In the face of this accelerated standard of living and modernization through communication, an emergent market may directly even further impact these present dire conditions (22). In the last decade, home delivery of foods has been revolutionized in Kuwait 8. Through the development of smartphone applications, ordering a high caloric meal with none to minimal movement has become possible through the click of a button (23). This, in turn, is a recipe for disaster in terms of the growing rates of obesity, and subsequently, diabetes. In terms of the increasing population amongst the youth and adolescents that presently constitute 80% of the non-diabetic obese population, the risk factors based on genetics put these demographics at risk for developing diabetes (24). While obesity itself is considered a debilitating condition, major studies have clearly correlated obesity with the development of chronic metabolic disorders such as diabetes, hypertension, and hyperlipidemia and reduced quality of life, shorter life expectancy, and an overall increase in the cost of care (22).
Chronic metabolic disorders are complex diseases that need ongoing care and management (25). Of the many lifestyle factors such as lack of exercise, a poor diet, and smoking, being overweight has been identified as the most critical predictor of obesity-related diseases (1).
In the Arabian Gulf region, due to the high prevalence of obesity and the lack of national screening programs and routine medical checkups, there is a higher potential for the delay in diagnosis and commencement of treatment that increases the risks of complications, metabolic comorbidities, and mortalities (26). Some of the complications of uncontrolled diabetes include diabetic retinopathy, diabetic neuropathy, diabetic nephropathy, macrovascular events like cardiovascular diseases and diabetic foot ulcers, and amputations (27). According to the International Diabetes Federation’s publication titled Diabetes Atlas, Kuwait is ranked amongst the top 10 countries with a national prevalence of 22% in adults aged 20–79 years (28). While diabetes can be controlled and managed with oral hypoglycemic agents, insulin, and lifestyle modification such as diet and exercise, recent updates from the Standards of Medical Care published by the American Diabetes Association also recommend metabolic surgery to manage diabetes in appropriate obese patients (27, 29).
Metabolic surgeries have opened a new door for the management of obese patients with diabetes and became accepted as a safe and effective method for treating and controlling diabetes in the obese population (30–34). The American Diabetes Association, 2018 Standards of Care for the Management of Obesity and diabetes indicates that metabolic surgery is an effective treatment to improve weight loss measures and is beneficial in treating diabetes (27, 29). In fact, no other treatment has produced such durable and ample control of diabetes (9, 31, 32). Accordingly, in a study conducted by the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) of 42 countries that indicated metabolic trends worldwide, Kuwait ranks number one for the frequency of metabolic procedures performed as a percentage of the national population (20, 33).
In terms of surgery, there are many types of metabolic surgeries performed to manage obesity, e.g., Roux-en-Y Gastric Bypass, Adjustable Gastric Band, and Laparoscopic Sleeve Gastrectomy (35). Bariatric surgery is instrumental in treating metabolic syndrome with significant remission or improvement in most cases (31, 32, 34, 35). Metabolic outcomes have improved over time with these surgical procedures. While all these procedures have been studied in relation to metabolic syndrome and obesity, LSG has been gaining popularity and is the highest performed surgery in the Arabian Gulf region and especially Kuwait for the management of obesity (32, 34, 36–40).
In terms of funding in Kuwait, bariatric / metabolic surgery is covered by the government sector (Ministry of Health) with the exception of medical equipment specific to the procedure like ports, stapler, energy device etc. Ministry of Health covers pre-operative, intra-operative, and post-operative care, including clinical investigations, doctor visits, operating room fees, multidisciplinary bariatric team professional visits, and hospital stays. Additionally, the Ministry of Health covers the management of complications, revisional procedures, and international visitors workshops for challenging cases. Ministry of Health also covers international care for eligible patients abroad. Bariatric procedures performed in private-sector hospitals are not covered by insurance. However, the government covers complications that originate from private sector bariatric procedures.
With the increasing frequency of bariatric procedures performed in Kuwait and Kuwait ranked as one of the highest countries for the frequency of bariatric surgeries performed, collecting this growing body of data into national registries is crucial. One of the most essential facets of collecting this data is the need for standardization in reporting the different comorbidities. In this report, there is a need to include more complete details on patients consistently and accurately (41).
It remains a goal for the future to incorporate data from all key stakeholders in bariatric surgery, especially surgeons, and physicians to embrace this data collection and reporting process at individual clinics and hospitals. It will require widespread involvement and ongoing commitment from all those involved in the care of the bariatric patient to ensure high-quality data can be collected, properly analyzed and shared, so that we will be better able to understand shifts in disease patterns, practice, and outcomes on a national scale. Therefore, the data is presented using a small and far from comprehensive dataset, as simple tables and graphs usually 2 variables, one for each axis, plus a dedicated commentary for each.