The weight of the world – childhood obesity

In 18th-century London, the import of cheap gin, a revolutionary type  of alcohol much stronger than beer and brand new to the largely untravelled population of the city, was the biggest cause of social problems at the time. Histrionic politicians, religious leaders, social commentators and health officials – or the people as close to it at the time – all queued up to castigate the poor underclass who were drinking themselves into an early grave with the help of the juniper plant.

The gin was cheaply made, often from unreliable producers, and could be poisonous. The anti-gin hysteria reached
a crescendo in the middle of the 1700s, with five major acts passed through UK Parliament to try to curb the appetite for it; none of them had a major effect. William Hogarth’s famous Gin Lane painting, produced in 1751, depicted the depravity and social ills the drink wrought upon the city – particularly for those belonging to the poorer end of society, who, in those days, were thought not to have the moral fibre to resist the demonic drink. 

Today, we know that particular brand of moralising is not valid, more often representing correlation than causation; ‘moral fibre’ does not determine our ability to steer clear of alcoholism and, while scientists still search for the true origin of why some humans struggle with addiction, a new health blight is launching itself from the West to all four corners of the globe.

Obesity is the moral outrage of the 21st century. Cheap, sugary, salty and additive-laden processed food is made in bulk and shipped out to our restaurants, canteens and supermarkets. Coupled with people’s increasingly sedentary lifestyles, love of cars, and refusal to integrate urban planning and lifestyles that emphasise walkability, we’ve quickly entered a new era where being overweight is the norm.

In the West, it is largely the lower-income sectors of society that suffer the ills of obesity. Food deserts – where neighbourhoods don’t have supermarkets, only convenience stores selling overpriced and unhealthy snack foods – are a blight of poorer neighbourhoods, and government campaigns to educate citizens about the dangers of poor eating habits are usually designed to focus on less-affluent areas of society where educational attainment and social engagement are lower.

But what of the Middle East, where this is not the case? Obesity in this part of the world is not the modern-day ‘Gin Craze’ of the West but often a problem of the wealthy elites as much as it is all other strata of society. This is exacerbated by the demographics of the region: with its young population and high birth rate – 54% of the Arab population is under the age of 25 – there are more young people tipping the scales. Estimates vary, with many putting the number of obese people at 30% in some of the Gulf countries, but some studies have it as high as 45%.

Western ideal

This new heavy-set population could have devastating effects on the countries’ healthcare provision and budgets – data from the International Diabetes Federation in 2014 showed that there were 803,900 type 1 and type 2 diabetics in the UAE – about 19% of the population. This is a huge section of the country that must, effectively, be medicated up until they die and, with the robust association between obesity and type 2 diabetes, this is an obvious cause for concern.

Bahrain has the highest rate of childhood obesity in the region. High temperatures, lifestyle factors, city planning in terms of location of shopping malls and motorways, and rapid cultural change are all known to be factors in the development of obesity. Bahrain ticks all the boxes.

“It is widely accepted that the high consumption of foods rich in fat and calories, and the sedentary lifestyle among most communities in this region have played an important role in the rise of obesity,” says Professor Abdulrahman Musaiger of the Arab Center for Nutrition (ACN), a non-governmental organisation with its headquarters in Bahrain that sits under the purview of the University of Bahrain’s Nutrition and Health Research Unit. “This is particularly true with the great shift from traditional food to more Westernised food in these countries.

“Low intake of fruit and vegetables is another important factor,” he continues. “It was found that children who eat fruit and vegetables regularly are less likely to be obese than children who did not eat or less frequently eat these foods. Skipping breakfast or intake of a poor-nutritional-value breakfast is also a contributing factor.”

These are all accepted elements when it comes to obesity, and it does seem like it is the already-well-known influences from the West that have spread eastwards and led to this jump in obesity rates.

“Recent studies have shown that children who consume breakfast regularly are less likely to be obese and to have diabetes than those who skipped breakfast. In general, the percentage of schoolchildren skipping breakfast in the region is high, ranging from 30 to 70%.  The proportion of breakfast skipping is higher among girls than boys, and increases with age.”

In terms of an explanation for why the Middle East has developed such high rates in such a short time, Musaiger believes this is fairly straightforward too. “Changes in lifestyle and socio-economic status in this region have a significant negative effect on physical activity. With the availability of cars, electric home appliances, and more involvement in the internet, watching television and playing video games, the life has become more sedentary, and the pattern of exercise has diminished steeply in most countries in the region.”

Exercise in policy

So far, so similar to all the other parts of the world where this association has been documented, but are there any specific cultural, public policy or healthcare-style factors in the Middle East that could have contributed to this – and, more importantly, that could be used to tackle it?

Musaiger believes there are several, including some historical reasons. “Cultural factors may play an important role in occurrence of obesity among children. Preferring a plump child is widely prevalent in some societies in the region; this means that this child is overweight and ready to become obese.”

He also thinks that, unlike in the West, the traditionally modest clothing could be a hindrance in teaching and confronting children about their issues with weight. “The traditional long, wide dress for teen boys and girls may hide the fatness and consequently reduce their motivation to lose weight,” he explains.

There is another, more serious issue to consider in this context, too: “Females face some difficulties excercising compared with males; as males in general have more freedom, and places to exercise and [practise other] recreational activities.

“It is true that, in some cultures, girls and women are not allowed by the family to exercise outdoors, or in the same place as boys and men. For example, 79% of Bahraini women perceived that the lack of availability of women’s clubs is one of the main factors for not practising exercise.”

The sudden rise in obesity has been alarming, so what do authorities in the Middle East do now to combat it? It’s an issue that has been a struggle in other parts of the world facing the same crisis, and a mix of ideas has proven less than effective, with no coherent, concerted actions yet taken to face up to the problem. The Middle East has a proven ability to quickly reshape and reinvent itself – are there lessons that could be learnt from other countries, or indeed coordinated across the different countries in the region?

“Obesity has become one of the main health problems, and it’s associated with several chronic diseases, yet there is no strategy to prevent and control obesity in the health plans of most countries,” Musaiger says. “There are, however, some successful activities in schools focused on promotion of healthy eating and the lifestyle of children, especially in Saudi Arabia, which could be exported to most countries in the region.

“In order to prevent and control obesity in communities, it is necessary to induce changes in dietary habits, health behaviour and lifestyle, taking into consideration several issues. Change in food habits is one important element to solve this problem through inclusion of more low-energy food, such as fruit and vegetables. Change in lifestyle is another element that needs to be considered, especially increasing physical activity among the Middle East population.”

Musaiger also sees a desperate need for coordination and cooperation among all related sectors, governmental and private, to establish successful programmes to solve this problem.

“Obesity is a serious health hazard and action is needed to prevent it becoming even more widespread. A national strategy to prevent and control obesity in each country needs to be established,” he concludes.

Childhood obesity is clearly a growing problem in Middle Eastern countries. It needs epidemiological studies, and preventative and early-intervention programmes, as well as full government-backed health campaigns across all countries in the region, otherwise the future generation will be sitting on a health time bomb.