World Obesity Day: Disease should be treated as a chronic illness, doctors say

Dubai study links Caesarian sections with higher risk of babies becoming overweight

Kuwait has the region’s highest number of people at risk of developing health problems because of their weight. Photo: World Obesity Federation
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Obesity should be managed as a lifelong condition in the way diabetes and hypertension are controlled if the growth of expanding waistlines in the Arab world is to be reversed, doctors said.

According to the World Health Organisation, the average prevalence of obesity in Arab countries increased from 6.5 per cent in 1975 to 20 per cent in 2016.

On World Obesity Day, March 4, obesity prevalence varies significantly across the 22 Arab countries with associated health problems such as diabetes, hypertension and cancer placing a huge financial burden on healthcare facilities.

The latest World Obesity data showed Kuwait had the region’s highest number of people at risk of developing health problems related to their weight, with 43.75 per cent of the adult population obese, and 36 per cent overweight.

If someone is obese, they need to be monitored, managed and educated – as well as given the information for better self-management of their condition
Aisha Yousuf, Dubai Health Authority

Libya has the second highest prevalence, with 42.4 per cent of adults obese and 32.9 per cent overweight, followed by Bahrain where 36.9 per cent of the adult population are classed as obese and 35.5 per cent are overweight.

“Obesity should be treated as a chronic condition,” said Aisha Yousuf, a senior specialist in family medicine at the Zabeel Health Centre, Dubai Health Authority.

“It should be recognised in the same way as diabetes and high blood pressure.

“It needs a lifetime of care, not just a one-time intervention.

“If someone is obese, they need to be monitored, managed and educated — as well as given the information for better self-management of their condition.

“Just like other diseases, it needs constant management, with support sustained for life.”

Dr Haitham Sawalmeh, a bariatric surgeon at Prime Hospital in Dubai, said: "obesity is now considered a disease of the age, and it is a disease that is spread all over the world.

“It is mainly a result of lifestyle changes in many societies, such as lack of physical activity and the availability of unhealthy foods.”

In the UAE, data showed that 40 per cent of adults are overweight and 27.8 per cent are obese, while in Saudi Arabia the figures are slightly lower with 38 per cent overweight and 20 per cent of adults obese.

Obesity is estimated to be responsible for 5.02 million premature deaths each year around the world.

“Obesity worldwide tripled in the last 40 years and the Arab world emerged as one of the leading regions in obesity rates, as a result of genetic risk, rapid globalisation, higher availability of food and lack of physical exercise,” said Dr Ines Barros, an endocrinologist at International Modern Hospital in Dubai.

“This excessive amount of fat is responsible for metabolic alterations that lead to the development of other well-known diseases, such as diabetes, hypertension, high cholesterol levels and cardiovascular disease.

“It is also related with an increased incidence of several types of cancer and is responsible for asthma, sleep apnoea, osteoarthritis, gastric disorders, infertility, depression and dementia.”

Dr Ashwin Pankajadhan, a specialist endocrinologist, at NMC Royal Hospital in Dubai Investments Park, said obese people are more at risk of developing high blood pressure or diabetes, which increases the risk of heart disease.

“Insulin resistance that happens in obesity is the main contributing factor to the cardiovascular effects of obesity," he said.

Financial impact

A model compiled by World Obesity and RTI International, an independent research institute, forecast an extra 3 per cent of GDP spending was required to tackle the additional demands of an overweight society by 2060.

Using data from 161 countries, the biggest increase will be concentrated in lower-resource countries with total economic effects increasing fourfold between 2019 and 2060 in high-income countries.

Reducing projected overweight and obesity rates by 5 per cent from current trends could save about $2.2 trillion in costs by 2060, the report found.

“When we talk specifically about childhood obesity, Arab countries account for the highest rates,” said Dr Barros, who is Portuguese.

“In Libya, 25.4 per cent of children under five years of age had obesity in 2020, whereas the respective rates in the US were 8.8 per cent and in Europe they ranged between 4.1 and 8.5 per cent.

“In our clinical practice, we have been seeing a shift to younger ages of the patients with life-threatening conditions, namely heart attack or stroke, mainly because obesity is increasing in the younger population.

“It is therefore mandatory to develop government measures to fight obesity and protect the population from its complications and premature death.”

World Obesity reported a similar regional trend for childhood obesity with Kuwait, Qatar, Bahrain and the UAE showing the greatest prevalence in young people.

Obesity task force in the UAE

In 2022, a national UAE obesity task force was established to develop a road map to explore effective ways to address childhood obesity.

A combined effort from the Ministry of Health and Prevention, Dubai Health Authority, Department of Health, and Abu Dhabi Public Health Centre aims to combat obesity in children from 5 to 17 years, based on WHO recommendations.

It outlined six key elements to treat the disease, including healthy eating, weight management, pre and post-conception care, healthy eating and physical activity in early childhood, and healthy nutrition for school students.

One contributing factor to the recent increase in childhood obesity could be the rise in caesarean sections performed.

A recent study of more than 500 infants attending Primary Health Centres in 2019 was examined to look for trends in overweight babies at one year old.

“Childhood obesity has been increasing in parallel with the increase in C-sections, so we wanted to study this area to see a possible association,” said Dr Yousuf at Zabeel Health Centre, who led the study.

“The pattern of deliveries has changed, with not too many C-sections in the past but they have since increased threefold in recent decades.”

The study found overweight and obese infants were associated with a greater likelihood of Caesarean delivery and explained by newborns delivered naturally being exposed to more protective gut bacteria.

Researchers said the altered foetal microbial environment in Caesarean-delivered infants had a tendency to yield more energy from dietary nutrients, placing a child at higher risk of being overweight.

A link with larger babies was also found, with this category tending to have fewer siblings, while those who were not breastfed were also more likely to be overweight.

“Our research associated different factors that could cause infants to be overweight or obese,” Dr Yousuf said.

“There is a link between less breastfeeding and infants being overweight, most likely because of the lack of natural nutrients passed on via breast milk which is not present in formula milk.

“If there is more breastfeeding there is less chance of an infant being overweight or obese.

“Planned C-sections are becoming more common because mothers do not want to go through the pain of a natural birth.

“Often they are unaware of the consequences for their own health and that of their child compared with the benefits of a natural delivery.”

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Updated: March 04, 2023, 4:51 AM