The men are whip-thin and wiry, bent to the task of launching a heavy wooden dhow from the beach into a mirror-calm sea. The iconic black-and-white photograph, taken by British explorer Wilfred Thesiger in Abu Dhabi in 1948, captures a way of life now gone.
Little more than two generations ago, the forebears of today’s Emiratis lived tough, physical lives, in which every calorie consumed came at the expense of energy expended eking out a meagre living from the sea.
Thanks to the miracle of oil, which first began to flow in the mid-60s, life for many in the UAE and the wider Gulf today bears no comparison. In place of what the admiring Thesiger described as “the satisfaction which comes from hardship and the pleasure which derives from abstinence” is a physically undemanding good life and a cake-stocked cafe on every corner.
The result is an epidemic, a perverse by-product of success that, according to a worldwide study coordinated by the Institute for Health Metrics and Evaluation at the University of Washington, has left 66 per cent of men and 60 per cent of women in the UAE medically overweight or obese.
Worse, the research shows that obesity is on the rise among the UAE’s children, with grim consequences not only for their health and happiness, but also for the economic future of a country facing ever-increasing medical costs.
The obesity epidemic isn't a problem only for the UAE. According to the IHME study, published in medical journal The Lancet in 2014, between 1980 and 2013, the global proportion of adults who were overweight increased from 28.8 per cent to 36.9 per cent in men, and from 29.8 per cent to 38 per cent in women.
The study also revealed that in 2013, 23.2 per cent of the world’s children were overweight or obese.
But in the UAE the obesity problem, fuelled in large part by the nation’s meteoric economic development, is among the worst in the world.
In the wake of the oil discovery, by 1980 – just nine years after the founding of the UAE – 62 per cent of the adult population (over the age of 20) was overweight or obese, putting the fledgling nation at 16th place on the global table.
By 2013, the UAE had slipped down to 27th position, but this was more a reflection of other countries gaining weight rather than of the UAE losing it: since 1980, the percentage of overweight or obese adults in the UAE has increased from 62 per cent to 65 per cent.
Worryingly, over the same period the increase in the number of overweight children has been even higher, from 25.6 per cent in 1980 to 31.2 per cent – almost a third of the nation’s youth – in 2013. By this measure, the UAE ranks 16th in the world in terms of childhood obesity.
On the surface, the cause of obesity – too much food, too little exercise – would seem to be as obvious as its solution – eat less, exercise more. But “obesity in children is a complex disorder,” says Dr Fani Bakaradjieva, a paediatrician at Abu Dhabi’s Healthpoint.
“Many factors, including genetics, environment, metabolism, lifestyle and eating habits, play a role in its development.”
Which is not to say we can shrug, blame it on the genes and carry on watching the kids pile on the kilograms. “Less than 10 per cent of cases are associated with hormonal and genetic causes,” says Bakaradjieva, “and more than 90 per cent are related to lifestyle.”
Many aspects of life in the modern UAE conspire to exacerbate the problem, says Dr Ameera Al Dewani, a general practitioner at Healthpoint. These include “sedentary lifestyles, long working hours and lack of activity due to high temperatures during the hotter months”.
Before oil, “many people in this region lived a life that was often harsh, with no luxuries and only basic foodstuffs, while today they are tempted by readily available fast-food choices in the malls,” she says.
As the statistics demonstrate, overweight parents raise overweight children, not because they don’t care about their health but because for them this has become the new normal.
Part of the problem, says Al Dewani, is that “parents of obese children often don’t recognise that their kids are overweight”. In fact, “the vast majority think their obese children are ‘just right’, because they’re comparing them to their peers, not to medical standards.”
The diagnosis of obesity is usually based on body mass index, a calculation determined by the ratio of weight to height, and appropriate for use in children from the age of 2. A BMI above the 85th percentile – greater than 85 per cent of the average – is defined as overweight, a BMI equal to or greater than the 95th percentile is regarded as obese.
If you are concerned, any paediatrician can quickly confirm whether your child’s “puppy fat” is actually a lifetime of obesity in the making.
For children, the term “overweight”, considered to be less stigmatising, is usually used. But whatever you call it, the consequences of obesity for a child can be devastating.
“The first problems to occur in obese children are usually emotional or psychological,” says Al Dewani. “Obese children often suffer from teasing by their peers and some are even discriminated against by their own families.”
Children can be cruel and in the harsh environment of the classroom “stereotypes abound and may lead to low self-esteem, anxiety and depression, and low school performance”, which in turn can disadvantage a child for life.
Children who are obese are also likely to be obese as adults and, as they grow into adulthood, may find psychological issues to be the least of their problems.
Childhood obesity, says Al Dewani, “can also lead to life-threatening conditions, including diabetes, high blood pressure, heart disease, sleep problems, liver disease, eating disorders such as anorexia and bulimia, skin infections and asthma.”
These can lead to an increased risk in later life of stroke, cancer and osteoarthritis, and it’s small wonder that the lifespan of an obese child is on average five years shorter than it ought to be.
So what can be done?
In January, the World Health Organization’s Commission on Ending Childhood Obesity completed its two-year investigation into what it called “the alarming levels of childhood obesity and overweight globally”.
The key problem it identified was that “many children are growing up today in environments encouraging weight gain and obesity”.
It was, concluded the commission’s report, down to governments to change that by promoting healthy foods and making unhealthy ones less attractive (by taxing sugary drinks, for example), promoting physical activity and healthy eating in schools, improving nutritional education for new and existing parents and making sure lifestyle- and family-based weight-management services were available for overweight children.
In the UAE, says Bakaradjieva, “there are signs of urgency among all officials in tackling the problem”, with a draft strategy in hand for reducing obesity, diabetes and other diet-related diseases being developed with support from the WHO.
But as important as public awareness and education is, she says, ultimately it is up to parents to take responsibility for their child’s well-being.
“The link between obese parents and obese children is very evident,” she says. A child stands a 30 per cent chance of becoming obese if one parent is overweight, and up to 80 per cent if both parents are.
“Many overweight parents are unconcerned if their children are also too heavy,” says Al Dewani. “They blame genetics.”
In fact, says Bakaradjieva, the overwhelming risk factor is environmental: “It is all about role models and the lifestyle that the child sees, so everything that may change this lifestyle matters.”
Parents, she says, “must shop for healthy foods, understand correct portions, limit junk foods and sugary drinks. They should encourage children to play, run and bike, and discourage them from sitting and watching TV and playing games for hours – limit those activities to a maximum of two hours a day.”
Crucially, “talk to the child and get the whole family involved in healthy-behaviour activities”.
The cost of failing to curb the growing problem of obesity in the UAE is to condemn a generation of children – and, most likely, their children and grandchildren – to a shortened, disease-ridden life.
Those men pictured almost 70 years ago on the barren shore of Abu Dhabi would doubtless have been amazed to see the transformation of the harsh land on which they clung so obstinately to life.
Perhaps they would also have been saddened to see that the comparative wealth enjoyed by their descendants has caused the lives of a new generation to be so plagued – not by want, but by plenty.