Introduction
Global obesity has reached epic proportions in countries across the world (Sadaqat, 2020). United Arab Emirates (UAE) is among the leading high-income, oil-producing nations to be affected by this health issue. The increase in obesity among the UAE population is alarming. Obesity levels were as high as 37% in 2010, double the global average (Sadaqat, 2020). This report will provide a detailed analysis of obesity from the perspective of three recurring factors – nutrition, physical activity, and lifestyle choices, while also describing the measures taken by the UAE authorities to curb obesity.
Adult Obesity Prevalence
Obesity Prevalence Today
According to the National Health Survey (2019), the proportion of 18-year-old adults and above who were obese reduced to 27.8% compared to 37.2% in 2010. This improvement became possible due to government actions, including health awareness campaigns, early adult and child intervention programs, weight loss challenges, public health draft law, interactive map for physical activity, and other. For example, ‘Etminan’ initiative, which is an examination program measuring body mass and promoting weight management through visits to nutrition centers and healthcare clinics (National Health Survey results, 2019).
Besides, the UAE government, under its Vision 2021 National Agenda, is focused on reducing obesity rates through various programs and initiatives promoting healthy living (UAE Vision, n.d.). In the framework of the program, scientists record the prevalence of diabetes, the number of deaths due to cardiovascular diseases, and obesity prevalence amongst children.
Statistics of the Past Years
Earlier studies can give an even more comprehensive picture of the prevalence of obesity in the UAE. According to a 2003 study, the obesity rate among UAE male students was 35.7%, and this percentage was higher than for female students (Musaiger et al., 2003). Watching TV for more than 4 hours a day, smoking, having a car, not practicing sport, and having a family history were considered as factors that increase the risk of obesity. However, only a family history of obesity proved to be statistically significant. In light of the above, it turns out that the level of obesity remained stable from 2003 to 2010.
Besides, since the level of obesity did not decrease during this time, the conclusions about healthy lifestyle influence on the risk of obesity are significant. A more recent study in 2013-2016, conducted among residents of Ras Al Khaimah, showed that 67.6% of the study participants were overweight or obese. The share of overweight was 36.2%, and the percentage of obesity was 31.4%, of which 22.8% were of category I obesity, 5.5% of category II, and 3.1% of category III (Kalavathy, Al Araj and Rabbani, 2019). These results also showed a high prevalence of obesity among men.
Determinants of Adult Obesity
The prevalence of obesity in the UAE is emerging from the interaction of diet, lifestyle, socioeconomic factors, and inadequate physical activity. Obesity results in dangerous health conditions like diabetes, heart disease, or musculoskeletal disorders (Awofeso, Al Imam, and Ahmed, 2019). Also, obesity is recognized as one of the primary contributors to worldwide morbidity and mortality and is associated with a rising incidence of global deaths (Hussain, 2017).
A detailed examination of the factors linked with obesity reveals numerous causes implicated in the etiology of this chronic medical condition across nutrition, socioeconomic aspects, and physical activity (Hussain, 2017). Thereby, analysis of the issue is yielding essential insights for managing the obesity epidemic and designing long-term interventions to combat this chronic health problem in the UAE.
Nutrition Transition Concept
The global economic development of the early 1990s has caused changes in people’s lives, one of which was a nutrition transition. Lots of families moved to urban areas and were forced to rethink their nutrition habits. Life in the cities, which is characterized by a fast rhythm, an abundance of fast foods, and high-calorie products of low quality on supermarket shelves, made these new habits extremely harmful to health. According to scientists, the term nutrition transition means changes in nutrition due to changes in economic, social, demographic, and health factors (Kubena, 2003). Therefore, as a result of the nutrition transition, people began to eat more fat, added sugars, and saturated fat, and less complex carbohydrates, dietary fiber, fruits, and vegetables.
Nutrition Knowledge
Nutrition knowledge is very beneficial, as it has significant effects on dietary habits. For example, one study compared nutrition knowledge among Health Sciences and non-Health Sciences students in one of the universities in UAE. The first found that they were much more knowledgeable about the health benefits and safety of dietary supplements (Al Homoud, Basil, and Bondarev, 2016). Therefore, scientists concluded that it is necessary to inform the population about the characteristics of nutritional supplements. According to the results of another study, it turned out that 69% of men and 47% of women consider traditional Emirati foods to be healthy, even though the study participants spoke about foods with high-fat content. Interestingly, the main factor influencing their choices was the taste of the products.
Another investigation held among UAE and Oman residents studied the nutrition awareness of people with diabetes, as carbohydrate-containing foods have the most significant impact on post-meal blood glucose levels (Ali et al., 2008). Participants showed low awareness of carbohydrate sources; 88% were sure that unsweetened fruit juice could not increase blood levels, and 93% incorrectly thought that whole wheat bread would not affect their blood sugar levels. However, two-thirds of participants knew that honey and dates increase sugar levels, and less than a third knew that cow’s milk affects sugar levels more than camels. Also, more than two-thirds of those surveyed were aware that chicken and green salads neutralize sugar levels; Emirati citizens were better informed than their Omani counterparts.
Unhealthy Nutrition
Unhealthy nutrition remains the most crucial reason for the rise in obesity levels. Scientists found out that the rising consumption of high-calorie processed foods with less nutritional value across Emirati citizens is one of the causes for the rising prevalence of obesity in the UAE (Khawaja et al., 2019). Massive lifestyle changes over the past three decades have also transformed dietary habits. High energy intake, sugars, saturated fats, less consumption of complex carbohydrates and fibers are the aspects of the dietary pattern that predispose UAE residents to obesity (Khawaja et al., 2019). As rates of obesity are rapidly rising, co-morbidity due to poor eating habits is likely to impact UAE in many ways, as well as the development of associated medical conditions.
Sports and Physical Activity
The rapid economic growth in the UAE contributed to improved socioeconomic status, resulting in increased reliance on technologies, the use of computers, and television, further perpetuating a sedentary lifestyle that prevents physical activities. Mainly, the high temperatures experienced in the UAE make it challenging to walk. Hence, most people prefer to use cars for transport, even for shorter distances, and to stay indoors (Sulaiman et al., 2017). Besides, only 16% of young people reach the recommended levels of physical activity (Davison and Dalibalta, 2019). Both scientists emphasize that the lack of physical activity and associated lifestyle factors limit the opportunities to reduce body weight among younger and older people.
Smoking and Obesity Impact on Health
Smoking, diabetes, obesity, and abdominal obesity are the main risk factors for the development of cardiovascular disease. According to a 2010 study, the average age of smokers in the UAE was 32.8 years, with a smoking prevalence of 24.2% for men and 0.78% for women, and smoking started at the age of 22-24 (Al Houqani and Hajat, 2011). Also, 78% of smokers consumed tobacco, 13% preferred midwakh, and 5% preferred Shisha. A later study in 2019 noted that most men living in Al Ain, UAE, started smoking earlier than 28 years old, 59.5% of the participants usually smoked cigarettes (Al Tabakha et al., 2019). At the same time, 76.7% of the participants expressed a desire to quit smoking in the future, and 55.3% were ready to participate in the smoking cessation program.
Government Promoting Healthy Nutrition
The consumption of sugar-sweetened drinks such as energy drinks, soft drinks, and flavored milk with added sugar is showing a positive correlation between obesity and single-stranded binding proteins (SSBs). To reduce the intake of sugar, the UAE government introduced taxes on sugary drinks. Also, excise taxes on fizzy drinks were imposed in October 2017 (Rizvi, 2019). The Sharjah government introduced a 50% tax on energy and soft drinks to reduce consumption (Chaloupka and Powell, 2019). And the UAE government imposed a 50% charge on fizzy drinks to lower the obesity rate (Rizvi, 2019). In 15 months following the introduction of the taxes in 2017, the sale of sugary drinks in the UAE fell by 65%, according to research organization Euromonitor International.
Such policies and initiatives will ensure that the nutritional lifestyle choice of UAE consumers is becoming healthier (Gulf Today, 2019). Besides, the new strategy changes requirements for nutritional labeling data on saturated and regular fat, sugar, and salt content. From now, products should be labeled in different colors on the front of food packages based on high or low levels of the mentioned contents. Information regarding the calories is also included in this label.
Implementing policies to limit the marketing of unhealthy foods and drinks is vital to curb obesity prevalence. Some of the ways the UAE government promotes healthy eating habits include the approval of the Nutrition Labelling Policy by the Government of UAE (Gulf Today, 2019). The policy is an outcome of the Community Design for Wellbeing program launched by the National Initiative of Happiness and Wellbeing in 2019. Authorities have also taken steps to reduce the consumption of harmful products that cause obesity. Following the UAE national health plan, the Department of Health in Abu Dhabi seeks to implement regulations on processed food. For instance, the establishment of the Wegaya (meaning prevention) program, which requires putting a blue and green Wegaya logo on healthy foods, supports nutritious eating.
Government Programs Promoting Physical Activity
The UAE government supports engagement in physical activity through various healthcare programs. The Dubai fitness movement started in 2017 by his Highness Sheikh Hamdan Bin Mohammed Al Maktoum motivates citizens, residents, and visitors to participate in daily physical activities (Sports and recreation, 2020). It is assumed that walking, cycling, and going into sports 30 minutes a day for at least 30 days can enhance people’s fitness level.
Notably, the Bareen International Hospital launched the Take the Stairs Challenge social media campaign aimed to boost exercise by encouraging people to use stairs instead of lifts. Participants are persuaded to post pictures while climbing alongside the #TakeTheStairs hashtag. Hence, engaging in physical activity enables individuals to maintain a healthy lifestyle (Highlights of the anti-obesity campaign, 2019).
Additionally, the UAE government created new parks and sports cities to promote physical activity (Sports and recreation, 2020). It has established free-zone sports complexes and sports cities to encourage sports uptake. Sports cities are mixed-use properties with sports clubs, training academies, residential and commercial spaces, and stadiums. Also, in 2018, a UAE federal law was approved, allowing residents of all nationalities to take part in national sports competitions throughout the country.
Childhood Obesity Prevalence
Obesity prevalence is admittedly high among schoolchildren. The United Arab Emirates Global School-based Student Health Survey (2016) of grades 8-12 attended by 13-17-year-old students measured dietary behavior and obesity. The results showed that 16.6% of students were obese, among whom 21.1% were males, and 12.3% were females. Thus, obesity among adults and children is measured at high percentages. Presented below are the results of the survey:
Obesity has been investigated among children in the UAE using different BMI interpretation methods. These methods were developed by the Centers for Disease Control and Prevention (CDC), World Health Organization, and International Obesity Task Force (IOTF) (Al Blooshi et al., 2016). According to the CDC data, the prevalence of obesity and overweight in kids aged 6-16 years was 8% and 17%, respectively (Al Matroushi, 2005). Besides, the IOTF found out that 14% of children aged 5-17 years were obese, and 22% were overweight. The WHO study revealed 16% and 17% prevalence rates of obesity and overweight in kids aged 6-18 years, respectively (Al Blooshi et al., 2016). Also, it was found that sub-optimal infant feeding practices increase childhood practices (Radwan, 2013).
Childhood Obesity Evaluation
The participation of parents and teachers is needed critically to cope with childhood obesity. Moreover, actions should be taken as soon as possible, as indicators of childhood obesity continue to grow. According to a more recent study, in 2019, 19% of adolescents in the UAE reported obesity (Bani-Issa et al., 2019). The good news is that according to the study, diet and physical activity can affect teenagers’ involvement in healthy behavior. However, adolescents are more likely to stick to a diet if they receive parental support. For instance, parents of children who were most inclined to stick to a diet used to make sure that their children regularly have breakfast at home and do not drink sugary drinks. Besides, weekly physical exercises at school had a positive impact on self-engagement in sports and physical activity.
Nutrition Guidelines for Children
Creating awareness of proper nutrition through public health campaigns is essential. As postulated by Moonesar and Hickman (2017), having a clear perspective of what nutritional health entails promotes healthy eating. Lack of awareness of proper nutrition and the type of foods consumed may result in unhealthy eating habits that lead to obesity and other related health issues. Through social media campaigns, the public can access information about the proper foods to eat. Guidelines such as those presented below are critical for combating childhood obesity in the UAE:
Government Initiatives Regarding Childhood Obesity
To combat childhood obesity, the Department of Health in Abu Dhabi organized a Childhood Obesity Forum, which called upon its participants to present initiatives to eliminate this chronic disease. The proposed solutions from the forum focused on the school environment (Zaman, 2017). It was suggested to design the school environment in a way that promotes healthy food options and physical activity. For example, school canteens are being instructed to focus on a healthy diet to control the prevalence of obese and overweight children. Also, school classrooms are being designed with different facilities for physical activities to engage children and impact obesity reduction.
Besides, the UAE Ministry of Health and Prevention works to combat obesity in children through its Student Growth Record initiative by registering obesity cases among students and examining their dietary habits (National Health Survey results, 2019). It has also launched the Mutabah program, the first online obesity data collection system among pupils (Bridge, 2020). The project was launched in the framework of Arab Health 2020 to identify obese students on an annual basis.
Programs and Initiatives Promoting Physical Activity among Students
Moonesar and Hickman (2017) found that the percentage of students who were involved in physical activities were limited, with 34.5% being boys and 22.8% being girls. The UAE Ministry of Education holds Sports Olympics programs comprising several games such as swimming, athletics, taekwondo, judo, archery, fencing and badminton at these venues (The 7th edition of the School Olympics, 2019). Parks and recreational open spaces have been created to fit workouts for adults and children, as well. Apart from this, the UAE Ministry of Education regularly disseminates educational material regarding obesity control and healthy eating patterns.
The MA’KOM for healthier life initiatives under the UAE Ministry of Health and Prevention programs encourage the Emirate society to engage in physical activities and adopt a healthy lifestyle. Furthermore, the Department of Health and Physical Fitness is mandated to promote and maintain a healthy lifestyle through physical exercises (Health and Physical Fitness Department activities, n.d.). The department’s role in health and physical activities encompasses establishing policies and strategic plans for improving health in schools and supporting physical fitness. Encouraging students’ involvement in sports activities like swimming or athletics ensures reducing the risk of obesity.
Thus, a detailed analysis of obesity from the perspective of nutrition, physical activity, and lifestyle choices was provided, and the measures taken by the UAE authorities to curb obesity were described. To summarize, the extensive and detailed analysis of causal factors of obesity enables UAE policymakers to devise measures for addressing this public health challenge. The increased changes in socioeconomic status, the absence of healthy nutritional habits, and the sedentary lifestyle associated with individuals living in the UAE have contributed to rising levels of obesity. Moreover, the daily consumption of unhealthy foods, coupled with a lack of physical activities, has raised the prevalence of obesity in children and adults. Obesity causes complex health conditions, such as diabetes and cardiovascular diseases.
Almost 10% obesity rate reduction during the last ten years became possible thanks to government actions, including health awareness campaigns, early adult and child intervention programs, weight loss challenges, public health draft law, interactive map for physical activity, and others.
The most prominent examples are the Etminan initiative, #ThakeTheStares challenge, the introduction of taxes for sugary drinks, and building sports cities. Nutritional guidelines aimed to prevent and reduce childhood obesity also deserve attention, as well as School Olympics and other physical activity programs for students. As long as lifestyle and nutrition are the main contributors to obesity, these governmental measures will surely help to combat the overweight problem in the UAE and create an inspiring example for neighboring countries.
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