While sitting on a coffee shop bench in Beirut, typing away on my laptop, Ismael, the coffee shop owner asked me, curious: “What are you writing?” I smiled and said: “I am writing about obesity”. “Yes, they eat a lot in America” said Ismael before pouring me coffee “we don’t have this problem here”. I was a little surprised, opened my mouth, mentally preparing for a long speech- unspoken. I preferred sparing busy Ismael from an argument over the prevalence of obesity worldwide. Like my favorite coffee shop owner, I also believed, until recently, that the problem is a western one, mistakenly associating affluence with obesity, “Europeans and Americans” you hear people from different social spheres saying “citizens of developed countries who are well off and can afford to eat and eat have problems of excess body weight-not us”. Not quite so!
The number of people who are obese and overweight is on a steady rise worldwide
In reality, the number of people who are obese and overweight is on a steady rise worldwide. Studies performed in Latin America, Middle East, Asia and Africa are showing that poor nations are exhibiting an increase in the percentage of overweight and obesity, sometimes higher than the percentages in the United States of America (USA). Although still affecting all social classes, obesity is slowly moving from being the disease of the wealthy to the disease of the poor. If we zoom in on a country in Latin America, Brazil, for instance, a study 1 conducted there shows that women who earn less money are more likely to be obese than wealthier women. Obesity in higher income women of Brazil was increasing from 1975 to 1989 only to later decrease from 1989 to 1997. Are wealthier people less likely to be obese due to their access to resources and education? In other countries of Latin America such as Chile3 and Mexico2 , studies have also shown that obesity and poverty are going hand in hand. Take a deep breath: obesity is even increasing in Tanzania4 ! One of the poorest countries in sub-Saharan Africa, and over 13% of women were found to be overweight or obese, whereas in Asia, although obesity and overweight levels are lower than in many of the other countries and regions, excess weight still emerges as a public health problem and overweight individuals in China moved from composing 10.3% of the population in 1989 to 15.4% in 19975 .
53% of Lebanese aged above 20 years old are overweight
And what about us, in Lebanon? What percentage of the Lebanese population is considered to be overweight? How many are obese? How do we stand compared to the USA and countries in the region? Would I have shocked Ismael had I told him that, according to a study done by the American University of Beirut (AUB)6 , 53% of Lebanese aged above 20 years old are overweight, and 17% are obese? The percentages are high, especially when compared to the reported numbers in the USA, 56% overweight and 19.8% obese7 . However, when the same numbers are compared to the percentages found in the Middle East, Lebanon scores amongst the lowest. According to a number of studies done in the neighboring countries, obesity is more common in women than men, with some countries in the Arab world exhibiting alarming numbers, such as in Kuwait8 and in Jordan9, where 40% and 60% of women are obese, respectively! The percentages for men are also high in the above mentioned countries: 32% and 33% respectively. Numbers can be easily compared in the graph, and it is clear that the percentage of obesity in Lebanon, although considered high, is lower than in surrounding countries.
So now you know, obesity is on the rise everywhere, in Lebanon and surrounding countries as well, but the real question is why? Why are we getting bigger? Why all of us? Scientists call this phenomenon the “nutrition transition”: Globally we are moving far away from the prehistoric man, who actively hunted and gathered wild animals and fruits, lean from jumping around, and heading towards a diet high in total fat, cholesterol and refined sugars, sitting on our desks, watching television, taking elevators, standing on conveyor belts, in one word, motionfree. We eat highly dense foods and hardly ever move to burn the excess energy, and what for? Everything is made available; no need to run after the deer for an hour in a dangerous forest, all restaurants deliver! Less physical activity, induced by the boom of technology and transport, coupled with the availability of high-fat, high-sugar foods are accused by many, and rightly so, to be the main causes of the global rise of obesity worldwide.
The Lebanese consumes too much fat
Although the two factors mentioned above are suspected in every country to contribute to the rise of obesity, differing factors are responsible for the different percentages seen from country to country. Of course, more research is needed to fully understand the problem in Lebanon and the Middle East, however, a few studies do shed some light on the possible causes of this obesity rise in the region. For instance, in Lebanon, obesity in adolescents was linked with lack of physical activity whereas obesity in adults was linked with illiteracy, non smoking, and family history of obesity6. Studies on Lebanese food consumption are pointing at a higher consumption of fat over the years: concomitant with the increase in obesity, the Lebanese population increased its fat consumption, 24% to 34.3% of total calories from 1963 to 1998, and decreased its carbohydrate consumption over the same years, 64.8% to 52.9%10. More so, according to a study11 done in 2004 on the food consumption of 444 adult subjects living in Beirut, Lebanese were found to consume excessive amounts of fat, 38.9%, and less fish, fruits and vegetables than what is recommended. So maybe it’s more the excess butter, cream or ‘samneh’ and the lack of cucumbers than the consumption of bread that is making us go wide!
What about the Arab world, what do they have to say for themselves? How can the mounting rates of obesity there be explained? Some studies8 have suggested that society’s view of excess weight as being a sign of beauty, prosperity and affluence, might be one of the reasons behind the alarming rates of obesity found in the Middle East. Beautiful? Can be! However, obesity is not to be taken lightly! Apart from being stigmatized in social circles and having to deal with the low self-esteem generated by failing to meet unrealistic weight loss expectations, obese individuals also have to face health problems. In fact, the risk of developing chronic diseases increases with excess weight; hypertension, coronary artery disease, lipid disorders, type II diabetes mellitus, obstructive sleep apnea, joint disease and other respiratory problems are just the main stars of the cast list. In a word, obesity is a disease that needs to be treated with the help of a team of health specialists, supporting and guiding the patient through the often long and tedious process. So Ismael, obesity is everywhere, can you hear me? In Lebanon as well! So take a stand now and support healthy alternatives today for a leaner future tomorrow!
1- Monteiro CA, Conde WL, Popkin BM. Is obesity replacing or adding to undernutrition? Evidence from different social classes in Brazil. Public Health Nutr. 2002; 5; 105-12.
2- National Institute of Statistics (INE). Statistics summary 2000. Chile :INE, 2000.
3- Peña M, Baccallao J. Obesity and Poverty: an emerging problem in the Americas. In: Peña MaBJ, ed. Obesity and Poverty: A New Public Health Challenge. PAHO Scientific Publication No. 576. Washington, DC:Pan American Health Organization, 2000;132.
4- Maletnlema TN. A Tanzanian perspective on the nutrition transition and its implication for health. Public Health Nutr. 2002 ; 5 : 163-8.
5- Du S, Lu B, Zhai F, Popkin BM. A new stage of the nutrition transition in China. Public Health Nutr.2002 ; 5 :169-74.
6- Sibai AM, Hwalla N, Adra N and Rahal B. Prevalence and Covariates of Obesity in Lebanon : Findings from the First Epidemiological Study. Obes Res. 2003;11:1353-1361.
7- Mokdad AH, Bowman BA, Ford ES, et al. The continuing epidemic of obesity and diabetes in the United States. JAMA. 2001 ;286 :1195-200.
8- Kandela P. The Kuwaiti passion for food cannot be shaken. Lancet 1999; 353 :1249-50.
9- Ajlouni K, Jaddou H, Batieha A. Obesity in Jordan. Int J Obes Relat Metab Disord. 1998 ; 22 : 624-8.
10- Hwalla Baba N. Dietary intake and nutrition related disorders in Lebanon. Nutr Health 2000; 14:33-40.
11- Nasreddine L, Hwalla N, Sibai A, Hamze M, Parent-Massin D. Food Consumption patterns in an adult urban population in Beirut, Lebanon. Public Health Nutrition: not known (not known), 1-11.
