With waistlines expanding rapidly thanks to a fast-food culture and sedentary lifestyles, the region can no longer ignore the cost of obesity, both in terms of healthcare expenditure and human misery. But what’s the solution, asks Nick Harding.
For years I have watched people in their millions inflict more illness and suffering on themselves than any war has ever done. The suffering is beyond apocalyptic and increasingly fills me with a sense of rage because mainly it is avoidable. From kids jamming fat-laden time bombs in their faces to the millions and millions of couch potatoes who haven’t done a minute’s exercise since they passed puberty; obesity is already an epidemic and is rising with no signs of slowing.”
So writes paediatric neurologist and neurobiologist, Dr Andrew Curran; a man on a mission to stop the global Armageddon of obesity. And nowhere do his words ring with more resonance than in the air-conditioned malls of the Gulf where the sight of a swelling population bears testament to his prophecy that the fat apocalypse is now. People in this part of the world are getting bigger.
Figures from obesity studies vary wildly but all point towards a singular conclusion; there is a time bomb of obesity-related disease ticking in the UAE.
According to the latest available study by the World Health Organisation (WHO), 67 per cent of Emirati men and 72 per cent of Emirati women are overweight. Around 39.9 per cent of UAE women are obese, the seventh highest proportion in the world. Among men, 25.6 per cent were classified as obese, the ninth highest figure. Official UAE health ministry figures are more conservative but still alarming. They calculate that 44.6 per cent of Emirati women will be obese by the year 2015. At an obesity conference in Abu Dhabi, in 2010, it was released that 71 per cent of the Emirati adult population is obese, while in a recent survey in Abu Dhabi, 35 per cent of the population was classified as obese and 32 per cent as overweight. In 2009, Elaine O’Connell, senior show manager for the Wellness & Spas Middle East exhibition, was quoted as saying that 60 per cent of Emiratis are overweight, with the expatriate community following on the same track.
Studies have also found that expatriate workers hailing from the subcontinent are far more likely to suffer from obesity after spending a period of time in the UAE, according to Dr Mark Newson-Smith, chief medical compliance officer of Emirates National Oil Company (ENOC).
“When workers arrive into the UAE their obesity levels are far lower than after they have been here for a period of time,” he told delegates at the Global Health and the UAE: Asia-Middle East Connections’ conference at the UAE University in Al Ain in 2010.
“It was found that before employment workers from India had an obesity level of 2 per cent, the level rising to 7 per cent among workers in employment; those from the Philippines were at 6 per cent on arrival rising to 8 per cent and those from Pakistan were at 16 per cent on arrival rising to 43 per cent.
Diabetes affects around 20 per cent of the population – the second highest national prevalence in the world behind Nauru, an island nation in the South Pacific – and there will be 680,000 sufferers here by 2030. Treating the condition currently costs between 13 and 40 per cent of the national health budget, depending on which estimate you come across.
Spending increases with weight
Perhaps the most accurate gauge of the problem is the effect expanding waistlines have had on healthcare spending in the region as a whole.
Gulf Cooperation Council member states (the UAE, Saudi Arabia, Qatar, Bahrain, Kuwait and Oman) have all seen huge hikes in medical budgets driven by a transformation in demand. In 2011, GCC states spent around $28.9 billion on healthcare. By 2014 that figure will be $44 billion and by 2025 it will rise to $60 billion as all those fried chickens come home to roost.
We don’t have the exact cost for the UAE but with the country ranking high globally in obesity and diabetes prevalence, the economic impact could run into billions.
This is the stark cost of the sedentary lifestyle both Emiratis and expats live here, along with the addiction to low-nutrient, high-fat, sugary foods. While most markets across the world are suffering a slowdown, business for those at the sharp end of obesity is booming because of a shift in the profile of the healthcare market from tackling communicable diseases to battling conditions arising from obesity.
Dr Curran, whose book Get Off The Sofa (available at Amazon.com) offers a wake-up call to those slipping into obesity, believes it is time for a debate on whether or not people should be penalised for burdening the healthcare system. The idea seems to be gaining popularity globally, with the Irish Government considering introducing a sugar tax to tackle their growing problems with obesity and diabetes.
“Obesity is a factor in our growing rates of Type II diabetes,” Irish health minister Dr James Reilly wrote, though their figures – 180,000 in Ireland have been diagnosed with the condition, with a further 50,000 unaware they are diabetic – are tiny compared to here.
France has also introduced a ‘fat tax,’ in a bid to deter children drinking fizzy drinks, a move which saw it embroiled in a dispute with Coca-Cola. Up to six Euro cents have been added to regular soda drinks, while zero calorie drinks will be exempt from the tax.
It has also rationed ketchup, salt and mayonnaise in school canteens, while Denmark has introduced a new higher level of tax on foods containing high levels of saturated fat.
A sign of changing times
Until people start to take responsibility, one of the keys to averting the coming disaster is to try to understand why people get fat in the first place. Reasons vary widely across the globe but in the Gulf, economic and cultural issues have been blamed. Desert life used to be so hard that Arab tribesmen were inevitably lean. But the socio-economic transition of the past four decades, fuelled by oil, has afforded most the luxury of a sedentary lifestyle lived in comfortable houses, cars, offices and shops. This combined with the climate means only 4 per cent of the population walk on a weekly basis.
Diets have changed too. Most family events centre around food but, thanks to advertising and convenience, traditional home-cooked meat and rice meals are now often substituted for deep-pan pizzas and fast food order-ins.
Aesthetically, plumpness is seen as desirable. Chubby children are valued. This cultural propensity towards fuller body shapes gives people a skewed view of themselves and prevents the health message getting through.
The same WHO survey that found that almost three quarters of people in the UAE were overweight also found that 75 per cent of those surveyed believed they were not. Worryingly, 99 per cent of those surveyed also did not believe heart disease was a significant threat. All these factors contribute; however, new studies which look at the inner workings of the brain are beginning to suggest that obesity is more deep rooted. Some people, it transpires, are hard-wired to become fat.
“If you are not able to discipline your habits, which is a core neurobiological function, then you will become obese,” Dr Curran explains. “Studies show that obesity is not about laziness or greed; it is about the neurological processes of want, need, reward and satiety. Obese people don’t feel gratified or slow down when they are eating so there is something wrong with this delicate interplay.
“As a neurobiologist it is my belief that a vast majority of obese people, at a very early stage in childhood have had their brain reset.
“Recently it has been discovered that early infantile and childhood experiences fundamentally and irreversibly alter brain function. Early life experiences are incredibly powerful in determining future behaviour and habits. There is a reasonable argument that at some point in obese children and adults, an event has occurred which has reset their satiety reward mechanism in such a way that they no longer experience satiety and reward in the same way as a non-obese person.
“This resetting could occur because someone is given too much food as a child.”
Exercise is good but diet is the key factor
While scientists decipher the neurological functions that lead to obesity, the ground troops in the war against want-more continue to fight the tide. Jon Dean works in Saudi Arabia and runs Spoon Fed Fitness, a weight-loss programme. He believes more research needs to be done to highlight the scale of the problem.
He says, “For me the main problem is diet; there are plenty of studies which show you can change the diet and do hardly any exercise and still see significant weight loss. A lot of times when you add exercise into the equation what you get is a lot of hungry people. Exercise is a tool to help but the main problem here is food.”
Children particularly are becoming addicted to sugar-laden carbonated drinks. “Socially, people tend to drink lots of sodas which have around ten spoonfuls of sugar in each can,” Dean says. “Half of that sugar is in the form of fructose, which damages the liver. Drinking excessive amounts regularly has the same effect on children as if they were drinking alcohol.
“When I tell parents this they are shocked. We are seeing massive metabolic problems with children. They have trouble walking, they get to 12 and their knees are like you would expect to see in a 70-year-old. They have arthritis and suffer sleep apnoea as well as bullying and psychological problems associated with obesity.
“In women obesity means birth weights are increasing and this leads to complications and babies which are predisposed to becoming obese adults.”
He believes soon the problem will become so acute, governments will be forced to legislate.
“There are soft campaigns with messages such as ‘eat less and move more’ but they fight to be heard above junk food advertising and, in the case of rising levels of bariatric surgery, the focus is shifting onto quick fixes to mask the problem. The big change will happen when there is a policy change. No campaign to promote change in health has ever worked without policy to back it up,” he says.
“After school, kids go straight to junk food outlets, they have no one offering good advice and alternatives so they don’t know any better.
“If the authorities stepped in and stopped outlets selling to under 18s until after 7pm that habit may change,” he feels.
That said, the UAE health authorities are going to great lengths to ensure that the people are aware of the dangers of being overweight. Anti-obesity campaigns are conducted regularly among school children and adolescents.
The UAE department of health education and promotion under the Ministry of Health launched a ‘No to Obesity’ programme a couple of years ago to create awareness among youth regarding obesity along with implementing physical training sessions.
Apart from organising and supporting events that would enhance physical activity, the health authorities also regularly conduct health awareness lectures about food and exercise.
The private sector, as well as voluntary organisations in the UAE, too have joined hands to raise awareness about the ill-effects of poor diet and lack of exercise. Fitness First, Gulf News and VLCC have been regularly organising fitness drives and distributing pamphlets urging people to take more care of their health.
But the big question remains: Is that enough? It seems that until we can unlock the secrets of obesity within the human brain and find a way to stop ourselves being seduced by fat, the best we can do is keep temptation at arm’s length.
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