Death by a thousand pies

Fifty percent of people with type two diabetes don't even know they have it. The UAE has incredibly high rates of people with the condition. Why? Damian Reilly reports.

Nauru. Heard of it? It's a tiny island in the south Pacific, 21 square kilometres, picturesque from the air, populated by roughly 12,000 fatties. 75 per cent of the population is obese, and 90 per cent unemployed.

On Nauru, the people lie about by day, lazily dropping pastries and pies into their salivating mouths. By night, they roll about, clutching their flatulent guts, and vowing that things will change.

Money laundering aside, Nauru isn't famous for much, but it is top of the pops in one regard: Nauru leads the world in the diabetes stakes. Nearly half of the population has type two diabetes. Half.

And type two is the bad one, the one you get for not being able to take your fingers out of the cookie jar. Type two diabetes is the scourge of the indulgent and overweight.

Second on the global type two diabetes chart? It's not America, famously the land of the supersized meal and the steatopygous populace. Look around you. Perhaps you've heard? Second in the world for this most preventable of conditions is the UAE. One in five adults here has it. In fact, in the Gulf there is what can easily be termed a diabetes epidemic occurring.

After the UAE, the next highest rates for the disease occur in Saudi Arabia (16.7 percent), Bahrain (15.2 percent) and Kuwait (14.4 percent). What is going on?

Official statistics from the International Diabetes Federation state baldly that one person dies every ten seconds of diabetes. It's the fourth main cause of death in developed countries. And for those not yet killed by it, but merely living with it, the symptoms are no fun. In the developed world, it's the main cause of blindness, and non-accidental limb amputation.

And then there's the other stuff, like cardiovascular disease (the unsmiling harbinger of the most common terminal event in the civilised world), paralysing strokes, and kidney failure. The list, as lists do, goes on. There is no upside to type two diabetes.

Why does the UAE have such a problem with diabetes? Most of the reasons are obvious, and immediately apparent, after only one waddle through any of the country's myriad malls or shopping precincts.

The place is hoaching with fast food stores. Dunkin' Donuts, McDonalds, Burger King and the like; the lurid signs of these purveyors of tasty saturated fats light all corners of the country's thoroughfares.

And people don't walk, much less run, to these least healthy of restaurants. They drive. The temperature must play a part. For more than six months of the year, to go outside, even to dispose of fast food detritus, say, pizza boxes, or kebab wrappers, is to return drenched in sweat.

Climatic conditions of over forty degrees Celsius, coupled with grotesque levels of humidity, does not for a healthy outdoors lifestyle make.

And so people, too many people, spend their days either sitting at their desk, if they're employed, or sitting behind the wheel of their car, or lying about on the sofa eating, one suspects, to alleviate boredom. You don't need to be a doctor to diagnose this state of affairs as unhealthy. Do you?

Dr Maha Taysir Barakat, Consultant Endinocrinologist and Medical and Research Director at the Imperial College London Diabetes Centre, explains: "It isn't just UAE nationals who are susceptible to developing diabetes, but all ethnic groups to varying extents.

One of the earlier studies done on prevalence looked at several thousand people, and it found that expats had a prevalence of diabetes higher in this country than they had in their own country. People may be exercising less here than they would at home. They may be walking less. They may be eating more unhealthy food.

"All we can say, without going to a level of detail for which there is no evidence yet, is that it looks like there is a genetic predisposition whereby the diabetes is bought on by a change of lifestyle involving weight gain and a reduction in exercise."

That sounds like an explanation for what many expats refer to, with a nervous laugh, as the "Dubai stone."

They mean the extra stone, or two, in weight, that seems to magically appear around their waists shortly after disembarkation from the plane that has ferried them to their new life in the UAE.

Dr Barakat says: "We have followed the cases of expats when they come for health checks. You see that their cholesterol level is excellent when they arrive, but within one or two or three years, you can see their cholesterol has risen significantly, primarily because of a lack of exercise and a change in diet. It affects everybody, all categories of earners."

Nathalie Haddad, a dietician and nutritionist at the French Medical Centre in Dubai, agrees: "The majority of clients we see are for problems related to weight and obesity. In Dubai there has been an increase in obesity in both adults and children. A lot of people who move to Dubai see an increase in weight. It is due to the lifestyle, the eating habits, lack of physical activity, ease of access to food, and the wide availability of fast food."

Haddad explains what obesity actually is: "We measure it in Body Mass Index, which is your body weight over height ratio. It is your weight in kilograms divided by your height in metres squared. If the result is 20-25, you are normal. 25-30, you are overweight. 30 to 35, you are obese class one. 35-40, obese class two. And from 40 onwards, you are morbidly obese."

Morbidly obese sounds like a bad thing to be.

Haddad explains that the BMI index is not foolproof. Ten stone weaklings with no muscle will not be found out by it. So medics will look at body fat levels in relation to muscle, too.

One revelation from talking to Dr Barakat that surprised this observer, who has always been highly sceptical of the overweight or adipose who blame their physical condition on their genes rather than their propensity for stuffing their faces with burgers, is that the genes argument might indeed hold some weight.

She says: "Satiety is a very complex physiological state. The state of being full. There are various elements. There is a psychological element. Let's say someone is eating a meal in front of the television, or eating a meal while reading a book, it's known that someone will eat more when they are doing something else at the same time. So there are behavourial components. Because you are distracted. So you don't realise how much you have eaten. But when you eat with other people, there are limits to what you can put on your plate, because it becomes embarrassing."

"There are also hormonal aspects to satiety. Some peoples' hormones just don't make them feel full, when other people around them feel full. There is a whole class of hormones from your intestine, from your bowel, that makes you feel full. Actually, this goes back to your genes. This is where your genes do matter. There are certain genetic make-ups that make these hormones very effective, and there are some genetic make-ups in which the hormone response to a meal is not to make you feel so full."

It is one thing for the adult population of the UAE and the wider Gulf to have a serious problem with obesity and diabetes. They have, afterall, made their own choices.

But it is altogether a more shameful state of affairs for the children of the region to be afflicted by these conditions. Children are not responsible for the choices they make in terms of lifestyle.

Dr. Barakat says: "Type two diabetes is what used to only occur in adulthood, except now we are seeing it also in children. The type two diabetes that is affecting children is related to obesity. The rate of obesity in children is going up worldwide. From the age of five onwards, children should really be eating a healthy diet and exercising regularly. They say below the age of five you shouldn't really be restricting the cholesterol intake of a child."

So why aren't many children in the Gulf being encouraged to eat properly, and to exercise? You need only spend a day at the beach here to see kids beneath the age of ten floundering about in the shallows, huge swathes of fat shifting across their ribs and jowls.

Yet, parents love their children, and want the best for them. So how did it come to this? Surely, the ultimate responsibility for obesity in a child must lie with its parents?

Haddad, who oversees the manufacture of a range of healthy, low calorie foods, explains: "A lot of it can be put down to education about diabetes, perhaps. It is certainly improving now - the government is making big efforts to educate adults and children about it. But there is also the issue of who is looking after the children."

Children here eat a lot more than they might do in other parts of the world, and they are less active. A lot of local children here, they eat a lot of fast food, and have no activity.

Often they are in the care of drivers or housemaids or nannies. And when you are looking at it on that level, often the child is more in control than the house help, or the nanny.

"So, basically, if the child says he or she wants food, the nanny might not have the authority to refuse it. We see this in both male and female children. Often, giving children food is a way of pleasing them."

The best thing about type two, or acquired, diabetes, is that you can lose it, through exercise, through what is commonly referred to as willpower. This, hopefully, is what will happen in the UAE, as the education campaigns kick in. Being fat is no longer a desirable symbol of wealth or social standing. It's a handicap.

Slimmer people have better lives. Let the people of Nauru keep their title. It's an accolade no one wants. Now is the time to embrace self-control; just half an hour of brisk walking five days a week can reduce your chances of developing diabetes by 58 per cent.

Dr. Barakat says: "If someone could take the essence of willpower, and put it in a tablet, that would be a good thing to do."