Doha, Qatar - As the holy month of Ramadan begins, this small country observes a total ban on eating or drinking (including water) in public during daylight hours. Many in this desert nation - where temperatures regularly exceed 47°C (117°F) - struggle to keep their fast. It is a time of quiet reflection, for charitable giving, and, once the sun sets, the sharing of the communal iftar feast - where's the day's hunger and thirst are sated by often extraordinarily lavish meals.
Indeed, in Qatar, the breaking-of-fast feasting, and the suhoor
- the pre-dawn meal in preparation of the fast - has reached extravagant proportions, with average food intake reportedly doubling
during the holy month, leading to some 128 people being hospitalised
due to stomach upsets on the first day of Ramadan alone.
Some 73 per cent of Qatari men and 70 per cent of Qatari woman are overweight, according to the World Health Organisation's latest statistics,
Even given drastic changes in both diet and general lifestyle, it's hard to grasp the speed at which Qatar has piled on the pounds. As of 2003, 45 per cent of Qatari women were obese, then second only in the Arab world to Egypt, with 46 per cent. Qatar also has the sixth highest rate of obesity among boys in the Middle East and North Africa. In a 2006 study of children between the ages of 12 and 17, almost 29 per cent of boys and girls were overweight, with eight per cent hitting the obesity mark.
Bulging with fast food outlets and home delivery services, capital city Doha is devoid of pedestrian walkways, and those in power have seen the effects of the spreading sedentary lifestyle.
Like those in many other small, resource-rich Arab nations, Qataris have slid from a physically demanding life in the desert to torpidly inhabiting rich cities in little more than a generation. To combat the ill-effects of such changes, the country of 1.8 million (300,000 of which are Qatari citizens) has also seen a wave of initiatives, strategies, reports and overarching proposals issued by various government councils, all stating their enthusiasm towards building a healthier citizenry.
During the latest in a series of talks set up as public health meet-and-greets, Ellen Wartella, a professor of psychology, human development and social policy at Northwestern University, suggested a joint US and Qatari effort to combat the country's obesity.
"Given the US experience and the fact that Qatar is very concerned about the environmental factors [contributing to obesity], I am proposing that some experts from both countries come together to establish a research agenda," she said.
"We need to collaborate and design some interventions."
"A personal approach is not adequate to deal with the seriousness and scope of the obesity crisis... there needs to be intervention at multiple levels."
- Ellen Wartella, Northwestern University
At the symposium, put on by the Sidra Medical and Research Centre in Doha, Wartella advocated the the development of various "front-of-package" nutrition advice systems, such as those already in use in Europe and North America, wherein products are labeled according to their nutritional value.
She noted that attention to food information and marketing is not generally thought of as a factor in child obesity in Qatar. "I hope it can be pegged higher on the [list of] public health issues," she said. But this top-down approach is not the only suggestion on the menu of healthy choices.
A family approach
In addition to the strict interventionist solutions that dominate the discussion here, Wartella also put forward a more family-oriented approach to combating obesity, explaining that another, albeit less discussed, angle of attack "is to launch a public service campaign directed at new mothers to teach them about good nutrition standards for their children".
This method would take a far more holistic approach, using government marketing and public service campaigns to target obesity where it begins - with the child's desire to eat, and the parents' desire to feed them - seeking to establish a more European-style of nutrition, and a culture of healthy living.
Yet Wartella was quick to note that past experience in the US reveals "a personal approach is not adequate to deal with the seriousness and scope of the obesity crisis", and urges a nuanced angle, adding "there needs to be intervention at multiple levels".
While a focus on families is undoubtedly valuable - traditional Qatari diets can be high in fats and protein, and parents around the world tend to underestimate the weight of their child, or even view obesity as a sign of health - health experts here are sceptical of an approach that directly targets the family.
"It's not just a personal problem, it's really a community and social problem" said Dr Ahmed Mohammed Saeed El-Awwa. In his experience as acting head of the Pediatric Endocrinology and Diabetes Unit at the University of Alexandria Children's Hospital, he has researched diabetic children extensively, and understands how to raise awareness of diabetes and other illnesses which are often dietary-related.
"We are importing most of the food in Qatar, and importing as well the culture and environmental factors from other areas into our area" he said at the Sidra symposium, echoing ties Wartella made between obesity causes in the US and Qatar.
El-Awwa acknowledged that the cornerstone of health management was illness prevention, saying obesity prevention should be a "national project".
In a 2006 study of children between the ages of 12 and 17, almost 29 per cent of boys and girls were overweight, with eight per cent hitting the obesity mark.
"A lot of behaviour change should be there from the start."
Sheikh Mohammed Hamad J Al Thani is the director of public health at the Supreme Council of Health in Qatar. He said that the need to change behaviour to make a better life for people was paramount for a healthy country. "We know it's not very easy, but it's doable," he said. But "changing the economy is easier than changing the behaviour of people", he added.
"Sometimes, in changing [their ways], people feel they are not loyal to their grandfathers," he said. He continues to favour initiatives centred on infrastructure, such as the nutrition labels suggested by Wartella.
While there is still currently little in the way of concrete steps toward a solution, both el-Awwa and al-Thani spoke highly of proposals brought up in some parts of the US, such as banning certain soft drinks and a gradual phasing out of trans fats from public consumption.
Their sentiments reflect the 2010 PhD thesis
[PDF] of University of Birmingham scholar Dr Amal Essa Ahmad Thani al-Muraikhi, who had conducted surveys throughout Qatar, asking participants about education, perception of weight problems and family history.
The study noted that those questioned emphasised the school environment, quoting one as saying "children learn from school more than they learn from their mothers". The author concluded that, while "any intervention is likely to involve schools ... a family or community component should also be considered".
Looking for action
In 2010, the Supreme Councils of Education and Health launched the School Health Initiative. The project involved holding workshops for 11 schools in an attempt to improve, through education, "the health of students, school personnel, families and other members of the community through schools". No other school initiatives have been publicly announced since, and so far no results from this initiative have been published.
The National Health Strategy, 2011-2016
, spearheaded by Sheikha Moza bint Nasser, contains the most exhaustive outline of a national health initiative available. In a section outlining a series of "quick wins", the report describes a need to "ensure that all menus, especially in fast food restaurants, mention the number of calories in listed items". Along with a call for education on the benefits of breastfeeding in the same section, this is the only stated initiative in this or any other recent report that targets children.
The five-year report does not involve schools in any of the initiatives, and acknowledges that 'Qatar does not have comprehensive and accurate data on healthcare'.
The five-year report does not involve schools in any of the initiatives, and acknowledges that "Qatar does not have comprehensive and accurate data on healthcare". While there is clearly no lack of awareness of a national obesity problem among government and medical professionals, it remains unknown whether this understanding, and the inevitable diet changes that accompany it, has filtered through to the general population.
According to the CIA World Factbook, Qatar boasted a 19 per cent growth rate in 2010, the largest in the world. In the same year, industrial production grew by 27 per cent, another world best. The country also accrued $23.3bn of imports, roughly one sixth of the country's total purchasing power for that year. Since 1995, Qatar's per capita GDP has more than doubled every five years and average per capita income now exceeds $100,000 a year.
In the past two generations, the Arab world has undergone incredible economic and demographic shifts. The constant push for new reserves of energy has pushed this tiny finger in the gulf coast to new heights of extravagance, both in economic gains and feats of engineering. Much like its eastern neighbour, Dubai, which recently constructed the largest building in the world, large sections of Doha have been raised from the sea. Indeed, the majority of the skyscrapers that punctuate the city's horizon were built in the past 15 years, requiring massive pumps to push water out from under foundations.
It's clear that the country's leadership has few qualms about restructuring the fundamental makeup of the nation. For this government, health could just be yet another metric to tackle.