The hidden obesity toll on women in Arab states

A dramatic increase in obesity among Arab women is threatening to become a health crisis with almost half of adult females overweight in some countries – double the rate of men.

Surveys by the International Association for the Study of Obesity show that the rates of female obesity in the region are significantly higher than those of males. In Kuwait, 47.9% of women are obese, compared with 34.6% of males. In Qatar and Saudi Arabia, around 45.3% and 44% of women are obese – nearly double the rate in men there¹.

The cause of the increase varies between Arab countries depending on socioeconomic, geographical and cultural differences. But a marked change in diet seems to be a common thread, coinciding with the introduction of a more 'Western' diet about three decades ago as the demands of growing populations outstripped domestic production.

The consumption of more calorific food, a higher intake of animal fats and sugars and reduced dietary fibres became prevalent in the region and foods which had previously been unavailable, such as pasta and sugary carbonated drinks, became popular. With more women going into the workforce, traditional home cooked meals were often replaced with fast foods, high in saturated fats, cholesterol and sodium.

Najat Mokhtar, president of the Moroccan Society of Nutrition, explains that most Moroccan and Tunisian women fail to lose the weight they gain during pregnancy. "Young mothers are not offered any follow-up on nutrition after they had a child, and they tend to let themselves go."

Obese women are also more prone to miscarriages, and can experience difficulties becoming pregnant, according to Nagwa Hassan, a pediatrician and head of the Laser Department at the Egyptian National Research Center. "Extreme fat surplus lodges itself around the internal organs, surrounds the ovaries and reduces fertility."

Physical activity levels in the MENA region are low, especially among women. In Saudi Arabia and Bahrain, for example, only 2% and 6% of women take exercise^2,3. Opportunities to work out or practice sports are limited, where cultural sensitivities preclude women from exercising in public.

In a study led by Abdulrahman Musaiger, a professor of nutrition and public health at the University of Bahrain and head of the Arab Center for Nutrition, also based in Bahrain, 67% of females said there was gender discrimination since most sports and recreational facilities were for males only⁴.

In Saudi Arabia, a pilot project is underway to open some schools at night for women to exercise, says Musaiger. "Most of the family-related commitments in the Arab world fall to women. This drastically restricts time during which they could exercise." Through his consultations with female patients, he believes that women generally dislike physical activity as an option to lose weight, put off by the idea of building muscles.

A further issue is the perception in Arab society that plumpness is associated with beauty and high social standing. A study conducted by the Philips Center for Health and Wellbeing in the United Arab Emirates in 2010 revealed a vast discrepancy between people's perception of their shape and their actual physical condition. Around 75% of the respondents believed that their weight was normal, when official figures showed only 30% were in the normal range.

Musaiger points out that this misconception may have cultural roots. "Our culture helps hide the visible marks of obesity under long abayas that cover the whole body. The men's garments also hide the extra weight, so there is no recognition that you are overweight," he says.

This phenomenon, which Mokhtar calls 'hidden fatness' or 'hidden obesity', makes it difficult to see a woman's shape, and thus recognize a potentially life threatening health condition⁵.

Poor nationwide intervention

Our culture helps hide the visible marks of obesity under long abayas that cover the whole body.

In North Africa and the Levant, rural women have generally been less prone to obesity, due to greater physical activity, but according to Mokhtar, the healthier diet and increased physical activity of rural Moroccan women is changing. "Peasant women sell fruits, vegetables, milk and eggs and use that money to purchase energy dense foods like sugar and wheat flour." While a lot of rural women get physical exercise while working, their diet undermines their output.

Hassan, laments the lack of nationwide government campaigns to target obesity. "The focus is on hepatitis and cancer," she says, and not on a holistic approach to nutrition by health services.

Mokhtar echoes Hassan's concerns about the scant attention paid by North African health authorities to raising awareness of obesity and the lacking of funding for studies on the subject.

She says that heath ministries plan their programmes around guidelines provided by the Millennium Development Goals (MDG), such as hunger, maternal and child mortality, education, environment, gender equality, but neither obesity nor chronic diseases. "Although every single family in the region has at least one case of obesity, cancer, high blood pressure or diabetes, our governments focus on other areas," Mokhtar says.

Health professionals recognize the heavy financial burden of chronic diseases associated with obesity and say campaigns which involve the media, manufacturing food companies and doctors are needed.

Musaiger would also like to see family doctors be trained in nutrition "since they don't know much about it and people trust doctors more than nutritionists"

He and other nutritionists from the Arab Taskforce for Obesity and Physical Activity have prepared a set of guidelines to combat obesity and promote physical activity in Arab states.

He says the guidelines should be adapted to the needs of each country, but that the general goal is to promote healthy dietary habits, reduce the risk factors for chronic non-communicable diseases, promote more research and raise awareness. They can also help develop partnerships between government institutions, the private sector and civil society to tackle obesity effectively.

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