Obese? You are not alone, reports Amira El-Noshokaty Saida Ibrahim is a 55 years old housekeeper who can barely walk. Dressed up in a black galabia that does little to hide the proportions of her figure, she remembered how two years ago she suffered severe back pain and could not breathe without wheezing. At the time her doctor advised her to lose weight. "That was the only time I considered following a different mode of nutrition -- basically getting rid of fatty foods and carbohydrates," she recalled. Ibrahim followed a strict diet for a week or so, but quit after she started feeling marginally better. Today she is still obese, but argues that as long as she can move she is just fine. Ibrahim is not alone in this world. According to the World Health Organisation's (WHO) online publications, "obesity is one of today's most blatantly visible -- yet most neglected -- public health problems. Paradoxically coexisting alongside under-nutrition, an escalating global epidemic of overweight and obesity -- 'globesity' -- is taking over many parts of the world. If immediate action is not taken, millions will suffer from an array of serious health disorders." The document goes on to illustrate how being obese is far from a simple issue. "Obesity is a complex condition, one with serious social and psychological dimensions, that affects virtually all age and socioeconomic groups and threatens to overwhelm both developed and developing countries. In 1995, there were an estimated 200 million obese adults worldwide and another 18 million under-five children classified as overweight. As of 2000, the number of obese adults has increased to over 300 million. Contrary to conventional wisdom, the obesity epidemic is not restricted to industrialised societies; in developing countries, it is estimated that over 115 million people suffer from obesity-related problems." In addition to simple bad eating habits, Kunal Bagchi, Regional Advisor of Nutrition at the East Mediterranean Regional Office (EMRO) of WHO, connected globesity to changing lifestyles during the past 20 years. "The world has witnessed economic prosperity where less and less physical effort is exerted because of better means of transportation, domestic help, and fast food," he told Al- Ahram Weekly. But how is obesity defined in a world flooded with images of unhealthily thin female movie stars and models? Obesity, according to Aisha Abul-Fotouh, professor of public health, Faculty of Medicine, Ain Shams University, is defined as an excessive accumulation of body fat for given body size based on muscle and bone. It is the condition in which fat represents more than 25 per cent of the total body weight for a man and more than 30 per cent of total body weight of a woman. According to Dr Farouk Shahine, dietitian and the ex-head of the National Nutrition Institute, "Obesity can be defined in many ways but the best way is by using the Mass Body Index which is calculated as a person's weight in kilogrammes divided by the square of the height in metres. For men, obesity starts when one exceeds the number 25. As for woman, when they exceed 30, then they are obese." In Egypt, obesity has been on the rise over the past five years. "The latest national study on obesity was held in 2001-2002 covering a sample of 36,000 people and an age group that extended from two years old to above 70," explained Affaf Abdel-Fatah, assistant professor of field studies and research at the National Nutrition Institute, to the Weekly. The results were as follows: Out of the women aged 20 and above, 47.8 per cent were obese. As for men, same age group, 18.9 per cent were obese. Among teenagers, obesity ranges at around 10 per cent among girls and seven per cent among boys. In children, age six to 11, obesity among girls is 6.5 per cent, and 4.5 per cent among boys. From age two to six, obesity reaches three per cent among girls and 1.7 per cent among boys. Such high obesity rates are linked to several factors. For example, most social events and special occasions are centred around food, leading Egyptians to generally cook more than they can eat. A more important consideration than the quantity of food available is the quality -- plates are usually full of starchy and fatty items. Moreover a health-conscious culture emphasising exercising or walking is not present -- besides the fact that the streets and air quality of Egypt do not exactly lend themselves to either, sports clubs are reserved for the elite, and public park space is limited. Shahine points out that in Egypt obesity is not limited to a certain social class. "The underprivileged eat a lot of carbohydrates so as not to be hungry like bread, macaroni, rice, french fries sandwiches and the fried eggplant sandwiches. The privileged are consuming too much meat, empty calories, junk food as well as too many sweets," he said. Obesity's undesirability is more than superficial, since it is a factor in many grave health problems. "It increases the risk of diabetes, cardiovascular diseases and can lead eventually to heart failure. There is a definite link between obesity and suffering gall bladder problems and there is also the risk to their knees and joints. Obesity is also related to depression: a person sees oneself as obese, becomes depressed, and starts to eat more becoming more obese," spelled out Shahine. Moreover, the negative effects of obesity even affect fertility. According to Mohamed Abul-Ghar, professor of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, "It is well known that obesity is often associated with hormonal imbalance and a condition called polycystic ovaries, which is associated with irregular menses and infertility. In many patients, simple weight reduction results in the resumption of normal menses and spontaneous pregnancy." Abul-Ghar continued, "During pregnancy, obese women are more liable to suffer complications. There are more possibilities for the development of hypertension in obese pregnant women, as well as venous thrombosis. Some obese women tend to develop diabetes restricted to the period pregnancy. Delivery is often more difficult, and if surgery or Cesarean section is required, it is even more difficult, due to the thick fatty abdominal wall." And men are not exactly immune to obesity either. According to Hamed Abdallah, professor of Andrology at Cairo University, obesity has a negative effect on the sexual ability as well as the fertility of the man. "In the marital relationship, male obesity makes it difficult mechanically for a man to perform. The stomach is large and the heavy body weight makes certain positions very difficult to perform. Also the hormonal disorders that result from obesity can increase the feminine hormone, estrogen, in a man leading to impotence, low sex drive. Further, because of the increased risk of diabetes, high blood pressure and hypertension -- all of these result in the disturbance of the blood flow to the genital organs which leads to obstruction of the erection. Moreover, hormonal disorder may lead to the absence of production of the sperm." While less prevalent, obesity is spreading amongst children. "Obesity has a hereditary element accounting for not over two per cent of obesity cases. The real problem is that parents teach their children the eating habits that could result in their obesity," explained Shahine. According to Maissa Shawqy, assistant professor of Public Health and Preventive Medicine, Faculty of Medicine, Cairo University, "According to the 1998 national survey conducted at the NNI, it was found that obesity escalated among school children and the reasons were poor eating behaviour, a non-interest in physical activity, skipping breakfast and the consumption of starchy food. The second problem is the media promotion of junk food," explained Shawqy, adding "Junk food is really bad for you because it is energy dense, made of white flour and saturated fats that block arteries in addition to the fact that they are full of food additives which promote cancer." According to Safaa El-Hoseiny head of overweight clinic at the NNI the average number of calories that a child should eat is roughly 2000 calories daily. Not all calories are equal, though, and the problem today is that many children are basing their diets on junk food. Bassant Mahmoud is 11. When we met her, her hands were busily searching for the junk food that she keeps in her school bag. She explained that her parents would prefer that she ate more healthily, but that she eats junk food at school regardless. With obesity's numerous dangers and social costs, combating fat is becoming a priority item on the national agenda and last April the regional consultation in preparation for the global strategy on diet, physical activity and health was held jointly by WHO and EMRO in Cairo. On a more personal level, fighting obesity starts with the basics, a healthy diet. "In short, you have different kinds of food organised into a pyramid. Energy foods are on top of the food pyramid, namely fat and oils and at the bottom are the starchy foods and cereals that provide energy. The other pyramid is that of vitality which includes vitamins and minerals in vegetables and fresh fruits. The daily diet must include all these components," said Shahine. "There also should be a pattern of physical activity which in our culture is rather random and sometimes nonexistent," added Abdel-Fattah. "I have women patients whom I tell that they should walk perhaps get down from the bus at an early stop and walk for 15 minutes. There are cases where they refuse to walk in the street simply because they are self-conscious and afraid of the mockery of the people watching them. Other obese women used to come to the clinic of the institute and would explain that their husbands and their mothers-in-law see them as fat and demand that they lose weight. The result is that they may become more stubborn and refuse to lose weight, just to spite their household." Ultimately, however, the golden rule to dieting seems to be to cut down and not to cut out. According to Dr Farouk Shahine the don'ts of the diet world: Diuretics : are artificial. These are generally harmful to your health, as any weight shed is from your body's water supply. Vital minerals may be lost, and kidney damage could ensue. Some diuretic medications could bring about diabetes. Appetite suppressants: are proven to have dangerous side effects on the brain's functions. The Thyroxin Gland Hormone: is an agent increasing the metabolic rate, but suppressing the natural function of the thyroxin gland. When a patient stops using the hormone additive, he or she will start feeling very sluggish, as the thyroxin gland's capabilities have declined in the meantime. Medications blocking fat absorption: are intended for use while dieting, working to block the body from absorbing up to a third of the consumed fat. However, this also prevents the body from utilising beneficial fats, such as the essential fatty acids needed for a vital metabolism. Fatty acids act as the carrier of the fat-soluble vitamins A, D, E and K, and so these medications can do more harm than good to the body. Cosmetic Surgery: Such surgeries are not recommended except in extreme cases of morbid obesity, technically defined as a person weighing at least twice their healthy weight. In this case, obesity becomes life-endangering, and surgery is a necessity. For purely cosmetic reasons, however, surgery is not a wise choice. Liposuction: does not lose much weight, but it reshapes and contours the body. It is not a quick and easy substitute for a regular diet and exercise programme, but is only recommended as a follow-up after one. Liposuction itself will only eliminate two to three kilogrammes of fats and water, and so by itself does little good. The chemical diet: allows for the incomplete oxidation of food, as well as creating unwelcome byproducts such as beta hydroxic protereic acid and acetone. These are dangerous, with the attendant risk of damage to brain cells and even the stopping of the heart and the kidneys.
