Obesity is a multifactorial condition projected to affect over half of the global population by 2035, posing significant clinical and socioeconomic challenges. Traditional metrics such as body mass index lack precision in predicting individual risk, disease progression, and therapeutic response due to the heterogeneous nature of obesity. Advances in omics technologies such as genomics, epigenomics, transcriptomics, proteomics, and metabolomics have enabled the identification of molecular subtypes and candidate biomarkers that offer deeper insights into obesity pathophysiology. Genomic studies have revealed hundreds of loci associated with obesity related traits, while polygenic risk scores offer modest improvements in early risk prediction. Epigenomic profiling, particularly deoxy ribose nucleic acid (DNA) methylation signatures such as those at carnitine palmitoyl transferase 1A (CPT1A) and hypoxia inducible factor 3 subunit alpha (HIF3A), has uncovered modifiable pathways linked to adiposity and metabolic dysfunction. These findings are increasingly being integrated with other omics layers to improve stratification and therapeutic targeting. Metabolomic subtypes, including ceramide driven insulin resistance and branched chain amino acid (BCAA) dominant dysregulation, have shown potential in guiding treatment selection, such as sodium glucose cotransporter 2 (SGLT2) inhibitors or glucagon like peptide-1 (GLP-1) agonists. Proteomic markers like proprotein convertase subtilisin/kexin type 9 (PCSK9) and retinol binding protein 4 (RBP4) are being evaluated for cardiovascular risk stratification independent of body mass index (BMI). Integrative multiomics frameworks and AI driven models are beginning to bridge molecular data with clinical phenotypes, enabling patient stratification and risk modeling. However, most findings remain in research grade environments, and clinical translation is limited by cohort diversity, data harmonization challenges, and the lack of standardized validation protocols. This review synthesizes evidence from single and multiomics studies, highlights emerging biomarkers and molecular subtypes, and discusses the potential of omics guided frameworks to inform precision obesity care.

Obesity is a global health challenge characterized by significant heterogeneity in causes and treatment responses, complicating sustainable management. This narrative review explores the genomic architecture of obesity and its implications for personalized interventions, focusing on how genetic variations influence key biological pathways and treatment outcomes. A comprehensive literature search, guided by the authors’ expertise, was conducted to identify key publications on the genomics of obesity and personalized approaches. The selection of articles prioritized those that provided direct insights into the genomic basis of obesity and its potential for informing tailored strategies. Genomic studies reveal both monogenic and polygenic influences on obesity, identifying numerous susceptibility loci. Genome-wide association studies (GWASs) have linked common variants in genes like FTO and MC4R to increased BMI and appetite dysregulation, respectively. Epigenetic research highlights the role of DNA methylation and other modifications in gene–environment interactions. Genetic and polygenic risk scores (GRSs and PRSs) show potential for refining risk stratification and predicting treatment response. The gut microbiome and metabolome also contribute to obesity pathogenesis, offering novel targets for intervention. Personalized medicine offers significant potential for improving obesity management through tailored interventions based on an individual’s genetic and ‘omics’ profile. Future research should focus on elucidating the functional consequences of identified variants, exploring gene–environment interactions, and developing strategies to overcome current limitations in clinical translation. With continued advancements, precision medicine can enhance treatment efficacy, increase sustainability, and help reduce the global burden of obesity-related diseases.

Objectives: To identify and summarize studies carried out in Arab countries on anti-obesity medications (AOMs), with a focus on the types of medications investigated, study designs, and the efficacy/effectiveness and safety metrics reported. Methods: We carried out a comprehensive scoping review of primary studies examining the use of AOMs in adult Arab populations. Five databases (Medline, Embase, Cochrane Library, Index Medicus for the Eastern Mediterranean Region, and e-Marefa) were searched for English-language publications up to October 2024. Data extraction was carried out on study characteristics, participant demographics, interventions, and outcomes related to weight reduction, metabolic parameters, and side effects. The risk of bias (RoB) was assessed using the Newcastle-Ottawa scale for non-randomized studies and a modified RoB tool for randomized controlled trials. Results: A total of 59 clinical studies published between 2014-2024 were included. The majority (89.8%) were observational in design. Most studies were carried out in Saudi Arabia (40.7%) and the United Arab Emirates (20.3%). Glucagon-like peptide-1 receptor agonists were investigated in 72.9% of the studies, with liraglutide being the most frequently studied agent (54.2%). The most commonly reported efficacy outcomes included changes in total body weight (45.8%), body mass index (39.0%), and the proportion of weight loss (28.8%). Gastrointestinal side effects were reported in 32.2% of patients across studies. Conclusion: Despite the growing body of research on AOMs in Arab countries, most studies remain observational and focus primarily on earlier-generation agents. There is a need for randomized controlled trials to evaluate the efficacy and safety of newer AOMs, such as semaglutide and tirzepatide, within Arab populations to inform culturally and genetically tailored obesity management strategies.

Background: Critically ill adults are at risk for stress‐related upper gastrointestinal bleeding (UGIB). Regional variations in gastrointestinal bleeding incidence, infection epidemiology, formulary access, and the relative value placed on bleeding versus infection outcomes by patients and clinicians necessitate contextualized recommendations. This guideline provides regionally adapted, evidence‐based recommendations for the use of stress ulcer prophylaxis (SUP) in Saudi Arabia, Kuwait, and the Nordic countries using the GRADE‐ADOLOPMENT methodology. Methods: A multidisciplinary panel from both regions prioritized PICO questions and ranked outcomes by patient importance. The 2024 Society of Critical Care Medicine (SCCM) and American Society of Health‐System Pharmacists (ASHP) guideline served as the source guideline and was evaluated for credibility; contextual fit in Saudi Arabia, Kuwait, and the Nordic countries; and alignment with the GRADE methodology. Evidence profiles and Evidence‐to‐Decision frameworks were adapted or developed, incorporating updated data, local epidemiology, drug access, and health system variables such as equity, cost, and feasibility. Results: The panel adopted the following five recommendations. In critically ill adults with coagulopathy, shock, or chronic liver disease, the panel suggests using SUP over no SUP (conditional recommendation; moderate certainty). In enterally fed patients at high risk of UGIB, the panel suggests using SUP over no SUP (conditional recommendation; very low certainty); in those at low risk, the panel suggests not using SUP (conditional recommendation; very low certainty). For patients receiving SUP, the panel suggests using a proton pump inhibitor (PPI) or a histamine‐2 receptor antagonist (H2RA) rather than sucralfate (conditional recommendation; low to moderate certainty) and suggests enteral or intravenous administration based on clinical feasibility (conditional recommendation; very low to low certainty). In critically ill adults receiving SUP, low‐dose PPI or H2RA therapy should be used rather than high‐dose regimens (best practice statement; not GRADEd). Regarding SUP discontinuation, the panel suggests discontinuing SUP in critically ill adults with resolved risk factors for UGIB (conditional recommendations; very low certainty) and in critically ill adults without UGIB risk factors but receiving SUP prior to intensive care unit (ICU) admission in the absence of an active indication (conditional recommendations; very low certainty). Differences in drug availability, ICU discharge practices, and health equity considerations shaped the panel's judgments and highlighted key implementation challenges. Conclusion: This guideline offers five context‐specific, evidence‐informed recommendations for SUP in critically ill adults in Saudi Arabia, Kuwait, and the Nordic countries. While grounded in the health system realities of these regions, the recommendations may inform practice in other settings with similar ICU structures and resource contexts. The panel also identified key research priorities to address remaining evidence gaps and support future updates.

Introduction This guideline offers evidence-based recommendations for physicians and policymakers on managing axial spondyloarthritis (axSpA) in Saudi Arabia. Methods A panel of 14 experts in research methodology, rheumatology, family medicine, and clinical pharmacology in Saudi Arabia approved 45 questions related to the monitoring and treatment, pharmacological and non-pharmacological, of different subtypes of axSpA. We conducted a search of different databases, including PubMed, EMBASE, and the Cochrane Library, from 2010 to 2024 to identify systematic reviews, meta-analyses, and clinical studies related to the diagnosis and management of axSpA. To evaluate the certainty of the evidence and formulate recommendations, we employed the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. The expert panel voted electronically on each recommendation. A recommendation was finalized when over 70% of the voting panel agreed. Results We issued 31 evidence-based recommendations and seven statements based on the experts’ opinions, which are grouped into nine categories. This guideline recommends initiating non-steroidal anti-inflammatory drugs (NSAIDs) as the first-line therapy for patients with symptomatic axSpA. If NSAIDs are ineffective, second-line treatments such as tumor necrosis factor inhibitors (TNFis), interleukin-17 inhibitors (IL-17is), or Janus kinase inhibitors (JAKis) should be considered. Localized glucocorticoid injections are suggested as supplementary therapy for cases of isolated sacroiliitis, enthesitis, or peripheral monoarthritis not responding adequately to the treatment options. Conclusion The Saudi clinical practice guidelines provide updated evidence-based recommendations for monitoring and treating adults with axSpA. These recommendations help guide the best practice for healthcare professionals in managing patients with axSpA in Saudi Arabia.