What a life!
(SPECIAL FEATURE)

23 September 2007

Hemchhaya De takes the lid off the increasing incidence of lifestyle diseases across the UAE.

Farid�s parents have sent his prospective bride a photo in which he looks fit and slim. But the 32-year-old man who works in Dubai is quite anxious about the photo because it has been taken a few years ago when he did not have an expanding waistline or a bulging tummy!

He has been steadily gaining weight over the past few years. Weighing more than 100 kg, Farid is now determined to shed the flab. �I have a 9 to 5 job in a bank in Dubai. Doctors say I am obese. I do eat a lot of junk food because I hardly have time to cook for myself and am worried that my unhealthy diet can lead to a lot of health problems,� says Farid, who has now joined a gym to get back into shape.

Rita is a homemaker with two teenage sons who are hooked on fast food. She has a tough time making them understand that a regular diet of pizza and soft drinks can wreak havoc on their health. �They are overweight. Wish I could force them to spend more time at sports centres than at their play-station!� says the worried mother.

Sanjay, a 43-year-old businessman based in Dubai, had to undergo surgery to get rid of his obesity which led to a lot of health complications including diabetes. He weighed more than 150 kg and nothing seemed to help him lose weight. He has been leading a sedentary life with almost no physical activities.

All of them are grappling with the problem of obesity, which is just one of a series of health problems that are linked to lifestyle choices we make. Thanks to rapid urbanisation and comforts of modern life ensuring that we restrict our physical activities to a minimum, lifestyle diseases in the UAE and elsewhere in the world are on the rise. One look at the figures available with the UAE Ministry of Health regarding lifestyle diseases is enough to gauge the magnitude of the problem � one out of four adult UAE citizens is diabetic, one out of three is hypertensive and two out of three are obese and overweight.

Defining lifestyle diseases

Chronic diseases of lifestyle are a group of diseases that share similar risk factors as a result of exposure, over many decades, to unhealthy diets, smoking, lack of exercise and possibly stress, according to Dr Suresh Menon, Specialist, Internal Medicine, Jebel Ali Hospital in Dubai. The major diseases include metabolic syndrome, high blood pressure, high blood cholesterol, diabetes and obesity. �These lead to strokes, tobacco- and nutrition-induced cancers, chronic bronchitis and many other diseases that result in high mortality and morbidity rates,� says Dr Menon.

Elaborating on metabolic syndrome, he adds, �People with metabolic syndrome are at increased risk of coronary heart disease and other ailments related to plaque build-ups in artery walls (eg stroke and peripheral vascular disease) and Type 2 diabetes. Metabolic syndrome has become increasingly common in the US. It�s estimated that over 50 million Americans have it.�

The dominant underlying risk factors for this syndrome appear to be abdominal obesity and insulin resistance, a generalised metabolic disorder that prevents the body from using insulin efficiently. Hence, metabolic syndrome is also called Insulin Resistance Syndrome. Other conditions associated with the syndrome include physical inactivity, hormonal imbalance and genetic predisposition. Explains Dr Menon, �Some people are genetically predisposed to insulin resistance. Acquired factors such as excess eating habits and body fat and physical inactivity can cause insulin resistance and metabolic syndrome in such people. Most people with insulin resistance have abdominal obesity.�

�In the UAE, there are three main health problems � obesity, heart diseases and cancer and all these are related to our lifestyle choices,� says Dr Abdul Ghaffar M Al Hawi, assistant undersecretary for curative medicine, UAE Ministry of Health (MoH).

There are various degrees of obesity. A back-of-the-envelope calculation often involves what is known as the body mass index (BMI) � a person�s weight (in kilograms) divided by his or her height (in metres) squared. If a person belongs to the 25 to 29 BMI range, he or she is overweight while a person belonging to the 30 to 34 range is considered obese. If a person has a BMI above 35, he or she is termed morbid obese. According to a World Health Organisation (WHO) report on obesity, globally, there are more than one billion overweight adults of whom at least 300 million are obese. Health experts say obesity and overweight raise the chances of occurrence of chronic diseases, including Type 2 diabetes, cardiovascular diseases, hypertension and stroke and certain types of cancer.

Internationally, lifestyle diseases are also called �non-communicable diseases� (NCD) or �degenerative diseases�. Health experts predict that globally, deaths from NCDs will increase by 77 per cent by 2020.

Risk factors

There are several risk factors contributing to the high incidence of lifestyle diseases in the country and other parts of the world. But primarily these include intake of nutrient-deficient, energy-dense foods that have high levels of sugar and saturated fats, lack of physical exercise, smoking and alcohol consumption. According to a WHO study on the Middle East, as a result of marked socio-economic changes in many countries of the region, particularly those of the Gulf Cooperation Council, rapid increases in non-communicable diseases are being recorded. For instance, according to the report, obesity has risen in the region two-fold or more since 1980.

�A city like Dubai where people can enjoy all the comforts of living is ripe for lifestyle diseases that can be called the scourge of modern life,� says Dr Menon. For example, usually people in urban areas have easy access to transport, which means they prefer to walk less. Moreover, people are nowadays shifting to work that is less physically demanding and opting for passive leisure activities. �Thanks to technology at home, household chores also require less physical exertion. People are even loath to go out to get their grocery items because supermarkets are just a phone call away,� says Dr Menon.

Unhealthy diet (too much food or too many calories, too much fat, sugar or salt and low intake of fruit and vegetables), physical inactivity and tobacco are also responsible for fatty build-ups in blood vessels, which are the most common reason for heart attacks and strokes.

Adolescents and young adults are apparently most vulnerable to lifestyle diseases. The play-station generation seems to be addicted to what is known as refined fast food that is tasty and easily digestible and lead to higher sugar and fat levels in the body.

�Even if healthier options are available, people are still flocking to fast food outlets fully knowing the perils. Even if people have 10 chefs at home, they prefer to buy fast food from outside,� says Mitun DeSarkar, dietitian and managing director of the Simply Healthy restaurant in Dubai. She adds that about 60 per cent of the people who consult her for diet problems are women, both homemakers and working professionals.

Smoking is another cause of concern. What is alarming is the fact that even children are picking up the habit. According to a study carried out by the UAE Ministry of Health in 2005, about 10.1 per cent of children in the country aged between 12 and 17 years are smokers.

Active living

To prevent lifestyle diseases, people need to bring some effective changes in their pattern of living. �People need to cut down on meat and oily food if they wish to avoid heart ailments. They should opt for daily fitness programmes for at least an hour. Being lazy simply won�t do,� says Dr Al Hawi.

Health education should be a crucial part of the school curriculum, feels Dr Al Hawi. �It should begin in schools,� he says. �School children should be educated about the importance of healthy eating habits and physical exercise. The Ministry of Education should ensure that physical education is an integral part of the curriculum.� People must also go for regular health check-ups. �As we know, diseases like cancer can be cured if they are detected at early stages,� he adds.

Stressing the importance of a balanced diet, DeSarkar says, �There�s no need to go on crash or mono diets like Atkins. I don�t believe that one needs a totally fat-free diet. You need to have a balanced nutrient-rich and high-fibre diet and there should also be variety. The key to healthy eating is portion control. As long as you are restricting your food portions to moderate limits, you are safe.�

Assessing individual needs, DeSarkar prepares diet management programmes. �It�s a misconception that you can eat a lot and manage to escape the ill effects of excessive eating by working out at gym. You need both physical exercise and healthy eating to avoid lifestyle diseases,� she says.

�About 50 per cent of lifestyle diseases can be cured if we bring about total lifestyle changes and follow it up. All people need to do is stop eating fatty food, exercise daily, stop smoking and give up alcohol. It�s all in our control,� says Dr Menon.

So, are you ready to make those changes?

The names of some of the people dealing with obesity problems have been changed on request. 

�         One out of four adult UAE citizens is diabetic

�         One out of three adult UAE citizens is hypertensive

�         Two out of three adult UAE citizens are obese or overweight

ON METABOLIC SYNDROME