Nowadays obesity is no more an adult problem. The prevalence of childhood obesity is on the rise and it continues to increase at an alarming rate. It is a particularly burning issue in the United Arab Emirates, where the number of obese children is about three times higher than established by international standards. Being harmful, obesity is also associated with adverse health consequences. Although the nature of obesity is multifactor, the major cause of the disease is an imbalance between energy input and expenditure. The high prevalence of overweight and obese school children in Emirates has been illustrated on the basis of three research studies. This research paper will analyze three contemporary studies on childhood obesity with an objective to gain an insight into the issue, establish the most important contributory factors and thus provide recommendations for future research.
Emirati Children Obesity
Obesity is currently one of the most burning health issues throughout the world. A disturbingly massive increase in the prevalence of obesity was witnessed in the recent two or three decades. The situation is similar in both developed and developing countries. The obesity issue is especially sharp in the countries of the Arabian Gulf, particularly in the United Arab Emirates. Thus, the number of obese children in the country has increased and is continuing to rise dramatically, surpassing similar statistics in European countries and the USA. Thus, according to a study by Al-Haddad, Little and Ghafoor (2004), the frequency of obesity in the UAE is two to three times higher than the number established by the World Health Organization (WHO) international standards. Moreover, overweight and obesity are associated with increased risks of a wide range of health problems, including cardiovascular disease, hypertension, diabetes mellitus and a higher chance of developing adult obesity. Therefore, it is important to conduct research of childhood obesity and overweight in order to gain a deep understanding of factors leading to the epidemic and thus be able to formulate effective interventions. The aim of this research study is to analyze the available literature on the topic of childhood obesity in the UAE and suggest possible interventions.
The economic boom and globalization resulted in considerable changes in the dietary habits of the Emirati. People borrowed some food consumption patterns from western countries and the USA. For example, a traditional Arabian low-fat and high-fiber lunch became more unhealthy due to high-fat and processed food, fast foods and increased average portions. Moreover, the epidemic of childhood obesity resulted from shifts in exercise patterns. Currently, children have a more sedentary lifestyle. They are more likely to travel in cars than walk, spend time in from of TV screens, playing computer games or watching videos on YouTube, which is often accompanied by eating unhealthy foods. In other words, the major factors leading to obesity is the imbalance between energy intake and expenditure as a result of unhealthy dietary habits and lack of physical activity.
Purpose and Overview of Research
This research study is an attempt to gain an understanding of childhood excessive weight issues in the UAE. The prevalence of overweight children in the country is extremely high, which is likely to transform into weight problems in adulthood. However, adult obesity can be prevented if the issue of childhood overweight and obesity is mitigated. Moreover, the epidemic contributes to higher mortality rates and serious health problems which lay a heavy burden on the Emirati government. Therefore, it is necessary to establish which factors have the closest relation to increased body weight. Knowing the causes of excessive weight, it will be possible to take preventive measures to avoid complications and establish effective treatment techniques. Hence, the purpose of the research is to analyze the available data about the problem from the research studies and define ways to tackle it.
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To gain an insight into the issue, three recent articles from medical journals on the topic of childhood obesity in the United Arab Emirates were utilized. First, the article “Childhood obesity in United Arab Emirates schoolchildren” by Al-Haddad et al. (2004) analyzed the issue of childhood obesity in the UAE based on a national study carried out in the 1998-1999 school year. The research was conducted on a representative sample of 16,391 pupils from eight Educational Districts of the country. The study focused only on the divergences between genders, disregarding other aspects, such as ethnicity, place of residence, etc.
A similar study on the prevalence of overweight and obesity was conducted by Malik and Bakir (2006). It is a secondary analysis that involved 4,381 children aged 5 to17 years, which represents 1% of all school children in this age group. These were further divided into four age groups. In addition, the sample included both Emirati nationals and expatriates of the UAE total population and made a distinction between sex, place of birth and location. The anthropometric data for the analysis were taken from another study and were further used to determine the BWI and the rate of obesity. All in all, the study by Malik and Bakir (2006) calculated the prevalence of obesity according to categories.
Finally, the paper investigated a study on the interconnection between dietary and behavioral factors and the risk of obesity in Dubai by bin Zaal, Musaiger and D’Souza (2009). The scholars carried out a study on a sample of 661 adolescents aged 12-17 years, all Emirati nationals. In addition, scholars made a distinction between male and female students. They calculated the BWI to determine the prevalence of overweight and obesity among adolescents, who also answered a questionnaire on the eating and activity habits. Afterward, the factors most related to increased risk of obesity were evaluated.
For the purpose of the research, the paper used comparative, descriptive and statistical methods. Thus, it focuses on three different studies on the issue of obesity in the UAE, which were conducted at a relatively the same time. First of all, the study sample was selected so as to represent the general Emirati population. Secondly, the body mass index (BMI) of the sample population was computed based on the formula: weight in kilograms divided by height in meters squared. Anthropological measurements were conducted either by trained school nurses (Al-Haddad et al., 2004, Malik & Bakir, 2006) or by a single nurse (bin Zaal et al., 2009) according to WHO standardized protocols. The height was measured with a portable stadiometer and the weight by an electronic portable scale (Seca) to the nearest 0.1 cm and 0.1 kg respectively (in the Study by Al-Haddad et al., the accuracy of measurement was lower, particularly 0.5 cm and 0.5 kg). The procedure was similar with slight differences in all three studies. After the BWI had been calculated, it was compared to age-related values recommended by the WHO. Thus, adolescents with BWI between 30 kg/m-2 were considered obese. Further, these data were statistically analyzed with special software and compared according to analysis criteria (gender, age, location, ethnic origin, etc.) to find out an association between the variables. Moreover, Zaal et al. used the descriptive method, namely in analyzing the answers to the questionnaire.
Findings and Analysis
The results of the studies suggest that childhood obesity has turned into an epidemic recently. Thus, according to the research results, the prevalence of obese children ranges depending on age. It was found out that children aged 5-9 have the lowest obesity prevalence, which is below the international standards (Al-Hadad et al., 2004, Malik & Bakir, 2006). From 9 to 18 years the rate of obesity increases, reaching its peak at the age of 12 (32.4%) and 14 (30.5%) in boys and 13-14 years (35.4% and 25.4%) in girls (Zaal et al., 2009). The study by Malik and Bakir (2006) showed similar results. Furthermore, the scholars concluded that prevalence rates are higher among girls (22.9%) than among boys. Overall, Malik and Bakir determined that 13.7% of Emirati children are obese.
In addition, Malik and Bakir evaluated an association between location and origin and the prevalence of obesity. According to the study, the epidemic is more widespread in urban areas and prevails in non-native Emirati citizens. Hence, it may be inferred that a high prevalence of overweight in the country is largely attributed to globalization and an increased number of foreigners in the country. Interestingly, the scholars pointed to another possible cause of the warning obesity statistics. Malik and Bakir (2006) argue that “a widespread perception among parents and their children that overweight is a sign of high social status, beauty, fertility, and prosperity,” which fuels the issue considerably (19). Moreover, there was the greatest sample compared to the other two studies and the most representative of the UAE population in terms of the urban and rural populations. Therefore, the results of the study by Malik and Bakir can be considered valid.
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The study by Al-Haddad et al. (2004) suggests that obesity gradually increases from the age of 10 to 18, suppressing the international standards both in males and females. Thus, according to the scholars, it amounts to 17.9% and 15.3% in 18-year old boys and girls respectively, which is three times higher than the recently published international standards. The scholars also argue that there is a close relationship between male overweight in early childhood and the increased risk of obesity in late adolescence among UAE children. These results indicate the need to conduct longitudinal studies to develop early preventive strategies and effective intervention plans.
In contrast to Malik and Bakir (2006), the research data by bin Zaal et al. (2009) show that the proportion of obese males (22.2%) is higher than that of obese females (20.5%). In addition, the study indicated a decline in obesity with age, being the lowest at the age of 17 years (12.5%), which opposes the research results by Al-Haddad (2004). This can be partly accounted to the small size of the study sample, which cannot represent the real situation entirely.
However, the major contribution of bin Zaal et al. to the issue is the analysis of factors leading to childhood obesity. First, the scholars established a relationship between breakfast intake and the risk of obesity. Thus, it was observed that obesity risk decreases in children who always and frequently eat breakfast. On the other hand, if a child does not eat breakfast, he or she is likely to eat more and order larger portions during lunch, thus contributing to weight gain. Moreover, high-density food, carbonated drinks, and canned food also add to the problem. By contrast, snacking between breakfast and lunch is greatly associated with obesity risk in girls, and midnights snacking is largely related to obesity in boys. Similarly, there was established an association between behavioral habits, namely watching TV, and obesity. Thus, “more than half of secondary school girls in the UAE frequently eat while watching television.” Thus, bin Zaal et al. state that eating while watching TV increases the risk of obesity. By contrast, they argue “…there was a decrease in the risk of obesity in girls who sometimes … and always …ate while watching TV, compared to the reference group” (bin Zaal et al., 2009, 439). However, such a statement does not sound reliable. Moreover, family habits may influence the energy intake due to the type of food on the table, typical portion size and the fact of having lunch together.
Another major contributing factor is the sedentary lifestyle of contemporary Emiratis. Children in the UAE prefer getting to school by public transport rather than walk. Additionally, a highly sedentary lifestyle is typical of Emirati females due to social and religious norms (Malik & Bakir, 2006, bin Zaal et al. 2009). Physical inactivity is especially widespread in families with a high social status since even domestic chores are performed by servants.
Although there are some shortcomings of the study by bin Zaal et al, its strengths suppress them. For example, the researchers compared their findings with other studies. On the other hand, the scholars did not beck up all their findings.
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Despite some differences in the methodology and results of the analyzed research studies, some general conclusions can be made. The results of tree contemporary researches show that childhood obesity has become an epidemic, which has detrimental health effects and cost the national government a lot. The research data prove that the number of Emirati children with obesity is two-three times larger than the one established by the recent international instructions. Moreover, there was evidence provided that adult obesity has its genesis in early childhood obesity. Therefore, establishing early intervention strategies for treating obesity is needed to mitigate the problem. Prevention and intervention should start at the earliest age possible and target primarily female population since obesity is the most prevalent among them. Further, since lifestyles and behaviors are formed in early childhood, it is essential to focus on promoting healthy habits by young parents and teenagers. Intervention should address increasing physical activity, reducing the time spent in front of the screen and changing school canteen menus by including more healthy options and forbidding processed and high-fat food. However, although there is clear evidence that childhood obesity is on the rise, no interventions have been undertaken yet to address this problem in the UAE.