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Global bariatric surgery

Bariatrics in Kuwait: Dr Salman Al Sabah

At least 6,000 people in Kuwait underwent bariatric surgery in 2012
Since 2012 over 25,000 bariatric procedures have been performed in the Gulf Region

With 80% of its population overweight, 47.5% obese and ranking the 8th fattest population worldwide, Kuwait has a serious obesity problem. This has lead to widespread practice of bariatric surgery. Dr Salman Al Sabah, Director of Surgical Research and Academic Program in the Department of Surgery, Consultant Surgeon at Al Amiri hospital, Kuwait, Director of the First and Second Kuwait Bariatric & Metabolic Surgery Conference and the First Gulf Obesity and Metabolic Surgery Society (GOSS) Meeting which is to be held in Kuwait on December 12-14 December 2014, talks to Bariatric News regarding educating the region about the dangers of ‘diabesity’ and the aims and themes of the First GOSS meeting.

Dr Salman Al Sabah

The rise and prevalence of obesity in Kuwait (and the wider Gulf region) has been well documented with 36% of men and 48% of women being nationally classified as obese while 74% of men and 77% of women are overweight or obese. (Obes Rev. 2011 Jan;12(1):1-13).  

“Ten percent are classified morbidly obese,” said Dr Salman Al Sabah. “Actually, the numbers are worse: Only 12 percent of Kuwaitis have a BMI below 25.”

According to a study published in June by the London School of Hygiene and Tropical Medicine, using data from the World Health Organization, Kuwait is the second-most obese nation in the world, behind the US, creating the need for bariatric surgery.

As waistlines in Kuwait and across the Gulf have expanded over the last three or four years, so too has the business of bariatric surgery. Ten years ago there were only few bariatric surgeons in Kuwait, he explained. Today, there are 35 surgeons involved in bariatric procedures (private and governmental hospitals) and this number will increase.

Table 1: Number of bariatric surgery procedures in Kuwait 2007-12

At least 6,000 people in Kuwait underwent bariatric surgery last year (Table 1), and a paper published in Obesity Surgery (2013) reported that the country has the highest numbers of operations performed as a percentage of national population (Table 2).

The rise in bariatric procedures in not just limited to Kuwait; the whole region is facing a dramatic rise in the number of operations. Since 2012, over 25,000 bariatric procedures have been performed in the Gulf (Table 3).

Diabetes

In addition to a rise in obesity, Kuwait (and the wider region) has also seen a rise in the numbers of diabetics. According to the International Diabetes Federation, Kuwait ranks 9th in the world for prevalence of diabetes (Table 4).

“One of the main challenges facing diabetics is the lack of knowledge and empowerment to take control of their diabetes,” said Dr Salman Al Sabah. “In 2011, The Diabetes Kuwait Resource Centre was established and is dedicated to provide diabetes focused education and support for individuals, family members, and the public of Kuwait thereby improving the lives of all those affected by diabetes and increasing overall awareness.”

In addition, the Dasman Diabetes Institute in Kuwait is the first research-based organization that addresses diabetes from a multi-disciplinary approach with education, treatment of patients, and health care professionals on a national level.

“There are some initiatives to raise awareness about diabetes and obesity,” he added. “These are geared towards educating people on healthy eating and exercise. However, we still need more.”

Table 2: Numbers of operations performed as a percentage of national population

Dr Salman Al Sabah explained that the rise of obesity and diabetes are multi-factorial, including the fact that some 60-80% of genetic factors predispose people of middle-eastern descent to both obesity and diabetes. However, he also stated that lifestyle plays a big role in the prevalence of obesity.

“Fast food in Kuwait, especially after the Gulf War, flooded the malls and the nation,” he added. “It is cheap, fast and convenient. The weather is another factor in the Gulf’s weight problem. In the summer, temperatures soar to 110F or 120F making it impossible to walk outdoors.”

Table 3: The growth of bariatric procedures in the Gulf region 2007-12 (data from industry)

In addition, the economic explosion in Gulf region (United Arab Emirates (UAE), Saudi Arabia, Kuwait, Bahrain, Qatar, Oman), after the discovery of oil, created the perfect breeding ground for non communicable diseases; mainly obesity, diabetes, and hypertension. This has happened due to the sudden increase in socio- economical status which led to population growth, drastic changes in food consumption patterns quality and quantity, a decrease in the physical activities brought on by prosperity, and the trend of overconsumption and over indulgence in every aspect of life.

Nutritional transition is due to a change in the socio-economic standard. The process known as "nutrition transition" is a global phenomenon affecting population diet and physical activity patterns in developing countries with characteristic nutritional outcomes.

In Kuwait, the discovery of oil opened the gates to a new era, which impacted every aspect of the traditional Kuwaiti lifestyle, in terms of nutrition, physical activity, and access to healthcare.

“Kuwaitis went from what used to be an extremely different lifestyle of highly intensive physical labor, like pearl diving, to reaping the benefits of the new found natural resource - oil in the late 1930s,” said Dr Salman Al Sabah.

He explained that this dramatic change in lifestyle provides the gateway for a change in both physical activity as well as dietary changes. Calories consumed started exceeding calories burnt, leading to the present increase of obesity in Kuwait.

Adult   Population (20-79) in 1000s

2293.74

Diabetes   cases (20-79) in 1000s

407.53

Diabetes National Prevalence (%)

17.77

Diabetes Comparative Prevalence(%)

23.09

Diabetes   related Deaths

1122

Incidence   Type 1 diabetes (0-14) per 100,000

22.3

Mean   diabetes related expenditure per person with diabetes (USD)

1886

IGT   cases (20-79) in 1000s

357.86

IGT   National Prevalence (%)

15.60

IGT   Comparative Prevalence (%)

17.88

Table 4: Prevelence and daibetes and its impact in Kuwait

Traditional foods have been replaced by energy-dense high-fat foods. Excessive dietary intake and unbalanced diets along with sedentary lifestyles have contributed to the increase in the prevalence of over nutrition and the incidence of diet related non-communicable diseases such as diabetes.

With regards to childhood obesity, Dr Salman Al Sabah said that education is the foundation that can reverse this trend.

“It should start with pregnant women, education at school level that promotes healthy eating and physical activity, and national awareness of obesity. Patients in Kuwait with Type II diabetes are much younger compare to patients around the world.”

The biggest challenge, according to Dr Salman Al Sabah, will be addressing the ratio of obese and morbidly obese individuals to the number of qualified surgeons. He said that policies need to be established on a national and regional level that fits the culture and the epidemic of obesity in the region. There is a need for collaboration and support from other health care disciplines to tackle the problem of ‘diabesity’ in the region.

First Gulf Obesity Surgery Society Meeting

“In December 2013, we will be hosting the First Gulf Obesity Surgery Society Meeting, and this will be an excellent opportunity for the gulf surgeons, health professionals, and industry to meet, collaborate, and share their experience as well as discussing with international experts,” said Dr Salman Al Sabah. “We have put together a great programme with the participation of world class regional and international faculty. Our GOSS meeting will include workshops, live surgery and relevant debates."

Some of the topics covered will be:

  • Surgery for type 2 diabetes
  • Mal-absorptive operations; are they suitable for our region?
  • Current trend of bariatric surgery in the Gulf region
  • Sleeve gastrectomy; why is it becoming so common?
  • Management of Sleeve gastrectomy complications
  • Revisional bariatric surgery
  • Complications of bariatric surgery
  • Gastric plication and Mini gastric bypass update
  • Adolescent bariatric surgery
  • Multidisciplinary session

“As well as surgeons, we will welcome health professionals of all disciplines and policy makers, who I am sure will benefit greatly from this meeting. Our vision is for this annual event to be the main bariatric surgery event in the Gulf region. The meeting will rotate annually between the six Gulf countries; next meeting will be in Dubai in 2014,” he concluded. “We encourage more surgeons and health professionals to join the GOSS and develop opportunities for career development, interpersonal networking, involve our residents and fellows in various committees and educational programs and extend our research internationally.”

To find out more about the meeting, please visit: gulfobesity.com

 

Bariatric News is planning to feature more articles from around the world examinig the status of bariatric surgery in different countries and regions. If you would like us to feature your country or region, please email: editor@bariatricnews.net

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