Overweight and Obesity in the Eastern Mediterranean Region
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Overweight and Obesity in the Eastern Mediterranean Region (An Annotated Bibliography, 2000 - 2011)
Compiled by Abdulrahman O. Musaiger Faiza Kalam Mutasim Algadi
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Overweight and Obesity in the Eastern Mediterranean Region (An Annotated Bibliography, 2000 - 2011)
Director of Arab Center for Nutrition – Bahrain Head of Nutrition and Health Studies Unit Deanship of Scientific Research University of Bahrain – Bahrain
First Edition, 2012 Arab Center for Nutrition Kingdom of Bahrain Faiza Kalam Department of Nutrition and Food Technology Jordan University of Science and Technology, Irbid, Jordan
Arab Center for Nutrition Manama-Kingdom of Bahrain
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Arab Center for Nutrition – Bahrain
Arab Center for Nutrition P.O. Box 26923 Manama – Bahrain Tel: +973-17 343460 Fax: +973-17 346339
www.acnut.com
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PREFACE Obesity has become one of the main health problems in the Eastern Mediterranean Region (EMR), which refers to all Arab countries (excluding Algeria), in addition to Afghanistan, Iran and Pakistan. Studies on overweight and obesity in the EMR have increased remarkably during the last decade. A systematic literature review of studies published in English between January 2000 and June 2011 using Pubmed and Google Scholar database was carried out. Keywords included overweight, obesity, anthropometric measurements, weight status and body mass index for each country in the EMR. Papers published in Arabic, Persian or in local Journals not abstracted in Pubmed or Google Scholar database were excluded. We hope that this document provides useful information on main studies published on overweight and obesity in the EMR.
Director of Arab Center for Nutrition Head of Nutrition and Health Studies Unit Deanship of Scientific Research University of Bahrain 5
CONTENTS Page - Afghanistan ………………………………………………………… 6 - Bahrain ………………………………………………………….…… 8 - Egypt ……………………………………..…………………………… 22 - Iran …………………………………………………….……………… 72 - Iraq ……………………………………………………………….…… 275 - Jordan
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- Kuwait ……………………………………………………………..... 303 - Lebanon ………………………………..…………………………… 343 - Libya …………………………………..……………………………… 372 - Morocco …………………………………………....……………… 374 - Oman …………………………………………….…………………… 395 - Pakistan ……………………………………………………………… 408 - Palestine ………………………….………………………………… 464
- Qatar ……………………………………….………………………… 465 - Saudi Arabia ……………………………….……………………… 479 - Sudan ………………………………………………….……………… 605 - Syria …………………………………...……………………………… 609 - Tunisia ………………………………………..……………………… 614 - United Arab Emirates ………………….……………………… 665 - Yemen …………………………………………………………..…… 686 - General ……………………………………………………………… 689 6
AFGHANISTAN Prev Med. 2011 Sep 1;53(3):149-54. Epub 2011 Jul 13. BMI Trajectory Groups in Veterans of the Iraq and Afghanistan Wars Patricia H. Rosenberger , , Yuming Ning, Cynthia Brandt, Heather Allore, Sally Haskell VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, USA.
Iraq/Afghanistan veterans over 6 years and to examine sociodemographic factors associated with BMI trajectory membership.
and entering the Veteran Healthcare Administration (VHA) healthcare system. We used national VHA administrative sociodemographic data, tracked veteran BMI for 6 years, and used trajectory modeling to identify BMI trajectories and sociodemographic characteristics associated with trajectory membership. RESULTS: Five trajectory groups determined in the full sample were primarily differentiated by their post-deployment initial BMI: "healthy" (14.1%), "overweight" (36.3%), "borderline obese" (27.9%), "obese" (15.7%), and "severely obese" (6.0). Being female, younger, and white were associated with lower initial BMI trajectory group membership (p's < .05). Greater observed BMI increase was associated with higher initial BMI across groups (0.6, 0.8, 1.5, 1.9, 2.7). Gender specific trajectory models found that male Veterans with higher education and white female Veterans were associated with the lowest initial BMI group (p's < .05).
BMI gain over time for both male and female veterans. Older age is associated with higher BMI regardless of gender. Education level and racial status are differentially related to BMI trajectory by gender.
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J Womens Health (Larchmt). 2010 Feb;19(2):267-71. Gender Differences In Rates Of Depression, PTSD, Pain, Obesity, And Military Sexual Trauma Among Connecticut War Veterans Of Iraq And Afghanistan. Haskell SG, Gordon KS, Mattocks K, Duggal M, Erdos J, Justice A, Brandt CA. Department of Medicine, Section of General Internal Medicine, VA Connec cut Healthcare System, New Haven, Connec cut 06516, USA. sally.haskell@va.gov
increasing number of female veterans seeking medical and mental healthcare in the Department of Veterans Affairs (VA) healthcare system. To better understand gender differences in healthcare needs among recently returned veterans, we examined the prevalence of positive screenings for depression, posttraumatic stress disorder (PTSD), military sexual trauma (MST), obesity, and chronic pain among female and male veterans of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) receiving care at the VA Connecticut Healthcare System.
OEF/OIF veterans at VA Connecticut who received services in either Primary Care or the Women's Health Clinic between 2001 and 2006.
women) were examined. Female veterans were more likely to screen posi ve for MST (14% vs. 1%, p < 0.001) and depression (48% vs. 39%, p = 0.01) and less likely to screen posi ve for PTSD (21% vs. 33%, p = 0.002). There was no significant gender difference in clinically significant pain scores. Men were more likely than women to have body mass index (BMI) >30 kg/m(2) (21% vs. 13%, p = 0.008).
exist in the prevalence of positive screenings for MST, depression, obesity, and PTSD. As the VA continues to review and improve its services for women veterans, clinicians, researchers, and senior leaders should consider innovative ways to ensure that female veterans receive the health services they need within the VA system.
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BAHRAIN Public Health Nutr. 2009 Oct;12(10):1791-8. Epub 2009 Jan 23. Study of the Knowledge, Attitudes and Practices of Physicians towards Obesity Management in Primary Health Care in Bahrain. Al-Ghawi A, Uauy R. Ministry of Health, Nutrition Section, Public Health Directorate, PO Box 42, Manama, Kingdom of Bahrain. Aghawi@health.gov.bh Abstract AIM: To examine the opinions of physicians in Bahrain regarding their role in obesity control, and to evaluate their knowledge, attitudes and practices towards obesity prevention and management in primary health care.
cluster sample was used, which included twelve health centres and 107 physicians. Ninety-seven physicians participated in the study with a 90% response rate. A self-administered questionnaire was used to measure physicians' knowledge and practices, their perceived role and potential limitations. Correction for design effect and finite population were considered in the analysis.
obesity epidemic and 60% of them felt capable of assuming a major role in obesity control, regardless of their negative views towards the success rates of weight management. Only 36% agreed that they had effective weight- management practices. They were knowledgeable about weight-loss goals and showed a reasonable level of obesity identification, especially as part of chronic disease care (71%). Physicians reported a high rate of u lization of various weight-loss strategies, except for pharmacotherapy and surgery. The major barriers identified in patient care included time constraints (91%), lack of specialty clinics (81%), absence of guidelines (78%) and an inadequate number of dietitians (71%). Sixty-four per cent reported that training in lifestyle counselling and behaviour modification are important requirements.
in participating in obesity prevention and management. It seems that there would be a good opportunity for better practice if physicians were
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supported with appropriate training and the constraints of their working environment were adequately addressed.
Ann Saudi Med. 2009 Jul-Aug;29(4):258-69. Anthropometry and Body Composition of School Children in Bahrain. Gharib NM, Shah P. Nutrition Section/Public Health Directorate-Ministry of Health, Kingdom of Bahrain, King Faisal University, Dammam, Saudi Arabia. gharibn@gmail.com Abstract BACKGROUND AND OBJECTIVES: This study was conducted because of the lack of a comprehensive nationwide assessment of data on the anthropometric status and related health problems in Bahraini school children aged 6 to 18 years. SUBJECTS AND METHODS: A cross-sectional survey was conducted on the anthropometric status of school children enrolled in the primary, intermediate and secondary government schools in all populated regions of Bahrain. The sample size included 2594 students (1326 girls and 1268 boys) represen ng 2.5% of the total student population. For sample selection, a multi-stage sampling design was chosen that combined multi-cluster and simple random sampling methods. Anthropometric measurements included height, weight, mid-arm circumference and skin fold thickness at two sites (triceps and subscapular). Anthropometric indices derived were body mass index (BMI) and arm muscle area. The WHO reference standards (2007) and the National Health and Nutrition Examination Survey (NHANES) II data were used for comparison. RESULTS: Compared to WHO reference standards, the median height of Bahraini children and adolescents in the age range of 6 to 18 years was close to the 25th percen le or lower, while the median BMI during adolescent years was comparable in boys, but higher than WHO standards in girls, reaching the 75th percen le. The cutoff values of BMI for overweight/obesity status (85th and 95th percen le) were higher by 3-6 kg/m(2) compared to WHO standards. While skin fold thicknesses were also higher in Bahraini adolescents compared to their American counterparts (NHANES II), arm muscularity was substantially lower.
thicknesses suggest an increased trend toward adiposity among Bahraini 10
adolescents, especially in girls, which puts this age group at a high risk of adult obesity and its consequences. A need for urgent intervention programs is emphasized.
Int J Pediatr Obes. 2009;4(4):414-6. Prevalence of Overweight and Obesity among Children Aged 2-5 Years in Bahrain: A Comparison between Two Reference Standards. Al-Raees GY, Al-Amer MA, Musaiger AO, D'Souza R. Nutrition Unit, Public Health Directorate, Ministry of Health, Kingdom of Bahrain. Abstract A cross-sectional study was carried out on Bahraini preschoolers aged 2-5 years (354 males and 344 females) to determine the prevalence of overweight and obesity using the World Health Organization and the International Obesity Task Force cut-off values. Weight and height were recorded and body mass index (BMI) was calculated to determine the proportion of overweight and obesity. Using the World Health Organization percentile cut-off values, overweight (12.3%) and obesity (8.4%) was higher in females between 2 and <4 years of age whereas, the proportion of both overweight (8.4%) and obesity (7.2%) were higher in males between 4 and <6 years of age. Rela ve to the Interna onal Obesity Task Force indicators, the World Health Organization cut-off values produced nearly a 2-fold increase in both overweight and obesity at most ages. It is therefore important to ensure that the same cut-off reference values are used to define overweight and obesity particularly in preschoolers. Shifting to the new World Health Organization child growth standards may have important implications for child health programmes.
Anthropol Anz. 2008 Dec;66(4):401-7. Overweight and Obesity among Adolescents in Bahrain. Bader Z, Musaiger AO, Al-Roomi K, D'Souza R. Ministry of Health, Kingdom of Bahrain.
A cross-sectional study was conducted to assess the prevalence of overweight and obesity amongst adolescents in Bahrain. The subjects
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consisted of grades 1-3 secondary school students (336 males and 396 females) between the ages 15-18 years, selected using a mul -stage stratified random sampling technique from government schools from all the governorates of Bahrain, represen ng about 3% of the target popula on. The mean height in males and females ranged between 162.9-171.3 cm and 157.4-159.9 cm, respec vely, while the mean weight ranged between 59-72 kg and 59-66 kg, respec vely. The propor on of those underweight was higher in males (8.6%) compared to that in females (2.3%). The highest propor on of normal weight was observed at the age of 15 years in both the male and female adolescents (66.0%). The prevalence of overweight and obesity was higher in female (17.4% and 19.4%) compared to the male (15.8% and 13.7%) adolescents. Although compared to previous reports, a decline in the body mass index (BMI) was observed for both the genders in Bahrain. We believe that the launch of intervention programs at a national level to educate school authorities, parents and concerned health professionals alike, is urgently required.
Saudi Med J. 2006 May;27(5):687-92. The Effect of Loss of Body Weight on Lipid Profile in Overweight Individuals. Alnasir FA, Masuadi EM. Department of Family and Community Medicine, Arabian Gulf University, PO Box 22979, Manama, Kingdom of Bahrain. faisal@agu.edu.bh Abstract OBJECTIVE: To determine the effect of reducing body weight and body mass index on serum lipid. METHODS: This is a prospective longitudinal study, which was implemented in Naim Primary Health Care Center in the Kingdom of Bahrain during May and June of 2004. The study included 55 individuals who were willing to participate. The criteria for the sample selection included being overweight, having high serum lipid and patients' willingness to reduce their weight. The patients were followed up for a 26 weeks period consis ng of con nuous health education program, maintenance on low caloric diet and exercise to help them reduce their body weight. This period included a lifestyle enhancement awareness program that included 4 health educa on sessions on weight loss, 4 sessions on weight loss maintenance and frequent and regular visits to the clinic to make sure that those patients were compliant with the given instructions. 12
RESULTS: The study showed that patients who completed the designed program had a reduction in body weight, body mass index, and lipid level and an increase in physical activity and dietary readiness to control over- eating. Although in both genders there was a significant drop in all the parameters, only body mass index (p<0.002) and cholesterol (p=0.007) showed a statistically significant difference between men and women. In men, cholesterol level at the initial stage of the study was strongly related to the body weight (r=0.65, p<0.002) and body mass index (r=0.83, p<0.0005). Despite that the cholesterol level reduced more in women than men; women decreased less in weight (p<0.0005) and body mass index (p<0.0005) than men.
enhancement program that increases their awareness on the danger of obesity and helps them in reducing body weight and serum lipid level.
Child Care Health Dev. 2004 Jul;30(4):369-76. Body Weight Perception among Bahraini Adolescents. Al-Sendi AM, Shetty P, Musaiger AO. College of Health Science, Ministry of Health, Bahrain.
status and perceptions of body weight in Bahraini adolescents. The study also investigates the adolescents' perceptions of parents' and peers' opinions of weight. METHODS: A cross-sec onal survey of 447 Bahraini male and female adolescents aged 12-17 years was conducted. Weight and height were measured and body mass index (BMI) was calculated. A short questionnaire was used to obtain their attitudes towards their weight status, as well as the attitudes of their parents and friends. The nine figure silhouettes illustration was used to measure perception of ideal body image and how it compares with their current body weight.
adolescents' perception of body weight and actual BMI. There was a tendency for teenagers to underestimate their weight status, which was especially noteworthy among the overweight and obese. More than half of the girls and about one-third of the boys expressed discontent with their
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