[6] Simon GE, Von Korff M, Saunders K, Miglioretti DL, Crane PK, van Belle G, et al. Association between obesity and psychiatric disorders in the US adult population. Arch Gen Psychiatry. 2006;63(7):824–830.

[7] Kreidieh D, El Masri D, Tannir H, Itani L, El Ghoch M. Health-related quality of life in treatment-seeking Arab patients with obesity. BAU J – Health Wellbeing. 2018;1(3,35):1–6.

[8] World Health Organization. UAE National Health Survey report 2017–2018. United Arab Emirates, Ministry of Health & Prevention. Accessed September 27, 2023. https://cdn.who.int/media/docs/defaultsource/ ncds/ncd-surveillance/data-reporting/united-arab-emirates/uae-national-health-survey-report- 2017-2018.pdf?sfvrsn=86b8b1d9_1

[9] Radwan H, Ballout RA, Hasan H, Lessan N, Karavetian M, Rizk R. The epidemiology and economic burden of obesity and related cardiometabolic disorders in the United Arab Emirates: a systematic review and qualitative synthesis. J Obes. 2018;2018:2185942.

[10] World Obesity Federation. Economic impact of overweight and obesity. 2023. Accessed April 12, 2024. https://data.worldobesity.org/country/united-arab-emirates-225/#data_economic-impact

[11] Abusnana S, Fargaly M, Alfardan SH, Al Hammadi FH, Bashier A, Kaddaha G, et al. Clinical practice recommendations for the management of obesity in the United Arab Emirates. Obes Facts. 2018;11(5):413–428.

[12] Gorgojo-Martínez JJ, Basagoiti-Carreño B, Sanz-Velasco A, Serrano-Moreno C, Almodóvar-Ruiz F. Effectiveness and tolerability of orlistat and liraglutide in patients with obesity in a real-world setting: the XENSOR Study. Int J Clin Pract. 2019;73(11):e13399.

[13] Khera R, Murad MH, Chandar AK, Dulai PS, Wang Z, Prokop LJ, et al. Association of pharmacological treatments for obesity with weight loss and adverse events: a systematic review and meta-analysis. JAMA. 2016;315(22):2424–2434.

[14] Hasan S, Al-Omar MJ, AlZubaidy H, Al-Worafi YM. Use of medications in Arab countries. In: Laher I, editor. Handbook of healthcare in the Arab world. Cham: Springer International Publishing; 2021. pp. 2197–2238.

[15] Valladales-Restrepo LF, Sánchez-Ramírez N, Usma-Valencia AF, Gaviria-Mendoza A, Machado-Duque ME, Machado-Alba JE. Effectiveness, persistence of use, and safety of orlistat and liraglutide in a group of patients with obesity. Expert Opin Pharmacother. 2023;24(4):535–543.

[16] Dubai Health Authority. Ejada Program. Obesity and metabolic syndrome: KPIs and recommendations 2024. Dubai: Dubai Health Authority. Accessed February 21, 2024. https://www.isahd.ae/ content/docs/Ejada%20KPIs%20and%20Recommendations%20Obesity%20and%20Metabolic% 20Syndrome_2024.pdf

[17] Yumuk V, Tsigos C, Fried M, Schindler K, Busetto L, Micic D, et al.; Obesity Management Task Force of the European Association for the Study of Obesity. European guidelines for obesity management in adults. Obes Facts. 2015;8(6):402–424.

[18] ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, et al.; on behalf of the American Diabetes Association. 8. Obesity and weight management for the prevention and treatment of type 2 diabetes: Standards of Care in Diabetes–2023. Diabetes Care. 2023;46(1):S128–S139.

[19] National Institute for Health and Care Excellence (NICE). NICE guideline CG189. Obesity: identification, assessment and management. London: NICE; 2014. Accessed September 27, 2023. https://www.nice.org.uk/guidance/cg189/resources/obesity-identification-assessment-andmanagement- pdf-35109821097925

[20] Nawar R, Ibrahim E, Abusnana S, Al Awadi F, Al Hammadi FH, Farghaly M, et al. Understanding the gaps in obesity management in the UAE: perceptions, barriers, and attitudes. Dubai Diabetes Endocrinol J. 2021;27(2):37–49.

[21] Anderson P, Benford M, Harris N, Karavali M, Piercy J. Real-world physician and patient behaviour across countries: disease-specific programmes - a means to understand. Curr Med Res Opin. 2008;24(11):3063–3072.

[22] Anderson P, Higgins V, Courcy J, Doslikova K, Davis VA, Karavali M, et al. Real-world evidence generation from patients, their caregivers and physicians supporting clinical, regulatory and guideline decisions: an update on Disease Specific Programmes. Curr Med Res Opin. 2023;39(12):1707–1715.

[23] Reilly MC, Zbrozek AS, Dukes EM. The validity and reproducibility of a work productivity and activity impairment instrument. PharmacoEconomics. 1993;4(5):353–365.

[24] Ware JE Jr, Gandek B. Overview of the SF-36 Health Survey and the International Quality of Life Assessment (IQOLA) Project. J Clin Epidemiol. 1998;51(11):903–912.

[25] Jenkins CD, Stanton BA, Niemcryk SJ, Rose RM. A scale for the estimation of sleep problems in clinical research. J Clin Epidemiol. 1988;41(4):313–321.

[26] Mamdouh H, Hussain HY, Ibrahim GM, Alawadi F, Hassanein M, Zarooni AA, et al. Prevalence and associated risk factors of overweight and obesity among adult population in Dubai: a population-based cross-sectional survey in Dubai, the United Arab Emirates. BMJ Open. 2023;13(1):e062053.

[27] Sanyal D, Raychaudhuri M. Hypothyroidism and obesity: an intriguing link. Indian J Endocrinol Metab. 2016;20(4):554–557.

[28] van der Valk ES, van den Akker EL, Savas M, Kleinendorst L, Visser JA, Van Haelst MM, et al. A comprehensive diagnostic approach to detect underlying causes of obesity in adults. Obes Rev. 2019;20(6):795–804.

[29] Alzahrani AS, Al Mourad M, Hafez K, Almaghamsy AM, Alamri FA, Al Juhani NR, et al. Diagnosis and management of hypothyroidism in Gulf Cooperation Council (GCC) countries. Adv Ther. 2020;37(7):3097–3111.

[30] Barber TM, Hanson P, Weickert MO, Franks S. Obesity and polycystic ovary syndrome: implications for pathogenesis and novel management strategies. Clin Med Insights Reprod Health. 2019;13:1179558119874042.

[31] Barber TM. Why are women with polycystic ovary syndrome obese? Br Med Bull. 2022;143(1):4–15.

[32] DiBonaventura M, Nicolucci A, Meincke H, Le Lay A, Fournier J. Obesity in Germany and Italy: prevalence, comorbidities, and associations with patient outcomes. Clinicoecon Outcomes Res. 2018;10:457–475.

[33] Rozjabek H, Fastenau J, LaPrade A, Sternbach N. Adult obesity and health-related quality of life, patient activation, work productivity, and weight loss behaviors in the United States. Diabetes Metab Syndr Obes. 2020;13:2049–2055.

[34] Goettler A, Grosse A, Sonntag D. Productivity loss due to overweight and obesity: a systematic review of indirect costs. BMJ Open. 2017;7(10):e014632.

[35] Claridy MD, Czepiel KS, Bajaj SS, Stanford FC. Treatment of obesity: pharmacotherapy trends of officebased visits in the United States from 2011 to 2016. Mayo Clin Proc. 2021;96(12):2991–3000.

[36] Suissa K, Schneeweiss S, Kim DW, Patorno E. Prescribing trends and clinical characteristics of patients starting antiobesity drugs in the United States. Diabetes Obes Metab. 2021;23(7):1542–1551.

[37] Ezendu K, Choong CKC, Brown M, Malik R, Hankosky ER. SAT664 obesity and overweight diagnosis, physician prescription and patient filling of anti-obesity medications in US. J Endocr Soc. 2023;7(Suppl. 1):bvad114.112.

[38] Ahmad NN, Robinson S, Kennedy-Martin T, Poon JL, Kan H. Clinical outcomes associated with antiobesity medications in real-world practice: a systematic literature review. Obes Rev. 2021;22(11):e13326.

[39] MacEwan J, Kan H, Chiu K, Poon JL, Shinde S, Ahmad NN. Antiobesity medication use among overweight and obese adults in the United States: 2015–2018. Endocr Pract. 2021;27(11):1139–1148.

[40] Sadiya A, Abdi S, Abusnana S. Lifestyle intervention for weight loss: a group-based program for Emiratis in Ajman, United Arab Emirates. Diabetes Metab Syndr Obes. 2016;9:101–108.

[41] Tchang BG, Aras M, Kumar RB, Aronne LJ. Pharmacologic treatment of overweight and obesity in adults. [Updated August 2, 2021]. In: Feingold KR, Anawalt B, Blackman MR, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000. https://www.ncbi.nlm.nih.gov/books/NBK279038/

[42] FDA. FDA approves new medication for chronic weight management [Internet]. FDA; 2023. Accessed November 23, 2023. https://www.fda.gov/news-events/press-announcements/fda-approvesnew- medication-chronic-weight-management

[43] Abusnana S, Abdi S, Tagure B, Elbagir M, Maleckas A. Bariatric surgery outcomes: a single-center study in the United Arab Emirates. Diabetes Metab Syndr Obes. 2015;8:461–471.

[44] Alnageeb H, Abdelgadir E, Khalifa A, Suliman M, Gautam SC, Layani L, et al. Efficacy of bariatric surgery in improving metabolic outcomes in patients with diabetes. A 24-month follow-up study from a single center in the UAE. Diabetes Metab Syndr Obes. 2018;11:459–467.

[45] Caterson ID, Alfadda AA, Auerbach P, Coutinho W, Cuevas A, Dicker D, et al. Gaps to bridge: misalignment between perception, reality and actions in obesity. Diabetes Obes Metab. 2019;21(8):1914–1924.

[46] Sbraccia P, Busetto L, Santini F, Mancuso M, Nicoziani P, Nicolucci A. Misperceptions and barriers to obesity management: Italian data from the ACTION-IO study. Eat Weight Disord. 2021;26(3):817–828.

[47] Sharma AM, Bélanger A, Carson V, Krah J, Langlois MF, Lawlor D, et al. Perceptions of barriers to effective obesity management in Canada: results from the ACTION study. Clin Obes. 2019;9(5):e12329.