Obesity and the persistent female-excess gender gap in Saudi Arabia: a scoping review of trends, determinants, and the Vision 2030 reforms

Background Saudi women have carried a higher burden of obesity than men for more than three decades, alongside a large deficit in physical activity. Since 2016, Vision 2030 has introduced reforms directly relevant to women’s activity, including licensed women’s gyms and girls’ school physical education (2017), women’s driving (2018), and relaxed male-guardianship rules (2019). No study has jointly examined whether these reforms have narrowed the gender gap and why the gap persists. This review asks what the evidence reveals about obesity trends and the gender gap across 2010–2026, what determinants may explain its persistence, whether the reforms produced measurable change, and what limits causal attribution. Methods We conducted a scoping review (Arksey and O’Malley; JBI) reported per PRISMA-ScR. PubMed/MEDLINE and Lens.org were searched on 6 April 2026; adolescent studies served only as contextual evidence. Determinant evidence was mapped onto the five socioecological layers. Source-survey overlap and survey-mode change were treated as analytic factors. Results From 1,916 records, 52 studies were included, plus two contextual adolescent studies. Women’s obesity exceeded men’s in every national survey except one small 2023 analysis (no significant difference). An apparent decline since the mid-2000s coincided with a shift from measured to self-reported surveillance, and gaps were wider in measured data (45.3% vs. 31.2% in the largest dataset). Apart from lack of time, the barriers women most often reported were at the organizational and community levels (institutional delivery, facility cost and provision, the built environment), and the largest differences between women and men concerned interpersonal and normative barriers such as family obligations and harassment; measured individual characteristics explained little of the gap. Sex-specific improvement signals came only from school-age studies, mainly among girls, consistent with generational selectivity; the adult gap persisted. Conclusion The evidence is consistent with the interpretation that the gender gap has persisted because the reforms acted mainly at the policy layer, whereas the gap’s main determinants appear to lie in inner layers: the built environment, institutional delivery, economic access, and domestic obligations. None of the included designs permitted causal attribution, and the surveillance system was not instrumented to detect reform effects, a priority for future research.