The United Arab Emirates (UAE) has one of the highest obesity rates in the world, with 2017-18 data from the Global Obesity Observatory reporting that in the Emirati population 38.5% of men were living with overweight and 32.2% living with obesity and 29.3% of women living with overweight and 41.8% living with obesity1. Bariatric News spoke with Professor Safwan Taha, Director of the Metabolic and Bariatric Surgery Center, Center of Excellence in Metabolic and Bariatric Surgery (SRC; USA), Mediclinic Airport Road Hospital Abu Dhabi, UAE, about the causes of obesity, access to metabolic and bariatric surgery, the changing perspective of the community towards obesity and the role of the local authorities in the management of this globally growing problem.
“The population of the UAE is highly multi-cultural with the UAE accounting for approximately 20%. Emirati’s have one of the highest obesity levels in the world. Published data ranked UAE fifth in the global obesity index (November 2017) which is also reflected into the accompanying comorbidities, notably diabetes mellitus” explained Professor Taha. “But the rise in obesity rates is not unique to the UAE - if we look across the world 40-60 years ago, there was very little prevalence of obesity – from Western Europe to North America, through Asia to the Middle east. I think the key drivers of obesity are the same across the world; easily available unhealthy food, lack of exercise, genetic factors etc."
However, he said that there are a couple of factors that are particularly relevant to the Gulf region. Firstly, the hot weather deems outdoor physical activity unsuitable, for most of the year. And, secondly, just like most Arab cuisines, the local food is, by definition, unhealthy being rich in carbohydrates, calories, sugar and fat etc. For example, he cited that bread is usually served with every meal, rice with two meals and sweets are craved by a wide segment of the population. This unhealthy diet combined with a sedentary life, as well as genetic factors, are driving obesity rates up.
One worrying aspect of the obesity rates within the UAE, noted Professor Taha, is the growing number of children who suffer from it. According to statistics compiled by the Ministry of Health and Community Protection, the rate of childhood obesity in UAE increased from 12 percent in 2018 to 17.4 percent in 2020 with other studies showing that about one-third of children in Abu Dhabi may be overweight.
The widely spread outlets that serve junk food, “quick meals”, soft drinks and even hot drinks that are full of sugar and cream, and are consumed by the younger population, seem to play an important role in driving obesity rates up in UAE, and the world.
Government initiatives
According to Professor Taha, the UAE authorities have been very assertive in adopting programmes that promoted healthy food in the canteens in schools and hospitals that were successfully promoted through the media. For example, food labelling now has a ‘star system’ to show which foods are healthy and their contents. The Department of Health in Abu Dhabi has also developed a scoring system for hospitals that encourage eating healthy food.
“As a result of these programmes, in my centre, around 95% of food is designated as ‘healthy’. There is also a focus on out-reach programmes where the public can meet with experts to discuss their health,” he added. “In the old days, people believed it was a good thing if you were overweight as it was a sign that you were eating very well. Thanks to the Government’s investments in programmes that encourage a cultural change in people’s perceptions of obesity, people with obesity are now much more open to go and see their physician, not just a metabolic and bariatric surgeon, and talk about different treatments and strategies to manage their obesity and its associated comorbidities.”
Surgery
Professor Taha has seen first-hand the change in people’s views on obesity and patients are now voluntarily attending his centre to ask about how they can manage their weight. Interestingly, he noted that patients are now much more open to the idea of surgery, whereas less than a decade ago patients were horrified at the prospect of undergoing surgery to treat their obesity.
“Patients are educating themselves about obesity and instead of fearing surgery they are asking us, ‘Do I need surgery? And if so, what type of surgery do you think I should have?’ Besides the Government’s programmes that increased the public’s awareness of obesity as a problem and the need to solve it, I think this change was also because of the excellent results we achieved from surgery at our Centre which also gained us the US-based Surgical Review Corporation’s (SRC) recognition as “Centre of Excellence in metabolic and Bariatric Surgery”.
It is worth mentioning that The Department of Health in Abu Dhabi is in the process of establishing its own criteria for “Centre of Excellence in metabolic and Bariatric Surgery” as part of its comprehensive approach to Quality Governance of the Medical Services in the Emirate.
In the last annual statistics of bariatric surgery in the UAE, just before the start of the COVID-19 Pandemic, around 5000 procedures were performed with sleeve gastrectomy being the most common procedure.
Bariatric surgery is currently covered for local citizens who fulfil the internationally approved selection criteria that include thorough assessment by the multidisciplinary bariatric team.
One of the important reasons for the increasing popularity of bariatric surgery in the UAE, according to Professor Taha, is its excellent safety track record that is, in no small part, driven by the stringent regular audits of metabolic and bariatric procedures by the Department of Health.
An electronic records systems that was introduced lately by the Department of Health in Abu Dhabi, code name “Malaffi”, i.e. “My File”, has enhanced the safety profile of Bariatric Surgery, and medical care at large, said Professor Taha. It connects the electronic medical records of all Abu Dhabi Emirate hospitals on one platform (Malaffi) where he, and any other physician, can access a patients’ clinical data for services that were performed at another Abu Dhabi Hospital both on inpatient\outpatient basis (excluding the privileged information).
“Extensive data of the outcomes of the metabolic and bariatric surgery in Abu Dhabi is collected by the Department of Health on monthly basis where it gets analysed and audited in comparison with international and local benchmarks to constantly improve the quality of care that is delivered to the obese population of the Emirate and the clinical performance of its metabolic and bariatric centres. I believe that there will eventually be a central Abu Dhabi bariatric database/registry that will enhance the process even more” he concluded.