It is a common scene repeated in air-conditioned homes across the Emirates. While the temperature outside reaches 40 plus degrees, mothers have little option but to keep their toddlers amused in front of the digital baby-sitter, the television.
As in many communities around the world, watching TV is the main leisure activity in the Gulf; and while it appears harmless enough, new research shows that even at a very young age, exposing children to too much television can make them fat in later life.
In a recently published study in the International Journal of Behavioural Nutrition and Physical Activity which investigated the effects of sedentary lifestyles on toddlers, scientists at the University of Montreal, in Canada, found that waistlines of ten-year-olds who had watched 18 hours a week at the age of four were 7.6mm bigger than those of children who had watched the average amount of 14.8 hours.
The distance children could jump was also reduced by a third of a centimetre for each extra hour of TV they had watched per week at the age of two.
The report concluded that the impact of watching too much television on young children was much more profound than simply encouraging them to be inactive. It also affected their attitudes to food and their attitudes to exercise in later life.
Researcher Dr Linda Pagani said: “The bottom line is that watching too much television is not good. It not only displaces other forms of educational and active leisurely pursuits but also places children at risk of learning inaccurate information about proper eating.”
Her fellow researcher, Dr Caroline Fitzpatrick added: “The pursuit of sports by children depends in part on their perceived athletic competence. Behavioural dispositions can become entrenched during childhood as it is a critical period for the development of habits and preferred activities.”
Another recent study revealed that inactivity now kills as many people globally as smoking. In July, medical journal The Lancet published the headline-grabbing Harvard University research that estimated 57 million lives are lost each year because of a lack of exercise. One in ten people on the planet die because they simply do not move enough.
Taken together, the two studies begin to show that the sedentary lifestyle we unwittingly instil in our children by feeding them television and junk food at an early age, leads them waddling to an early grave in later life.
Worryingly, medical professionals are seeing obesity indicators in younger and younger patients. Only a few years ago, type 2 diabetes did not affect young people in the UAE; today the condition is seen routinely in children. That’s because more than 30 per cent of children here are now overweight or obese – and, like little fat-grenades, these children are primed to explode in later life in a shower of health problems. A 2005 national study into childhood obesity published in the Annuls of Human Biology concluded: “The frequency of obesity among UAE youth is two to three times greater than the recently published international standard. Profound public health implications of childhood obesity for UAE children and young adults are seriously increased because of adult chronic disease processes.”
Last year delegates at the Childhood and Adolescent Obesity: A Whole System, Strategic Approach conference in Abu Dhabi heard that obesity in the Gulf has reached epidemic proportions with levels being doubled in the last 30 years. That first generation of obese child Emiratis is now reaching adulthood and so it is no surprise that heart diseases, often caused by overweight and obesity, are now the number one killer in the UAE.
“There are 750 people dying every year from cardiovascular diseases in Abu Dhabi, meaning that 38 per cent of all deaths among young adults here come from heart problems. It has become the biggest cause of death and there is a 35 per cent increase in the number of cardiovascular diseases predicted by 2020,” said Dr Jennifer Moore, section head of Family and School Health at Abu Dhabi Health Authority.
The future implications of an obese generation are massive. Children who become overweight and obese have a limited ability to understand the long term consequences of their behaviours and have less opportunity to influence what they eat. On the whole their parents and guardians make food and lifestyle choices for them. And like sponges, they absorb these choices and carry them into later life where they become prone to develop the range of health problems which include glucose intolerance, hypertension, coronary heart disease, certain cancers, respiratory disease and diabetes.
So why are children becoming larger? There is no single factor to blame. Childhood obesity begins mainly with the parents and is also fed by a complex set of cultural and environmental factors which include lack of opportunities for physical exercise, changing diet and weather restrictions.
A 2005 report by Abduelmula R Abduelkarem, of Ajman University of Science and Technology, titled Childhood obesity and type 2 diabetes: a growing public health challenge in UAE, investigated many of these factors. In addition to diet and lack of exercise it also identified the relatively high percentage of consanguine relationships, the elevated genetic risk for diabetes compared to many other populations in the world and the widespread use of traditional clothing as causes.
The reports stated: “Traditional dress in the Gulf region is signalled as a contributing factor in the stark rise in the number of people with obesity. Men and women (or indeed boys and girls) who regularly wear jeans or trousers are able to perceive their own weight gain as their clothing becomes tight and uncomfortable. But an expanding waistline easily goes unnoticed in a loose-fitting voluminous robe, such as a ‘dish-dash’. This serves to compound the negative effects of the widespread use of television and computers.”
In addition to these environmental causes, there are also deeper psychological and behavioural reasons why children get fat.
Stephanie Davies is a behavioural psychologist who lectures at the University of Chester on the behaviour modification in weight management programme, which has been attended by many Dubai-based health professionals.
She explains: “It is about education. Primarily adults will pass on ingrained behaviours to their children. But if we go deeper than that my studies have shown that increasingly in Westernised society we have become emotionally disassociated from the food we eat. This is for a number of reasons, one of the biggest being convenience culture. It doesn’t even have to mean fast food and unhealthy food. Even healthy options are pre-packaged now. Our understanding of food is that it is convenient and pre-packaged which, on a psychological level means we don’t think about what we eat. We don’t experience it. We don’t take pride in it or in many cases understand where it comes from. We have no connection to it. Convenience also breeds greed. If you produce you own food, it takes time and there is a limit to the amount you can grow or prepare. But with convenience foods, everything is geared towards instant gratification and marketed towards buying extra.”
Awareness is widely regarded as the first step to reducing obesity rates and there are several proactive schemes across the UAE in operation to try and arrest the rise. Earlier this year the Shaikh Saud Bin Saqr Al Qasimi Foundation for Policy Research produced a paper using a study carried out in Ras Al Khaimah to suggest solutions.
It surveyed 162 students, 41 parents and 15 teachers in six different schools in the emirate to ascertain attitudes towards obesity. Not surprisingly it identified lack of physical activities in schools as one of the main contributing factors in rising childhood obesity levels and also highlighted changing diets.
It also uncovered a worrying gap in awareness of the problem between adults and children.
The report states: “More than 60 per cent of parents and teachers perceived obesity to be a problem in their schools while less than 40 per cent of children viewed it as an issue. Interestingly more than 52 per cent of parents indicated their families had an issue of obesity while only 28 per cent of children saw it as a problem.”
While the lack of awareness in students is an obvious cause for concern, the positive message from the survey was that parents, who to a large degree have the ability to control their offspring’s lifestyle choices, were aware that there was an issue which needed addressing.
Teachers questioned highlighted lack of physical activity in schools as one solution and some participants suggested tighter controls on the types of foods available in school canteens.
The report drew up several recommendations. It suggested staging a quarterly heath fair sponsored by government to promote healthy lifestyles, constructing a community centre in which to house a fitness centre, introducing childhood obesity prevention programmes and encouraging more physical education.
However, in order to be effective, any strategy will first have to challenge attitudes. In a nation where being overweight is widely perceived as cute; a sign of health and wealth, and where ‘chubby’ children are prized, a paradigm shift is needed to realise that fat is a handicap. In addition to the practicalities of exercising in the desert climate there are also hurdles in perception to overcome. Walking is popularly perceived as a strictly the low-income transport option.
But with more and more research, increasing intervention and promising signs that adults and teachers are aware of the problems being created for this young Emirati generation, the fat time bomb may yet be diffused.
How to prevent your child from getting fat
Follow these simple steps from Dr Deepa Dhavjekar, Business Head, Balance Wellness Club, Dubai to keep your kids healthy:
1. Work with other parents to create a positive peer environment. Share problems that you face with other mothers – work out a common solution. Ensure that a set of three or four parents are using the same approach to physical and nutritional education with their children. Children talk to each other so if they find that a friend is doing the same set of activities at home – the activities won’t seem so bad!
2. Plan play dates that have an active indoor physical activity component. Anything from hop-scotch to hide and seek that can be played in the house. Special children’s cooking classes or yoga workshops (which Balance Wellness Club offers) are great activities that will get kids moving and thinking about making fun, healthy choices.
3. Make exercise a family affair. Children tend to replicate behaviour. If meal times are rituals when everyone gathers around a table and the TV is switched off, it will help set a discipline about eating and TV viewing. Exercise is also something that they will appreciate if they see positive role models. Enrol them in classes or to train for a sport along with their siblings or friends. A structured approach is likely to be more engaging for kids.
4. Instil pride in children. Teach them to feel a sense of accomplishment that comes with being physically fit and active.
5. Introduce smart rewards. Condition children to receive a healthy treat when they exhibit good behaviour. Choose these treats carefully – younger children will accept a fruit or an energy-rich granola bar as a reward, as easily as they will appreciate a small portion of healthier dark chocolate. It’s important to know more about the ingredients that constitute the treat. A bar of processed chocolate, or a sugary candy, or a bag of chips are loaded with carbohydrates and salts that are difficult for them to digest.
6. Engage them. Children can get on board very easily if you involve them in some aspect of the activity. If children are engaged through a ‘contest’ of some sort – they will be more interested.