Biomed Middle East

Health cost of the way we live

For many a working expatriate, having a few pegs of alcohol each evening and smoking a few cigarettes is a favourite pastime.

Weekends are when friends meet, but not many go for an outing, especially during the harsh summer months, so drinking, eating and smoking are a preferred option for many.

Media reports say that some young women in the Qatari community have begun smoking in all-women parties — something they were said to have been doing privately earlier.

This apart, Qatar being a rich country, eating is a pastime for many, with almost everyone having access to fast food.

Children are particularly fond of junk food and carbonated drinks and their mostly working mothers gladly order takeaway meals rather than slog it out in the kitchen.

The housemaids are mostly illiterate and know little about the calorific value of the food they make. Their accent is mainly on preparing food that tastes good, and on time.

Even the lowest-paid menial worker here has easy access to restaurant food, most of which is oily and can seriously compromise one’s health over the long term.

Given the conservative nature of Qatar’s social milieu, women have no avenues for outing and doing physical exercise.

Moreover, those having cars prefer to ride as a matter of habit rather than walk even short distances that can be easily covered on foot in pleasant weather.

It is no wonder then that the so-called lifestyle diseases have a high incidence in the country and are being increasingly recognised as a major cause of death and morbidity.

Some of the most common of these diseases are obesity, diabetes, hypertension and cardiovascular disorders.

Qatar’s Permanent Population Committee (PPC), in its latest report, had pointed out that diseases like hypertension, diabetes (Type 2) and cancer were among the top 10 causes of death among nationals.

Citing 2008 figures, the report said 21 percent of the deaths that year were caused by periodic systemic problems, while cancer accounted for at least 12 percent of the deaths. Nine percent of the deaths were due to diabetes.

The study, like many other studies conducted locally and regionally, attributed the high prevalence of hypertension in the country to obesity, high intake of fats and severe lack of physical exercise.

As the name indicates, lifestyle diseases are directly linked to a change in the way people live. They can be described as the price that human beings are paying for rapid modernisation and urbanisation, which, at the same time, have made life easier for people not only in Qatar and the rest of the Gulf region but in the world as a whole.

Science has helped eradicate many dreadful diseases from the globe, but changes in people’s way of living have brought in others, including the so-called lifestyle ailments.

Certain forms of cancer, most types of heart disease, high blood pressure, obesity and Type 2 diabetes are associated with the way people live, say reports.

Poor diet, lack of exercise, smoking, excessive consumption of alcohol and even poor sleep may contribute to these illnesses or be their primary cause.

According to the World Health Organisation (WHO), about 60 percent of deaths all over the world and 47 percent of the global burden of disease are attributed to non-communicable diseases (NCDs).

Most of the lifestyle diseases fall in this category. And 75 percent of the total deaths due to NCDs occur in developing countries.

The term ‘lifestyle disease’ mostly refers to those conditions that can be prevented if one’s lifestyle is changed. The prevalence of such diseases can be reduced or controlled through increased public awareness.

For instance, smoking rates have gone down due to vigorous anti-smoking campaigns and higher taxes on tobacco, and this will likely reduce some forms of heart disease and lung cancer.

Currently, many developed and developing countries are waging similar campaigns to reduce obesity, which is a growing epidemic and can lead to many other types of lifestyle diseases.

Another major factor in lifestyle ailments is changes in nutritional patterns experienced over the past few decades. As diet changes, usually to include a smaller proportion of complex carbohydrates and more sugar and animal fat, people become more susceptible to NCDs, studies show.

Obesity becomes more prevalent and, coupled with less physical activity, it increases the risk of morbidity and premature death. Epidemiological studies also provide evidence that dietary fats influence the risk of certain cancers such as those of the breast, colon and rectum.

Excessive alcohol intake is associated with increased risk of cancer in the oral cavity, pharynx, larynx, oesophagus and liver. High salt intake increases hypertension, raising the risk of stroke and coronary heart disease.

Considerable changes in food consumption patterns have occurred over the past 30 years all over the world, including in the Middle East. Data from the Regional Office for the Near East of the Food and Agriculture Organisation of the United Nations, based on food balance sheets for certain Arab countries, indicate that the per capita food energy and protein availability has doubled and fat has increased three-fold.

Cereals, which contribute more than half the energy and protein supply to Arab populations, increased in terms of per capita availability during the period 1961-1990. The degree of this increase varied from one country to another but availability of rice increased five-fold in some countries and that of wheat eight-fold.

During the same period, availability of sugar was also reported to have increased by up to 300 percent in one country.

Similarly, all countries showed a very large increase in the per capita supply of edible oil. On the other hand, there was no comparable increase in the availability of vegetables and there was, in fact, a general decline in this respect in some countries. Only a slight increase in the per capita supply of fruits occurred during this period.

There are other risk factors that are contributing to the increasing incidence of cardiovascular diseases, diabetes and cancer. Available data indicate a considerable and steady increase in tobacco consumption over the past three decades. Data also demonstrate high rates of smoking in the East Mediterranean Region, especially among men.

A smoking prevalence rate among adult males of up to 40 percent is reported in some countries. Extensive evidence is available about the role of smoking in causing several types of cancer. Since cardiovascular diseases are the major cause of death among people with diabetes, smoking is considered a significant factor affecting morbidity and mortality from both types of diabetes.

Very little is known about physical activity on a population basis in the region. With few exceptions, physical inactivity as a risk factor in NCD has not been adequately evaluated. Although some government facilities are available for sport, these facilities are often restricted to team sports and are not always available to the general public. There are several barriers to promoting physical activity, particularly among women.

The situation in Qatar is no better and could be worse in many respects. Obesity has been cited as the major risk factor for most of the lifestyle diseases and Qatar has one of the highest prevalences of obesity in the region.

According to available statistics, about 17 percent of the Qatari population is diabetic while 40 percent of Qatari children are obese.

And the use of alcohol is on the rise, particularly in the expatriate communities. “But no statistics are available,” laments prominent psychiatrist Dr Taher Shaltout, who says he treats a number of alcoholics.

Experts believe that the prevalence of diabetes in the country could be higher given the high prevalence of obesity and a steady rise in the number of diabetics.

The Qatar Diabetes Association, which is at the forefront of national efforts to raise public awareness about diabetes, is now preparing for a new survey to more accurately analyse the prevalence of diabetes in the Qatari population.

No studies have been conducted about the prevalence of lifestyle diseases in the large expatriate population in the country. However, results of screenings at a number of medical camps involving expatriate workers from South Asian countries have shown an alarmingly high prevalence of diabetes and hypertension.

A regional study on the prevalence of excessive weight, obesity and related nutrition-related non-communicable diseases in Bahrain, Kuwait, Qatar, Oman, Saudi Arabia and the United Arab Emirates found that obesity is common among women and an equal or higher number of men are overweight.

Among adults, the proportion of overweight and obese individuals is especially high in Kuwait, Qatar and Saudi Arabia, particularly in the 30–60 year age group (70–85 percent among men; 75–88 percent among women), with lower rates among younger and elderly adults.

A survey on child obesity in Qatar, conducted by the Childhood Cultural Centre in collaboration with the Hamad Medical Corporation, Qatar Statistics Authority and the regional office of the WHO, found that 70 percent of the children in Qatar don’t have a healthy diet.

One out of every three Qatari primary schoolchildren skips breakfast at home. The study covering 1,467 Qatari children at the primary (elementary) level in government and Independent schools also found that about half of the children suffer from malnutrition. They are either obese, underweight or overweight.

Of those surveyed, 23 percent were found to be obese while 16 percent had a body weight that was above average. Eight percent of those surveyed were underweight, a condition that has not received enough attention from the society, noted the study.

The study, which looked into the food habits of young Qatari schoolchildren, found that two out of every three children ate fast food once or twice a week. About 90 percent of those surveyed had snacks between their meals daily. Of these, more than 50 percent preferred chips and pastries for snacking.

Khawla Ali, a student of Weill Cornell Medical College in Qatar, in her research on obesity among women in Qatar has hit at the root of the problem.

“Obesity developed as food consumption patterns changed and personal income grew. Before the discovery of oil, fish, rice, and dates were the most commonly consumed food in the Gulf, especially among Bedouins.

Meat tended to be consumed only when guests were invited or by the upper social classes. However, in the last three decades, the economic development has resulted in an increase in purchasing power.

Consumption of meat and rice in Qatar has been very high, and women have been consuming high levels of fat, sugar and sweets but inadequate quantities of vegetables and fruits.

Although fats make excellent fuel, by providing the body with huge amounts of energy, this also means that a person must work harder and expend more energy to use up the fat stored in her body. These energy-dense foods that are stockpiled with calories may increase the incidence of obesity among women in Qatar,” writes Ali.

She attributed the high prevalence of obesity among women in Qatar — as high as 63.7 percent, according to the author — to a sedentary lifestyle and lack of physical exercise resulting from an affluent lifestyle, improved transportation facilities and the popularity of office jobs. She also drew attention to the damaging effect of the childcare system in the Qatari society.

“After the tremendous increase in families’ income and the fact that Qatari women need, or have the right to, go to work, many women workers consider the choice of alternative childcare inexpensive and easily accessible.

Non-parental childcare has a destructive effect on children’s development and health status…. Since most babysitters are illiterate in Arabic and limited in healthcare knowledge, they may provide a child with any type of food, ignoring the fact that this food is typically inappropriate to medical health.

As an example, most children under ten years of age are seen in malls and shopping centres with their housemaids. When it comes to eating lunch or dinner, maids try to satisfy a child’s needs by simply buying him/her an ice-cream from KFC or a happy meal from McDonald’s.

If this child suffers from obesity, eating fried food on a regular basis would eventually lead to serious chronic diseases including diabetes mellitus and cardiovascular diseases,” says Ali.

THE PENINSULA

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