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Abu Dhabi, UAESaturday 20 April 2019

Smart policy is a vital weapon in the battle against obesity

Government interventions, from taxes to urban planning, can all help to address a public-health issue that affects the whole Mena region

Measures such as including mandatory calorie information on food labels have been proven to reduce levels of obesity. iStock 
Measures such as including mandatory calorie information on food labels have been proven to reduce levels of obesity. iStock 

Impressive economic and social gains achieved in many Middle Eastern and North African nations have translated into better health and longer life expectancy for millions of people in the region.

But greater prosperity and longer lives have resulted in a new health challenge: the rising prevalence of obesity and diabetes.

MENA countries have obesity rates that are among the world’s highest, and the cost of diabetes, a disease strongly linked to obesity, is forecast to rise from $21.3 billion (Dh78bn) in 2017 to $35.5bn (Dh130bn) in 2045.

The rapid increase in obesity in Egypt, where 32 per cent of adults are affected, recently led the Egyptian president Abdel Fattah El Sisi to deliver an impromptu lecture on fitness during a televised meeting. But Mr El Sisi is not alone in his concern. Many other government and health-care leaders are trying to reverse this trend.

Adult obesity rates exceed 30 per cent throughout much of the region and are climbing. A sampling of rates in individual counties underscores the severity of the crisis: 36 per cent in Jordan, 38 per cent in Kuwait, 35 per cent in Qatar and Saudi Arabia, 32 per cent in the UAE.

Although the reasons for this obesity epidemic are complex, diet and exercise are the most common factors. Exercise levels have diminished because of rapid urbanisation and the transition to an economy dominated by sedentary work. A global study that relied on smartphone data to tally the number of steps taken daily by more than 700,000 people indicated that residents of Egypt, Saudi Arabia, and Gulf states are less likely to walk than their counterparts in a majority of the 111 countries measured.

Diets also have changed. Consumption of meat, sugary drinks, and processed food has soared, while fresh fruits and vegetables are lacking in the diets of many families. Low consumption of fruits and vegetables is most severe in Saudi Arabia and Gulf states, where there is less locally grown produce.

Adult obesity rates exceed 30 per cent throughout much of the region and are climbing.

The economic costs of these changes are high because obesity is a risk factor for chronic illnesses such as heart disease, diabetes, kidney disease, and some cancers. The link between obesity and diabetes is so strong that some refer to them as a single malady, “diabesity.” On average, obese individuals are 3.4 times more likely to have diabetes than those of a normal weight.

Governments are taking steps to encourage healthier habits. In 2017, the UAE imposed a 50 per cent tax on sugary drinks, and a 100 per cent levy on energy drinks and tobacco products.

The Abu Dhabi Department of Health’s Weqaya programme provides a population-wide screening tool for risk factors for diabetes and cardiovascular diseases, including heart disease, stroke, and hypertension. Individuals who show high susceptibility receive additional advice and information as part of the Abu Dhabi Cardiovascular Disease Programme.

A few weeks after Mr El Sisi’s December remarks, Egypt announced a public education campaign to encourage people to follow healthier diets. Saudi Arabia requires restaurants and cafes to display the calorie content of the meals on menus, a policy that has been effective in other countries.

Evidence from outside the Mena region demonstrates the effectiveness of these policies. For example, calorie labelling in the US and Europe indicates that it can reduce obesity rates by 2.5 per cent, and a study by the US government put the potential economic benefit at $500 million (Dh1.8bn). Taxes also have been used effectively around the world to reduce the use of tobacco and unhealthy beverages.

While disincentives have value in the fight against obesity and diabetes, policies to encourage positive behavioural changes may be more effective. Subsidised prices for fruit and vegetables can improve diets, especially among the poor. Better access to screenings and stronger school physical-education programmes have proven to be effective in other regions.

In too many cities, residents have very few options for exercise. In the smartphone study, people living in cities where the infrastructure accommodates walking took more steps than people in car-oriented cities. Looking to the future, planners should incorporate pavements, cycling and walking paths, playgrounds and indoor sports facilities in their designs.

These and other possible solutions will be addressed at the Milken Institute Mena Summit, which starts today in Abu Dhabi. Amid the search for answers, certain things are clear: smart policy is needed to enable intelligent consumer choices. Without it, the burdens of obesity and diabetes will continue to shorten lives and hinder productivity.

Hugh Waters is the director of health economics research at the Milken Institute in Santa Monica, California.

Updated: February 12, 2019 04:49 PM

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