UAE Report

The rising trends of obesity and overweight and its impact on children and adolescents in the United Arab Emirates

By Alexander Woodman M.P.H., M. Sci. and Haik Balayan M.D., Ph.D.

Background
Rates of obesity are increasing in adults and children worldwide. Obesity is a leading preventable cause of death worldwide and it is viewed by authorities view it as one of the most serious public health problems of the 21st century. Obesity is stigmatized in much of the modern world, particularly in the west. Historically, in a number of places around the world, obesity has been viewed as a symbol of wealth and fertility. This view persists in some parts of the world. In 1997 the World Health Organization (WHO) formally recognized obesity as a global epidemic. In 2013 the American Medical Association classified obesity as a disease.

Obesity is a medical condition, in which excess body fat accumulates to the extent that it may have a negative effect on the health. People are considered obese when their body mass index (BMI), a measurement obtained by dividing a person’s weight by the square of the person’s height, exceeds 30 kg/m2.

Obesity can result in reduced life expectancy and increased health problems. Prior to the 20th century, obesity was rare.

WHO estimates that about 13% of the world’s adult population (11% of men and 15% of women) were obese in 2014. WHO notes that the worldwide prevalence of obesity more than doubled between 1980 and 2014. According to the WHO, in 2014 more than 1.9 billion adults aged 18 years and older were overweight. Of these over 600 million adults were obese. And an estimated 41 million children under the age of 5 years were overweight or obese.

Trends
In the United Arab Emirates (UAE), obesity has become a major problem. Over 60% of Emirati nationals are overweight, and this figure is expected to rise. According to a recent study, published by a BMC Public Health journal, the UAE ranks as the fifth fattest nation in the world. Additionally, according to Forbes, 68.3% of citizens of the UAE have unhealthy body weight.

This growing health issue is worrisome to Emirati health officials, particularly when obesity, a leading cause of death, is preventable.

Over the past four decades, the UAE has gone through a profound and rapid socioeconomic transition to a more affluent society, which has led to fundamental changes in the population’s lifestyle, dietary habits, and physical activity pattern. This is similar to the modernization processes that occurred in the western world, but in the UAE it has occurred over a much shorter time.

There are several causes of obesity in the UAE. One of the major predictors is the lack of energy balance. Energy balance means that energy ‘in’ equals and energy ‘out’. Overweight and obesity occurs when more calories are consumed than utilized. Another factor is the environment, which is generally not conducive to an active lifestyle. There is a failure to promote healthy living. There is a lack of educational and informational tools that target and educate the population on impact of eating habits and lifestyle choices (Hajat, Harrison, & Shather, 2012).

Inactivity
Habitually, the population in the UAE is physically inactive. There are several factors that influence inactivity. One reason for the inactivity pertains to the number of hours they spend in front of the television (TV) and computer, whether to engage in professional duties, schoolwork, or leisure activities. In fact, two or more hours of daily TV viewing time has been linked to people becoming overweight and obese.

Inactivity in UAE is also due to the over reliance on automobile transport, as opposed to walking or cycling.

Additionally, the physical demands at work and in the home have declined because of the availability of, and help of modern technology and conveniences. At an early age, inactivity is reflected in the lack of physical education classes and sports activities in schools. Children who are inactive are more likely to gain weight as they do not burn the calories they consume from foods and drinks.

Another contributing factor is genetics and family history. Studies of identical twins, who have been raised apart, show that genes have a strong influence on a person’s weight. Overweight and obesity tend to run in families. The chances of being overweight are greater if one or both of parents are overweight, or obese.

Other factors include medical status, psychological factors, age, pregnancy, lack of sleep, and cultural influences.

Generally, cultural values represent as an influential variable, particularly in the home. This is exemplified in households where children observe the unhealthy eating habits their parents exhibit. Children are likely to adopt this attitude and behavior during early childhood. Unhealthy eating tends to run in families.

Prevalence
The prevalence of overweight and obesity in the UAE is significantly high among children and adolescents – and it continues to grow. Obesity during childhood should be regarded as a chronic medical condition that is likely to require long-term treatment. Childhood obesity can be a strong indicator of weight-related health problems in later life. This supports the view that learned unhealthy lifestyle choices continue into adulthood (Musaiger et, al., 2013).

Consequences
The health consequences of obesity fall into two broad categories: those attributable to the effects of increased fat mass (such as osteoarthritis, obstructive sleep apnea, social stigmatization) and those due to the increased number of fat cells (diabetes, cancer, cardiovascular disease, non-alcoholic fatty liver disease). Increases in body fat alter the body’s response to insulin, potentially leading to insulin resistance. Increased fat also creates a pro-infl ammatory state and a pro-thrombotic state. Overweight and obese people have an increased incidence of coronary heart disease. Being overweight, or obese increases the risk of developing high blood pressure. Obesity adversely impacts existing endocrine and metabolic disorders.

Metabolic syndrome
Metabolic syndrome is one of the fastest growing obesity-related health concerns in the UAE. It is characterized by a cluster of health problems, including obesity, hypertension, abnormal lipid levels, and high blood sugar. According to the US Centers for Disease Control and Prevention (CDC), metabolic syndrome affects almost one quarter (22%) of the Arabian population – an estimated 47 million people.

Obesity has a negative effect on lipid levels in the blood, which often leads to the development of dyslipidemia. Separately, thyroid hormones drive metabolism, which is why it is often assumed that there is a direct link between obesity, the thyroid gland, and its related thyroid conditions. Other obesity-related health conditions include colon cancer, polycystic ovary syndrome, reproduction/sexually issues, type-2 diabetes, and childhood obesity.

When complications occur, they are either directly caused by obesity, or indirectly related to its mechanisms. In a nutshell, the common denominators are unhealthy diet and a sedentary lifestyle (Baglar, 2013).

Childhood obesity
Childhood obesity is linked to numerous health problems. These encompass an increased risk of eating disorders, including misguided attitudes to eating, weight concerns, dieting, binge eating, anorexia and bulimia. In some Emirati states, obesity is found in nearly 40% of children. Besides negative psychological effects, childhood obesity causes physiological issues such as liver, lung, heart, and musculoskeletal complications.

Unfortunately, many people in the general UAE population are unaware that childhood obesity can lead these health complications (Junaibi, Abdulle, Sabri, Hag-Ali, & Nagelkerke, 2013).

Diabetes
Obesity has been linked with type 2 diabetes. More than 80% of people with Type 2 diabetes, the most common form of the disease, are obese or overweight. Excess body fat underlies 64% of the cases of diabetes in men and 77% of the cases in women. Data from the CDC and the National Health and Nutrition Examination Survey III show that twothirds of adult men and women in the UAE diagnosed with Type 2 diabetes have a body mass index (BMI) of 27, or greater. This is classifi ed as overweight.

Prevention
Obesity management is an important step in the prevention and control of chronic non-communicable diseases. Obesity-related cardiovascular diseases, diabetes, hypertension, and certain cancers contribute to 60% of the overall morbidity and mortality rate in most Arab countries (Musaiger, O. A., Zall, bin A. A., & D’Souza, R., 2013).

There are numerous strategies to promote the prevention of obesity. One measure is to encourage parental participation. It is a key factor in the prevention of, and management of childhood obesity.

Several studies in the UAE have reported high levels of parental misperception of their childrenfs weight. Of all parents, 33.8% misclassifi ed their childrenfs weight status . underestimating (27.4%) or overestimating (6.3%). Misclassifi cation was highest among parents of overweight/ obese children (63.5%) and underweight (55.1%) children.

To involve parents, however, would require parental recognition of their childfs weight status. Parents should be equipped to recognize and evaluate a child as overweight and obese. Incorrect perception may lead to an incorrect assessment of childrenfs eating habits and physical activity levels.

In a recent systematic review, it was found that parental misperception is common. For example, 62.4% of overweight/obese children were incorrectly perceived as having normal weight. In some countries, parents neither understand nor use, or trust common clinical measures to identify their childrenfs weight status. Fewer than 50% of parents accurately identifi ed their childfs weight status. Apparently, parents resorted to alternative approaches, such as visual assessments and comparisons to extreme cases, in evaluating their childrenfs weight status.

The issues of mistakenly identifying childrenfs weight status may be attributed to the accepted cultural norms within a population, or society. Parental perceptions towards childrenfs weight status and its determinants in the Arab world seem to have been largely overlooked, despite the high prevalence of overweight and obesity in this population. This is particularly concerning, especially when the prevalence of childhood obesity in this population is one of the highest in the world. Arguably, some parents may have deliberately chosen to underestimate the weight status of their child in order to avoid stigmatization associated with obesity (Aljunaibi, Abdishaku, & Nagelkerke, 2013).

It is well documented that childhood obesity is a risk factor for several noncommunicable chronic diseases during adulthood. The World Health Organization reported that the nutrition transition is observable in all Eastern Mediterranean countries. From a health perspective, the growing level of obesity among children and adolescents is particularly worrying. Therefore, it is important for the UAE to focus on prevention strategies.

Prevention strategies should focus on younger children, particularly those with a parental history of obesity (WHO, 2012). In addition, the consumption of dairy food should be encouraged. Moreover, it is recommended that longitudinal studies, that investigate the trends and the impact of childhood obesity on the prevalence of non-communicable diseases in the UAE, should be conducted.

Importantly, it is necessary to address the issues impacted by the concept of body image. Body image is a fairly stable belief system. Children, who exhibit higher levels of body dissatisfaction, are likely to practice this belief into adolescence and young adulthood. Consequently, it may result in eating disorders.

To address the challenges, and to combat the impact of obesity, the Arab Center for Nutrition prepared a strategy for the region. However, for this strategy to succeed, it will need proper and suffi cient baseline data on the epidemiology and etiology of obesity among children and adults in this region (Junaibi, Abdulle, Sabri, Hag-Ali, & Nagelkerke, 2013).


UAE MoH, Emirates Diabetes Society in partnership with AstraZeneca launch Circle of Care for diabetes

The UAE Ministry of Health and Prevention in partnership with the Emirates Diabetes Society, and within the framework of the new MoU signed by the Ministry with AstraZeneca Gulf, has launched Circle of Care, an education and support programme aimed to improve the well-being of people in the UAE living with or at risk of developing type 2 diabetes. The programme seeks to address the findings from a recent local diabetes report, undertaken by Project HOPE, a global health education and humanitarian assistance organization, beginning with a focus on Emirati diabetic patients.

Dr Hussein Al Rand, Assistant Under-Secretary for Health Centers and Clinics at the UAE Ministry of Health and Prevention, highlighted the importance of the new initiative, especially with its focus on chronic disease and impact on the society, something that ranks high on the Ministry’s national agenda.

“The Circle of Care partnership reinforces the Ministry’s goal to form strategic partnerships for community programmes, which supports the National Health Agenda to improve the curative and preventive services related to chronic diseases in the UAE, with the hope of decreasing the diabetes comparative prevalence in the country from 19.3 percent (IDF Diabetes Atlas, 6th Edition) in 2015 to 16.28 percent by 2021, complementing UAE Vision 2021.” he said.

Circle of Care comprises of three pillars that focus on:

1. Uplifting healthcare professionals’ medical capabilities

2. Supporting initiatives set by local health authorities and medical societies’ regarding the importance of early diagnosis and diabetes control, and

3. Educating patients and caregivers.

The initiative also includes providing new and culturally relevant diabetes resources and materials specifically developed for UAE residents, in line with the findings of the Project HOPE report, which focused on the main challenges that face diabetic patients. Another important component is scientific research on diabetes, in which the UAE will take part.


Further Education: (left to right) Mohammed Alteneiji, Sarah Bawazir, Mohammed Alharmoodi, Salim Almulla from Khalifa University (KU) have fl own to Washington, D.C. to participate in the Sheikh Zayed Institute for Pediatric Surgical Innovation’s annual Student Innovators Program (SIP), a summer program taking place at the Children’s National Medical Center. The students were selected alongside 20 others from universities around the world, and will have access to worldclass paediatric healthcare facilities and educational opportunities at the Sheikh Zayed Institute. The students will work on a number of projects with institute physician-scientists and bioengineers, mainly focusing on robotics in medicine and innovation in patient care and disease treatment. Other projects will also include basic science research and mobile app development.

The Authors 

  • Alexander Woodman is a faculty member of Department of Humanities and Social Sciences at Prince Mohammad Bin Fahd University, Saudi Arabia. awoodman@pmu.edu.sa
  • Haik Balayan is a faculty member of the Department of Surgery, Yerevan State Medical University, Armenia.

References

  • Aljunaibi, A., Abdishaku, A., & Nagelkerke, N. (2013). Parental weight perceptions: A cause for concern in the prevention and management of childhood obesity in the United Arab Emirates. PLoS One 8 (3).
  • Baglar, R. (2013). “Oh God, save us from sugar” an ethnographic exploration of diabetes mellitus in the United Arab Emirates. Medical Anthropology: Cross- Cultural Studies in Health and Illness, 32:2, 109-125.
  • Center for Disease Control and Prevention, CDC, 2008. Available at: www.cdc.gov/pcd/issues/2008/jul/07_0086.htm
  • Hajat, C., Harrison, O., & Shather, Z. (2012). A profi le and approach to chronic disease in Abu Dhabi. Globalization and Health, 8:18.
  • Health Authority of Abu Dhabi Statistics Report; 2010. available at: www.haad.ae/HAAD/LinkClick.aspx?fi leticket=clGoRRszqc% 3d&tabid=349
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  • Musaiger, A. O. (2011). Overweight and obesity in eastern Mediterranean region: prevalence and possible causes. Journal of Obesity, 407237
  • Musaiger, A. O., Al-Mannai, M., Al-Lalla, O., Saghir, S., Halahleh, I., Benhamed, M. M., Kalam, F., & Ali, E. Y. A. (2013). Obesity among adolescents in fi ve Arab countries; related to gender and age. Nutricion Hospitalaria, 28(6) 1922-1925.
  • Musaiger, O. A., Zall, bin A. A., & D’Souza, R. (2013). Body weight perception among adolescents in Dubai, United Arab Emirates. Nutricion Hospitalaria, 27(6) 1966- 1972.
  • Statistics Centre Abu Dhabi: Statistical Year Book of Abu Dhabi 2011; Available at: www.scad.ae/SCADPublications/EBOOKEnglishSYB2011.pdf
  • World Health Organization (2013). Plan of action for the prevention and control of non-communicable disease in the Eastern Mediterranean region. www.emro.who.int
  • World Health Organization 2008-2013 Action plan for the global strategy for the prevention and control of noncommunicable disease.

 

Date of upload: 13th Sep 2016

                                  
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