World Obesity Day: A growing number of Gulf youth are having bariatric surgery

“Studies have shown between 20 and 30 percent of children under the age of 18 in Saudi are overweight or obese,” says surgeon Dr. Aayed Alqahtani.
Updated 11 October 2018
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World Obesity Day: A growing number of Gulf youth are having bariatric surgery

  • A Saudi surgeon who is an expert in bariatric procedures will operate on children if it saves their lives
  • A Dubai doctor says there is a ‘serious incidence of obesity among children in the Middle East’ 

DUBAI: Rocketing obesity rates among children and adolescents in Saudi Arabia and the wider Middle East are leading to a growing number of young patients going under the knife for bariatric surgery.

Surgeons say region-wide awareness and prevention measures to tackle obesity are needed in homes, communities and in schools as they blame widespread access to unhealthy foods and sedentary behaviour for soaring numbers of severely overweight children.

Saudi surgeon Dr. Aayed Alqahtani, professor and consultant of minimally invasive and obesity surgery at King Saud University, told Arab News that over the past decade he has performed bariatric surgery on some 2,900 children and adolescents, including a four-year-old Saudi boy who weighed 70kg.

“His weight was killing him,” said Alqahtani. “A year later, thanks to bariatric surgery, he lost almost 20kg. It saved his life.”

Bariatric surgery includes a variety of procedures performed on people who are obese (those with a Body Mass Index of 30 or more) or morbidly obese (a BMI higher than 40). A person’s ideal BMI should be between 18.5 and 25.

The most common weight-loss surgeries involve either reducing the size of the stomach with a gastric band — restricting food intake — or non-reversible procedures that involve removing of a portion of the stomach or by re-routing the small intestine to a small stomach pouch.

Alqahtani said “more and more children” in the Middle East are having bariatric surgery. “It correlates with the rising number of obese children,” he said. “Studies have shown between 20 and 30 percent of children under the age of 18 in Saudi are overweight or obese. I would say this is the same in many Gulf states.”

Families from the Middle East travel to Saudi Arabia specifically to seek the help of Alqahtani, a renowned bariatric surgeon who is adamant — despite mixed views worldwide — that radical weight-loss surgery should be used on children of “any age” if their health is critically threatened by their size. 

There are no standards at which bariatric surgery is presented as an option for severely obese adolescents, but many countries set minimum age limits as guidelines for surgeons. In the UAE, for example, while guidelines differ by emirate, in Abu Dhabi and Dubai there are regulations suggesting surgeons should not operate on those under the age of 18. 

“People are concerned about bariatric surgery,” said Alqahtani. “Why? They believe that bariatric surgery will stunt a child’s growth, think children are not compliant, and they ask who has given consent for them to have this surgery.”

Alqahtani has published a series of research papers on the benefits of bariatric surgery, including a five-year study which followed the health progress of two groups of children; one who had undergone bariatric surgery and another who had followed traditional weight management techniques. On average, the children who had undergone surgery actually grew 10 centimeters taller than those who had not.

“Why? Because among other things, obesity stunts growth,” said Alqahtani. “Children ARE in fact compliant — despite beliefs of the contrary — and regarding consent, well, we should treat obesity like we would treat any other serious chronic disease. If you have cancer in a child would you wait until he is 18? No, you will discuss what is in the best interest of that child and make a decision.”

Children with severe obesity are at risk for health problems including Type 2 diabetes, sleep apnea, liver diseases and hypertension.

While Alqahtani advocates surgery as “by no means a first option” — stressing children who are eligible for surgery have spent months attempting traditional weight loss methods — he believes it should never be ruled out. “I would say, why should we wait until children are dying from these obesity-related diseases? Age should not be an issue.”

Alqahtani, who has performed more than 10,000 bariatric surgeries over his career, believes Gulf countries have the highest percentage of bariatric procedures, which include sleeve gastrectomy, gastric bypass and the placement of a gastric band, performed in the world. He himself has operated on a 21-year-old who weighed 610kg, having struggled with obesity since childhood. Today the patient weighs 68kg.

The fact that so many children and adolescents are undergoing radical weight loss surgery is an indicator of the obesity epidemic across the Kingdom and wider Middle East.

Children should be taught that a healthy lifestyle should be a daily routine and a lifetime habit, say the experts.

Last month, 2,500 health specialists from around the globe gathered in Dubai for the annual World Congress of International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO 2018), hosted by Gulf Obesity Surgery Society (GOSS).

Dr. Faruq M. Badiuddin, head of the organizing committee for IFSO and a laparoscopic, gastrointestinal and obesity surgeon in Dubai, said there is a “serious incidence of obesity among children in the Middle East.” 

“It is really a combination of all the things we talk about in relation to obesity; it is a sedentary lifestyle among children as well as a huge excess of food and the wrong types of food. The problem is, we know obese children grow up to be obese adults. That is a fact.”

Badiuddin, an Egyptian, said weight-loss surgery among children varies across the Gulf. “Saudi, for example, is probably one of the only places in the world where the incidences of bariatric surgery in children are very high,” he said. “A lot of surgeries are done there.” 

Compare that, he said, to the neighbouring UAE, where a single governmental hospital in Sharjah is the only one that allows bariatric surgery for under-18s. 

Dr. Basim Alkhafaji, consultant laparoscopic, gastrointestinal and obesity surgeon at Dubai’s Canadian Specialist Hospital, said bariatric surgery is recognized as an effective and relatively safe procedure for morbidly obese adults.

However, with children, there are concerns about the non-surgical risks revolving around a children’s development, chiefly the effect nutritional changes will have on a still-growing body. “When you are cutting something from the stomach, you are altering the autonomy of the body — so there are some objections from the endocrinologist and the dieticians. 

“Always, they urge surgeons not to jump to this step unless it is a hopeless case, a case where a child is unable to do any sports or activities, cannot control himself with food and cannot follow instructions from specialists. We also look at the psychological state of the child.”

So should young children be offered bariatric surgery? Dr. Alkhafaji is unequivocal about his answer. “If there is no other option then surgery is the right thing,” he said. “When you get a child who is aged 10 and reaching 100kg, psychologically he will be in a bad condition, physically he cannot do anything. In my opinion, then, surgery is the right option.”

Dr. Ali Khammas, president of GOSS and Emirates Pediatric Society, said many people fail to grasp that obesity is a disease.  “The major threat to health in the Gulf region, I would say, is obesity,” he said. 

Khammas said weight-loss surgery is not a cure for severe obesity in either children or adults.

“You can imagine — we are talking about millions of people who are obese across the Gulf. In the UAE alone, about 1.5 million. We can not operate on all of them. 

“We are not going to tackle this disease by surgery. We need prevention. We need campaigns in every single school in the region. There should be someone at every school campaigning for a healthy food culture.”

Dr. El Zaqui Ladha, a consultant in bariatric and general surgery at Abu Dhabi’s Bareen International Hospital, described obesity levels across the Middle East as “shocking.”

“You have kids who are overweight at the age of two. Can you imagine? I had one patient this age: The boy could barely breathe. Kids are so heavy that it impacts on everything. For example, the knees have to bear the weigh, but for children, the knees and cartilage are not properly formed.”

Mansoor Ahmed, director of health care, education, development solutions and PPP for the MENA region at advisory firm Colliers International, said obesity is one of the top lifestyle diseases that appear to increase in frequency as countries become more industrialized and life expectancy increases.

“As a result of urbanization and rising disposable income, the majority of the GCC population, including KSA, have adopted a sedentary lifestyle characterized by an aversion to exercise and consumption of processed food leading to increased chronic diseases (such as diabetes, coronary problems and other obesity-related illnesses) previously uncommon to the region.

“To control obesity, the problem should be established during childhood and parents and teachers can play a leading role in this case. Kids should be taught that healthy lifestyle is important for their future life and that a healthy lifestyle should be a daily routine and lifetime habit.”

The obesity pandemic can be solved only in strong collaboration between the public and private sector, non-profit and philanthropic organizations and society, including parents and children, said Ahmed.

“The key here is awareness,” he said. “Awareness the problem exists, awareness of appearance and awareness of how to fight this disease and especially how to
prevent it.”

 


Screen Savers: The best TV shows of 2018

The best TV shows of 2018. (Shutterstock)
Updated 13 December 2018
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Screen Savers: The best TV shows of 2018

  • Lineup of some of the best shows of 2018
  • From psycho killers to stellar spin-offs

DUBAI: From psycho killers to stellar spin-offs via dark comedy and romantic drama, here are the programs that we wasted the most work hours discussing this year. Warning: There will be spoilers.

The Handmaid’s Tale (Season Two)
After a first season that stayed fairly true to Margaret Atwood’s source novel, the dystopian drama took the theocratic Republic of Gilead into uncharted — and even bleaker, harder-to-watch — territory in its second season. Not everyone was on board (“The attempts to add more color and detail … ultimately register as brief pauses from the main event rather than necessary, interconnected sidebars,” wrote Vulture’s Jen Chaney), but, for us, season two more than justified its existence with its knuckle-whitening tension and of-the-moment examination of social issues.

Killing Eve
An unexpected, and hard-to-categorize, hit, “Killing Eve” mixed smart storytelling, thrilling action set-pieces and comedy (both dark and silly) to great effect, further boosting the reputation of showrunner Phoebe Waller-Bridge. Jodie Comer was a revelation as the paradoxically deadly-but-vulnerable assassin Villanelle, and Sandra Oh portrayed MI5 officer Eve Polanski’s confused love-hate obsession with her brilliantly.

Al Hayba (Season Two)
Director Samer Al-Barkawi’s drama about the arms-smuggling Sheikh El Jabal clan in a village on the Lebanon-Syria border was one of the big hits of Ramadan 2017, so expectations were high for this year’s follow-up (a prequel to the first season). The complex plot kept audiences gripped; Syrian actor Taim Hassan drew plaudits for his reprisal as the head of the clan; and Nicole Saba proved a solid replacement for season one star Nadine Njeim. A bit of social-media controversy (in which — shocker! — people online seemed to confuse fiction and fact) only made this more of a must-see.

Better Call Saul (Season Four)
Remarkably, this spinoff from what is widely regarded as one of the peaks of “peak TV” — “Breaking Bad” — looks like it may actually come close to eclipsing the dizzy heights reached by its parent show. Bob Odenkirk’s portrayal of Jimmy McGill’s transformation into the morally bankrupt Saul Goodman continues to dazzle, and the emotional back-and-forth between Jimmy and his girlfriend Kim (the excellent Rhea Seehorn) is the show’s dark heart. This season, too, had a payoff as brutal as anything “Breaking Bad” produced.

Atlanta (Season Two)
With his alter-ego Childish Gambino’s “This is America” and the sophomore season of this hip-hop comedy, Donald Glover proved himself one of 2018’s most powerful social commentators. Funny, frightening and thought-provoking, “Atlanta” built on its surprising, weird debut season to tackle heavy topics with surreal and subtle humor.

Bodyguard
Show creator Jed Mercurio had already proven with “Line of Duty” that he has a knack for gripping, jeopardy-heavy thrillers with jaw-dropping cliffhangers (and a penchant for killing off lead characters), so the success of “Bodyguard” — described by The Guardian as “a modern take on a hero’s fable” — wasn’t a huge surprise. Keeley Hawes was superb as ambitious home secretary Julia Montague and Richard Madden played her police protection officer David Budd with a compelling blend of hard-edged heroism and morally compromised frustration.

Tareeq
Nadine Njeim switched from “Al Hayba” to another Ramadan hit, this romantic drama also starring Syrian actor Abed Fahd as lovers Ameera and Jaber respectively. The moving story saw Jaber struggling to come to terms with the loss of his family in a car crash and unexpectedly falling for Ameera, a poor young law student. More than just a simple love story, “Tareeq” tackled themes of loss, class prejudice, and sacrifice.

The Americans (Season Six)
It’s pretty rare for a well-loved TV show to wrap up with a satisfactory climax (remember “Lost”?), but “The Americans” — a downbeat, tense tale of Russian deep-cover agents in Reagan-era America — did it brilliantly, continuing the hugely engaging spy-thriller plot while equally successfully presenting an intense examination of a couple caught between loyalties to their homeland, their kids, their new home, and each other. All topped off with a powerful, slow-burn of a tragedy as parents and kids are separated, not always by choice.

Barry
Another show based around the life of an assassin that, like “Killing Eve,” covers comedy and drama by keeping the best bits of both genres to the fore. Bill Hader once again proved his acting chops (often by pretending to be unable to act) as the titular hitman trying to escape his violent life and begin anew. Henry Winkler was typically superb as his acting coach, and each episode had belly laughs and gut-wrenching violence aplenty.

Sacred Games
This tense, dense Indian thriller won critical acclaim for its thoughtful storyline and stellar performances from the whole cast. Saif Ali Khan was superb as cynical police officer Sartaj Singh, promised (via an anonymous tip-off) the opportunity to finally capture the powerful underworld boss Ganesh Gaitonde (the outstanding Nawazuddin Siddiqui), only to find himself caught up in a wide-ranging conspiracy that goes way beyond Mumbai’s gangland.

Homecoming
Julia Roberts made her small-screen debut in this compelling psychological thriller, adapted from the popular podcast about social worker Heidi Bergman helping a soldier adapt to life after deployment, and directed by “Mr. Robot” creator Sam Esmail. The time-hopping story was shot unusually (but successfully) by Esmail, with Bergman’s future life as a waitress presented in vertical frame. This apparent gimmick paid off beautifully in a scene where she suddenly regains her memory of her time as a social worker, and the screen expands to full-width.

Tango
The talented quartet of Levantine actors Bassel Khayyat, Bassem Moughnieh, Daniella Rahme and Dana Mardini, directed by Rami Hanna, made this one of 2018’s must-see Arabic dramas. Married couples Sami and Farah and Omar and Lina are long-term friends, sharing a passion for tango dancing. When Farah is killed in a car accident that leaves Omar in a coma, it becomes clear the two were having an affair. What follows is an emotionally fraught depiction of how their spouses deal with the fallout.

Babylon Berlin
Beautifully shot and wonderfully acted, this German crime drama, set in 1929 Berlin, was hugely ambitious, but successfully so. Volker Bruch excelled as Inspector Gereon Rath — the emotionally and mentally damaged self-medicating war veteran sent to Berlin to investigate an extortion racket and stumbling on a bigger conspiracy — but was regularly overshadowed by scene-stealing Peter Kurth as the morally ambiguous, often revolting Detective Chief Inspector Bruno Wolter.