Dr. Hamad Hanafy Hefiela,
Specialist in Internal Medicine at Al Sager Specialized Clinic

This article was first published in The Times Kuwait on April 20, 2013

Kuwait seems to be bursting at the seams with sky rocketing growth in obesity and — linked to it — diabetes, with recent research placing the country at the top of these unhealthy lists.

Kuwait topped the list of high obesity prevalence with an estimated 36 percent of men and 48 percent of women obese, while 74 percent of men and 77 percent of women are overweight. Kuwait is also ranked third on a global level with high diabetes prevalence and ranked number one within the MENA region. Researchers say that by the year 2030, one in 10 adults will suffer from diabetes.

In conversation with The Times, Dr. Hamad Hanafy Hefiela, specialist in Internal Medicine at Al Sager Specialized Clinic, highlighted that the most common diseases in Kuwait — all closely linked with obesity — are hypertension, heart disease and diabetes. He warned that the soaring rate of diabetes within the country is a cause for concern and needs to be addressed at the earliest.

Diabetes mellitus, commonly known as Type 2 diabetes, is characterized by an increase in blood sugar levels which he explained was a result of drop in insulin produced by the pancreas, or the resistance of body cells to the available, circulating insulin produced. This differs from the less common Type 1 diabetes which is not linked to obesity and whose prevalence is relatively low.

In Kuwait, he said, diabetes mellitus occurs in 15-18 percent of the population which is one of the highest in the world. Dr. Hefiela links this high percentage to lifestyle at large. “With a sedentary lifestyle that involves hardly any activity and no exercise, coupled with poor eating habits, it is no wonder that diabetes in on the rise in Kuwait,” he said while adding that sometimes the causes are linked to genetics or other pancreatic diseases.

With regards to treatment, the doctor explained that in addition to lifestyle modifications of diet and exercise, medical solutions provide ample support to people with diabetes. Although oral hypoglycemic medication aids in lowering blood glucose levels and in stimulating the pancreas to secrete more insulin, many cases require shots of insulin.

He explained that there are three main types of insulin, categorized depending on the time of action. Short Acting Insulin provides effects in 15 minutes which last for approximately four hours and must be taken before each meal to prevent sharp elevation of the blood glucose level.

Intermediate Acting Insulin, works in two hours, continues to have effects for a good 12 hours and is usually taken twice a day. According to Dr. Hefiela the newest way to treat diabetes is by using Long Acting Insulin, which takes 2-4 hours to come into effect but lasts for 24 hours, keeping the blood glucose levels normal for the duration of an entire day. Most diabetics follow a schedule of short acting insulin such as Lespro before each meal or long acting insulin shots such as Glarigine once a day.

The strong correlation between diabetes and obesity is highlighted as the doctor moves the spotlight over to this ‘big’ problem in Kuwait. “Obesity is an increase in total body fat over and above the norm,” he said, “Kuwait is now the fattest country in the world with 40 percent of the population obese, included to the nearly 80 percent that are overweight.”

The disease is measured using a technique known as Body Mass Index (BMI), calculated by finding the proportion of weight related to height. The normal weight range of BMI is between 20-25 percent, with overweight categorized as 25-30 percent and obese at 30-35 percent. Individuals with 35-40 percent BMI are morbidly obese and any score higher is considered life threatening and is in need of surgical intervention.

Many complications arise as a result of obesity, explained Dr. Hefiela, linked to this disease is diabetes mellitus, hypertension, heart disease, dyslipidemia, vascular disease, infertility, cancer and sudden death. As treatment he recommends lifestyle modifications of diet and exercise and medical intervention of oral treatments to curb appetite, burn fat and increase metabolism, all under the supervision of doctors. He also highlighted the use of surgical treatment such as stomach stapling, stomach bands, stomach balloon and stomach bypass, all of which are strictly reserved for people with a BMI of 40 percent or higher.

“Awareness and concern with regards to health in Kuwait is high and free medical services make it easy to control, yet the extremely sedentary lifestyle coupled with widely available cheap junk food is responsible for the rise in poor health,” the doctor said, “There are 17 spoons of sugar in your average soft drink which comes with most meals, with free refills included consumers average an intake of more than 2500 calories at one sitting.

Countries in Europe and the West have already begun raising taxes on unhealthy junk food, along with regulations that compel chain food outlets to obtain and display obligatory information on nutritional value of their products, especially in terms of fat and calories. We are a far way off in Kuwait, but the cogs of the machinery are already in motion with many clinics participating in awareness campaigns for children in schools.

Dr. Hefiela himself runs a few campaigns for his clinic where a local boys school in Adailiya benefits from regular weight checkups, and open days every quarter, on common health risks and ways to avert them. “They are the future,” he said, “It is important to work at grass-root level to lower obesity — the mother of all diseases.”

– Staff Report

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