In December last year, Egypt’s President Abdel Fattah el-Sisi went on a 20-minute televised rant complaining about the country’s rising pandemic of obesity. In his second tirade against obesity in as many months, el-Sisi interrupted health minister Hala Zayed as she presented new numbers on the weight of Egyptians. “Why are we doing this to ourselves”, he asked and preached that Egyptians should exercise more and suggested overnight people should be banned from TV. Although a flood of jokes were spilled on social media and el-Sisi was slammed for taking an elitist approach to the problem and not offering concrete plans to combat obesity, no-one can dispute that Egypt has a serious and dangerous weight problem. According to a study published in the New England Journal of Medicine in 2017, over a third (35.5 percent) of adults in Egypt are obese - the highest rate in the world.
As well as 19 million obese adults out of Egypt’s 98 million population, the global study by the University of Washington’s Institute for Health Metrics and Evaluation also found that 10.2 percent of Egyptian children are obese, around 3.6 million.
Ali H. Mokdad, Professor of Health Metric Sciences at the University of Washington and one of the co-authors of the study which spans 195 countries and territories from 1980 through 2015, told Majalla that the rapid rise in obesity in Egypt is mainly due to a change in behaviours which is having the biggest impact on the poor.
“Egyptians simply are exercising less and eating more. Egypt has less physical activity and more caloric intake, this is resulting in a rapid rise in weight and obesity. Unfortunately, the epidemic is affecting poor and less educated people more”, he said.
Historically, Egyptians ate a Mediterranean-style diet, a combination of fresh vegetables, fruit and some protein, which correlates to low levels of heart disease and diabetes. However, there have been fundamental shifts in the country’s eating habits, associated with changes in working patterns and the high cost of food, compounded by Egypt’s subsidy program. While in some Western countries, ingredients linked to obesity - like hydrogenated oils, trans fats and sugar - are often taxed or restricted, in Egypt many of these calorific and low-nutritional value staples are actually subsidised by the government. 80 percent of the country have access to these subsidies, meanwhile, the economic crisis is increasing the prices of nutritious fruits and vegetables, forcing Egyptians - 30% of which live in poverty - to turn to rice, bread, pasta and other high carbohydrate and sugar-heavy foods to silence their hunger. And when it comes to fast food, there’s something for every budget -from American fast food chains marketed to the upper class, to local alternatives offering the same high-fat foods at a fraction of the price - lining the streets of Egypt’s cities. People who are uneducated on the effects of this food and aren’t financially stable tend to be the ones investing in fast food, and other unhealthy products.
A man walks with his bread bought from Magra El-Oyoun market in Cairo, Egypt (Getty)
Diet struggles are coupled with few opportunities for exercise. Although Egyptians are known for their enduring passion for football, a lack of public parks, spaces or bike lanes, let alone sports facilities, mean Egyptians spend hours watching sport rather than actually playing. There has however been a rise in the number sporting clubs in Egypt, but with membership fees reaching 1,000,000 EGP, these elite clubs are not accessible to the vast majority of Egyptians. Public schools also don’t pay enough attention to physical education, especially for young women.
There is also a phenomenon of cooking shows in Egyptian media and channels that are aired 24 hours a day. There is evidence to suggest that people who watch cooking shows are more likely to become obese compared to others. In Egypt, there are also no restrictions on food and beverage advertisements.
While it is well-documented that socioeconomic status is robustly associated with obesity, the underpinning psychological mechanisms remain unclear. But research by the European Association for the Study of Obesity found that socioeconomic disadvantage increases psychological distress, this, in turn, promotes maladaptive coping behaviours, such as emotional eating, and ultimately obesity. Egypt has gone through a period of political and security instability, and consistently high rates of inflation. Studies have also found that Cairo ranks as one of the most stressful, noisiest, as well as the most polluted cities in the world, creating a stressful living environment for most the 20 million people living in the over-crowded city.
With so many people eating badly, Egyptians suffer from a range of health issues. “Obesity is a major risk factor for morbidity and mortality. There is a rising epidemic of diabetes and chronic kidney diseases in Egypt. There is a rise in non-communicable disease. Obesity will result in poor health for Egypt and an increase in financial demand on medical resources,” Professor Mokdad said.
In addition to topping the obesity poll, Egypt also has one of the world’s highest rates of diabetes, with nearly 16 percent of working-age adults diagnosed with the disease and 86,500 dying from it every year, according to a 2014 study.
Childhood obesity also leads to many health risks. According to UNICEF, the double burden of malnutrition (DBM) among children is a major challenge in Egypt, especially for overweight/obesity and stunting. DBM is characterised by the coexistence of undernutrition along with overweight, obesity or diet-related deficiencies within individuals. Children who are overweight are more susceptible to non-communicable diseases such as diabetes and coronary heart disease and micronutrient deficiencies due to a poor diet.
The obesity crisis in Egypt is not just a health risk but also an economic threat as it not only costs millions of people their health but also carries significant costs to the economy. The global economic impact is roughly $2 trillion annually, or 2.8 percent of global GDP—nearly equivalent to the global impact of smoking or of armed violence, war, and terrorism. In particular, weight and obesity treatments increase the cost of healthcare and mounts pressure on the system. While medical care in Egypt has gradually improved over the past 30 years, an expanding and ageing population coupled with deficiencies in the existing public healthcare system already presents enormous challenges. Indirect costs include the economic impact of work absences, lost wages, and reduced productivity of patients and caregivers.
The scale of Egypt’s obesity problem means that no single solution creates sufficient impact to reverse obesity: only a comprehensive, systemic program of multiple interventions is likely to be effective. Professor Mokdad says that capturing the full potential impact requires engagement from as many sectors as possible.
“The solution has to be multi-approach. Many have to be involved in order to maintain weight and gradually lose weight from the ministry of health to other government agencies, schools, workplace, city planning, parents (have to be a role model for children), policies to support a healthy diet, etc,” he explained.
While education and personal responsibility are critical elements of any program to reduce obesity, they are not enough on their own. Professor Mokdad suggests that additional interventions need to be in the mix that rely less on conscious choices by individuals and individual responsibility and more on changes to the environment and societal norms. These interventions make healthy behaviour easier and more normal, thereby relying less on individual willpower.
“Basically, if an Egyptian tomorrow decides to live healthy by eating a balanced diet and be physically active, the environment and system have to be in place to support such activities,” said Professor Mokdad.
Getting the obesity and overweight epidemic under control will take more than just telling everyone to go on a diet, it needs to be regarded as a public health issue and not as a personal failing. Like with all major global health problems, such as pollution or malaria, obesity will not disappear with one simple solution, one person, or one policy. A challenge of this magnitude requires an ambitious, holistic, broad, and multipronged approach.