By Jawaher Al-Naimi
One year ago, 48-year-old Mohammed Ali Al-Abdullah could move only with the help of a walking stick and an oxygen tank connected to his nose. Doctors gave him a simple explanation: obesity was ruining his life.
Obesity is a medical term meaning a person has accumulated too much body fat. The condition, which can greatly limit a person’s physical capabilities, is a consequence of overeating and inactivity. Obesity can raise the risk of a person developing other health problems, including Type 2 diabetes, arthritis, the swelling or inflammation of one or more joints, high blood pressure, high cholesterol, heart disease and even organ failure.
Al-Abdullah, a retired social worker and father of four, has struggled with obesity for most of his adult life. But his story is not uncommon in Qatar. This tiny peninsula in the Gulf is home to a small citizen population of fewer than 300,000 people, but 75 percent of Qataris are overweight and 40 percent are obese or morbidly obese, according to the National Health Strategy 2011-2016. Recent studies confirm that Qatar is one of the fattest nations in the world, and to Al-Abdullah the reason is obvious: Qataris’ cultural beliefs and traditions are contributing to the country’s health epidemic.
Qatar is a country with a conservative Muslim society that deeply values its ancient beliefs and customs. Many of Qatar’s cultural and religious practices, from frequent family get-togethers to Ramadan celebrations, involve large amounts of food just like any religious holiday or family celebration elsewhere in the world. But in Qatar, food is also strongly connected to cultural notions of wealth and prosperity.
Al-Abdullah, the third son in his family, grew up believing that the bigger the man the wealthier he is. “A big gut is a status of wealth and royalty,” he explained. “Kings in the olden days always had stomachs that are not proportional to their body size. And do you know why? Because they have money, money to buy all the riches and food in the world.”
Exercise was never a major concern for Al-Abdullah, who had to take care of his family’s income along with his two older brothers. “My brothers and I worked after school taking different jobs and we moved a lot. So you could say I was slightly overweight, but going from one place to another was my daily exercise,” he said. “I was always proud of myself and with the way I looked.”
But as he grew content with his way of life, his eating habits began to deteriorate. “My snacks were not the regular fruits and crackers,” he said. “They would be juicy shawarma sandwiches and a can of Coke.”
Al-Abdullah’s weight increased steadily throughout the years. At 46, he finally realized his body was in a bad state. His weight had reached 176 kilograms (388 pounds).
“I didn’t know what was going on, but I noticed that I couldn’t breathe very well and my heart began to beat faster than its usual pace,” Al-Abdullah said. He was soon diagnosed with Type 2 diabetes and high blood pressure.
“Higher body weight can result in diabetes, Type 2 to be specific,” said Dr. Imad Arbab, a general doctor at Qatar Armed Forces Medical Services.
Type 2 diabetes is described as a medical condition in which a person’s body cannot properly absorb blood sugar or glucose into cells for energy; it often occurs in the obese because excess fat can prevent the body from properly using insulin, a hormone that is needed to move glucose into cells (in Type 2 diabetics, the person’s cells become insulin resistant). In 2010 the International Diabetes Federation ranked Qatar 5th globally (other sources rank the country 4th) in the proportion of people ages 20 to 79 living with diabetes.
Diabetes can result in other destructive medical complications such as blindness, nerve damage and even limb amputation. About 53.2 percent of Qatari women and 46.8 percent of Qatari men have the disease, according to a study carried out by the Hamad Medical Corporation in conjunction with other institutions.
Realizing that he was fighting a life-or-death battle with his body, Al-Abdullah pledged to change his outlook on food and exercise: “I promised myself that I would lose weight and look into a better lifestyle,” he said.
He began to follow a strict diet and joined a local gym. It took him 24 weeks to lose 30 kg (66.14 pounds). But a few months later, just when he thought he was on the right track, he caved to old temptations and his health went downhill. “I thought taking a break would be a good idea,” said Al-Abdullah. “This break added more than what I lost. I reached 186 kg (410 pounds) with a higher cholesterol.”
Unlike his eldest brother, Hassan, who considers himself a healthy athlete, Al-Abdullah hates to exercise. Hassan Al-Abdullah, on the other hand, enjoys waking up at the break of dawn everyday for his morning jog along the Corniche. “I like to either power walk or jog. My diets consists of healthy food,” Hassan Al-Abdullah said. “I stay away from the fast food industry as much as I can and stick to home cooked meals.”
Aware of his brother’s condition, Hassan Al-Abdullah was relieved when his brother began to follow a specific diet. But as his brother’s weight continued to fluctuate, Hassan Al-Abdullah grew increasingly concerned. He decided to book a flight to the United States as soon as possible when he heard about the Mayo Clinic in Rochester, Minn. “I spoke to a doctor about my brother’s condition and the best possible solution was performing a lap band surgery (a surgery that reduces the amount of food a person’s stomach can hold at one time).”
On Jan. 21, 2011, the brothers went to the United States where they spent six months under medical care. Al-Abdullah managed to lose 75 kg (165 pounds) after his surgery. “I’m still over weight but I’m in a better and healthier condition,” he said.
Now Al-Abdullah lives on a six-meal per day diet, which is composed of small portions of food, excluding dinner. “My lunch for instance is two tablespoons of rice and vegetables,” he explained. “If I’m craving something sweet, I would normally have a fruit or a small piece of dark chocolate.”
In Al-Abdullah’s case, Qatari traditional beliefs surrounding food put his health at risk. But other Qatari customs can have devastating consequences as well. Many Qataris continue to practice consanguineous marriage, tying the knot with a close blood relative. Intermarriage is one of the main causes of genetic diseases in Qatar, including a predisposition to obesity and Type 1 and Type 2 diabetes.
Only a few days after his birth, the first-cousin parents of Rashid Omar Rashid realized their son was struggling to breathe. Today, Rashid, 14, is one of the many teenagers in Qatar who need around-the-clock supervision.
Rashid is not a victim of obesity. He was struck down with Type 1 diabetes along with a defect in his central nervous system known as cerebral palsy, one of the common disabilities in Qatar, said Dr. Maha Yahya Mahmoud, a gynecology and obstetrics consultant at Doha Clinic Hospital.
“Given that Rashid’s parents are first cousins, there’s a higher chance conceiving a child with defects,” Mahmoud said. “However, it doesn’t make a difference whether he is your first, second or third cousin. There’s still a probability of inheriting genes from your ancestors that could cause birth defects.”
Official figures show that 27-30 percent of children in Qatar are diagnosed with Type 1 diabetes. Similar to Type 2, Type 1 diabetes is also a condition in which a person’s cells are unable to absorb and store glucose for future energy use. However, this condition is not connected to obesity; there is no known cause of Type 1 diabetes. It is thought to be an autoimmune disorder in which a person’s body is mistakenly triggered into attacking the pancreatic cells that produce insulin. Also known as juvenile diabetes or insulin-dependent diabetes, it is most commonly diagnosed in children and young adults and can be passed down in families.
The rate of birth defects is also high in Qatar: the March of Dimes global report on birth defects ranks the country 16th globally.
Premarital tests are important in determining what type of genetic diseases, including diabetes, could occur from such consanguineous marriages; Mahmoud said Qatar began conducting premarital genetic tests more than three years ago.
Aysha Jabor Al-Naimi, who has been married to her first cousin for almost three and a half years, went through these tests before the marriage. “We fill in a form and write down the different types of diseases that already exist in our family. After that, they take you to another room for some blood tests. When the results are out, they tell you what type of defects the marriage can cause and whether our genes are suited for children or not. But there isn’t a law that prevents the marriage and, thank God, our results were fine,” she said.
Rashid’s family did not want to mention their last name for personal reasons. “It is a sensitive topic,” his father said. His father and mother were married before premarital tests were implemented in Qatar.
However, Seham Rashid, Rashid’s paternal aunt, was eager to tell the story of her family because it is “important to raise awareness,” she said. “My nephew was born on Jan. 21, 1997, and almost six days after his birth, his mother noticed Rashid was having difficulties breathing.”
Because of high blood pressure, Rashid’s body lacked oxygen, which caused a disruption in his brain cells and led to a physical and mental disability. This has restricted him to a life in a wheelchair.
“When Rashid turned 10 years old, the doctor said he has Type 1 diabetes and it must be treated because it could effect any organ in his body, given that he already has present defects,” Seham said.
Patients with Type 1 diabetes rely on insulin medications for survival, Arbab explained.
“Otherwise symptoms like blindness, physical defects, internal disruption in the organs could occur. In some cases it could also lead to death,” he said.
Qatar, described as “the land of big numbers” by an article in The New York Times, is looking into the issue of diabetes and obesity with care, Arbab said. Weill Cornell Medical College in Qatar recently conducted research on diabetes and obesity to raise awareness and develop better treatments, according to an article in The Peninsula.
“If people in Qatar abandon this ship we call health, there’s a bigger chance of obesity and diabetes taking over the society,” Arbab said. Indeed, if the obesity rate continues to rise in Qatar, experts predict that by 2015, 73 percent of Qatari women and 69 percent of Qatari men will be obese.
But Qataris are slowly taking action. The country is opening enhanced sports centers and is beginning to promote more fitness activities for the public. Emir Hamad bin Khalifa Al-Thani recently declared that the second Tuesday of every February will be a national holiday called Sports Day.
“Qatar is realizing that it could be in bigger danger in the future and it is putting effort into reducing health hazards,” Arbab said. “ Along with the sports advertisement, Hamad General Hospital just recently opened a free obesity clinic for Qatari locals.”
Alongside that, nutrition centers are opening in Qatar, like the Perfect Nutrition Center for weight loss, which has several offices in Doha. Haya Al-Masoud is a regular client and lost 20 kg (44 pounds) following their diet. “I’m a member of an obese family and I didn’t want to reach a stage where I can’t walk or breathe properly,” she said. “So I joined Perfect Nutrition.”
The notion of working out and dieting is gaining speed in Qatar. Khalifa Al-Thani, a 21-year-old student at Carnegie Mellon University in Qatar, gives himself a nine out of 10 when it comes to fitness. “I go to the gym five times a week in the afternoon, and I practice, four times a week, with a professional football team in the evenings.”
Al-Thani has six to seven small meals per day, excluding lunch and dinner. Every few months, he treats himself to a McDonald’s burger or a meal from Burger King.
“During my middle school years, I was overweight. From that time, I became aware of the risks of obesity and diabetes,” he said. “This led me to lose weight and follow a healthy diet.”
Determined to maintain a healthy lifestyle, Maha Al-Maadeed, a 22-year-old student at Qatar University, is a member of a local gym. She exercises five times a week but eats whatever her very thin body desires.
She would prefer to stay skinny for the rest of her life. “I call it a lifestyle where I try to eat whatever I want in small portions, and make sure to burn them the following day in the gym,” she said. None of her family suffers from obesity or diabetes, and her routine is simply a choice she made years ago.
“In my opinion, if people will let themselves eat whatever they want, and never hit the gym, they will face obesity,” she said. “I choose to take a good care of my health, and I strongly believe in ‘a healthy mind, a healthy body.’”
The Supreme Council of Health is also tackling the crisis of obesity and diabetes in Qatar. It is in the process of launching a new study that will assess the risks of inactivity and smoking and the effect they have on diabetes and obesity rates in Qatar.
“From there,” said SCH Health Supervisor Dr. Ahmed Omar, “we and the population can tackle the issue of diabetes.”