A generation ago, the United States was the epicentre of the global obesity epidemic.  No longer.  Today, many countries in the Middle East have obesity rates that exceed even those of the United States, according to a recent report by the UK-based Overseas Development Institute.  

With growing waistlines come the diseases of obesity:  high blood pressure, heart disease, and, particularly, diabetes.  The statistics alone should ring alarm bells in Qatar and across the Middle East. 

According to the International Diabetes Federation, nearly 400mn people worldwide have diabetes – a number that is expected to climb to nearly 600mn by 2035.  For Qatar, the increase is even steeper.  Nearly 300,000 Qataris are estimated to be diabetic now, rising to over 700,000 in 2035.

The economic costs of the epidemic are equally alarming.  Global spending in health costs for diabetes already tops $400bn annually.  The indirect costs, including lost productivity of those affected with diabetes, are many times higher. 

Since the majority of those affected by diabetes globally are between the ages of 40 and 59, the costs of this epidemic will only continue to spiral in the years to come.  For Qatar, which already spends about $2,200 every year for each individual with diabetes, there are major economic stakes in finding ways to reduce this burden.

Fortunately, there is a wealth of evidence from countries that have battled this epidemic for decades on what is most effective in preventing diabetes or mitigating its effects.

The American Diabetes Association recently ranked diabetes interventions across the world according to their cost-effectiveness. Among the most cost-effective were stopping smoking and lifestyle modifications to eat healthier and exercise more effectively.  In Qatar, Action on Diabetes (AoD), is putting these findings into practice. 

AoD, a partnership between the Supreme Council of Health (SCH), Hamad Medical Corporation (HMC), the Primary Health Care Corporation, the Qatar Diabetes Association, Maersk Oil and pharmaceutical company Novo Nordisk, is a programme designed to help deliver Qatar’s 2030 National Vision of a healthy and prosperous nation. 

In 2013, AoD launched the National Diabetes Registry, a comprehensive online tool that for the first time will gather data about all diabetes patients into one nationwide registry, making it possible to monitor, compare and share best practices across different institutions.

Of course, many of us have good intentions when it comes to diet and exercise – only to see those intentions crumble under the pressure of fast-paced schedules, and the demands of work and family.

The fight against obesity and diabetes is hard, but it can be won – and government and corporate policies can help. 

For example, having healthy choices available in school lunches can help children develop healthy habits from the start.  Japan has led the way in this regard, with a school nutrition programme that makes healthy eating a national priority. This programme contributes to Japan’s almost unique ability to resist the global trend toward obesity among affluent nations.

Even the USA, which has long struggled with childhood obesity, is showing remarkable progress, with childhood obesity rates dropping by 43% over the last decade, thanks to programmes ranging from nutrition education to Michelle Obama’s “Let’s Move” campaign to promote physical activity for children.

Qatar is taking positive action too.  The Qatar National Health Strategy 2011-2016 is designed to help the country promote public healthcare, healthy lifestyles and disease prevention and community-based primary healthcare. The Strategy presents a shift to a more active approach in disease prevention and early detection, with more than QR608mn allocated to manage and implement the strategy.

Designing new communities that include pathways for walking or playgrounds can also encourage a healthy lifestyle.  High temperatures and hot sunshine need not be a barrier to success. 

Desert communities from Arizona in the United States to the Gulf have found innovative ways to create spaces for exercise, using shade plants, heat screens, or water misting to allow people to walk, play sports or take their children to the playground without risking heat stroke.

Employers also have a major part to play in encouraging a culture of fitness. Even seemingly small measures, like providing healthy choices at the company cafeteria, can have major impacts on the health of employees.

 Some of the most innovative companies have adopted wide-ranging wellness programmes that include biometric analysis to help employees tailor fitness programmes to their own personal needs and abilities.  Old-fashioned competition has a role too: some wellness programmes encourage different departments to compete against one another in reaching fitness goals. 

These programmes have a double benefit.  Not only does employee health and morale improve, but there’s a financial benefit to the employer.  A study in the journal Health Affairs found that, for every dollar invested in wellness programmes, employers recouped $3.27 in reduced medical costs and $2.73 in reduced absenteeism by employees – an enviable ROI for any investment!

Of course, the healthcare system is a major component of a successful response to the challenge of obesity and diabetes.  Medical education and even financial incentives to healthcare professionals can help sensitise doctors to the right steps to take.  For example, special attention should be focused on pregnant women, who are often at risk of gestational diabetes if overweight.

Medical professionals also need to heighten awareness during Ramadan, when different patterns of eating can cause wide fluctuations in blood sugar, putting individuals with diabetes at increased risk of complications.

The design of the new Qatar National Health Insurance Scheme can also aid in the fight against diabetes and obesity.  In my former position with the United States Senate, I had the privilege of working with President Obama in designing the American health reform effort, now known as Obamacare. 

One feature of that reform was to require insurance plans to provide free access to screenings and services proven to help prevent disease.  These include diabetes screening for patients with high blood pressure, and routine screening and counselling for obesity.

The American health reform also included financial incentives for doctors to provide higher quality care – rewarding doctors not for how much they did, but for how well they did it.  These kinds of incentive structures have been adopted by public and private health programmes in many parts of the world – all with the aim of encouraging high-quality healthcare. 

For diabetics, effective disease management includes regular screenings for complications of the illness and prompt, co-ordinated, and evidence-based interventions when those complications are detected.

By closely examining the successes and failures of countries that have battled the obesity epidemic for decades, the Middle East has the chance to reduce the impact of a looming health and economic disaster as the toll of diabetes and other obesity-related disease continues to climb.

 A thoughtful package of reforms adopted by  government and the private sector alike can save lives, improve productivity and reduce healthcare costs.

 

Dr David C Bowen, PhD, is global head of healthcare, Hill+Knowlton Strategies.

 

 

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