Obesity has become an increasing problem in the Middle East with the change in diet--partly through prosperity--the decrease in exercise, and also the more widespread use of the motor car and availability of public transport.

In Turkey, European writers from the early modern period wrote of obese Ottoman Sultans, officials, and courtiers as well as members of the sultan's harem. Even allowing for literary license, the problem does seem to have been a significant one, but was restricted to the extremely narrow ruling class. Most of the problems that Turkey has faced regarding obesity have been during the 20th century when there has been a decrease in manual labor and an increase in sedentary occupations, a decline in the amount of exercise, and a dramatic change in the local diet with the introduction of many foods that contain saturated fats.

Associate Professor Volkan Yumuk of Harbiye, Istanbul, from the Turkish Association for the Study of Obesity is the national representative on the International Association for the Study of Obesity (IASO) and responsible for increasing the public awareness of the problem of obesity in Turkey.

In a very recent survey carried out in Izmir City, Drs. F. Sarac, S. Paryldar, E. Duman, F. Saygyly, M. Tuzun and C. Yylmaz of the Department of Endocrinology and Metabolism, Ege University Hospital, Bornova, Izmir, distributed survey questionnaires to 1,752 obese and 400 normal-weight adults in the city, and from the replies that they received, they were able to show that 45 percent of obese women wrote that they experienced a reduced quality of life owing to their obesity, while 41.3 percent of men felt the same.

The results also showed that obesity is closely associated with poor levels of general health. Another survey led by Dr. D. Ozmen from the Department of Public Health Nursing, School of Health, Celal Bayar University, Manisa, found that low self-esteem and depression was more common among obese Turkish adolescents than their nonobese school contemporaries. The health complications coming from obesity were clearly shown to result in a lower level of disease-free and distant disease-free survivals in cancer patients being treated for operable breast carcinomas.

In Syria, there has also been a rise in obesity, but the better diet of many people in the country has led to lower rates than in Turkey. One study in 2004 of secondary schoolchildren in Damascus and nearby areas found that more than 35 percent of the children had not eaten meat in the week prior to being interviewed, and worryingly, more than half had not eaten green vegetables during that time, with only 11.9 percent having eaten fruit three or more times a day. Although the lack of meat eating has reduced the prevalence of childhood obesity, the lack of vegetables and fruit will result in other medical problems. In another study, which was into the cardiovascular health of adults in Aleppo, obese people were found to be more at risk of problems and complications than others. There is also a difference between obese people of different genders. A much earlier study, undertaken by S. Hadidy, L. Fahdi, H. Tabbakh, and M. Deebo and published in 1983, showed that the serum level of triglycerides was significantly higher in obese males than in females also suffering from obesity.

Lebanon, to the south of Syria, went through a period of prosperity from the 1930s, which ended with the civil war in 1975, and once again is going through rapid social change and modernization. During the 20th century, the diet of many people in Lebanon has significantly changed, with more dairy products and saturated fats being consumed every day. It is estimated that possibly a fifth of the current population of Lebanon are overweight, but no recent figures were collected until Drs. F. G. Haddad, H. Brax, E. Zein, and T. El Abou Hessen, of the Service de Medecine Interne, Centre Hospitalier et Universitaire Hotel-Dieu de France, in Beirut, carried out a survey assessing the prevalence of obesity among Lebanese patients in hospitals in Beirut from 2000, analyzing material on 313 patients aged 13 years and older. They found that 22.1 percent of these were overweight, and 18 percent were obese, with the percentage considerably higher for those aged 40 years and older. The figures are very high, but given that patients suffering from obesity have a higher prevalence to have other medical complications, the figures for the overall population would be considerably lower.

To ascertain the reasons for obesity, there was another survey into household consumption in 2001. Using a random sample of 444 Beirut residents aged 25-54 years, it was quickly discovered that fat contributed 38.9 percent of the average daily energy intake, with carbohydrates providing 47.2 percent and protein 13.4 percent. The average consumption was 3,030 grams per day, with 45.3 percent of subjects eating less than the recommended 400 grams of fruits and vegetables each day. With most cooking not using olive oil, it was also found out that women consumed more dairy products, milk, vegetables, and coffee than men, with women generally eating a lower-fat diet than men. People aged 25-34 consumed more meat, more sugar, and considerably more alcoholic beverages and soft drinks than older people. With a low consumption of fish and heavy intake of bread, the study highlighted some of the problems that may well lead to higher rates of obesity in Lebanon in the years to come. Indeed, in a study of 12,299 adolescents at private schools in Lebanon, carried out by H. Chakar and P. R. Salameh of the Faculty of Medicine, University of Balamand, 7.5 percent were found to be obese, with 24.4 percent at risk of obesity.

In Israel, although the prosperity of the population has led to increasing numbers of people being overweight, the strict diet followed by many people has reduced the prevalence of obesity, although there have been some notable exceptions such as Ariel Sharon, the prime minister from 2001 to 2006, who suffers from obesity and developed cardiovascular problems, eventually suffering from a stroke. The Israel Society for the Study and Prevention of Obesity has campaigned for greater awareness of obesity in the country, with Professor Maximo Maislos, Head of the Atherosclerosis and Metabolism Unit, Soroka UMC Department of Medicine, Ben Gurion University, Beer-Sheva, serving as the national representative on the IASO.

Obesity has not been much of a problem in Jordan, nor in neighboring Iraq, although the current Iraqi president, Jalal Talabani, has made occasional jokes about his own obesity, and there have been studies of rising levels of obesity among children, many of whom have been housebound for several years with their parents afraid to let them go to school or to sports activities because of the insurgency.

In the countries of the Persian Gulf, the incredible affluence brought by oil has resulted in a change in diet, a decline in exercise, and the increase in sedentary occupations, all of which have led, as they have done in so many other countries, to a rise in obesity levels. Studies have shown this to be the case in Kuwait. In Bahrain a study carried out at the Naim Primary Health Care Center by F. A. Alnasir and E. M. Masuadi of the Department of Family and Community Medicine, Arabian Gulf University, Manama, Bahrain, related obesity to the level of lipids in the bodies of the people being studied. With so little known about the diets of schoolchildren in the Gulf States, a 2006 study of children in Qatar, published in 2007, shows that the levels of obesity there were 1.6 percent for males and 5.4 percent for females, with 54.8 percent of males and 23.1 percent of females being underweight. This certainly indicates that the Gulf States probably have a much lower rate of childhood obesity than many other countries in the world, although figures collected in the United Arab Emirates at the same time show that 13.7 percent of schoolchildren were obese, again with girls much more likely to be obese than boys.

There have also been surveys undertaken in Oman by J. A. Al-Lawati and P. Jousilahti from the Department of Non-Communicable Diseases Surveillance and Control, in Muscat, who studied Omanis in Nizwa. In Yemen, Y. A. Raja'a and M. A. Bin Mohanna of the Department of Community Medicine, Faculty of Medicine and Health Sciences, Sana'a University, studied 1,253 school children in 2002-03 and found the percentage of children aged 10-14 who were overweight was only 6.2 percent, with those obese being 1.8 percent.

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