Kamis, 18 Oktober 2012

UAE and Arab Countries Explodes with Obesity


Here are the numbers according to national study.

10-year-old male UAE children had 1.7 times the rate of overweight compared to international standards and 1.9 times at 18 years.

Similarly, female UAE children have 1.8 times the rate of overweight compared to international standards at 10 and 18 years of age.

Obesity was 2.3-fold higher among UAE males at 14 years compared to international standards, and increased to 3.6 times at 18 years of age. Among UAE female children, obesity was same as males at 14 years, 2.3 times than the international standards.

At 18 years of age, UAE female obesity was 1.9-fold higher than the international standard, nearly one-half the rate of obesity among UAE males at the same age.

WHO reported that 13.5 per cent of the UAE population was diabetic, the second-highest prevalence of the disease in the world; this figure is expected to rise to 19.3 per cent by 2030. The report also said over 50 per cent of men and women in the UAE were overweight or obese.

How did it happen?

Our lifestyle has changed our earning has gone up and with it came obesity and other health problems, restaurants are everywhere and cooking at home is thing of the past and considered waste of time for today's young couple.

Our consumption of red meat is highest in the world, eating food rich in animal fat is the road to obesity, and lack of exercise makes it easier for fat to stay happily in our body. Only exercise we practice is while shopping and it is not enough to burn our body fat.

School children dine outside after school, having lunch at home is unfashionable and fun time is playing computer games for hours, not like the old days where we played outside the house in hot sun.

Our kids are used to eat processed food and fast food, processed unhealthy snacks is available in every home.

Saying all that it is clear that obesity starts from home, kids learn what is healthy and what is not from home, parents need to practice eating healthy food and pass it to their children and we need to introduce greens to our kids eating habits.

It should not be about what we like to eat, it has to be about what is healthy. Without parents playing their parts at home obesity problem will not go away and parents need to understand that obese kids will put financial and emotional pressure on the family.

Source: articlesbase.com

Palestinian Women Have The Third Highest Obesity Rate in The World



Obesity kills an average 20,000 people every year in Saudi Arabia, where nearly 70 per cent of the population are suffering from overweight, a Saudi medical expert has said.



Source: projectworldawareness.com

Obesity Kills 20,000 people a Year in Saudi Arabia


An average 20,000 people die in Saudi Arabia every year as a result of heart problems and other diseases associated with obesity, a newspaper in the Gulf oil producer reported on Monday.

The high death rate has prompted the Gulf kingdom to upgrade surgical treatment of overweight and this boosted spending on such operations to nearly SR17 billion a year, Alriyadh said, quoting Dr Abdul Mohsen Al Dhakri, Director of academic affairs at the Royal National Guards.

“Obesity kills an average 20,000 people in Saudi Arabia every year and most of the deaths are a result of cardiac arrest, infarction, stroke and renal failure,” he told an international conference on obesity in the eastern town of Khobar.

He said nearly 98 per cent of the surgeries conducted in Saudi Arabia last year to treat overweight were successful.

“Obesity is a dangerous phenomenon…it could be contagious within the family which does not follow a nutritious and good eating habits.”

Source: emirates247.com

Arab Diets


TYRE is a small province on Lebanon's border with Israel, a place of poor tobacco farmers and tin-roofed shacks. Only about half the population has enough to eat. Many say that, in the past six months, somebody in the household has spent a day without food or gone hungry to bed. But there is something odd about the burden of malnutrition. While in hungry households just over a quarter of children under five are too short for their age—a classic symptom of malnutrition—a third are overweight, malnourished in the opposite sense. Tyre is suffering malnutrition and obesity simultaneously.


This “dual burden” is growing everywhere, but nowhere as quickly as in the Arab world. Between 15% and 25% of Arab children under five are too short for their age and between 5% and 15% are underweight. Almost half of pregnant Egyptian women are anaemic, reflecting an iron deficiency often caused by poor diets. Yet a survey in 2006 reckoned that 30% of Egyptian adults were obese. Obesity estimates for Jordan, Kuwait, Saudi Arabia and the United Arab Emirates were even higher: between 35% and 45%.

The most obvious explanation for this paradox is that the two problems exist in separate realms: obesity among the well-to-do, under-nutrition among the poor. Yet this is not the whole story. Obesity and malnutrition exist not only in the same country but within the same community, the same household and even, strange as it may seem, in the same person.

A study by Hala Ghattas of the American University of Beirut looks at three marginal populations in Lebanon: the villages of Tyre, a group of Bedouins and Palestinian refugees. All are relatively poor, but a third of the worst-off Bedouin were still obese and another quarter were overweight. In Tyre, some villages are largely unaffected; one, called Tayr Harfa, is many times worse off than its neighbours. Problems of under- and over-nutrition appear in the same communities.

But how can they appear in the same household? It is largely because of the way the body reacts to changing diets. If a woman is severely malnourished in the womb or during her first two years of life, her metabolism will change permanently. She will store spare calories as fat—an insurance against future hard times. If 20 years later the family gets a more plentiful yet still poor diet (with a lot of calories but not many micronutrients, such as iron or vitamins) she will become overweight or obese, while her children will suffer nutritional deficiency, such as anaemia or blindness. They will be undernourished and she will be obese. As countries move from extreme poverty to middle-income status, this move from starvation rations to calorie-rich, nutrition-poor diets has become more common. In Egypt, 12% of children are stunted and have obese mothers.

The mothers will not escape problems from nutritional deficiency. They still have an unhealthy diet. In Egypt, Peru and Mexico, about half the women with anaemia are overweight or obese. They are simultaneously over- and underfed: too many calories, not enough micronutrients.

Source:  economist.com

Obesity Among Arab Women


According to the Wall Street Journal, about half the women in the Middle East are overweight or obese:

In Bahrain, 83% of women are obese or overweight, according to International Obesity Task Force, a London-based think tank that tries to persuade countries to tackle the problem. In the United Arab Emirates the figure is 74%; in Lebanon it is 75%, the groups says. By comparison, about 62% of American women are overweight or obese. The prevalence of childhood obesity in the Middle East has risen rapidly in recent years and diabetes is spreading across the region, according to WHO.

Even predominantly Arab North African countries without oil wealth are wrestling with the challenge, in part because of a traditional preference for larger women. Half of all women in Tunisia and Morocco are overweight or obese — two standard measures of a person’s weight — according to a 2001 study published in the U.S.-based Journal of Nutrition.

What I found disturbing in this article was the statement:

The belief that rotund women are more desirable as wives helps explain why much of the Arab world — which stretches from the Persian Gulf in the east to Mauritania in North Africa — is experiencing an explosion of obesity.

As an Arab woman myself (who is currently struggling to lose weight) I totally disagree with this faulty statement. The reason there is obesity among Arab women is mainly due to lack of exercise and the lack of awareness about healthy diets. The author’s statement is a generalization, as he (or is it she) began the article discussing the issue of force feeding among women in Mauritania:

Force-feeding is usually done by girls’ mothers or grandmothers; men play little direct role. The girls’ stomachs are sometimes vigorously massaged in order to loosen the skin and make it easier to consume even greater quantities of food. … Local officials say some women are so fat they can barely move. In [a Mauritanian] survey, 15% of the women said their skin split as a result of overeating. One-fifth of women said one of their toes or fingers were broken to make them eat.

Well, If Mauritanian women want to be obese, then that’s their problem. I’m not gonna speak for other Arab women, but I can certainly speak for Jordanian women. In my country, the skinnier the woman is the better she looks! Obesity is never encouraged, in fact it is a turn-off!

Source: http://natashatynes.com

Obesity More Prevalent inTanzania Women


Around 25% of women in the Kinondoni municipality, Dar es Salaam are obese, compared to around 9% of men, according to new research. Also, obesity was more prevalent in people with high socioeconomic status (29%), compared to medium or low socioeconomic status (14% and 11%, respectively). Compared to single people, people who were married or cohabitating with someone else were more likely to be obese; however, widows and widowers were also at a greater risk for obesity. The overall obesity prevalence in the Kinondoni municipality (19%) is higher compared to other parts of the country, and suggests the obesity prevalence in Tanzania is on the rise.

"Prevalence of obesity and associated risk factors among adults in Kinondoni municipal district, Dar es Salaam Tanzania"

Source: procor.org

Rabu, 17 Oktober 2012

Obesity is The New Black Plague of Arab World

By 2015, WHO predicts that about 2.3 billion adults will be overweight and over 700 million people will be classified as obese. Now, 400 million people have a body mass index exceeding 30kg/m² according to WHO criteria.  Obesity is not just a phenomenon that affects adults: in 2005, 20 million children under 5 years were overweight in the world. Obesity is a recent, complex and highly worrying phenomenon.


Obesity is an epidemic of utmost importance in Arab world, especially in the Gulf countries -KSA included. And Google Arab users behavior confirms this trend. However, information is not missing on the Net and health Websites (like this private one in Dubai) are increasing. Obesity is often seen as a developing countries disease due to changes in eating habits (high calorie diets) and more urban lifestyles.
Country Percentage of obese population Country Percentage of diabetic population
Nauru 78,50% Nauru 30,70%
Tonga 56,00% United Arab Emirates 19,50%
Saudi Arabia 35,60% Saudi Arabia 16,70%
United Arab Emirates 33,70% Bahrain 15,20%
United States 32,20% Koweit 14,40%
Bahrain 28,90% Oman 13,10%
Koweit 28,80% Tonga 12,90%
Seychelles 25,10% Mauritius 11,10%
United Kingdom 24,20% Egypt 11,00%




Ranking of the countries with the highest percentages of obesity and diabetes (Source : Government Office for Science)
Obesity is a significant risk factor of comorbidities and mortality, most importantly from cardiovascular disease (CVD) and diabetes, but also from cancer and chronic diseases. It is a social phenomenon and a major public health concern for MENA countries.
In July 2009, Eric A. Finkelstein leaded a survey (available on Health Affairs) about the correlation between the increase of obesity in the United States and the one of health spending (MediCare, MediCaid and private insurers).
The increased prevalence of obesity is responsible for almost $40 billion of increased medical spending through 2006, including $7 billion in Medicare prescription drug costs. We estimate that the medical costs of obesity could have risen to $147 billion per year by 2008.
 
Obesity: a significant risk factor of comorbidities
Obesity: a significant risk factor of comorbidities (Source : http://www.dwp.gov.uk)

In the Middle East, figures are alarming and governments (and private investors) are promoting solutions to reverse the trend of obesity. However, tackling obesity raises a good many questions.

In the Gulf countries (KSA included), obesity rate among women hits 70% (50% among males). Saudi Arabia opened a debate last year “over women’s sports, particularly women’s gyms, physical education instruction in girls’ schools, and competitive sports clubs for women.” A controversial fatwa reminds that women should not go against Allah’s will who created them to stay home and to educate their children
Public awareness campaigns to help tackle the issues of overweight and obesity are a major challenge. That is why, the Ministry of Health in UAE has launched a “No to Obesity” programme, which will include health awareness lectures, dietary practices and physical training programmes.

The problem of nutrition is obesity… and some severe nutrient deficiencies

We must bear in mind, as GAIN (Globale Alliance for Improve Nutrition) experts said in Dubai on May, 2010, that the problem of nutrition in the Gulf states is obviously linked with obesity but also with some severe nutrient deficiencies. Indeed, a government report reveals that 35 percent of infants (6-22 months) are suffering from anemia, while 41 percent of UAE women have a deficiency of folic acid and 35 percent are obese.

Against obesity (and also to be slender like famous movie stars and models), most women of all ages are seeking out “slimming medications” usually including appetite suppressors, fat burners or fat absorption inhibitors. In spite of the warnings against the harmful side effects (welling in the stomach, anemia, low calcium levels to inflammation, diarrhea, colon problems, heart palpitations or nervous disorders), the lack of regulation and control allows to purchase them everywhere (hairdresser, mall, etc.). The Jerusalem Post on July, 6, 2010 said that in many Middle Eastern countries slimming pills are loosely regulated, giving rise to a vast market of unregulated and sometimes dangerous pharmaceuticals, moreover when used in self-medication without the monitoring of a professional.

The very interesting benchmarking analysis made by Antoine Flahaut, chairman of EHESP, on his blog, deserves special attention: he wonders about the French paradox (high fat diet vs. good obesity figures and myocardial infarction). According to him, and to the experts of the Strategic Analysis Center regular eating habits are the main raisons of explanation. He follows the results of a study published on March 2010 in the Pediatrics review showing that on 8550 American four-year-olds, those who regularly (5 times) ate dinner with the family, got enough sleep and watched less than two hours of TV a day were 40 percent less likely to be obese.

Prevention and information are the crux of the matter to tackle this epidemic. The partnership between all the stakeholders (both institutional and private) is also a necessary prerequisite for establish effective public health policies in the long term against obesity. Nevertheless, these public policies to prevent obesity have to be in it for the long term to change habits and behavior.

Source: vincentfromentin.fr
 

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Mom’s Obesity Tied To Child’s Autism And Developmental Delays



NEW YORK: Children born to obese women are more likely to be diagnosed with autism or related developmental delays than the children of slimmer mothers, according to a U.S. survey.

The research, which appeared in Pediatrics, was looking for the impact on childrens’ cognitive development from a variety of “metabolic conditions” in the mother, including high blood pressure or diabetes. The strongest links were found between obesity and autism-related disorders.

Although the study cannot prove that one condition causes the other, its authors caution that even the possibility is worrisome in the light of rising U.S. obesity rates.

“If there is anything you can do to make yourself healthier, this is yet another reason for moms to consider,” said Paula Krakowiak, a researcher at the University of California, Davis, who led the study.

The study comes on the heels of a report from the U.S. Centers for Disease Control and Prevention that estimated one in every 88 children in the U.S. has an autism spectrum disorder. That number represents a 25-percent increase from the agency’s last report in 2006.

Krakowiak and her colleagues looked at 1,004 children who were between 2 and 5 years old, born in California and already participating in a study underway at UC Davis.

Of those children, 517 had an autism spectrum disorder and 172 had developmental delays. For Krakowiak’s study, the children’s diagnoses were confirmed by a re-evaluation at the UC Davis MIND Institute.

Milder versions of autism, such as Asperger’s syndrome, form a “spectrum” of autism-related disorders. In addition, impairments in any one of the autism-related cognitive skill areas are considered developmental delays.

Among the children in the study with an autism spectrum disorder, 48 were born to mothers with Type 2 or gestational diabetes, 111 to mothers who were obese and 148 to mothers with any sort of metabolic condition, like high blood pressure.

For children with a developmental delay, 20 were born to mothers with Type 2 or gestational diabetes, 41 to mothers who were obese and 60 to a mother with any metabolic condition.

Overall, the connection between diabetes in a mother and her child being diagnosed with autism was not significant, but the researchers did find links between a mother being obese or having other metabolic conditions and her child having autism.

Developmental delays were associated with both obesity and diabetes, along with having any other metabolic condition. “There is definitely an association present and it adds to the reasons for finding ways to lower obesity rates or diabetes rates and make greater efforts to change lifestyle factors,” Krakowiak said.

She and her colleagues also noted that nearly 60 percent of U.S. women of childbearing age are overweight, one third are obese and 16 percent have so-called metabolic syndrome – a constellation of symptoms, including high blood pressure and insulin resistance, which raise heart risk.

Although nobody can say the nation’s rising obesity rate is to blame for the prevalence of autism, Krakowiak said the parallel increases did catch her attention.

Hannah Gardener, an epidemiologist in the Department of Neurology at the University of Miami, told Reuters Health that she thinks it’s natural for people to connect the two rates.

“There is a lot that is unknown and studies like these really help us figure out the questions that need to be answered,” Gardener said.

By Andrew Seaman | www.dailystar.com.lb


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Weight Loss Surgery Tied to Increase in Alcohol Use


People who had weight loss surgery reported greater alcohol use two years after their procedures, according to a US study.

The researchers, whose findings appeared in the Archives of Surgery, said it’s possible that some patients may turn to drinking if the surgery successfully stops their ability to overeat without addressing underlying issues.

In addition, the effect of certain stomach-shrinking procedures on alcohol tolerance may play a part.

“This is perhaps a risk,” said Alexis Conason, who worked on the study at the New York Obesity Nutrition Research Center at St. Luke’s-Roosevelt Hospital Center.

“I don’t think it should deter people from having surgery, but you should be cautious to monitor (alcohol use) after surgery,” Conason told Reuters Health.

The study didn’t show whether people were drinking in a dangerous way, and there was no clear increase in drug use or smoking after surgery.

Her team’s study involved 155 people getting gastric bypass or gastric banding surgery, mostly women. Participants started the study with an average body mass index, or BMI, of 46 — equivalent of a 168 cm (five foot six inch) person weighing 129 kilograms (285 pounds).

Surgery is typically recommended for people with a BMI of at least 40, or at least 35 if they also have health problems such as diabetes or severe sleep apnea.

Alcohol use dropped immediately after surgery, from 61 percent of people who initially reported drinking to 20 percent at one month post-surgery. But by three months, drinking rates had started to creep back up.

And at two years out, people were drinking significantly more often than before their procedures.

That was mainly the case for those who had gastric bypass surgery, not banding. On a scale from 0 to 10 of drinking frequency, where 0 represented never, 5 was sometimes and 10 always, gastric bypass patients reported an increase from 1.86 before surgery to 3.08 two years later.

Conason said gastric bypass, in particular, has been shown to drastically lower alcohol tolerance, to the point that some post-surgery patients have a blood alcohol content above the legal driving limit after just one drink. For some, that could make drinking more appealing, she added.

One limitation of the study is that only one-quarter of the initial participants were still in touch to report their current alcohol and drug use at the two-year mark, so the researchers don’t know how everyone else fared.
James Mitchell, a psychiatrist who has studied alcohol use after weight loss surgery at the University of North Dakota School of Medicine and Health Sciences in Grand Forks, said there’s also a need for research going on for longer than two years, to see if alcohol use keeps increasing.

“The health risks of obesity are such that people with severe obesity should not forgo bariatric surgery because of this,” said Mitchell, who was not involved in the study.

But he added that everyone should be warned about the possibility of increased alcohol use — and people with a history of alcohol abuse should be especially careful.

Source: arabnews.com


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Young Woman with Obesity Dies 5 Months After Birth


BUCHAREST: A 25-year-old Romanian woman who weighed 240 kg when she gave birth to a baby girl more than 5 months ago, has died, media reported on Monday.

Relatives of Victoria Lacatus said she died of a heart attack Sunday after developing a high fever and breathing problems. Doctors from Craiova hospital in southern Romania said Lacatus' heart stopped. Hospital manager Florin Petrescu said doctors tried to resuscitate Lacatus for 30 minutes, a task made difficult because of her extreme obesity. After she gave birth by cesarean section to a 6.4 pounds baby girl on Feb. 18, Lacatus gained another 44 pounds, her sister Cristina Sosoiu told the daily Libertatea.
Doctors had told Lacatus to go on a diet but she apparently kept eating, the paper reported. Her daughter, Anisoara, currently weighs just a little over 9 pounds, the paper said. She lives with her maternal grandmother. It is not clear why the baby does not live with her father, Costica Lacatus. Lacatus fell ill with a fever last week and was hospitalized in her hometown of Caracal in southern Romania before she was moved to the main regional hospital where she died.

Source: arabnews.com

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Child Obesity in Saudi Arabia


A 1997 study on obesity among adult Saudis, aged 14 and above, showed 27.23 percent of males and 25.20 percent of females were overweight. There was 13.05 percent obesity among males and 20.26 percent among females. The study did not focus on children but of course overweight children have a higher risk of becoming obese adults. Obesity is a concern because of health problems associated with it.

Some of those are cardiovascular disease, diabetes, hypertension, cerebral and peripheral vascular disease, osteoarthritis, gout, gastrointestinal and uterine cancers and diseases of the female reproductive tract.

Researchers at the Center for Disease Control in the United States say obesity-related child hospitalizations have increased alarmingly in the past 20 years. They blame high-calorie snack foods and soft drinks plus a more sedentary life based on TV and computer games. Busy parents who opt for quicker, high-calorie meals are also at fault.

While genetic and environmental factors play a role in the development of diabetes, there are other factors more common in the Saudi population. There is our high consumption of dates and carbohydrate-rich foods, the hot climate that discourages individuals from exercise and cars being used even for short distances. Too many of our social occasions focus on food — and not the sort of food which is best for our health.

In Jeddah more people are becoming aware of the problem of overweight and obesity and are choosing to exercise by walking or jogging at various locations around the city or by joining a health club. Unfortunately for a variety of reasons, these options are not available to everyone.

The Dr. Suleiman Fakeeh Hospital Health Center is one of the best equipped in Jeddah; it offers complete facilities for different sports and exercise programs. In summer when children have more time on their hands, the SFH Health Center provides special programs for children aged 8 to 12 and for 12 to 16. The programs range from aerobics to tennis and swimming. As for children under 7, the Center allocates an entire floor to them where they can participate in games and activities.

Amira Al-Sharbini, the director of the Center’s women section, said that there were also nutritionists available for adults and children who need advice on their diets. She noted that more boys than girls attend their programs and spend more time using their facilities.

Once school starts, the best place for children to exercise is at school but not all our schools are equipped with the place, facilities and programs for exercise and sports — particularly girls’ schools. There is a lack of concern for the health of our young girls. Not only do most girls’ schools lack a proper area where students can play but the schools also fail to provide them with healthy meals and snacks.

Social, economic and other restrictions put the responsibility in the hands of parents who must find the time and place for them and their children to exercise. The parents must also see that their children are provided healthy, balanced meals. Experts recommend that for a child to lose weight, the whole family should be involved and the whole family should decided on a more healthy lifestyle.

Following are some general tips:

— Try to reduce the consumption of fatty food; use skimmed milk, margarine, brown bread and sugar-free products.

— Eat foods with a high-fiber content such as vegetables and salads.

— Do not always fry food; try boiling, steaming, roasting or poaching.

— Do not allow children to eat while watching television. They tend to eat without thinking and so to eat more than is good for them.

— Do not allow junk food in the house.

— Encourage your child to take up a sport — even simple walking or perhaps a sport such as badminton. Join in with your child and make it a family affair.

Finally, awareness programs must be formulated to increase information on obesity, its harmful effects and the measures which can prevent it. Surely changes must be made to the Saudi lifestyle and we must start with our children and reduce the dangerous tendency to obesity.

Source: arabnews.com

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Obesity Major Problem Among Saudi Arabia Women


Obesity is a major problem in Saudi Arabia, particularly among women. A recent study found that about 66 percent of Saudi women are overweight or obese.

“It is a problem here because of its association with such health risks as heart disease, diabetes and cholesterol, all of which are on the rise in Saudi Arabia,” said Patricia Fenton, chief clinical dietitian at King Faisal Specialist Hospital.

Foods high in fat and sugar and the sedentary lifestyle here are leading factors that lead to obesity, though heredity also plays a big role.

“I think the influx of fast food restaurants is also a contributing factor,” Fenton said. “Most entertaining and socializing here revolves around eating.”

Some people resort to diets that are not medically based and can harm their health. “These diet fads don’t teach healthy eating habits or affect weight management in the long-term. They can cause deficiencies in certain nutrients that the body needs,” Fenton said.

Saudi women don’t have many venues to exercise or participate in sports activities and the health clubs are not easily affordable to most.

“It’s important to incorporate exercise into healthy living. When we recommend exercising, we keep in mind the environment of each patient and the difficulty involved for women,” she said.

But she said she noticed an increase in the number of women walking as a form of exercise and following aerobic instructions on videotapes at home. “There are also more low-fat products available in grocery stores.”

She said the hospital takes a dietary history of patients and recommends an individually tailored diet plan and follow-ups.

“The most important thing is to educate them about the health risks of obesity and encourage them to reduce fat content in meals and avoid unnecessary sugary things.”

When diet and exercise fail, or when obesity is becoming a threat to the patient’s health and life, the next step is weight-loss medication. “We are frequently asked for medication such as Xenical, but they have to be subscripted by a doctor and taken under supervision,” Fenton said.

Such medication is not automatically effective in reducing weight; it has to be used correctly in combination with proper diet and exercise. “It can be misused if it’s available at pharmacies without a doctor’s prescription,” Fenton warned.

A new weight control medicine called Reductil was recently approved by the Saudi Ministry of Health. An appetite suppressant, it will be available in the market soon. There are, however, side effects such as headaches, constipation and palpitation, which is why it is necessary to consult a doctor, particularly if the patient has certain health conditions, or is taking other medication.

As a last resort, many Saudis are opting for surgical procedures such as gastric bending or stomach stapling, but these procedures are mostly for morbid obesity and, as with any surgery, there are health risks and side effects associated with them.

One of those diet fads that became popular in Saudi Arabia recently is using the blood-type analysis, NuTron, to determine the kinds of foods that should be avoided by each individual.

The Saudi Minister of Health Dr. Hamad Al-Manea has announced two days ago that there is no scientific or clinical proof on the effectiveness of this type of diet and consequently revoking the licenses of all institutions for using this method.

“Conducting these analyses is a kind of blackmail and public deception of the patient scientifically and financially,” said the minister and issued a ban on any advertisements by the institutions for conducting these analyses.

Source: arabnews.com

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Senin, 15 Oktober 2012

Lifestyle Intervention in Obese Arab Women


Few randomized controlled trials on lifestyle interventions have been reported in non-Western populations; none have been reported in Arab populations. From 2 Muslim Arab communities in Israel, obese, nondiabetic women aged 35 to 54 years with 1 or more components of the metabolic syndrome were randomized to either an intensive (n = 1) or a moderate (control) (n = 11) 12-month lifestyle intervention. Women in the intensive intervention had 11 individual and 11 group counseling sessions per year with a dietitian and 22 physical activity group sessions per year. Women in the moderate intervention had 3 individual and 2 group dietary counseling sessions per year and no guided physical activity. Cultural issues were addressed in the design and conduct of both interventions. The primary outcome measure was change in the metabolic syndrome and its components. At 12 months, the intensive intervention group had median declines of 3. mg/dL (to convert to millimoles per liter, multiply by .555) in fasting plasma glucose and 4.5 mg/dL (to convert to millimoles per liter, multiply by .113) in triglyceride levels compared with median increases of 1 mg/dL in fasting plasma glucose and 5.8 mg/dL in triglyceride levels in the moderate intervention group (P = .1 and P = .2, respectively). The median waist circumference decreased by 5.4 cm in the intensive intervention group and by 3.1 cm in the moderate intervention group (P = .1). The prevalence of the metabolic syndrome decreased by 4.% in the intensive intervention group and increased by 5.2% in the moderate intervention group (P = .12). The 12-month culturally sensitive intensive lifestyle intervention was effective in improving some of the metabolic syndrome components in obese Arab women.Trial Registration clinicaltrials.gov Identifier:

Source: http://scienceindex.com

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Obesity in North Africa and the Middle East


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Obesity in North Africa and the Middle East is a notable health issue. In 2005, the World Health Organization measured that 1.6 billion people were overweight and 400 million were obese. It estimates that by the year 2015, 2.3 billion people will be overweight and 700 million will be obese. The Middle East, including the Arabian Peninsula, Eastern Mediterranean, Turkey and Iran, and North Africa, are no exception to the worldwide increase in obesity. Subsequently, some call this trend the New World Syndrome. The lifestyle changes associated with the discovery of oil and the subsequent increase in wealth is one contributing factor. Urbanization has occurred rapidly and has been accompanied by new technologies that promote sedentary lifestyles. Due to accessibility of private cars, television, and household appliances, the population as a whole is engaging in less physical activity. The rise in caloric and fat intake in a region where exercise is not a defining part of the culture has added to the overall increased percentages of overweight and obese populations. In addition, women are more likely to be overweight or obese due to cultural norms and perceptions of appropriate female behavior and occupations inside and outside of the home.

Obesity

The medical condition of being overweight or obesity is defined as "abnormal or excessive fat accumulation that may impair health". It is measured through the Body Mass Index (BMI), defined as a person's weight, in kilograms, divided by the square of the person's height, in meters. If an individual has a BMI of 25–29, he or she is overweight. Having a BMI of 30 or more means an individual is obese. The greater the BMI, the greater the risk of chronic diseases as a result of obesity. These diseases include cardiovascular diseases, diabetes, musculoskeletal disorders, cancer, and premature death.


Cause

The MONICA Project, sponsored by the World Health Organization, discovered that 30% of the population in the Arab World is overweight or obese, including adolescents and adults. This percentage is smaller for North African countries than oil-producing countries, but is still a prevalent trend. The spread of the Western lifestyle, defined as "the intake of attractive energy dense food with undesirable composition, increased consumption of animal fats and sugars and reduced consumption of dietary fiber, along with a lack of sufficient physical activity", is one of the leading causes. Specifically in the Arabian Peninsula, "physical activity of the population has significantly diminished with the availability of housemaids, private cars, television, and sophisticated household appliances. In addition, the types of food and fat intake have changed...". Other common factors, besides a sedentary lifestyle and unhealthy food choices, across the Arab world include urbanization, technology, and a cultural appreciation of female plumpness.

By country
Overweight and Obesity Statistics in the Middle East and North Africa


 % of Overweight Men    % of Overweight Women    % of Obese Men  % of Obese Women   Source   Link to Article
Turkey 2001–2002 46.5% 28.6% 16.5% 29.4% [8] Obesity in Turkey
Israel 1999–2001 45.8% 33.1% 19.9% 25.7% [8] Obesity in Israel
Jordan 2002 --- 27.6% --- 26.3% [8] Obesity in Jordan
Lebanon 1998–2002 --- ---- 36.3% 38.3% [8] Obesity in Lebanon
Palestine 2003 --- ---- 29.1% (urban), 18.2% (rural)   46.3% (u), 35% (r) [9] Obesity in Palestine
Bahrain 1998–1999 36.7% 28.3% 23.3% 34.1% [8] Obesity in Bahrain
Kuwait 1998–2002       36.3% 32.8% 27.5% 29.9% [8] Obesity in Kuwait
Oman 2000 32.1% 27.3% 16.7% 23.8% [8] Obesity in Oman
Qatar 2003 34.3% 33% 34.6% 45.3% [8] Obesity in Qatar
Saudi Arabia 1995–2002 42.4% 31.8% 26.4% 44.0% [8] Obesity in Saudi Arabia
United Arab Emirates   2000 36.7% 28.4% 17.1% 31.4% [8] Obesity in United Arab Emirates
Iran 2005 27.9% 29.3% 9.1% 19.2% [8] Obesity in Iran
Algeria 2003 27.4% 32.2% 8.8% 21.4% [8] Obesity in Algeria
Egypt 2005 --- 33.2% --- 46.6% [8] Obesity in Egypt
Morocco 2000 25.5% 29.8% 8.2% 21.7% [8] Obesity in Morocco
Tunisia 1997 23.3% 28.2% 6.7% 22.7% [8] Obesity in Tunisia

Turkey

In 2001–2002, 36.8% of the population was overweight and 23.5% obese. In that same year, 11.4% of boys and 10.3% of girls age 12–17 were overweight. The occurrence of diabetes is higher among women than men.

Obesity and being overweight is higher among women for several reasons. A majority of women do not have jobs outside of the home and lead more sedentary lifestyles as a result. Housework is often the only source of physical activity for women, as there is no prior tradition of women participating in sports. Individuals living in urban areas are more likely to be overweight or obese because of the availability of public transportation and the sedentary lifestyle. A lack of knowledge about diabetes and the health consequences also contribute to the high percentage of excessive weight.

Israel

Men and women of Arab descent are more likely to be of an unhealthy weight than Israeli men and women.

Socio-economic status was one factor that impacted overweight and obesity percentages, particularly for women. Women in lower classes were four times as likely to be overweight or obese as women in upper classes. The frequency of exercise among the Israeli population was twice as high as that for the Arab population. Only 20.2% of the entire population reported that they exercise for twenty minutes or more three times a week.

Jordan

This is attributed to a change in diet, a lack of physical activity, urbanization, and new technologies.
Lebanon

23.4% of boys and 19.7% of girls were overweight in 1996. Among university students at Lebanese American University in 2008, more male students were overweight or obese than female students. 37% of males were overweight and 13.6% were obese, while 13.6% of females were overweight and 3.2% were obese.

The current trend towards obesity is influenced by more than the shift from traditional Mediterranean to fast food. Individuals who had a low level of education, were non-smokers, and had a family history of obesity were more likely to have an unhealthy body weight. Although females at the Lebanese American University were more likely to snack between meals than their counterparts, they were subjected to the cultural notion that females need to be thin. Males did not have this societal pressure.

West Bank & Gaza Strip

The Palestinians are listed at the 8th place in world overweight population rankings. This is due to decreased physical activity and greater than necessary food consumption, particularly with an increase in energy coming from fat. Two other factors are smoking and urbanization. In addition, "leisure-time physical activity is not a common concept in the Palestinian context, especially for rural women, where lack of sex-segregated facilities and cultural norms are prohibitive factors." Women in urban areas face similar cultural restrictions.

Bahrain

The Food and Agriculture Organization estimates that almost 66% of the adult population is overweight or obese. In 2000, it was determined that amongst children age 12–17, 29.9% of boys and 42.4% of girls were overweight. The MONICA project, sponsored by the WHO, found that 15.6% of boys and 17.4% of girls in high school were obese. Currently 15% of the population suffers from diabetes.

Increased consumption of fast food and predominance of sedentary lifestyles have led to this occurrence. These unhealthy eating habits are reinforced in school canteens, where high fat and high carbohydrate foods such as pizza, burgers, sandwiches, and za'atar, are available for lunch. Between meal times, children prefer French fries, chocolate, and soda, which lack micronutrients and dietary fiber.

Kuwait

From 1980 to 1993, the percentage of individuals age 18–29 that were overweight rose from 30.6% to 54.4% and the percentage of those who were overweight increased from 12.8% to 24.6%. The number of women who are either overweight or obese has jumped to 80% in 2010. In the book "Top 10 of Everything 2011", the women of Kuwait ranked 5th for the highest percentage of obesity. In 2000, it was determined that amongst children age 10–14, 30% of boys and 31.8% of girls were overweight.

According to the Dasman Center for Research and Treatment of Diabetes, 15% of the adult population has diabetes, with 50% of adults over 45 living with the disease. 22 of every 100 children have developed diabetes as a result of an unhealthy weight.

The increased risk of excess weight or obesity is due to a combination of overeating energy-dense, high-fat foods and sedentary lifestyles. Meals consisting of processed ingredients with preservatives, saturated fats, and hydrogenated oil are preferred over traditional foods. Advertisements for unhealthy junk food are seen everywhere and public schools sell candy, chocolate, and soda to their students. Specifically in Kuwaiti universities, other factors include eating between meals, marital status, and a male domination of sports.

Oman

The key factors to these high obesity levels are the adoption of eating habits in the Western lifestyle. The youth population consumes more fat, milk, and meat than previous generations.

Qatar

36.5% of boys and 23.6% of girls age 12–17 were overweight in 2003. By 2015, it is predicted that 73% of women and 69% of men will be obese. According to the International Association for the Study of Obesity, Qatar has the 6th highest rate of obesity among boys in the Middle East and North Africa region. It is also ranked 5th for having the highest percentage of people between 20 and 79 with diabetes. Currently 16% of the population suffers from diabetes.

One reason for the obesity trend is the lack of exercise and poorly designed pedestrian friendly cities. "Like other oil-rich nations, Qatar has leaped across decades of development in a short time, leaving behind the physically demanding life of the desert for air-conditioned comfort, servants, and fast food". Although the type of food eaten has changed, the cultural traditions surrounding food have not. Food is often consumed communally, making it nearly impossible to ensure proper portions. A person who does not eat when food is offered is seen as offensive and shameful. It is also normal within Qatari society to be obese.

Saudi Arabia

Across the whole population from 1995–2000, 36.9% was overweight and 35.6% was obese. Rates were high amongst children aged 5–17, as 16.7% of boys and 19.4% of girls were overweight. By 2006, 52% of men, 66% of women, 18% of teenagers, and 15% of preschoolers were overweight or obese.

In 2008, 17.99% of deaths were caused by cardiovascular disease. During this year, 95% of the 424,968 total appointments to diabetics clinics were made for Saudi citizens. 55% of these diabetic citizens were women and 44% were men.

Part of the reason for the high rate of overweight and obesity within the population are urban residents that consume hypercaloric foods while maintaining a sedentary lifestyle. The less-than physically demanding lifestyle urban residents lead are linked to a high level of education and income. In addition, women had an increased risk of obesity because of cultural and religious beliefs that require women to stay at home as a housewife. Women are prohibited from using hotel gyms and pools and are targets of harassment when they exercise publicly. This is based on the belief that giving women the freedom to exercise would lead to the corruption and decline of the nation. In schools, physical activity for girls is avoided because some fear that changing clothes outside of the home would cause girls to lose their shyness, an admirable moral quality.

United Arab Emirates

In 1999, 24.8% of boys and 89.2% of girls age 4–18 were overweight. This number increased to 25% in 2008. As a result, 13.5% of the population had diabetes in 2000. This number is estimated to rise to 19.3% by 2030. Currently 20% of the population suffers from diabetes.

The population, especially children, over-consume food rich in carbohydrates, salt, fat, and processed sugar. This health problem is exacerbated due to the lack of an exercise culture. The recent availability of wealth due to oil has allowed Emiratis to purchase luxury items, including imported food and tobacco products. The marketing of such products is effective on the youth population. There is little to no awareness of the health impact of these items among the population. Another factor of obesity risk is prevalence of the cultural notion that a fat child is healthy, while a thin one is sick.
Iran

In 1988, Iran was one of the top seven countries with the highest rate of childhood obesity. In 2005, 33.7% of adults were at risk of developing metabolic syndrome. Eight million Iranians already live with this syndrome. In 1995, 24.7% of boys and 26.8% of girls age 6 were overweight.

One of the major reasons for increased obesity is urbanization. In 2005, an average Iranian citizen consumed 42 liters of soda per year, as well as 40% more carbohydrates, 30% more fat, and 40% more food than the body needs. The greater availability of fast food and junk food in combination with a low activity lifestyle has contributed to the obesity trend. Other factors include the impact of technology and a high consumption of rice and bread. Many families with a moderate income are limited in the foods they are able to afford, resulting in a higher incidence of obese children. However, childhood obesity is not a concern because it is believed that these children will outgrow their fatness as they age. The health impact of childhood obesity is unknown or ignored.

Algeria

In 2003, 16.4% of the total population was obese. In 2006, 10.3% of boys and 8.7% of girls age 6–10 were overweight.

Egypt

In 1996, Egypt had the highest average BMI in the world at 26.3. In 1998, 1.6% of 2–6 year olds, 4.9% of 6–10 year olds, 14.7% of 10–14 year olds, and 13.4% of 14–18 year olds were obese. 45% of urban women and 20% of the rural population were obese.

Obesity rates rose as oils, fat, and sugars were more regularly consumed, beginning in the 1990s. The cultural appreciation of heavier female bodies is a factor. Another explanation is the degree to which food is the center of social events and special occasions. Heavy consumption of starchy and fatty foods without the presence of a health-conscious exercise culture is a major factor. As parents teach this lifestyle to their children, the prevalence of childhood obesity increases. Today, Egyptian teenagers drink three times as much soda as milk. Ten percent of males and females drink five or more cans of soda a day, which can lead to early osteoporosis in women in the future. These food habits are reinforced by junk food advertisements and the availability of unhealthy food at supermarkets. As a result, teenagers are three times as likely to be overweight than they were 20 years ago.

Morocco

As adolescent girls age, they are at a greater risk of becoming obese.

Obesity is linked to a greater availability of food, particularly from the West, and an increasingly sedentary lifestyle in urban areas. A woman who has a low level of schooling or no education in urban areas is significantly more likely to be obese. She, along with the general public, are not aware of the medical conditions that result from obesity. Rather, female fatness is embraced as it "is viewed as a sign of social status and is a cultural symbol of beauty, fertility, and prosperity". Being thin is a sign of sickness or poverty.

In Sahrawi ethnic groups, this concept of beauty is embodied through the practice of fattening. Before marriage, girls intentionally overeat and perform limited physical activity for 40 days in order to be attractive for their soon-to-be husbands. Women will repeat this process if they want to gain weight after marriage. It is believed that traditional clothing of these ethnic groups require a heavier body in order to be attractive.

Tunisia

In 1997, 27.4% of the population was overweight and 14.4% were obese. Obesity rates were twice as high in urban areas than in rural areas.

Obesity is culturally seen as a representation of beauty and success. A woman who is of a healthy weight is not as desirable. There is a lack of knowledge about the life-threatening medical conditions that result from obesity.

Government response

Jordan

The Jordanian Government released the document National Health Research Priorities 2009–2012, briefly describing health concerns in a variety of areas. The section about non-communicable diseases and health behavior specifically addressed obesity and its effects. The diseases that were targeted were hyptertension and obesity dyslipidemias. Dietary habits, exercise, and alcohol consumption were targeted in the health behavior section. The paper did not elaborate on how these priorities would be addressed or resolved.

Kuwait

The Kuwaiti government has dealt with the prevalence of obesity through a variety of methods, including awareness campaigns through exercise, health forums, and health fairs. In 2007, the Health Ministry supported the National Bank of Kuwait Walkathon in Salmiya in an effort to raise awareness of the health problems associated with weight gain and obesity. Over 9,000 people attended. Another individual, Jasem Al-Zeraei, started the Six-K Walking Club with the intention of achieving the same goal.

In 2009, the Mediterranean Diet Fair was held at Kuwait's Dasman Institute for Research, Training, and Prevention of Diabetes & Other Chronic Conditions. Educating the public about how to eat a healthy diet was the purpose of the fair. However, unlike other initiatives, participants were told how to eat well and enjoy food at the same time.

In 2010, the New Mowasat Hospital hosted a Ramadan health forum. Entitled "Stay Healthy...While Fasting", the audience was lectured on diabetes and obesity and the health benefits of fasting. Four qualified doctors from the New Mowasat Hospital's Cardiology, Diabetology, Dietetics, and Urology Department, presented medical information and advice. They spoke on various topics, including meal management, the role of physical activities, and the types of high fat foods eaten during Ramadan. Additionally, the Petrochemical Industries Company organized several health-care related activities for their employees. One of the main focuses was countering obesity. The entitled "Get Fit" campaign offered free blood tests and nutritional advice and provided lectures given by knowledgeable doctors. The dangers of obesity were also addressed through the distribution of brochures and fitness advice and public posting of awareness posters.

Oman

The Omani government responded to the health issues related to obesity in its 7th Five-Year Plan for Health Development National Strategic Plan 2006–2010. Acknowledging within the document that the swift to an unhealthy lifestyle is leading to obesity, hypertension, cardiac diseases, and diabetes, strategic objectives and visions were developed.

The visions included prevention and control of non-communicable diseases, promotion health awareness of the community and establishing a culture of healthy lifestyle. These goals are to be achieved through a focus on the areas of reducing non-communicable diseases, health education, adolescent and youth health, and nutrition.

In 2000, 11.6% of the adult population had diabetes and 35.2% of males and 30.9% of females had hypertension. By 2010, the target goal was that only 45% of the population 20 years or older were overweight or obese. Increasing the percentage of people who walked 150 minutes a week to 50% would aid in this goal. Early diagnosis of non-communicable diseases was another strategy to improve the health of the Omani population.

In order to educate the target goal of 90% of the population on unhealthy practices in nutrition by 2010, a website was to be designed and made available by 2007. Weekly series on health covered by radio, newspapers, and television should be established by 2010, as should 30 substantial health education materials produced on various health topics. Additionally, health institutions and communities in the country should have completed 250,000 health-related activities by 2010. This would aid the government in achieving its goal of increasing the percentage of the population exercising to 40%.

In order to combat childhood obesity and the medical consequences of it in adulthood, the promotion of healthy lifestyles was designated as the central focus. Three factors were mentioned: eating breakfast, physical activity outside of school, and maintaining positive attitudes towards a healthy lifestyle. By 2010, 70% of 13 through 15 years old should be eating breakfast, 70% should be exercising independently of school requirements, and 50% more youth and families should have positive ideas about healthy lifestyles. All of these factors would result in a lower percentage of overweight youth population.

Improved nutritional practices were also linked to decreasing obesity by a significant percentage. This is prescribed to occur by the promotion of healthy nutritional practices, such as community activities and informational pamphlets. By 2010, 60% of the population should have adequate knowledge of beneficial nutritional practices.

Saudi Arabia

The government is combating the obesity concern with regular coverage of the disease and the other consequences of being of an unhealthy weight in daily newspapers. During Ramadan, it established a program called "Hello Ramadan." It provided health information related to fasting and allowed listeners to call in to learn more about diabetes, high blood pressure, and diabetes. Listeners could also receive medical information via fax from the program.

United Arab Emirates

The United Arab Emirates has launched an intense campaign to address the high rates of obesity. It began its campaign in 2007 and has continued it today. In the summer of 2007, the Sanofi-Aventis along with the World Health Organization sponsored an event with free health screenings. The purpose was to raise awareness about obesity, its dangers, and its connection to cardiovascular diseases. This was in response to unacceptable results from the International Day for Evaluation of Abdominal Obesity survey, which determined that 37% of adults age 30 plus were obese. The Ministry of Health also designed a school program for the 2007–2008 year which targeted teenagers and their health. Topics addressed in the year-long awareness and education program included smoking, personal hygiene, physical exercise, and obesity. Exercising and playing sports in order to fight obesity was a key component.

In 2009, the Ministry of Health drafted a set of nutritional guidelines focused on maintaining the current level of non-communicable diseases. The other major goal was to improve the well-being of the entire population. Nutritional education programs were set up in health centers, schools, and women associations to spread awareness of non-communicable diseases and how to prevent them. The development of a better dietary culture in school canteens and hospitals was a second approach. This draft was included as part of the National Nutritional Strategy and Action Plan for 2010–2015. The National Nutrition Committee was also founded at this time with the purpose of creating a national strategy.

The National Nutrition Strategy was announced in early 2010. It was designed to ensure that the citizens of the United Arab Emirates would have a healthier future. The Strategy outlined how this goal would be achieved. Early nutritional intervention programs and an emphasis on healthy foods and exercise at home, school, and the workplace was one way listed. By spreading health and nutrition awareness, the prevalence of obesity and non-communicable diseases was being addressed. The Ministry of Health later announced that a nutritional survey would be completed in December 2010. This would ensure that the nutritional strategy was being implemented properly and effectively.

The General Administration of Youth Centers and the Department of Health Education and Promotion sponsored a camp in July 2010 for a select 20 teenagers battling obesity. Every participant was challenged to lose one kilogram a week. A medical check up and relevant tests were conducted at the beginning and end of the session. At the camp, the teenagers were given lectures on healthy food consumption. They also participated in daily sports activities and ate healthy meals and snacks.

The Ministry of Health conducted an awareness campaign at the same time, entitling it "Summer in My Country." This consisted of a series of lectures aimed at teenagers and covered topics such as smoking, obesity, and losing weight. The Abu Dhabi Food Control Authority, addressed the rising rates of obesity by banning all junk food from school canteens. This included burgers, shawarma, sugary drinks, and energy drinks. Parents were supportive of the decision, as one in eight children is obese.

On October 8–9, 2010, the Ministry of Health sponsored the International Diabetes Summit in Dubai. The purpose of the conference was to "highlight the rising prevalence of diabetes and its complications in the world in general and the Middle East in particular". One of the topical focuses was diabetes in the Middle East, especially amongst youth populations. Another summit will take place on February 25–26, 2011.
Iran

In 2002, a dietary health intervention program called "the Isfahan Healthy Heart Programme" was established. The program is supported by the Iranian Budget and Planning Organization, as well as the Deputy for Health of the Iranian Ministry of Health and Medical Education. Intervention took the form of public education through the mass media, marketing, and policy making. After an evaluation in 2006, the results showed that the program was effective in improving dietary behaviors. The population of Isfahan had switched to liquid oil and olive oil, rather than using hydrogenated oil, and consumed more healthy foods. Fruit, vegetables, fish, and low-fat dairy products were preferred over sausages, animal fat, and sweets. The Fat Consumption Index was lower after the campaign than before it.

Egypt

The Egyptian government produced a Demographic and Health Survey in 2008, covering topics from family planning to maternal health care to nutrition. Chapter 14 was dedicated to nutritional statistics and specifically mentioned obesity. It did not discuss future policy plans to address the rising trend of obesity.

Source: wikipedia.org

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Israeli Jewish and Arab Women Aged 25 to 64 Years Are Overweight or Obese

 

Amanda Niskar, DrPH, Orna Baron-Epel, PhD, Noga Garty-Sandalon, RD, MSc, Lital Keinan-Boker, MD, PhD

Suggested citation for this article: Niskar A, Baron-Epel O, Garty-Sandalon N, Keinan-Boker L. Body weight dissatisfaction among Israeli Jewish and Arab women with normal or overweight-obese body mass index. Prev Chronic Dis 2009;6(2):A51. http://www.cdc.gov/pcd/issues/2009/
apr/08_0118.htm
.

PEER REVIEWED
Abstract
Abstract

Introduction

In Israel, 58.9% of Jewish and Arab Israeli women aged 25 to 64 years are overweight or obese (body mass index ≥25 kg/m2). The objective of this analysis is to describe body weight dissatisfaction differences between Jewish and Arab Israeli women with normal or overweight-obese body mass index.

Methods

This analysis included 1,393 Jewish and Arab women who participated in the Israeli National Health Interview Survey, 2003-2004. The survey covered a random sample of the Israeli general population aged 21 years or older. All variables were based on self-report. Body weight dissatisfaction was a multiple-choice question in the survey that offered the following responses: very satisfied, satisfied, reasonably satisfied, not satisfied, or very unsatisfied. Univariate and multivariate analyses were conducted.

Results

Overall, 39.1% of Jewish women reported body weight dissatisfaction, compared with 29.1% of Arab women. Older overweight-obese Arab women had a lower prevalence of body weight dissatisfaction than Jewish women of the same age group, which indicates cultural differences in body weight dissatisfaction among older overweight-obese women. However, cultural differences do not appear to influence body weight dissatisfaction among younger Jewish and Arab women of normal weight.

Conclusion

This study suggests that Jewish and Arab women differ in their perceptions of body weight. Interventions tailored to each group are needed to promote healthy dietary and physical activity behaviors.

More than 400 million adults are estimated to be obese worldwide (1). In Israel, the prevalence of overweight and obesity among Jewish and Arab women aged 25 to 64 years is 58.9% (2). Study samples vary by many factors such as nationality, race, and ethnicity. Thus, results from studies among different populations cannot necessarily be generalized to other populations. A study in Israel among Arab women showed similar findings to studies on US populations regarding an association of increased body mass index (BMI) with onset of type 2 diabetes (3). Despite the public health risks associated with overweight and obesity, we know of no data that describe the relationship between body weight dissatisfaction (BWD), overweight-obese BMI, dieting, and population group among Israeli women. Understanding the possible relationship between BWD, BMI, dieting, and population group among Israeli women is of interest to Israeli health professionals delivering health care services including preventive services to the diverse populations of Israeli women who are in varying levels of acculturation. In addition, findings of this study are relevant to providing health care services to similar populations living in other countries.

Israel is a complex country that is pluralistic, multicultural, and democratic (4). Israel’s national health care system is highly developed, and national health insurance covers the entire population. Israel is a small country with approximately 29,000 km2 of land (4). The approximately 7.3 million people of Israel originate from more than 30 countries (4). The 2 major ethnic populations are Jews (approximately 80%) and Arabs (approximately 20%), and Israel has 2 official languages, Hebrew and Arabic (4). These 2 populations differ by language, religion, and culture.

Studies describe minority and immigrant populations living in Israel, Australia, and other countries whose weight-related values and behaviors are similar to those of Westernized white women as they become acculturated (5,6). People’s food consumption is sensitive to changes in food portion size, the number of people with whom they eat, the amount of food that others eat, and the variety of foods available (7,8). These external environmental factors may explain the finding that body weight often increases or decreases when people move from one area of the world to another, when they enter the college environment, or when they have a change in marital or relationship status (7). Stress-induced eating may be another factor that contributes to the development of obesity (9). Chronic life stress seems to be associated with a greater preference for energy- and nutrient-dense foods high in sugar and fat (9).

Factors associated with BWD include body weight, muscle tone, and body fat (10). Cultural attitudes regarding appearance, physical activity, and health influence BWD (11). In Israel, married women and women with low education are at risk for a sedentary lifestyle, which relates to cultural attitudes about physical activity and may be associated with modernization (12). Identifying factors associated with BWD among Israelis could help health professionals develop tailored interventions to promote healthy weight for Israelis (13). The objective of this analysis is to describe the nationally representative prevalence of BWD among Jewish and Arab Israeli women with normal or overweight-obese BMI, by age, dieting status, education, smoking status, and general health status.

Methods

Survey framework

The Ministry of Health’s Israel Center for Disease Control (ICDC) conducted the first Israeli National Health Interview Survey (INHIS-1) during 2003 and 2004 (14). Informed consent for each participant was obtained by telephone after a brief explanation about the health survey, including the objectives and importance. People who consented by telephone to participate in the survey were interviewed and were told they could stop the interview at any point and could decline to answer any question at any time. According to Israeli legislation, such a telephone health survey is conducted within the capacity of the ICDC and is not considered medical research. Thus, no approval of an ethical committee was needed for this data collection and analysis.

The INHIS-1 data are nationally representative of the Israeli general population, including the Arab population. INHIS-1 was based on the European Health Interview Survey (EUROHIS) framework initiated in 2000 by the World Health Organization Regional Office for Europe. In 2000 and 2001, EUROHIS field tests were conducted in participating countries, including Israel (15).

INHIS-1 sample

The study sample consisted of a random sample of the Israeli citizen general population aged 21 years and older. Telephone numbers were selected from a computerized list of national telephone company subscribers estimated to cover 94% of Israeli households, according to the Central Bureau of Statistics (16). The 6% of the population without a national telephone company subscription are likely to have a subscription with another telephone service provider. These other telephone service providers were not accessible in the computerized list used for random selection of survey participants.

INHIS-1 data collection

The ICDC prepared the EUROHIS questions for application in Israel. The 150 EUROHIS questions were translated into Hebrew and back into English to ensure correct translation. INHIS-1 included 142 EUROHIS questions after 8 questions not relevant to the Israeli population were removed. An additional 129 questions relevant to the Israeli population (eg, regarding population group) or related to specific topics of interest were added to INHIS-1 for a total of 271 questions. The Hebrew questionnaire was then translated into Arabic and Russian and translated back into Hebrew for quality control. The questionnaire was administered over the telephone by trained interviewers from the corresponding population group in Hebrew, Arabic, or Russian. Data were entered and analyzed with a statistical package developed for INHIS-1, and logic checks were performed.

INHIS-1 women’s health module

The findings presented in this analysis are results from the INHIS-1 women’s health module (WHM), conducted in 2003. The WHM included the 86 core questions from INHIS-1 and an additional 66 questions relevant to the women of Israel (part of the additional questions described in the above section) to monitor health status and to evaluate the use of health services and health behaviors specific to women. Although modules were not validated, they were pilot tested. For the WHM, 1,491 (27.5%) households could not be located, and 3,927 households from the INHIS-1 were contacted. Households were identified as lost to follow-up after 6 failed attempts to contact the household. The response rate for the WHM was 60.9%. Nonresponses included outright refusals, partially completed interviews, and repeated postponements. Three women did not provide population group data. A total of 1,393 women provided population group data and were available for analysis (1,065 Jewish and 328 Arab). This random sample is nationally representative of the Israeli Jewish and Arab populations.

Definitions

All variables were based on self-report. Key variables for this analysis were defined on the basis of the survey questions. Population groups were organized into 2 categories: Jewish women or Arab women (Muslim, Christian, and Druze). The survey included other categories of women who did not identify themselves as Jewish Israeli or as Arab Israeli but because their numbers were so small they were designated Jewish Israeli, in accordance with INHIS-1 methods and because these women have similar sociodemographic characteristics to Jewish Israelis.

BWD is a valid assessment commonly used in studies and surveys (17,18). BWD was a multiple-choice question in the survey with 5 possible answers. For this analysis, the 5 categories were grouped into 2 categories: satisfied (0 = very satisfied, satisfied, and reasonably satisfied) or dissatisfied (1 = not satisfied, very unsatisfied). In the survey, women who reported being on a diet were asked to specify 4 diet categories: dieting for weight reduction, dieting for weight maintenance, dieting for health reasons, or dieting for weight gain. For analyses, dieting was grouped into 2 categories: dieting (1 = for weight reduction or weight maintenance) or not dieting (0). Dieting for weight reduction or weight maintenance was the dieting category of interest for this analysis because we were interested in the increasing trends of obesity and overweight among Israeli women. Dieting for weight maintenance is included in the dieting category because the purpose of dieting is to avoid gaining weight and to maintain health.

BMI was calculated as the reported weight without clothes and shoes divided by the square of the reported height without shoes. This analysis is interested in obesity issues and focused on the differences between women of normal BMI and women of overweight or obese BMI. These 2 BMI categories are defined by the World Health Organization as 18.5 kg/m2 to 24.9 kg/m2 (normal BMI) or 25.0 kg/m2 or more (overweight-obese BMI) (1). General health status was reported as 1 of 5 categories (good, very good, fair, bad, very bad). For this analysis, general health status was defined in 2 categories as optimal (1 = good, very good) or suboptimal (0 = fair, bad, very bad).
Statistical analyses

Univariate and multivariate analyses were conducted by using SAS version 9.1 (SAS Institute, Inc, Cary, North Carolina). The effect of population group (Jewish or Arab Israeli women) and BMI on BWD was assessed by age group. Except for the logistic regression modeling, all P values were the results of a χ2 test. The percentage of women dieting was assessed by BWD, BMI, and population group. To estimate the independent associations of each variable on BWD, χ2 statistics and multiple logistic regression models were conducted with BWD as the dependent variable. Odds ratios and 95% confidence intervals were calculated for each variable, controlling for other variables in the final logistic regression model. Significance was set at a P value of <.05. Confounders adjusted for in the final logistic regression model are population group, age, BMI, dieting, marital status, health status, and education.

Results

Overall demographic characteristics of the Israeli population in 2003 are described in Table 1. Characteristics of the INHIS-1 sample by Jewish and Arab women are presented in Table 2. In this survey, 39.1% of Jewish women and 29.1% of Arab women reported BWD. Among overweight-obese women, 67.6% of Jewish women and 44.9% of Arab women reported BWD. Among overweight-obese women, 45.9% of Jewish women and 39.3% of Arab women with BWD reported dieting for weight reduction or weight maintenance. The percentage of normal-BMI women dieting for weight reduction or weight maintenance was not significantly different between Jewish (20.9%) and Arab (21.4%) women.

Results of the multivariate analyses are presented in Table 3. Smoking, physical activity, and having children were not included in the logistic regression model displayed in Table 3 because these variables were not significantly associated with BWD in either population. Interaction terms between population group, age, BMI, and dieting were not significant in logistic regression modeling.

Discussion

This is the first analysis describing BWD among Jewish and Arab Israeli women. Differences in the prevalence of BWD were found between these 2 populations. In this INHIS-1 analysis, Arab women were less likely than Jewish women to report BWD. A higher percentage of Arab women than Jewish women were overweight-obese. Another recent Israeli survey that measured body weight found Arab women have a higher rate of obesity than Jewish women (2). Our finding that BWD was associated with an overweight-obese BMI and dieting to lose or maintain weight is consistent with other international research showing that dieting is a common weight-loss strategy among women with BWD (19,20). Chronic dieters are likely to have BWD (11), and older overweight or obese women may have a history of unsuccessful weight loss attempts resulting in depression and BWD (21). A study in South Africa examined the prevalence of BWD in both normal and overweight glucose-intolerant nondiabetic women (18). Both overweight and normal-weight glucose-intolerant women experienced a chronic dieting mindset, binge or uncontrolled eating, and feelings of guilt or depression after a binge in conjunction with BWD (18).

The Israel Heart Fund develops health promotion projects in the community to focus on special populations such as Arab women to prevent and reduce obesity (22).

A main finding of this study is the difference in BWD among young Arab women compared with older Arab women. Muslim Arab people in Israel have a history of less educational attainment than Jewish people in Israel (23). Cohorts born from the mid-1920s to the 1970s experienced a narrowing of population group differences in educational attainment at the lower levels of schooling, but the differences increased at higher levels of education (23).

Our findings that BWD is associated with sociodemographic factors such as population group are consistent with previous studies in America and Europe (20,21). Overweight and obese US minorities were more likely to believe and to self-report that they were not overweight than were nonminorities (24). Targeted media campaigns and culturally tailored community educational events are examples of strategies to raise awareness about healthy living to promote healthy eating and healthy physical activity patterns among US minority populations (25).

Our finding showing that older overweight-obese Arab women reported a lower prevalence of BWD than Jewish women of the same age group may reflect a difference in the degree of urbanization and industrialization between Jewish and Arab Israelis (26). The morbidity and premature mortality seen in the Arab population is higher than that of the Jewish population (27). This finding that Arab overweight-obese women were more likely to be satisfied with their weight is of concern, because their obesity rates place them at higher risk for developing chronic disease. For example, the prevalence of diabetes is higher among Arab Israelis than among Jewish Israelis (27). Approximately two-thirds of Israeli Arabs diagnosed with type 2 diabetes were women, and most of these women had a higher BMI at diagnosis of type 2 diabetes than did men (3).

Although older Arab and Jewish women differed in terms of BWD, our results demonstrated a similar prevalence of BWD among young Jewish and Arab women. The similarities among Arab and Jewish young women’s attitudes to body weight may suggest that the Arab community is in transition from a more traditional and collective way of life to a more individualistic way of life, adopting more modern lifestyles (26). Similarly, immigrants who lived in Israel for 4 to 15 years adopted Israeli cultural norms for eating patterns related to obesity and eating disorders (6).

A major strength of this analysis is that the results are nationally representative for adult women in Israel. INHIS-1 is among the largest national surveys in Israel, and this is the first time that BWD was studied in Israel. The BMI calculations in our study are limited by the self-reporting method of gathering height and weight data. Most women underestimate their weight and overestimate their height, resulting in BMI miscalculations (28). The degree of self-report weight inaccuracies can vary by population group (29), and chronic dieters are likely to overestimate their body weight (11). Actual height and weight measurements would be more reliable for studies calculating BMI. Another strength of this analysis is that multivariate analyses were conducted with and without controlling for education, income, and employment, and the same differences were observed, which indicates that cultural issues may explain the differences rather than income or education.

Conclusion

Israeli Jewish and Arab women differ with regard to BWD. To prevent eating disorders and chronic diseases, Israeli women need to balance healthy behaviors and body weight attitudes. Interventions should be tailored to age group, education level, religion, marital status, language, and cultural traditions to promote satisfaction with normal BMI and to prevent obesity and related chronic diseases. Interventions are needed to promote proper nutrition, regular physical activity, and stress-reduction techniques (9,13). Some evidence suggests that eating is an automatic behavior that is not strongly influenced by nutrition education and that physical activity cannot compete with increased consumption of food (8). Therefore, additional interventions are needed that shape the external environment relevant to person, place, and time of food purchase, preparation, and consumption (7). Public health professionals in other countries with minority and immigrant populations may consider developing interventions to prevent obesity that are tailored to age group, religion, language, and culture of each population group.

Acknowledgments

We thank Professor Manfred S. Green, Ms Rita Dichtiar, Ms Tamar Peled-Leviatan, Ms Anneke Ifrah, and the INHIS-1 interviewers, Israel Center for Disease Control, Ramat Gan, Israel, for their contributions to this manuscript.

The manuscript does not necessarily reflect the views of the Israel Ministry of Health.
Author Information

Corresponding Author: Amanda Niskar, DrPh, Office of Preparedness and Emergency Operations, Assistant Secretary for Preparedness and Response, US Department of Health and Human Services, 330 Independence Ave SW, Rm G644, Ste 320, Washington, DC 20201. E-mail: amanda.niskar@hhs.gov. At the time this article was prepared, Dr Niskar was affiliated with Tel Aviv University, Tel Aviv, Israel.

Author Affiliations: Orna Baron-Epel, University of Haifa, Israel; Noga Garty-Sandalon, Israel Center for Disease Control, Ramat Gan, Israel; Lital Keinan-Boker, University of Haifa, Israel and Israel Center for Disease Control, Ramat Gan, Israel.

References
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Tables

Table 1. Characteristics of Jews, Muslim Arabs, Christian Arabs, and Druze in Israel, 2003
Characteristic Value
Jews Arabs
Christian Druze Muslim
Population 5,165,400 115,700 110,800 1,072,500
Population younger than 15 y, % 25.5 28.5 34.8 41.2
Full high school education with matriculation certificate, % 56.3 67.4 48.3 49.4
Employed, ages 15-64 y, % 55.0 50.8 35.5 35.9
Urbanization: living in townsa, % 90.8 99.1 97.4 92.7
   Of these, living in towns with <50,000 inhabitants, % 32.7 53.7 96.7 63.8
Annual population growth, % 3.8 1.9 3.8 4.4
Total fertility rateb 2.7 2.4 2.9 4.5
Infant mortality rate (per 1,000 liveborn) 3.6 3.2 7.1 8.8
a Urban settlements are defined as those with at least 2,000 inhabitants.
b
Average number of children per woman during her lifetime.
Table 2. Characteristics of Israeli Women Who Participated in the First Israeli National Health Interview Survey, 2003 (N = 1,393)
Characteristic Jewish Women, n (%) Arab Women, n (%) P Valuea
Total  1,065 (76.4) 328 (23.6) NA
Age group, y 21-34 304 (28.5) 128 (39.0) .007
35-44 199 (18.7) 60 (18.3)
45-54 230 (21.6) 55 (16.8)
55-64 167 (15.7) 45 (13.7)
≥65 165 (15.5) 40 (12.2)
Education, y <12 150 (14.2) 189 (57.8) <.001
12 561 (53.0) 108 (33.0)
>12 348 (32.9) 30 (9.2)
Marital status Married 767 (72.2) 246 (75.0) .31
Not married 296 (27.8) 82 (25.0)
Net monthly income, NISb <5,200 137 (18.2) 125 (56.3) <.001
5,200-8,500 139 (18.5) 55 (24.8)
>8,500 476 (63.3) 42 (18.9)
Employment Yes 593 (58.7) 59 (18.9) <.001
No 417 (41.3) 254 (81.1)
Smokingc Yes 217 (20.4) 21 (6.4) <.001
No 848 (79.6) 307 (93.6)
General health statusd Suboptimal 160 (34.0) 96 (35.4) .70
Optimal 310 (66.0) 175 (64.6)
Body mass indexe Normal 525 (55.7) 101 (44.1) .002
Overweight-obese 417 (44.3) 128 (55.9)
Dieting to lose or maintain weight Yes 308 (29.0) 63 (19.5) <.001
No 754 (71.0) 260 (80.5)
Abbreviation: NA, not applicable; NIS, New Israeli Shekel.
a P values were derived from χ2 tests.
b Net monthly income was described in terms of the NIS.
c Defined as current smoker or nonsmoker.
d General health status was defined as optimal (good, very good) or suboptimal (fair, bad, very bad).
e Body mass index was defined as normal (18.5-24.9 kg/m2) and overweight-obese (≥25.0 kg/m2).
Table 3. Odds of Factors Influencing Body Weight Dissatisfaction Among Israeli Women (n = 626a), First Israeli National Health Interview Survey, 2003
Variables OR (95% CI) P valueb
Jewish women [reference] vs Arab women 2.19 (1.29-3.71) .004
Age [continuous from young to old] 0.97 (0.95-0.98) <.001
Body mass index [continuous from low to high] 1.39 (1.31-1.48) <.001
Dieting [reference] vs non-dieting 2.44 (1.55-3.84) <.001
Married [reference] vs single 1.63 (0.99-2.82) .06
Health status: optimal [reference] vs suboptimal 0.43 (0.26-0.70) <.001
Education: <12 years [reference] vs ≤12 years 1.35 (0.98-1.87) .06
Abbreviation: OR, odds ratio; CI, confidence interval.
a
Only participants with information regarding all variables were included in the logistic regression modeling analyses.
b P values were derived from multiple logistic regression.

Source: cdc.gov

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