TIME TO THINK DIFFERENTLY ABOUT OBESITY
DESPITE GLOBAL EFFORTS TO STEM THE OBESITY EPIDEMIC, NO COUNTRY HAS SUCCEEDED IN DECREASING IT IN THE LAST 33 YEARS.
Despite global efforts to stem the obesity epidemic, no country has succeeded in decreasing it in the last 33 years.
Worldwide obesity has more than doubled since 1980, with almost 30% of the population overweight or obese. In the Middle East, obesity rates among adults are exceptionally high at more than 37% in Kuwait and more than 35% in Qatar, Saudi Arabia and Jordan, according to latest WHO figures.
Experts said that one problem is that most campaigns to combat the disease have overly simplified obesity by focusing on healthy eating and exercise, when the reality is that obesity is not a lifestyle choice, but a chronic disease with complex origins. In addition, simplifying obesity poses the risk of stigmatizing people with obesity instead of treating them as patients and providing them with access to viable treatment options. The belief that obesity is a lifestyle choice remains prominent, significantly affecting the psychosocial well-being and behavioural patterns of people with obesity.
According to Dr Nadia Ahmad, Senior Advisor for Obesity Solutions at Johnson & Johnson Medical Devices Middle East, weight bias is society's last acceptable form of discrimination and is largely driven by
limited understanding of obesity.
She says that environmental, social and dietary factors and aspects relating to common medications, stress and sleep can all play a role so there is no ‘one size fits all' approach to combating obesity.
A growing body of research supports the concept of ‘set point', which posits that regardless of what you would like your weight to be, your brain has its own sense of how much body fat you should retain and regulates energy intake and expenditure to maintain levels within a ‘set point' range.
Moreover, research suggests that when people with obesity go on a low-calorie diet then there are significant alterations in appetite hormones leading to increased food intake and reductions in energy expenditure, including changes in ‘muscle efficiency', that can together increase body weight.
Measures to introduce healthier food options at schools, to tax sugary drinks and to encourage people to exercise are all important steps towards promoting a healthy lifestyle, but some individuals still struggle to lose weight based on lifestyle modification alone and may require pharmacotherapy and metabolic surgery.
In addition, while prevention is critical for the next generation, it is of little use to those already severely affected by obesity as they are vulnerable to serious comorbidities such as diabetes, hypertension and cardiovascular problems, which ultimately lead to shortened lives.
The Middle East and North Africa (MENA) region is at the epicentre of an obesity and diabetes crisis, according to Dr Karl Miller, Chief Medical Officer at JJMD Middle East and Vice President of the Obesity Academy Austria. There are 318,000 deaths caused by diabetes each year in the region alone.
Diabetes prevalence in MENA stands at 10.8%, the second highest among regions monitored by the International Diabetes Federation (IDF), which projects the number of people with diabetes in MENA to increase by 110% to 82 million in 2045 from 39 million in 2017.
Spending on diabetes care in the region, as a percentage of total health expenditure, stands at 17% compared with 12% globally, according to the IDF, which said healthcare expenditure in MENA is expected to increase by 67% to $35.5 billion by 2045 from $21.3 billion in 2017.
The rising social and economic burden of obesity requires a new approach to tackling this chronic disease. The current patient pathway to surgical intervention can take as long as eight years, according to Dr Ahmad, even though metabolic surgery is associated with higher diabetes remission rates, lowered mortality risk, fewer complications, higher weight loss and improved quality of life than short and long-term control mechanisms.
To make real progress in the fight against obesity, partnerships are required at every level to guide patients appropriately through the treatment pathway, i.e., prevention, access to treatment and longterm follow-up