The Struggle to Treat Obesity, Diabetes


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By Shaikha Al-Thani

A Qatari woman checks her weight and BMI at the Dietary Clinic at Al-Ahli Hospital. Photo by Caitlin Sewell, 2012.

Weight loss procedures, such as liposuction and gastric bypass surgery, are quickly becoming the most popular surgeries in Qatar. These operations are viewed as possible solutions to the growing crisis of obesity and diabetes in the country. But, as Abdulaziz Al-Thani can attest, these quick-fix procedures can have dangerous consequences.

“My cousin had gastric bypass surgery two months ago [through Hamad Medical Corporation] and the surgery didn’t go well and he was immediately taken to a hospital in London,” said Abdulaziz Al-Thani, 13, a grade eight student at Qatar Academy. Abdulaziz Al-Thani refrained from stating his cousin’s name for privacy reasons, but he said his cousin decided to do the surgery because he weighed more than 200 kilograms (about 440 pounds). His cousin survived the surgery’s complications, but only after spending three weeks in a comatose state. Another one of Abdulaziz Al-Thani’s relatives, a 25-year-old Qatari male, died from complications during his gastric bypass surgery last year.

Obesity is also a huge problem in Qatar, where approximately 40 percent of Qataris are obese or morbidly obese, according to the National Health Strategy 2011-2016. Obesity means a person has too much excess body fat; the condition also increases the likelihood of a person developing various diseases and health problems, including diabetes and heart failure. Obesity is a leading but preventable cause of death worldwide.

Gastric bypass surgery is an operation prescribed to treat the morbidly obese and certain cases of Type 2 diabetes. The operation reduces the size of the stomach to result in dramatic weight loss. “Gastric bypass is becoming more popular but there are great risks in that, and other diets don’t have success rates,” said Ellen Wartella, the Hamad Bin Khalifa Al-Thani professor of communication studies at Northwestern University, who has extensively studied food marketing and its contribution to child obesity.

Instead of going under the knife, some Qataris are turning to nutritional programs. Aisha Al-Thani, a 21-year-old Qatari, said her weight led her to join Perfect Weight, one of the many nutrition centers in Doha. “There are three stages of obesity, and I recently found out that I have stage one. [I joined because] I had no control of what I was eating,” said Aisha Al-Thani, who has faced health problems since she was a teenager and has a history of diabetes in her family.

Aisha Al-Thani’s nutritional plan includes a specific carb re-distribution in her meals, and every two weeks she has her weight checked to monitor her progress. “As a child growing up, weight was not an issue for me, but I started gaining weight when I was in high school and it kept getting worse every year,” Aisha Al-Thani said, blaming both genetics and bad eating habits. “I used to skip meals and then eat a lot of junk food, and for someone who has diabetes running in their family, I should have been more careful.”

Aisha Al-Thani thinks children in Qatar are facing a bleak future because they are learning at younger ages to live off fast food. Dr. Sharoud Al-Jundi Matthis, program manager at the Qatar Diabetes Association, a non-profit organization part of Qatar Foundation, agrees and said the only way the obesity and the diabetes rates will drop in Qatar is if younger generations begin to change their unhealthy lifestyles. “The majority of the problem is from the children because their parents give them the freedom [to chose what to eat], and when they get older they must learn how to take care of themselves [properly],” she said.

Type 1 diabetes and Type 2 diabetes rates are also shockingly high in Qatar. Type 1 diabetes is a disease most commonly diagnosed in children and young adults that prevents a person’s body from properly producing insulin, a hormone produced by the pancreas. The insulin needed allows the body to transform blood sugar (glucose) into energy. In Type 2 diabetes, insulin is often produced but the body’s cells become resistant to it, which prevents them from properly absorbing and storing glucose; this type, also known as adult-onset diabetes, is most often linked to an unhealthy diet and lack of exercise. Obesity is one of the primary causes of Type 2 diabetes, especially for people who are already genetically predisposed to the disease. Both types of diabetes result in unsafe elevated levels of glucose in the bloodstream. Diabetes can lead to blindness, kidney failure and nerve damage if left untreated or unmanaged.

The World Health Organization reports that diabetes has become a worldwide “slow-motion catastrophe.” The International Diabetes Federation estimates that about 20.2 percent of Qatar’s adult population suffers from diabetes. Matthis said that the diabetes rate in Qatar is continuing to rise despite the increase of awareness campaigns. She is concerned about the rising rate of diabetes among Qatari boys:

“[The rise] has to do with the [unhealthy] foods and [lack of] exercise,” Matthis said. “We are focusing on the boys of Qatar as there’s a 38 percent chance they might get diabetes.”

The QDA conducts community outreach campaigns that include visiting schools and organizing walks to help Qataris adopt healthier lifestyles. “We try to teach children who have Type 1 diabetes how to deal with the disease and we work with the family,” Matthis said. “We try to put them in similar programs [to see] other kids [facing] the same problem to learn from each other.”

Dr. Maher Rashed, a diabetes and intelligence specialist at the Supreme Council of Health, said the lack of exercise is the main reason for the high obesity rate among the population. “It’s a behavioral aspect, [there’s] a lack in daily effort. Food is [also] a main problem, where natural fibers have decreased and sugar has increased in drinks and food [and] prevalence is increasing each year,” he said.

He said the number of people living with diabetes in the Gulf is higher than what current studies show. “There is a problem in undiagnosed cases in the GCC region. [Statistics here only report] diagnosed cases, this means the figures are [actually] doubled,” Rashed explained.

In 2007, Abdulla Al Kaabi, a 21-year-old engineering student in the United Kingdom, was temporarily paralyzed in a car accident. During his time in hospital, Al Kaabi found out that he had Type 1 diabetes. Immediately afterwards, he was taught how to maintain a healthy lifestyle. His insulin injections increased gradually to three injections daily. “It’s dangerous, if I don’t pay attention it’ll cause blindness or problems with my liver, heart or even result with death,” he said. Al Kaabi knew the dangers associated with diabetes before his diagnosis: His five uncles and aunts and both his grandparents have Type 2 diabetes.

Diabetics can experience either a rise or drop in their blood sugar levels. When Al Kaabi was hospitalized, his sugar level was discovered to be 32 mg/dL (milligrams per deciliter); a healthy sugar level ranges from 70-140 mg/dL. “[At any second] I could have gone into a coma,” he explained.

The QDA’s new program could have helped Al Kaabi discover his diabetes earlier. The program currently has 60-70 children and adults with diabetes. Matthis said most people in the program have Type 2 diabetes because so many Qatari families lead unhealthy lifestyles. “We try to find out if they have symptoms or any family history,” Matthis said. “We try to teach them how to balance their food and exercise daily.” Type 2 diabetes is the most common form of diabetes; it accounts for about 90 percent of diabetes cases in the world.

Wartella said reducing obesity levels should be the most important priority for health officials in Qatar. “Qatar has the sixth-highest rate of obesity in the world, and in five years between 70-75 percent of the [Qatari] population will be obese,” she warned.

That figure could include Qatari children, about 28 percent of whom are currently overweight, according to the NHS. Fawzi Jadallah, a consultant general and laparoscopic surgeon at Al-Ahli Hospital, said in an article about Qatar’s obesity epidemic that obese children are considered “abused” by their parents for their unhealthy lifestyles.  Wartella said parents should be careful very early on. “The best way to counteract obesity is not to allow them to be obese in the first place,” she said.

Wartella said as part of the conclusion of her studies, she has recommended a marketing campaign in the United States that encourages new mothers to be vigilant early on. Wartella thinks a similar marketing campaign should be considered in Qatar. “The evidence we compiled is that [the issue of obesity] starts with babies. People think that having a fat baby is seen as a healthy baby; we’re mistaken in that regard,” she explained.

Studies show that obese children are likely to suffer from serious health problems and social stigma. “[Obesity is] associated with Type 2 diabetes, coronary heart disease, and emotional and psychological effects. The [children] tend to be teased and some data in the U.S. suggests that over time they will have social problems and an overall [unhappy] life,” Wartella said.

Wartella, who is also an independent consultant to the Institute of Medicine, said Qatar lacks information and data from statistics to fully comprehend the reasons as to why childhood obesity is so high. “In countries such as Qatar with [such] a small population, it’s truly a terrible problem to have it so high, it needs to be dealt with [immediately],” she said.

Radhika Mohan, an assistant dietician at Al-Ahli Hospital, frequently receives patients for weight management, diabetes control and dyslipidemia (high blood cholesterol levels). Mohan said that within the three years she has been at Al-Ahli Hospital, she has seen firsthand the rise of diabetic and obese patients.

“The age group is mostly mid thirties and over [and] 50 percent of the patients we receive are either obese or diabetic. The rise has more to do with stress and life style changes, [for example] junk food,” Mohan said. “Promoting a healthy lifestyle starts with the family and our idea is creating awareness through counseling as a first step,” Mohan said about a recent program set up by Al-Ahli Hospital to promote proper diet and good health in schools.

Mohan said that, apart from the lack of exercise and unhealthy eating habits among Qataris, obesity and diabetes can also be attributed to genetic predispositions. “If the factor is genetics, a healthy life style right from childhood can avert obesity but diabetes cannot be averted, but definitely can be delayed and controlled,” she said.

Some experts say the high levels of obesity in Qatar is partly due to the country’s extreme weather conditions, particularly the hot summers that discourage outdoor activities. “This is breeding a whole lot of couch potatoes. I do believe some measures are taken to promote sporting and healthy life style both at schools and at country level,” Mohan said.

Despite such measures and outreach programs, Qataris have yet to embrace exercise; the society’s conservative traditions and expectations particularly discourage women from exercising in public.  Thus, gastric bypass is popular in the country because people believe it is the most realistic way of losing weight, according to Dr. Siddig El-Malik, a consultant gastroenterologist, interventional endoscopist and hepatologist at Al-Ahli Hospital, “The Qatari community is very conservative, [for that reason] you can’t ask a 45-year-old women to jog in the Corniche, it’s unlikely that it’ll make a difference and that they’ll lose [a significant amount], so [surgery] is the most effective way. There is no medical treatment for obesity, [no pills] to bring the weight down. There’s only dieting,” he said.

But Mohan thinks gastric bypass surgery should be the last option. “Patients [at Al-Ahli] who are morbidly obese feel gastric banding or bypass more often to be a quicker route to fix their weight issues. It is quite common. In my opinion prevention is better than cure,” he said.

Major efforts have been launched to try to minimize the health crisis of diabetes and obesity in Qatar. The Supreme Council of Health is trying to provide preventative care by devising nutritional strategies. It is also conducting a survey to determine the reason for the rise of diabetes and obesity and to investigate whether smoking is also a contributing factor. “When [people have control of their health] it works to normalize the levels of the disease,” said Dr. Ahmad Omar, a health supervisor at the Supreme Council of Health.

But for those currently living with diabetes or obesity, all that matters is maintaining a positive attitude and daily routine.

When asked if diabetes has made his life more difficult, Al Kaabi said no except for the occasional colds and injuries that take longer to heal. “I just have to pay attention to what I eat and not mess up or think about it too much,” he said, “because then it can be very depressing.”


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