BackgroundObesity is defined as abnormal or excessive fat accumulation, generally accepted as a BMI of 30 kg/m2 or greater, and is associated with increased health risks. 1 Worldwide, obesity has become a pandemic, as rates have doubled since 1980.2 Approximately one-third of the world's inhabitants are obese.3 Globally, in 2014 trends in BMI among adults showed that 10.8% of men, and 14.9% of women were obese.4 An increased prevalence of obesity also affects adolescents and children at a more alarming rate (5.6% among boys and 7.8 among girls).5 Notwithstanding, the Saudi population also faces an obesity epidemic. Data from the 2013 Saudi Health Interview Survey (SHIS) demonstrate elevated rates of obesity throughout Saudi Arabia (prevalence of 28.7% among adults).6 More recently, this prevalence has increased to 33.7% within the adult population. Furthermore, it is predicted that the obesity prevalence will be 41% among men and 78% among women by 2022.7 Studies investigating obesity confirmed that this condition increases the risk of developing other diseases, including insulin resistance, type 2 diabetes, cardiovascular disease, and cancers.8,9 The obesogenic environment in Saudi Arabia has been attributed to many factors, all resulting from economic growth during the last three decades.10-12 In parallel, a noticeable change and modernization started characterizing Saudi society where 80% of Saudi citizens now live in urban areas.13 In tandem, in terms of food consumption, a remarkable increase in variety of food choices has exacerbated concerns over obesity among the Saudi population.14Recent research indicates that eating patterns in Saudi Arabia have shifted from a traditional diet containing dairy products, dates, and cereals toward a more westernized diet composed of foods high in added sugar, cholesterol, and fat.14-20 According to the General Authority for Statistics, more than 15,700 restaurants in Saudi Arabia promote dining out and convenient home delivery service for obtaining ready-to-eat meals.21 In fact, sales related to dining out is estimated to reach 7-9 billion USD in 2020.22 The result has been a remarkable increase in daily calorie consumption.23 Adam et al.24 estimated that dietary energy supply was 3078 kcal/capita/day, which is remarkably higher than the average requirements of 2100 kcal/capita/day. To combat this growing concern, the strategic plan, "Vision 2030", was created with an aim at reducing the rising rate of obesity among the Saudi population.25 Consequently, beginning in 2019, the Saudi Food and Drugs Authority required that restaurants label calories on menu choices in the hopes of enabling informed meal choices by Saudi consumers.26 In the effort to reduce non-communicable diseases, the Saudi Arabian government introduced the aforementioned as a component of a larger set of regulations all aiming to reduce the high rate of NCD in Saudi Arabia. In fact, these regulations included the reduction of amounts of sugar, salt, along with saturated, and transformed fats in processed...
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