July 4 calumny! Hotdogs and hamburgers blamed for making Kuwaitis fat

Is nothing sacred?

A rather astonishing recent story in Bloomberg Businessweek called "Obesity, the other Gulf War syndrome," blames the fact that Kuwait is by some measures now the second fattest nation on the globe on a surprising culprit: The introduction of American fast food to the tiny kingdom after US troops drove out Saddam Hussein's army in 1991. The article is illustrated with a Kuwaiti man and woman snarfing hamburgers being dropped out of an American warplane.

"According to surgeons like Al Sanea, the bariatric boom can be traced to the buildup to the 1991 Gulf War. That was when hundreds of thousands of U.S. troops descended on the Gulf nation, bringing with them Taco Bell, Hardee’s, Baskin-Robbins, and Nathan’s Famous (NATH) hot dogs, among others," writes Bloomberg's Peter Savodnik. "'The [war] was the demarcation line,” says Dr. Abdulwahab Naser Al-Isa, at the Department of Community Medicine & Behavioral Sciences at Kuwait University. Andrew Smith, the author of the Encyclopedia of Junk Food and Fast Food, says, “The American military went in, and obviously they wanted fast food. Therefore, the number of fast-food establishments expanded exponentially.' And Kuwaitis fell in love."

Mr. Savodnik's article, relying as it does on anecdotes rather than research, and a strange confusion of correlation with causation, caught my attention. It's true that Kuwaitis are today, along with residents of the other wealthy Gulf monarchies, among the fattest people in the world. The ready availability of high-fat food coupled with sedentary lifestyles are the not particularly surprising causes. Too many fast-food burgers? Of course. But also too much kofta, and too much machboos, the national lamb dish served on a bed of rice (the rice cooked in fatty lamb-stock).

And while ice-cream, hot dogs and the other favorites that Americans will be eating at picnics and in backyards around the country today to celebrate July 4 are certainly fattening, the popularity of these foods are no more the cause of obesity here or anywhere else than the heavy use of butter in French cuisine is the reason that only 10 percent of the French are obese (against about 30 percent in the US and about 33 percent in Kuwait).

Food culture, portion size, and a lack of exercise seem to be the most important causes. And across the world, increasing prosperity in previously poor countries is the most clear reason for rising body mass indices.

A 2009 review of medical literature examining obesity in the Gulf, "The prevalence and trends of overweight, obesity and nutrition-related non-communicable diseases in the Arabian Gulf States," found fairly similar obesity rates in Qatar, Kuwait, and Saudi Arabia, similarly wealthy kingdoms, and noted that "along with the economic growth of the Gulf region, there have been increases in nutritional health problems and related diseases. This is often referred to as the nutrition transition, which was first noted in developed countries, but has quickly spread to emerging economies and developing nations in the past two decades."

A 1998 study at the University of Kuwait, Changes in body mass index (BMI) and prevalence of obesity among Kuwaitis 1980-1994 found that "BMI and prevalence of obesity increased among Kuwaitis between 1980-1981 and 1993 and 1994 probably due to the effects of modernization, affluence, increased food consumption and the concomitant changes to sedentary lifestyles. The rate of temporal changes in BMI and obesity were higher, by comparison, in Kuwait than in selected other countries."

Another University of Kuwait review of reports on local obesity from 2005 references two investigations of domestic obesity that predate the Gulf War: A1981 national survey that found that 25 percent of men and 48 percent of women between 16 years old and 60 were obese; and a 1985 Kuwaiti survey that found 31 percent of Kuwaiti men and 62 percent of women between the ages of 20 and 59 were obese. That shows Kuwaitis were pretty fat in 1981, and got a lot fatter by 1985, years before Saddam Hussein invaded Iraq and President George H.W. Bush rallied an international coalition to drive the Iraqis from the country. 

The report's introduction argues that "obesity is one result of the rapid cultural and social changes that have occurred in the Arabian Gulf region and
Kuwait since the discovery of oil in 1936 and the economic boom in the 1970s and 1980s. Three major societies were found in the Arabian Gulf and in Kuwait before economic booms: agricultural, grazing, and sea and fish societies. All have their healthy and natural food which are considered to be high in fiber and less in fat, carbohydrate and proteins."

More fatty food, and less fresh fruit and vegetables, always spells trouble for a nation's waistline. To be sure, the Kuwaiti taste for fast food is part of their problem; when the first McDonald's opened in Kuwait in 1994, apparently a 7-mile line formed for its drive through window.

But on this July 4, don't blame that burger you've just pulled off the grill for Kuwait's weight problem. The proximate cause appears to be another national addiction Americans share with Kuwaitis. Oil, and not the kind you'll be scraping off the grill tomorrow.

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