THE TIMES KUWAIT REPORT
Infections and death-toll from the COVID-19 crisis, as well as its economic and social repercussions hogged media headlines during the global pandemic that erupted in early 2020. However, long before the pandemic emerged, and through it and since then, obesity, a persistent and deadly chronic disease has been lurking in our midst and exacting a heavy toll in terms of hundreds of millions affected, and the severe health, social and economic costs associated with it.
In Kuwait, where the prevalence of overweight and obesity among both adults and children is among the highest in the world, the disease has been wrecking lives and livelihoods for decades. A ranking of countries around the world by the Global Obesity Observatory show that in 2018, for which the latest data was available, 36 percent of adults over the age of 18 in Kuwait were overweight and 44 percent were obese. The study also showed that while overweight was higher among men, obesity was found to be greater in women, with with 37.6 percent men and 49 percent women being obese.
Adding to Kuwait’s health woes, the country also ranked third in diabetes prevalence on the global level and was ranked number one within the region. Studies prove that diabetes is closely correlated with overweight and obesity, and estimates are that by 2030 one in 10 of Kuwait’s population will suffer from diabetes. A separate population-based cross-sectional survey of diabetes and obesity in adults aged 18–82 years in Kuwait — conducted as part of the Kuwait Diabetes Epidemiology Program that concluded in 2014 — reiterated this link between diabetes, overweight and obesity.
In addition, the epidemiology study showed that greater educational attainment, physical activity, and non-Kuwaiti status were associated with lower odds of obesity. While a history of smoking, elevated blood pressure, higher income, being married, greater age and being female, were linked to greater odds of obesity. Of significant public health concern for Kuwait in future was that the study also found overweight and obesity prevalence especially high in young adults aged 18–29 year.
Another cross-sectional study conducted in 2019 by the Faculty of Medicine at Kuwait University (KU) in line with World Health Organization (WHO) standards, revealed that the prevalence of combined overweight and obesity among children in Kuwait aged 6 to 8 was 40.9 percent. While these figures are among the highest in the world, even more worrying to policymakers and health authorities is that the study also pointed out that many parents were not even aware that their children were overweight or obese.
The KU study noted that nearly 78 percent of overweight and 46 percent of obese children were perceived by their mothers to have healthy body weights. Moreover, around 40 percent of children who were of normal weight, were judged by their mothers to be underweight. An alarmingly high prevalence of childhood obesity among Kuwaiti children, coupled with the distorted perception of their child’s actual weight status among mothers, is a serious concern that warrants urgent public health intervention, said the study organizers.
Efforts to create more awareness among mothers and integrating mandatory ban on fizzy drinks, crisps and chocolates on school premises to reduce the intake of fat and sugar by pupils, and adding compulsory physical education to the school curriculum, as well as creating more recreational spaces to promote physical activities, are expected to help reduce and prevent overweight and obesity among pre-school and school going children in Kuwait. Unfortunately, while the ban on unhealthy snacks and sugary fizzy drinks is monitored by the Ministry of Education, compliance has so far not been reported to be high.
The role of food quality in reducing the incidence of overnourishment cannot be denied. In its annual ‘The State of Food Security and Nutrition in the World’ (SOFI) report in 2021, the United Nations Food and Agriculture Organization (FAO) noted that with rising world population, increasing globalization and urbanization, there have been worrying global trends in malnutrition, including a rapid rise in overweight and obesity, even as forms of undernutrition persist.
The anomaly of an increasing number of people facing hunger and the prospect of being underweight, even as more people suffer from overweight and obesity, was reiterated in a separate report by the World Health Organization (WHO) published in mid-2021. The WHO report showed that while millions around the world were undernourished, over 1.9 billion adults, 18 years and older, were overweight. Of these over 650 million were obese. Additionally, in 2020 more than 39 million children under the age of 5 were overweight or obese while over 340 million children and adolescents aged 5-19 were overweight or obese.
Globally the medical consequences of obesity are predicted to rise to well over US$1trillion by 2030. Direct and indirect costs associated with medical, social and economic responses to the high ratio of population being overweight or obese have currently not been computed in Kuwait. Nevertheless, it would be safe to extrapolate approximate figures from a 2019 study in neighboring Saudi Arabia, which has a similar obesity and overweight profile as Kuwait, while adjusting for the larger size of the economy and population in the kingdom.
The economic impact of overweight and obesity in Saudi Arabia in 2019 was estimated to be US$19.2billion annually, or 2.4 percent of GDP, and equivalent to around $560 per capita. Unless urgent mitigation strategies are implemented, health experts estimate that by 2060, these figures could increase to $78.1billion, or 4.2 percent of GDP and equivalent to $1,722 per capita, which represents a four-fold increase in total costs.
Similarly, while there is no data on the mortality rate as a direct result of obesity in Kuwait, correlated chronic non-communicable diseases (NCD) linked to obesity, such as cardiovascular diseases, chronic respiratory diseases, and diabetes have been found to be major causes for morbidities and fatalities in Kuwait.
While addressing a program on ‘Awareness of the risk factors leading to chronic non-communicable diseases’ organized by the Ministry of Health last week, Director of the Department of Health Promotion, Dr. Abeer Al-Bahouh, noted that more than 70 percent of deaths in Kuwait are attributed to chronic NCDs. She revealed that several NCDs correlated to overweight and obesity, including cardiovascular disease, which resulted in 41percent of deaths, certain cancers (15%), diabetes (3%), and chronic respiratory diseases (3%), were among the top causes for deaths reported in 2019..
The significant risks attached to a large portion of the public being overweight and obese, and the enormous economic costs and medical consequences to society, has apparently begun to trickle down to the desks of policymakers. In recent months there have been a spate of awareness campaigns on obesity and chronic non-communicable diseases associated with overweight and obesity.
Last week, the Central Administration for Primary Health Care at the Ministry of Health organized a campaign to raise awareness about obesity risks. The event came amid a rise in obesity rates in Kuwait and around the world, said the administration’s Director Dr Dina Al-Dhubaib. She added that the campaign, being held in cooperation with the diabetics care committee for ‘combating non-infectious diseases and early cancer detection program’, aims to spread awareness on the risks of obesity and means of preventing it.
The campaign is scheduled to continue for the next five weeks in 25 primary care centers around the country and will involve free tests being carried out for body mass index, blood sugar level and the hemoglobin A1C that determines average blood sugar levels over the past 3 months. On a similar vein, the country’s premier diabetes management establishment, the Dasman Diabetes Institute (DDI), recently inaugurated the Kuwait Obesity Academy, a first of its kind in Kuwait and regionally. The Academy, in collaboration with the World Obesity Federation (WOF), offers a certification in ‘Obesity Management’, which delivers training to graduate health care professionals from the Ministry of Health in Obesity Management.
Other policy measures taken by the government in a bid to rein-in the rampant rise in obesity since the late 1970s include: the first phase of the five-year (2013-2017) Kuwait National Programme for Healthy Living. The program, which was initially initiated to promote health and well-being for individuals living in the country, was later modified to focus on obesity and diabetes due to the historically high prevalence of these conditions in Kuwait. Another policy, the National strategy for the prevention and response to noncommunicable chronic diseases in Kuwait (2017-2025), includes specifically targeting tobacco control, diabetes and obesity.
However, Kuwait is not alone in suffering from overweight and obesity. Reports from the WHO and other leading medical and health institutions reveal that overweight and obesity, once considered only a high-income country problem, has morphed and is now on the rise in low- and middle-income countries as well, especially in urban settings.
Studies show that most of the world’s population now live in countries where overweight and obesity kills more people than underweight, and that globally there are more people who are obese than underweight. Obesity has been found to occur in almost every region of the world except parts of sub-Saharan Africa and Asia, where malnutrition from undernourishment is the major concern.
Malnutrition develops when the body is deprived of vitamins, minerals and other nutrients needed to maintain healthy tissues and organ function, and can occur in people who are either undernourished, or overnourished. Many low- and middle-income countries now face the ‘double whammy’ of malnutrition arising from under-nourishment existing alongside over-nourishment. In these countries, health authorities have to deal with the problems of undernutrition, while also tackling the recent rapid upsurge in overweight and obesity.
Overweight and obesity are defined by WHO as abnormal or excessive fat accumulation that may impair health, based on a simple index of weight-for-height known as the Body mass index (BMI). It is defined as a person’s weight in kilograms divided by the square of his height in meters (kg/m2). For adults, WHO defines overweight as people with BMI greater than or equal to 25; and obesity as a BMI greater than or equal to 30. The BMI provides the most useful population-level measure of overweight and obesity as it is the same for both sexes and for all ages of adults. But experts warn that BMI should be considered only as a rough guide because it may not correspond to the same degree of fatness in different individuals.
The fundamental cause of obesity and overweight is an energy imbalance between calories consumed and calories expended, largely from physical inactivity due to the sedentary lifestyle now in vogue. Adding to this, the global food environment has changed drastically over recent decades. Heavily promoted, calorie-dense, nutrient-poor unhealthy processed foods are now readily available and affordable in many countries. This undermines local diets and contributes to the rapid rise in obesity. It is not by coincidence that mirroring this change in the food environment there has been a spurt in overweight and obesity worldwide over the past 40 years.
Overweight and obesity, along with correlated noncommunicable diseases, are largely preventable. Rather than blaming and shaming overweight or obese individuals, what is needed is a supportive environment that helps shape the choices available to these people by making healthier foods and regular physical activity readily accessible, available and affordable.