86 Restaurants in 16 km
Posted by nadeem on February 25, 2008
by Astrid Al-Hadeedi, Lecturer, American University of Kuwait
The World Health Organization lists Kuwait as the 8th fattest country in the world with a 74.2% prevalence of overweight individuals, behind Nauru (94.5%), Federated States of Micronesia (91.1%), Cook Islands (90.9%), Tonga (90.8%), Niue (81.7%), Samoa (80.4%) and Palau (78.4%). This small group of Pacific Island countries has a genetic propensity for larger muscular physiques, and abdominal fatness has long been considered a symbol of wealth and prosperity for Pacific Islanders. Second to this cluster of small Pacific Islands is Kuwait. We are heavier than the Americans and report the highest rate of obesity of all Gulf Arab countries. We have the highest prevalence of hypertension and elevated cholesterol levels in all the Gulf region and we rank 5th for the global prevalence of diabetes behind Nauru, UAE, Saudi Arabia and Bahrain. Small-scale national studies report that only 2 - 5% of our population is physically active despite the fact that International Diabetes Federation tells us that up to 80% of type 2 diabetes is preventable by adopting a healthy diet and increasing physical activity.
Clearly Kuwait has an overweight/obesity/diabetes problem. We also have a high blood pressure and high cholesterol level problem. We have been told this already, many times, and through many different forms of media. Indeed much time, effort and money has been spent on forming committees to supervise subcommittees to form other committees to organize expensive seminars to tell us what we already know - we are eating too much of the wrong foods and we are moving too little.
The situation is now dire and is, incredibly, getting even worse. Obesity prevalence rates, especially in children, continue to increase, not to mention the number of newly diagnosed diabetes cases which are occurring every month. The socio-economic burden of our presently unhealthy choices may not be felt right now but it spells economic disaster for our tiny, but wealthy, state. This burden is not just in health care costs but also in terms of disability, unnecessary human suffering and impaired quality of life. Until we direct some effort at treating ‘the causes of the causes’ (why we are eating too much, moving too little and what we must do to reverse this), the situation can only be expected to get worse and the socio-economic consequences will be nothing short of catastrophic.
Kuwaitis of today are getting fatter and sicker simply by living in the Kuwait of today. Our environment can best be described as an ‘obesogenic’ environment, i.e. one that encourages obesity rather than healthy eating and active lifestyles. To highlight just how ‘obeseogenic’ our environment is becoming on January 12, 2008, 9 young, predominantly Kuwaiti people took on the challenge of walking the entire length (21 kms) of the Arabian Gulf Road, counting the total number of eateries and restaurants versus the total number of advertisements promoting physical activity on our way. We counted only eateries on the sea side of the Gulf Road so to a greater extent our figures dilute the truth by half.
The results are both startling and staggering. Beginning at the Scientific Center and continuing as far as the fish market at Souk Sharq (a 16 km stretch) there are a total of 86 eateries, plus an additional 4 under construction near the Kuwait Towers. This works out at 1 eatery every 186 meters. And this excludes the restaurants on the other side of the road. There are 17 eateries at Marina Crescent, 29 at Souk Sharq and another 36 between both malls. There are no restaurants, as yet, on the 4 km sea side of the Gulf Road between the Amiri Diwan and the KPC buildings in Shuwaikh.
One sign (20 x 30 cm), promoting walking, was seen on the side of a seemingly unused Kuwait Heart Association mobile promotion bus which is semi-permanently parked near the Kuwait Towers. The bus does not look as if it has been used for months despite having been designed to be a mobile information facility. Quite amazingly for a country that ranks so high for the prevalence of overweight/obesity, not one single government ad was seen promoting walking, jogging, swimming or indeed any other form of physical activity. Our health-care budget is the 3rd largest budget in the state and expenditure is directed primarily at treating diseases and illnesses associated with an unhealthy lifestyle. Perhaps there is a budget for health promotion, but until now health promotion efforts to encourage people to be more active are neither prominent or visible, nor effective. Providing each residential area with a 2 km straight, boring, black, asphalt strip to walk on is just not enough. Much more needs to be done to educate and motivate people to adopt healthy eating habits and engage in more physical activity.
This tiny initiative of counting restaurants is part of a very much bigger project which I would like to initiate. In December of 2007, I submitted a researched proposal to the Diwan Al-Amiri for a population-based physical activity campaign for Kuwait. I am seeking both funding and support from our leadership for this one-year long campaign which includes an additional 5 year plan. The campaign would be fresh, innovative, engaging, fun and motivating to different target audiences of the Kuwait population.
The primary aim of the campaign is to promote physical activity and remove the barriers to physical activity. It is NOT just a campaign to get just a few already-active people doing more - but rather aims to get huge numbers of the overall population doing a little. This would be a long term economic investment for Kuwait and the people of Kuwait, not just by reducing the health-care costs associated with treating diseases associated with physical inactivity, but also in terms of increased efficiency and productivity of our own nationals.
As an allied health care professional myself, and lecturer in Health and Wellness at the American University of Kuwait, I remain quite shocked at the reportedly low levels of physical activity amongst our Kuwaiti population. I believe the situation is even worse for women between 30 and 59 years of age. This is the sector of the population where obesity rates for this country are highest. It is the women of Kuwait who set the tone and culture in the home. If the mothers of Kuwait are overweight and inactive, why then are we surprised to note that childhood obesity in Kuwaiti children is burgeoning? For this campaign to be successful, it must be targeted at many different segments of the population.
AIMS OF POPULATION-BASED PHYSICAL ACTIVITY CAMPAIGN FOR KUWAIT
PROMOTE ‘30 MINUTES PER DAY’ OF PHYSICAL ACTIVITY FOR EVERYONE.
To encourage everyone, irrespective of their age, to take a minimum of 30 minutes of moderate intensity (walking briskly) exercise per day. This is the recommendation of the WHO, the American Heart Association, the International Task Force on Obesity, the International Diabetes Federation and the American College of Sports Medicine to mention but a few of the more internationally recognized health research and promotion organizations. Walking for 30 minutes per day is equal to expending 500 - 1,000 calories per week and can decrease overall health risk by 22%, whilst walking for one hour a day expends between 2,000 and 3,000 calories per week and can reduce overall health risk by 38 - 54%. Taking less than 30 minutes of physical activity per day is a major risk factor for the development of cardiovascular diseases, stroke, hypertension, diabetes, obesity, some cancers and depression. Physical activity should not be confused with exercise which many associate with something intense, difficult, and competitive and only appealing to younger, more athletic individuals.
REMOVE THE BARRIERS TO PHYSICAL ACTIVITY.
Scientific research highlights the fact that current levels of physical activity in any country are a reflection of personal attitudes about time use and of cultural and societal values. Given the extraordinarily high prevalence rate of obesity and diabetes directly related to physical inactivity it is considered prudent to try to create an appropriate cultural shift in thinking. Physical activity needs to be viewed as normal, desirable and a positive, selfcare choice. In addition to altering people’s perceptions of physical activity (especially for women), there needs to be a massive drive to create more pleasant, free and varied facilities for all Kuwait’s population to enjoy.
CORRECT THE MISCONCEPTION THAT ‘BEING HEALTHY IS BEING SLIM’.
Most Kuwaitis associate health with body size, which is incorrect. Review of peer research tells us that it is healthier to be a little overweight but fit, than to be slim and unfit. Similarly, there is a deeply ingrained concept that physical activity is ‘exercise’ and exercise means going to the gym.
CREATE AWARENESS THAT REDUCING WEIGHT AND MAINTAINING A HEALTHY WEIGHT INVOLVES EATING LESS CALORIE DENSE FOOD AND CONTROLLING THE SIZE OF PORTIONS TOGETHER WITH BALANCING THE AMOUNT OF FOOD YOU EAT WITH AN ADEQUATE AMOUNT OF PHYSICAL ACTIVITY.
When large numbers of the population understand that the 300 calories in a jam and custard donut is equal to about one hour of walking at a moderate pace they may be less inclined to eat a second one. Similarly, a fast food meal of a double cheeseburger, extra large fries and a 24 oz. soft drink is equal to running 2.5 miles at a ten min./mile pace (1,500 calories). The campaign will have an enormous educational component utilizing all mass media communication tools.
CREATE A DEMAND FOR FOOD LABELING
As education and public awareness about the disease preventative benefits of healthy eating and physical activity increase, it is hoped that a health promoting culture, where Kuwaitis themselves will create a demand for accurate and honest food labeling from the major fast food companies, will emerge. Food labeling alone does not greatly influence consumer choice. However, food labeling has been proven to be more successful in promoting healthy consumer choices when it is combined with such information as how much walking, biking, dancing etc. we need to do to work off that scoop of ice-cream, that sandwich or that pastry.
It is my strongest hope that this campaign will receive the necessary support and funding. The anticipated costs of running such an intense and highly visible campaign now will be redeemed 100 times over in the coming 5 to 20 years. It has taken 30 years to create this obesity/diabetes epidemic. It will not be reversed overnight. Economically, we really cannot afford to ignore the impending health catastrophe at our door.
To promote public interest in this initiative I propose a once a month mini marathon of 21 km over one year plus a 42 km full marathon as the last walk. This will be followed by a big event to celebrate physical activity. The purpose of this walk is to create awareness that walking and physical activity are entirely normal, desirable lifestyle choices whilst inactivity is undesirable, irresponsible and a socio-economic burden to one’s country.
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