COMMENT: Fat lands —Saleem H Ali

Many Muslim countries, including Pakistan, are being gripped by an obesity epidemic that should alarm us. Just walk in any market around the country and observe the number distended bellies and double-chins

Continuing my series on food during the month of Ramazan, let us consider the latest data on obesity worldwide. Human weight in the context of public health is internationally measured by the Body-Mass Index (BMI), which is calculated by taking the ratio of the weight and the square of the height. Despite its deficiency of not measuring actual body fat, the measure provides a good estimate of general obesity in a population. There are certain thresholds of the BMI which public health officials now consider to be “overweight” and more extreme cases as “obese,” and these levels vary based on gender and age.

Usually we associate obesity with the United States — a land of proverbial “couch potatoes” consuming fried chicken and Big Macs. No doubt, the United States has its share of rotund individuals but the untold story of global obesity remains draped under the flowing robes of Arabia.

According to the World Health Organisation, the most obese country in the developed world is Saudi Arabia, with an estimated 73 percent of the population classified as “overweight”, and 36 percent of this number are clinically “obese”. The United Arab Emirates is not far behind with 34 percent of the population clinically obese — a number that roughly matches the United States.

Pakistan’s weight problem varies dramatically between rural and urban areas and also across age demographics. In one study conducted by the Aga Khan University in Karachi and published in 2002, the prevalence of clinical obesity as defined by the World Health Organisation for 25-44 year olds in rural areas was 9 percent for men and 14 percent for women; in urban areas, prevalence was 22 percent and 37 percent for men and women, respectively. For 45-64 year olds, prevalence was 11 percent for men and 19 percent for women in rural areas, and 23 percent and 40 percent in urban areas for men and women, respectively.

While there may have been some changes since the study was carried out, the general trends are likely to be similar. Far higher obesity levels for women in Pakistan also follow similar trends in other Muslim countries where patriarchal systems prevent women from going outdoors and exercising or where the confinement to the house may also lead to psychological factors that encourage greater food consumption. In rural areas this factor is less prevalent among younger women who may help their husbands in the fields and hence remain more athletic.

Ramazan may be considered a time for some reflection on this assemblage of disturbing data. While we should certainly not make fun of fat people, it is high time we start to address the problem of excessive food consumption and concomitant lack of exercise as a public health problem. Unfortunately, during the month of fasting, Muslims tend to rarely reduce their daily caloric intake but rather make it more asymmetrically during a 24-hour period. Thus any potential for weight loss is very limited and often the gormandising frenzy at saher and iftar time becomes a palpable strain on the digestive tract with side effects such as ulcers.

With busy routines in current times, Ramazan is also equated with sleep deprivation for most working families. Nutritionists have also learned recently that lack of sleep has a direct impact on appetite and food consumption. A persistent lack of sleep stimulates the production of the hormone ghrelin, which stimulates appetite and also decreases the production of leptin, a hormone which helps the brain register fullness. One study at the University of Chicago, reported in last month’s issue of Popular Science, suggests that sleep deprivation particularly triggered surges in cravings for excessively sweet and salty foods — both of which can have adverse health effects without moderation.

Most religions, including Islam, have clear injunctions against gluttony. In Christianity, excessive food consumption is one of the “seven deadly sins”. Muslims have been advised to exercise moderation in their food intake in numerous Ahadith, and the whole concept of fasting is meant to enjoin self-discipline that should transcend the period of the fast. Yet, sadly, most who fast do not consider this larger purpose in earnest.

Many Muslim countries, including Pakistan, are being gripped by an obesity epidemic that should alarm us. Just walk in any market around the country and observe the number distended bellies and double-chins. No doubt there is also malnutrition among our poor but the overall demographic indicates that we are becoming flabbier folk. Our public health system is already stressed and it is high time we pay more attention to preventative education on this matter.

Ramazan provides us with a golden opportunity to consider self-denial and to limit our appetites, but unfortunately the way we practice fasting often misses this message. So the next time we grouchily wake up for saheri after watching a Bollywood movie till 2 am and then proceed to down parathas, let us pause to consider how we are valuing food and our health.

Dr Saleem H Ali is associate professor of environmental planning at the University of Vermont. His forthcoming book Treasures of the Earth: Need, Greed and a Sustainable Future will be published by the Yale University Press in October 2009. www.saleemali.net

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