Curbing High Fat, Salt, and Sugar in the Middle East

By Rola Arab, EAS Strategic Advice

Non-communicable diseases (NCDs) are prevalent in the Middle East, particularly in the Gulf Cooperation Council (GCC) countries of Bahrain, Kuwait, Oman, Qatar, the Kingdom of Saudi Arabia, and The United Arab Emirates (UAE). NCDs-particularly cardiovascular disease, diabetes, cancer, and chronic respiratory disease-cause an average of 53% of all deaths in the region, and in some countries up to 80% of all deaths¹, according to statistics from the World Health Organization Eastern Mediterranean Regional Office (WHO EMRO).  NCDs affect young people in this region especially more than in any other in the world.

Unhealthy diets are a big reason for the rapid rise of NCDs in the GCC region. Unhealthy food is a key contributor to overweight, obesity, and diabetes, especially in children. Regulators in the region have even begun targeting some traditional foods as contributors to obesity and diabetes, such as dishes containing margarine; Arabic sweets containing high amounts of sugar and/or fat; traditional drinks with high levels of sugar²; foods rich in salt, which are highly consumed in the region; and foods containing table salt and spices. Another cause of obesity is a lack of physical activity due to the hot weather conditions.

Regulators Step In

How are regulators addressing the rapid rise in NCDs? The WHO EMRO has pressed regulators in the region to adopt stricter measures to prevent and control NCDs. More-immediate actions include restricting the marketing of foods and beverages high in salt, fat, and sugar, especially to children. Health regulators have already started developing some measures to restrict the availability of unhealthy foods in primary schools, organize health-awareness campaigns, and develop physical-activity programs.

The WHO EMRO has also partnered with WHO Collaborating Centers for Nutrition to support WHO programs at the country level and regionally. Participants include universities, institutions, and research centers, such as the Department of Health Promotion and Community Health (HPCH) at the American University of Beirut (AUB) in Lebanon, and the faculty of food and agriculture at The United Arab Emirates University. By providing information, research, studies, training, and workshops, these partners help to support their countries’ national health and nutrition development.

Significant plans to prevent NCDs are underway. Member States of the Eastern Mediterranean region agreed to prioritize NCDs in their policies and budgets during a WHO EMRO regional meeting back in June 2012. The meeting’s purpose was to develop an updated 2013–2020 global action plan for the prevention and control of NCDs. The Member States agreed on the need to strengthen the role of NGOs in the fight against NCDs, to update public health laws to support NCD prevention and control, to focus on the global recommendations for promoting physical activity and national action plans, and to adopt more innovative health initiatives.

In January 2013, the WHO EMRO announced an action plan focused mainly on salt and fat reduction. Ministries of health in the region have started developing guidelines and recommendations and are raising awareness among the population on the negative health effects of high salt, fat, and sugar consumption.

In September 2013, WHO EMRO experts presented a plan to enhance regulations for marketing food and non-alcoholic beverages to children. Other developments include establishing a cross-departmental working group focused on legislation for preventing and controlling NCDs. A panel of regional experts and researchers is also convening to help the WHO and Member States implement region-specific recommendations to promote physical activity.

In May 2013 at the World Health Assembly, governments of Arab countries reiterated their full commitment to the voluntary targets of reducing premature mortality from NCDs by 25% by 2025, as highlighted in the “Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases.” There was also general support for the adoption of other targets to address raised blood pressure, salt/sodium intake, and physical inactivity.

In October 2013, The WHO Regional Committee for the Eastern Mediterranean held its 60th session in Oman. The Committee addressed health issues and priorities, among which was the implementation of the UN Political Declaration on Prevention and Control of NCDs. The WHO EMRO is currently helping countries develop national targets and indicators on the basis of the regional framework for action, and to establish and implement national, multi-sectoral NCD policies and plans.

Additionally, the Health Ministers’ Council of GCC countries has developed an initiative called The Gulf Plan for the Control and Prevention of Non-Communicable Diseases (2011-2020)³. The mission is to promote awareness of NCDs and risk factors in the GCC, and to support the development of early-detection programs and integrated health care. The Gulf Plan’s main targets over the next 10 years include:

• Decreasing prevalence of overweight and obesity by 5% at minimum (i.e., 0.5% annually)

• Increasing the percentage of physically active people by 10% at minimum (i.e., 1% annually)

• Reducing the prevalence of high cholesterol by 5% in men and by 1% in women

• Reducing the intake of carbohydrate- and fat-rich foods by 10%

• Reducing salt intake rate

• Increasing awareness of NCDs and its causes and methods of prevention by 5%. Measures to achieve these targets include addressing NCDs in school curricula and conducting field programs and health education and media campaigns about risk factors and how to avoid them.

Some countries have also developed their own national programs to prevent and control NCDs. Iran, for instance, has developed a national program to reduce salt, sugar, and fat intake. The program’s main goal is to promote healthy diets; to encourage reducing oil, salt, and simple sugar in processed foods; and to promote low-fat diets and appropriate food labeling. Iran’s Ministry of Health and Medical Education, which is responsible for developing relevant standards and strategies, is working on revising national standards for levels of salt in processed and ready-to-eat food. It is also working to encourage food processors to make low-fat, low-sugar, and low-salt foods; to expand/strengthen nutritional labeling laws and regulations; to alert consumers of salty food through food labeling; to educate food processors, technical personnel, health and agriculture personnel, and schoolteachers about health initiatives; and to provide the public with nutrition education through radio, television, and other media. Additionally, the program will conduct surveys to determine salt, sugar, and oil consumption patterns; collaborate to develop relevant food standards; expand nutritional labeling by working with the food industry; and implement programs among health workers and technical staff in provinces.

Iran also plans to develop food legislation and standards that will be endorsed as national law and which include:

• Limiting trans-fat content to less than 10% of total oil and fat of corn, palm, and mixed liquid oils, as well as frying oil

• Reducing the salt content of food products by at least 33%.

Challenges Ahead

Despite these initiatives to prevent NCDs in the Eastern Mediterranean region, there are still many challenges ahead, such as the lack of technical capacity and sufficient funds, surveillance gaps, and lack of recent data on obesity and diabetes published by the Ministries of Health. The only currently available data on obesity and diabetes in the region is from regional universities, WHO Collaborating Centers, and the Arab Center for Nutrition. A 2011 WHO NCD profile report⁴ on select countries is currently the main reference used for diabetes and other NCD trends in the region. The data is based on estimates from 2008.

Moreover, the region still suffers from an absence of a clear political commitment and policy framework on health and nutrition, a lack of institutional capacity to develop sustainable nutrition programs, and disproportionate allocation of health budgets⁵ despite the heavy impact these diseases have on the socioeconomic development of countries. 

Rola Arab is adviser of health and nutrition policy, Middle East and Africa, for EAS Strategic Advice.

References

1. www.who.int/nmh/obesity_meeting_20091218.pdf
2. http://applications.emro.who.int/dsaf/emropub_2011_1274.pdf
3. GCC strategy on NCDs.pdf
4. www.who.int/nmh/publications/ncd_profiles2011
5. Regional strategy on nutrition 2010–2019 http://applications.emro.who.int/dsaf/dsa1230.pdf