That would seem to be some sort of Medal awarded President Bush by Saudi Arabia, and since there has been no outrage in the press previously I think we can assume it was memory dumped because it was probably for his efforts towards peace in the region as well as the war on terror.
I didn’t understand what the medallion represented, but the important thing in this context is that Bush didn’t bow; he leaned over so the king could place the medallion around his head.
No bow.
Bush left it up to Obama to genuflect in submission.