Fat of the land - Issue 120 - Magazine | Monocle

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Obesity epidemic


“I go into schools in Doha to teach children about eating fruit and vegetables. When they look at the cucumbers and carrots, they always look down at them.” Ghanim al-Sulaiti is sitting on a wooden bench outside Evergreen Organics, the vegan café he co-founded in 2016 in Doha, the Qatari capital. A glass of green juice sits beside the 26-year-old, who is on a mission to make his country healthier. Changing attitudes is challenging, he says, and promoting vegetables has been particularly tricky. “The children think they are poor people’s food.”

Qatar was an impoverished British protectorate until oil was discovered in 1939. In the past 80 years the country has become one of the world’s richest: income per capita stands at €112,300. But waistlines have grown alongside wealth: today more than 70 per cent of Qatari nationals are either overweight or obese, and a worrying 17 per cent have diabetes, which is double the world average.

“We recognise that we have to do something quick because we now have an intergenerational problem that is going to be costly on so many levels: personal and societal,” says Dr Monica Skarulis, director of the National Obesity Treatment Center, which opened last year under the state healthcare umbrella.

The Gulf’s weighty issues are the result of a fairly unique set of circumstances (alongside Qatar, Kuwait and Saudi Arabia also struggle with similar obesity levels). A penchant for American fast food combines with cultural traditions that value meat-rich family banquets. A location at the heart of a trading region means food is abundant. Markets overflow with tropical vegetables, nuts, seeds and spices – but also with pistachio nougat from Iran and bright sweets from India. Lifestyles are car-driven as summer temperatures in the mid-40cs make walking nigh on impossible. The problem isn’t confined to Qatari passport holders, either: it’s commonly said that new expats gain a stone (6.35kg) as they settle into their new home.

“In my first six months in Doha I gained 15kg,” says Rasha Gadelrab, a 42-year-old nurse at the obesity centre who is originally from Egypt. “There was no time to do any activity and the weather makes it too difficult to walk outside.”

Qatari authorities are waking up to the costly problems of an overweight nation. The current national health strategy aims for a 5 per cent reduction in obesity levels by 2022 – an ambitious target – alongside promoting healthy eating and exercise. A major anti-diabetes campaign (the condition is closely linked to excess weight) means adverts boasting the words “Preventing Diabetes Together” and the Ministry of Public Health logo now grace shopping malls and newspapers. The campaign’s advice is blunt: “Remember: eat less and move more.”

Demand at the obesity centre is high: Dr Skarulis’s team receives 500 referrals every month. Services – even bariatric surgery to drastically reduce stomach volume – are free for Qatari nationals, while residents, who make up more than 80 per cent of the small country’s population, receive discounted medication and testing. At reception, women in black niqabs stand next to teenage boys wearing AirPods. The buttons strain on their thawbs, the long white gowns worn by men in the Gulf region.

“This population has very erratic and, forgive me for saying it, undisciplined eating behaviour – they eat late at night,” says Dr Skarulis, sitting in a bright consultation room. “These are challenges not only to the [healthcare] provider but, clearly, to the patient to try to modify their lifestyle so that they can actually lose weight.”

Nevertheless, her small team is already producing results. A typical programme includes fortnightly consultations, a diet plan and exercise guidelines. Monishaw Gakhar has lost 15kg in eight months, under the guidance of consultant endocrinologist Noor Suleiman, after warnings that she could develop diabetes. “I had to lose weight no matter what. It became a necessity,” the 58-year-old administration manager says.

Staff have also benefited from their own advice to patients. Gadelrab, the nurse who had gained weight on arrival in Qatar, has since lost 27kg. “I had to be a good example for the patients; I decided to change my lifestyle forever,” she says, beaming.

Although the car is still king in Qatar, opportunities to exercise are becoming more accessible. Public Al Bidda Park reopened last February after a four-year hiatus. Equipped with outdoor gym equipment and cycle paths, the space is a welcome green spot in central Doha. All the same, working out inside is the only practical summer option so mass-market gyms have multiplied in recent years, while the elite hire specialists to keep the kilos off. At The Diplomatic Club private members’ club, Sheikh Khalifa al-Thani – a member of the Qatari royal family – lifts weights under the watch of his personal trainer, Houssam Thumayd. “I do a lot of cardio and I control my food; I lost more than 25kg,” says Al-Thani. “I feel like a family with Houssam: he does a great job.”

Qatar still faces challenges, particularly when it comes to cultural hurdles. Ghanim al-Sulaiti of Evergreen Organics comes across some reticence to choosing vegetables over meat. “I get a lot of people coming to me saying, ‘You’re fighting against tradition and culture and that’s not good,’” he says. “People [in Qatar] used to eat lots of grains, root vegetables, dates and fruit. They rarely used to eat meat because it wasn’t available and it was so expensive. We were a poor country at that point. I think people don’t realise that.”

Indeed, Qatar got rich quick. It also got fat quick. While it might take time to reverse the obesity trend, the Gulf nation has made strides to slim down. More obesity treatment centres, cheaper healthy food options and more public transport could move things along – not to mention a national campaign to celebrate cucumbers and carrots.

Qatar’s weighty statistics:

More than 70 per cent of Qataris are at an unhealthy weight, with 28.7 per cent classified as overweight and 41.4 per cent obese.

43 per cent of five- to 19-year-olds are overweight or obese (the global average for children the same age is 18 per cent).

The average adult BMI falls in the “overweight” range for both men (28.6) and women (29.6), according to Qatar Biobank, a research centre working with the state healthcare provider and the Ministry of Public Health.

Nearly half of all men and women eat fast food more than three times a week.

Qatar’s National Obesity Treatment Center receives 500 referrals a month.


Sweet blessings


Much has been made of so-called sugar taxes in various countries grappling with the health issues surrounding swelling obesity rates. According to the World Cancer Research Fund, global sugar consumption has increased in the past decade alone, from about 130 to 178 million tonnes a year. But do taxes on sugar actually work?

Norway’s example suggests they do. Since 1922 the country has had a tax on sweets and chocolate and the nation’s health statistics point to it being an inspired money-grab: only one in six children in Norway is classified as overweight, compared to nearly one in three in the UK.

In early 2018 Norway decided to go even further by bumping the tax up a staggering 83 per cent, with the aim of reducing sugar consumption by 12.5 per cent by 2021. The tax applies to ready-to-eat sugar and chocolate products, including those that are imported.

It’s too soon to determine whether the increased tax has whittled waistlines but some dramatic outcomes have already been reported. In the first quarter after the tax was introduced, soda sales in Norway had dropped 11 per cent from the previous year, though news that some Norwegians were venturing into neighbouring Sweden to buy lower-priced treats took away some of the fizz.


Collective tightening of belts


In October 2017 the US’s National Center for Health Statistics released wince-inducing findings: 40 per cent of adults in the country were classified as obese. Yet one city had already made an example of what an ambitious anti-obesity programme could achieve.

Oklahoma City, home to about 650,000 people, had long reaped the economic benefits of its nearby oil-fields. The network of highways that ring the city limits were built from the profits, meaning much of the area soon became only traversable by car. Those may have felt like golden days for Oklahoma City but they also made the city fat.

So, on New Year’s Eve 2007, then mayor Mick Cornett set a challenge: Oklahoma City was going to collectively shed one million pounds in weight. A series of initiatives followed: fast food chains agreed to offer healthier and more diverse menus and an organised programme to get people to eat better saw a remarkable 47,000 people signing up to the “This City is Going on a Diet” campaign. Meanwhile a concurrent initiative to plough $777m into building new green spaces and public parks ensued in order to boost citizen activity.

By 2012 the mayor’s ambition had been fulfilled and Oklahoma City had indeed shed a million pounds.


Education fix


The easiest way to fix a problem is to prevent it. In Japan, lifelong eating habits are acquired at school, where lunches are carefully planned and cooked from scratch with fresh ingredients. At the beginning of each month parents are given a lengthy menu calendar, which outlines the dishes that their children will be eating every day. In the aftermath of the Fukushima nuclear disaster many schools added an extra level of detail: exactly where in Japan the ingredients were coming from.

Eating properly is treated like a school subject and taken as seriously as maths or kanji; a term report will comment on a child’s attitude to eating along with his or her academic progress. The menus are a nutritional mix of classic Japanese – rice, fish and miso soup – with elements of international cuisine thrown in, reflecting the way many people eat at home. The children take it in turn to don overalls and serve lunch to their peers.

The result of this is that Japanese children have some of the lowest obesity rates in the world and develop sensible eating patterns from an early age. Curiously, given the health crisis that is starting to affect young people everywhere, no other country has chosen to adopt Japan’s school lunch programme. It’s time to take a closer look.


From the top down


Tonga is going wide when it comes to tackling obesity in the Pacific islands. Last year prime minister Samiuela Põhiva challenged his regional counterparts to a yearlong weight loss challenge – and the 77-year-old has his work cut out. “Tonga is one of the few countries in the world where the prevalence of obesity exceeds 50 per cent in both males and females,” says health minister Saia Piukala.

Obesity here contributes to heart disease and other non-communicable diseases (ncds), which gobble up one in every five dollars spent on hospital treatment. Eating plays a large part in this hefty problem, as a traditional diet of fish and vegetables has been substituted with imported corned beef and carbonated drinks. But there is also a socio-cultural component: food plays a central role in communal gatherings, where generous hosts over-cater and polite guests consume as much as possible.

The government is also prioritising youth education – some 55 per cent of Tongan girls are obese by their early teens. Põhiva used his weight-loss challenge to draw attention to childhood obesity; one month later, this issue and ncds featured in the communiqué issued by the region’s annual political gathering, the Pacific Islands Forum. “Good leaders must lead by example,” says Piukala.

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