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 Table of Contents  
REVIEW ARTICLE
Year : 2017  |  Volume : 5  |  Issue : 2  |  Page : 57-65

The prevalence and risk factors of obesity in the United Arab Emirates


1 Statistics and Research Centre, Ministry of Health and Prevention, King Saud Bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
2 Statistics and Research Centre, Ministry of Health and Prevention; College of Public Health and Health Informatics, King Saud Bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
3 Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, UAE

Date of Web Publication29-Dec-2017

Correspondence Address:
Ahmad Qawas
Statistics and Research Centre, Ministry of Health and Prevention, King Saud Bin Abdul Aziz University for Health Sciences, Riyadh
Saudi Arabia
Hira Abdul Razzak
Statistics and Research Centre, Ministry of Health and Prevention, Sheikh Muhammed Bin Zayed Road, Muhaisna Area 2 1853
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/sjo.sjo_9_17

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  Abstract 


Obesity is a global epidemic, preventable, and a disease of clinical and public health significance. It has emerged as a major risk factor for the development of disability, several other noncommunicable diseases, and premature death. This review summarized epidemiological studies related to the obesity prevalence and identified its potential risk factors among the Arab population in the United Arab Emirates (UAE). PubMed, Scopus, ScienceDirect database, and other local journals were searched to identify relevant literature by means of appropriate keywords to retrieve studies conducted in the UAE. Search limits were restricted to studies in English language, between 2007 and 2016, and on the UAE population (both citizens and expatriates). The search yielded 15 studies regarding the prevalence and risk factors of obesity, including cross-sectional studies (n = 11), a population-based survey (n = 1), a retrospective cohort study (n = 1), and qualitative focus group surveys (n = 2). Cross-sectional studies found that the prevalence of obesity ranged between 16 and 28.4%, with a higher proportion of adult females being more obese than males in UAE. This increasing obesity prevalence places a large burden on healthcare costs and usage. Furthermore, some potentially essential risk factors were identified, which would help to guide future research strategies. This review signifies a promptly increasing obesity prevalence in the UAE and suggests that extra effort is needed for preventive and curative strategies to reduce the burden of this common condition.

Keywords: Anthropometric measurements, diet, obesity, overweight, physical activity, UAE


How to cite this article:
Razzak HA, El-Metwally A, Harbi A, Al-Shujairi A, Qawas A. The prevalence and risk factors of obesity in the United Arab Emirates. Saudi J Obesity 2017;5:57-65

How to cite this URL:
Razzak HA, El-Metwally A, Harbi A, Al-Shujairi A, Qawas A. The prevalence and risk factors of obesity in the United Arab Emirates. Saudi J Obesity [serial online] 2017 [cited 2018 Sep 20];5:57-65. Available from: http://www.saudijobesity.com/text.asp?2017/5/2/57/221994




  Introduction Top


Obesity is a widespread and foremost public health issue worldwide, having economical, psychosocial, and medical health (cancer, respiratory and digestive disorders, cerebrovascular disease, cardiovascular diseases, and type 2 diabetes mellitus) consequences.[1] It is a principal independent risk factor for dyslipidemia development, type 2 diabetes, and hypertension.[2] Over the last few decades, obesity prevalence is increasing rapidly and globally.[3] Overweight or obesity is defined physiologically as fat accumulation in an excessive or abnormal pattern in the adipose tissues, which may lead to serious healthcare concerns.[4] The body mass index (BMI) is one of the most practical and prevalent indicators for the obesity and overweight evaluation among adults.[5] In the year 2014, more than 1.9 billion adults, aged 18 years or older, were overweight. Of these, more than 600 million were obese.[6] A “case–control study” conducted in 52 countries showed that adult men in the Middle East have the second highest mean BMI (27.4), with the USA (27.7) in the first place.[7]

The World Health Survey undertaken in United Arab Emirates (UAE) in 2010 revealed that 37.2% of the Emiratis were obese.[8] The highest percentages of overweight respondents were living in Dubai (52.6%), while the highest percentages of obesity were observed in Sharjah (47.1%). Around 88% of the Emirati respondents in Dubai were overweight or obese compared to 64.5% Emirati counterparts in Abu Dhabi. Non-Emiratis had slightly lower levels of overweight and obese population, with 26.3% in the obese category.[9] Over the past few years, UAE has gone through a rapid and profound transition socioeconomically, which leads to fundamental variations in the patterns of physical activity, as well as dietary habits, over and above the variations in the population’s lifestyle.[10] Obesity is considerably preventable through the implementation of continued evidence-based and population-based policies that create awareness about the healthier dietary choices and the need for physical activity.[6] However, getting a better understanding of the issue in terms of epidemiology, prevalence, and risk factors was considered the basis for designing, implementing, and monitoring effective prevention strategies for obesity.

The rationale for undertaking this review is to offer a comprehensive understanding of the situation of obesity in UAE and to highlight current gaps in existing knowledge to notify future research. The alarming obesity levels and its deleterious consequence on health in the UAE population led us to perform this systematic review, mainly for the purpose of evaluating the present state of epidemiological investigations concerning obesity in UAE. Studies conducted in the past have reviewed the prevalence rates of obesity together with the causes among the Arabic-speaking population,[11] Gulf regions,[12],[13] Eastern Mediterranean[14],[15] in addition to the Middle East.[16] However, none of these studies exclusively focused on the UAE. This review aims to conduct a comprehensive search together with enclosure of epidemiological studies concerning obesity in UAE for evaluating the research findings and methodology. Previous studies reporting risk factors and trends in addition to the prevalence of obesity in UAE are drawn from the scientific databases.


  Materials and methods Top


PubMed, Scopus, and ScienceDirect database were searched for articles by using a combination of keywords and Medical Subject Headings including “UAE” and “obesity.” Obesity was defined as a BMI ≥30. Other key terms included were “over-weight,” “anthropometric measurements,” “diet,” “activity,” “Dubai,” “Abu Dhabi,” “Al-Ain,” “Ajman,” “Fujairah,” “Dubai,” “Sharjah,” “Ras al-Khaimah,” and “Umm al-Quwain.” Furthermore, cross-reference lists were also screened to ensure a thorough literature search.

Selection criteria

Our search was restricted to articles in the English language, those that were peer-reviewed, concerned with the disease of interest (such as obesity), having a geographically relevant location (mainly the emirates of UAE), and with a year of publication between 2007 and 2016. Initially, publications were chosen based on the abstract review and title, taking into account those studies on obesity epidemiology; however, studies not related to the subject were excluded. A full-text review was also conducted and mainly excluded self-reported studies instead of studies with overlapping and redundant data. In addition, studies with measured height and weight were also excluded. From the overlap studies, the articles reporting the most detailed findings were included.

Data extraction

Overall, 107 records were identified, 55 of which remained after duplicates were removed. Abstracts and titles were reviewed for scanning to exclude nonrelevant articles; 25 and 15 articles were excluded further at this stage, because they did not meet the inclusion criteria. These were excluded because of their incompatibility with the topic, insufficient data, they being secondary review papers, articles being not up to date or being in languages other than English, or covering a different population, that is, studies not conducted in UAE. Fifteen full-text articles were then retrieved for careful assessment and thorough review. Two researchers independently extracted the data from the studies. Any disagreements raised were resolved as well as noted by consensus among other researchers. Different information was obtained for each study including author’s name, year, source, methods, eligibility, and study outcomes. This review was performed based on the Preferred Reporting Items for Systematic Review and Meta-analyes (PRISMA) guidelines. The flow chart for article selection and identification is shown below in [Figure 1].
Figure 1: Schematic representation of the studies selected for the systematic review of literature

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  Results Top


Following a literature search to identify epidemiological studies that had been conducted in the UAE with regard to its risk factors and prevalence, only 15 studies were included based on the hierarchy of evidence related to the strength of the literature, which included cross-sectional studies (n = 11), a population-based study (n = 1), a retrospective cohort study (n = 1), and qualitative focus group surveys (n = 2). Out of the 15 studies eligible for inclusion, six reported estimates on obesity prevalence[8],[17],[18],[19],[20],[21] and nine reported estimates on the risk factors of obesity.[19],[20],[21],[22],[23],[24],[25],[26],[27]

Prevalence of obesity

Two of the prevalence studies[17],[18] were multicenter studies, one was conducted in seven emirates, and the others were performed in five Arab countries including UAE. Two studies were conducted in Abu Dhabi,[20],[21] one study in Dubai,[19] and another study in Ras Al Khaima.[8] Of the six studies reporting on the obesity prevalence, five were cross-sectional studies[17],[18],[19],[20],[21] and one was a population-based survey[8] [Table 1]. Sheikh-Ismail et al.[17] demonstrated the prevalence of obesity along with overweight in the seven emirates of UAE to be 27 and 16%, respectively. Adult females were prone to be more obese in UAE than the male counterparts. Mahboub et al.[19] revealed the rate of obesity prevalence to be 20.9%; 19.5% females and 2.9% males were known to be at a higher risk for obstructive sleep apnea syndrome (OSAS). On the contrary, Al Junaibi et al.[20] demonstrated the crude prevalence to be 18.9% for obesity, 14.7% for overweight, and 7.6% for underweight. Advancing age was positively associated with an increasing prevalence of obesity. Conversely, Musaiger et al.[18] observed no trends for obesity and overweight with respect to age. Papandreou et al.[21] showed overweight and obesity prevalence as 28.4% (n = 69).
Table 1: Published papers on the prevalence of obesity in UAE in 2007–2016

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The rate of prevalence has gradually increased in the past few years and was higher significantly in older adults and women, showing that these groups are specifically vulnerable. As a result of difference in the age groups, the procedures of sampling, and the year of data collection, not all findings were comparable directly. Yet, the cautious extraction of important information permits to recognize the features that might contribute to variations in the results and compare studies mainly similar to each other. Moreover, the exhaustive search of literature and an extensive range of inclusion criteria offered a precise understanding of the recent epidemiological state of obesity in UAE.

Risk factors of obesity

One multicenter risk factor study conducted in two emirates of UAE,[22] four studies in Abu Dhabi,[20],[21],[25],[26] one study in Dubai,[19] two in Al Ain,[23],[27] and another study in Ajman[24] were included as risk factor studies. Of the nine studies reporting on obesity prevalence, six were cross-sectional studies,[19],[20],[21] one was retrospective,[25] and two were qualitative studies[22],[23] [Table 2].
Table 2: Published papers on the risk factors of obesity in UAE in 2007–2016

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A manifold of risk factors, for example, sociocultural influences were examined in the reviewed studies; nonetheless, factors were assessed crudely.[23] The risk factors that were associated with obesity in these studies included dietary, lifestyle, sociocultural, socioeconomic, sociodemographic, in addition to hereditary factors. The direction of association and specific factors examined, summarized, and categorized for all studies are listed in [Table 2]. Among the health magnitudes associated and examined with obesity were included health conditions such as biochemical and physiologic outcomes [glucose measures, blood lipids, respiratory, and blood pressure (BP)], osteoarthritis, hypertension, and diabetes.[24],[25],[27]

Ali et al.[22] explored the barriers as well as facilitators for managing weight along with the perspectives of the Arab women at risk for diabetes mellitus. Several different system of health care relates to the social, physical and personal barriers toward managing weight. Participant’s suggestions such as provision of important resources, support policies related to lifestyle alterations, and health awareness programs facilitated in the management of weight among local females. Culturally acceptable programs and peer support were recommended; these offered a holistic strategy to manage and prevent obesity.

On the other hand, Ali et al.[23] explored the facilitators and barriers for managing weight together with the outlooks of the Arab women at risk for diabetes mellitus. Social supporting strategies, for example, inviting other female friends to walk may help in staying active physically. Sociocultural norms, limited culturally sensitive exercise facilities, competing demands, limited social support, low motivation, and restricted outdoor physical activities were considered to be the primary barriers cited by the respondents. Useful information was offered for forming culturally congruent healthy weight promotion programs for females with type 2 diabetes, or who were at risk. This has implications mainly for the obese females in the intervention programs in several other “Arabian Gulf Countries.” Culturally acceptable and peer support programs are recommended, which offer a holistic approach to the management and prevention of obesity.


  Discussion Top


This paper summarizes and reviews the epidemiological studies conducted in the UAE in relation to its risk factors and prevalence between 2007 and 2016. Approximately, 15 studies were extracted and selected based on the criteria specified. The data were thoroughly categorized with an intention of easing the comparison of a study. Through this study, we were able to identify the gaps in knowledge and make recommendation for research directions in the future. The present review is based on 11 cross-sectional studies, one population-based study, one retrospective cohort study, and two qualitative focus group surveys.

Only two studies were performed over a decade to estimate the obesity prevalence among adults, and none of them were conducted at the national level. In a study among adult females, the prevalence of obesity and overweight were about 16 and 27%, with the age group between “30 and <60 years” having a higher prevalence of obesity (24%) and overweight (33%).[17] Another study was undertaken in Abu Dhabi to measure the levels of obesity in a “college population,” which was found to be 28.4%.[21]

The review found three studies conducted on child obesity, and all revealed the burden of child obesity in UAE. A multicenter survey in among “secondary school students” from five Arab countries (including Palestine, Libya, Kuwait, Syria, and UAE) revealed that although obesity is high among the five countries, the highest prevalence was not reported in UAE (in Kuwait).[18] Another study conducted in Abu Dhabi revealed that the crude prevalence rates were 14.7% for overweight, 7.6% for underweight, and 18.9% for obesity. Hence, obesity rates significantly increased with age.[20] In Ras Al Khaima, a population-based study conducted among the students of government schools indicated that extreme obesity rate was “9.6-fold higher” in boys as compared to girls (0.58% vs. 0.06%). From 15–18 years, 10.3% of the boys were exceptionally obese, while 3.0% of the girls were also obese.[8]

Two studies were conducted to investigate the relationship of “obesity” and “OSAS”. A study conducted in a healthcare setting in Dubai revealed that the prevalence of OSAS was very high, and 70% of those in the high-risk group had a BMI ≥30 kg/m.[22] Another retrospective study in Abu Dhabi indicated that 16.8% of OSAS filled diagnostic criteria for obesity hypoventilation syndrome.[25] Another study performed on obese/overweight Emirati women attending nutrition counseling at the clinics suggested that oxidative stress and the levels of inflammatory markers were prevalent in higher levels among obese/overweight Emirati women, other than predisposing them to cumulative cardiovascular risks at a comparatively young age.[27]

A qualitative in-depth individual interview study was undertaken in two emirates in 29 primary healthcare nurses, dieticians, and physicians identified various barriers toward the control of obesity in UAE along with suggesting provision of the essential resources, policies supporting lifestyle alterations, other than health awareness programs.[22] Another qualitative study among 75 Emirati women suggested that sociocultural norms, limited culturally sensitive exercise facilities, competing demands, a lack of social support, and low motivation that restricts the outdoor physical activities were the primary barriers cited by the respondents.[23] In Abu Dhabi, a cross-sectional survey on the perceptions of parents suggested that the true BMI of children, sex, and household income were the main predictors of precise parental perception. This will be valuable in the formulation of the health awareness messages during obesity management and prevention.[26]

One study aimed to study the indicators to measure obesity and specified that waist circumference is considered the best anthropometric indicator that is known to predict the risk of hypertension among youth in the UAE.[24] Another study in Abu Dhabi indicated and measured the relationship of anthropogenic measures to obesity levels in a college population and found that neck and waist circumstances are independently associated with obesity.[21] Gathered evidence revealed that the problem of obesity is in line with the findings from the global reports conducted by World Health Organization (WHO). The Global Report of Non-Communicable Diseases, 2014 revealed that the proportion of obesity among adults was 32.7%, with a higher proportion in females (39.9%) than males (30.0%).[28]

The findings from the existing evidence on the obesity provided us with a risk factor overview that may be a significant contributor for obesity in UAE. For instance, the studies were based on the factors established such as smoking, diet, physical activity, income status, occupation, education, gender, and age together with bringing our attention to the significance of “sociocultural variables.” The genetic susceptibility and its role recognized in this study, however, were crudely examined as the “family history” of obesity. Majority of the studies were cross-sectional studies[19],[20],[21] that were susceptible to reverse causation bias. In addition to the above factors, future studies might consider enquiries about lately emerging obesity factors, for instance, developmental origins, sleep deprivation, and gene–environment interactions.[29] The risk factors identified by the reviewed studies were of essential practical value for intervention programs related to obesity. The reported risk factors were also set by supplementary cohort studies.[30],[31] There were some limitations arising from the review. For example, Arabic papers were not included; although the majority of papers are written in English, findings from cross-sectional studies do not inevitably indicate causality, and there was a possibility of publication bias. Nevertheless, we made an attempt to minimize the bias by searching local and governmental reports. Likewise, the full text of the relevant articles was also requested.

This review can be a very valuable resource document for public health professionals and researches concerned with obesity prevention and control, to better understand the situation and priorities needed for further research. Despite no studies having been conducted at the national level, this review has included a thoughtful number of studies from countless geographical regions of UAE. Local journals were reviewed to include all the studies related to the UAE. Cross-referencing of all included evidence was undertaken by the researcher, so that it can be recalled efficiently for examination and sorting over the course of this study.


  Conclusion Top


Obesity has become a global healthcare issue and is no longer limited to countries developed industrially. The adoption of western lifestyle such as consuming attractive energy-dense food with adverse composition, reduced dietary fiber consumption, enhanced sugars and animal fats intake, along with limited physical activity often results in increasing obesity prevalence. On the basis of the results of previous studies, obesity and overweight prevalence is significantly high among the UAE population. Although national figures were not available, the current review obviously revealed key areas that need further research and intervention for both adults and children. Healthy lifestyle promotion from early life is a national priority. To be successful, such actions should consider economic, cultural, and social influences with an intention of cultivating lifelong healthy habits from childhood. Interestingly, this review documented the results of some important studies that will be helpful in the course of framing future public health programs. Bearing in mind the fact that several life-threatening complications ensue obesity/overweight, it is imperative to have nationally organized preventive and educational programs. In future, longitudinal studies are needed and recommended to inspect the impact and trends of obesity and other nutrition-related noncommunicable diseases.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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