Monday 27 / January / 2025
Sixty-nine per cent. That’s a big number isn’t it? Although I guess that would depend on what this figure represents.
It’s not the latest stat on how likely you are to “forget” your New Year’s resolution within the first month, nor is it the latest stat on Omanisation. What it is, is the number of expatriate families in Oman that don’t eat enough fruits and vegetables.
Oman’s Ministry of Health and the World Health Organisation recently conducted a survey on the threats posed by non-communicable diseases (NCDs) in the Sultanate, and while healthcare services in the country are doing much to address those areas that are a cause for concern, data showed that 69.3% of expatriates in the country did not consume enough fruits and vegetables on a daily basis.
The reality is that three-fifths of the people in Oman do not consume the required amount of fruits and vegetables every day, which could lead to health problems in the long-term.
In addition, 57.5% of all Omanis surveyed admitted they did not consume their daily-expected quota of fruits and vegetables. Men were more likely to ignore eating their greens, with 63.9% of men admitting they didn’t pay as much attention to it as they needed to, while the number was significantly lower – 57.3% - for women, but still high enough to cause concern.
Overall, data showed that 60.7% of people in the country did not eat enough fruits and vegetables. That means nearly three million people among Oman’s population of 4,646,655 don’t get their daily quota of five daily servings of fresh fruits and vegetables, as laid down by the World Health Organisation.
A total of 9,053 adults participated in the survey, which was then used to extrapolate for the entire population, of which 6,833 adults responded, leading to an overall response rate of 75.5%.
To find out why so many were unwilling to eat or unaware of the benefits of fruits and vegetables, T Weekly spoke to Dr Nuthaila Al Kharousi, a psychologist at Al Harub Medical Centre.
“In most countries, among all age groups, there has been an increase in fast-food consumption, especially amongst teens and young adults,” she explained. “This may be attributed to the fact that such foods are fast to prepare, convenient, and relatively inexpensive. In addition, high-school adolescents become relatively more autonomous and have easy access to unhealthy dietary choices. Social norms and friendship are motivating factors for fast food consumption, in that, eating in fast food restaurants is a way to socialise with friends.”
“Moreover, eating fast food is attributed amongst many as a type of food that is globally popular with a sense of modernism and belonging to a higher social class,” added Dr Kharousi. “Since fast food is easily prepared and cooked in large amounts, it tends to be highly processed with additives, artificial flavourings and chemicals to preserve its palatable appeal. The possible side effects on mental health are a high tendency to develop depression, jitters and anxiety in children, attention deficit hyperactivity disorder in children, a shrunken hippocampus, which is the part of the brain responsible for memory and cognition.”
“What’s important to understand is that the dietary habits of the youth are of significant importance because these dietary habits are likely to remain stable for their entire life span,” she said. “Therefore, to control fast-food consumption, policy makers and health campaigns should pay special attention to interventions designed for adolescents.”
According to the WHO, the worldwide prevalence of obesity nearly tripled between 1975 and 2016. In 2016, more than 1.9 billion adults aged 18 years and older were overweight. Of these, over 650 million adults were obese. In 2016, 39% of adults aged 18 years and over (39% of men and 40% of women) were overweight. Overall, about 13% of the world’s adult population (11% of men and 15% of women) was obese in 2016.
In 2016, an estimated 41 million children under the age of five years were overweight or obese. Once considered a high-income country problem, being overweight and obesity are now on the rise in low- and middle-income countries, particularly in urban settings. In Africa, the number of overweight children under five has increased by nearly 50 per cent since 2000. Nearly half of the children under five who were overweight or obese in 2016 lived in Asia.
Over 340 million children and adolescents aged five to 19 were overweight or obese in 2016. The prevalence of excess weight and obesity among children and adolescents aged five to 19 has risen dramatically from just 4% in 1975 to just over 18% in 2016. The rise has occurred similarly among both boys and girls: in 2016, 18% of girls and 19% of boys were overweight.
“More than six billion people live in countries that don’t protect their citizens from the harmful effects of industrially produced trans-fats,” admitted Tedros Adhanom Ghebreyesus, Director General of the World Health Organisation. “Imagine if an epidemic threatened to kill 41 million people every year. It’s already happening. This year. Last year. Next year, too. Non-communicable diseases are the world’s biggest killers. That’s why, this year at the UN General Assembly, we are joining forces to beat NCDs.”
The prevalence of eating junk food is such a global threat that the United Nations has decided to step in and act on a worldwide scale. On September 27, 2018, the UN General Assembly staged the third high-level meeting on the prevention and control of NCDs.
The result was heads of state and governments committing to 13 new steps to tackle non-communicable diseases, including cancers, heart and lung diseases, strokes and diabetes, and promote mental health and wellbeing, in the form of calling upon food manufacturers to reformulate products to reduce salt, free sugars and saturated and industrially produced trans fats, using nutrition labelling on packaged food to inform consumers, and reduce the exposure to, and curb the impact of, the marketing of foods and non-alcoholic beverages on children.
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In addition, policy recommendation includes public education and awareness campaigns to promote healthier lifestyles.
“A key priority for me is to enhance our approach to resource mobilisation among donors, old and new,” said Ghebreyesus. “That has to start by building confidence among partners, that WHO will deliver results and impact. I want WHO to be synonymous with results. And that is doable. At the same time, we must recognise that WHO is the world’s platform for global health. It’s the only venue where all governments, along with other stakeholders, come together to discuss and decide fundamental issues with regard to global health.”
“If the platform did not exist, we would need to create it. This global governance function is the infrastructure of global health and the global public good,” he added. “WHO is committed to promoting healthy, sustainable diets globally. We’re working with the Food and Agricultural Organisation to develop guidance on healthy and sustainable diets to ensure that people eat nutritious food that is safe and produced in a sustainable way.”
Consuming a healthy diet throughout the life-course helps to prevent malnutrition in all its forms, as well as a range of non-communicable diseases and conditions. However, the increased production of processed foods, rapid urbanisation and changing lifestyles have led to a shift in dietary patterns. People are now consuming more foods high in energy, fats, free sugars and salt/sodium, and many people do not eat enough fruits, vegetables and other dietary fibre such as whole grains.
The exact make-up of a diversified, balanced and healthy diet will vary depending on individual characteristics (e.g. age, gender, lifestyle and degree of physical activity), cultural context, locally available foods and dietary customs. However, the basic principles of what constitutes a healthy diet remain the same.
“While we must sow the seeds of peace in order to achieve food security, improve nutrition and leave no one behind, we also need to redouble efforts to build climate resilience for food security and nutrition,” added Jose Graziano da Silva, the Director General of the United Nations’ Food and Agricultural Organisation. “The food insecurity we are witnessing today also contributes to excess weight and obesity, which partly explains the coexistence of these forms of malnutrition in many countries.”
“In 2017, over 38 million children under the age of five were overweight, with Africa and Asia representing 25 per cent and 46 per cent of the global total, respectively,” he added. “The problem of obesity is most significant in North America, but it is worrying that even Africa and Asia, which still show the lowest rates of obesity, are also experiencing an upward trend.”
“Furthermore, being overweight and obesity are increasing the risks of non-communicable diseases, such as type 2 diabetes, high blood pressure, heart attacks and some forms of cancer. If we are to achieve a world without hunger and malnutrition in all its forms by 2030, it is imperative that we accelerate and scale up actions to strengthen the resilience and adaptive capacity of food systems and people’s livelihoods in response to climate variability and extremes.”
Locally, hospitals are also taking more steps to ensure that young families start their children eating healthy at the right age.
“Now, in maternity hospitals, doctors tell mothers and fathers of young children about the importance of breastfeeding,” said Dr A. Basheer, a senior internist and diabetologist at Badr Al Sama’a Hospital. “The practice of eating healthy and raising awareness therefore starts right from birth. The initial few months of development are very important, before switching to regular foods. This period is called the weaning period. This kind of education is now a regular practice. It starts while patients get admitted for delivery, and it continues until the patient is discharged.”
Some families, however, point to the increasing costs of fruits and vegetables as reasons to not feed their kids the right amount or the correct foods. Ramanuj Venkatesh, though, a long-term resident of the Sultanate, knows just how widespread fruits and vegetables are in the country. Don’t tell him about cost either: Venkatesh is a fully-trained finance professional who knows just how to eat healthy on a budget.
"At a time when people are looking for the most value for money, they will automatically gravitate towards things that give them maximum quantity for minimum price," said Venkatesh, an economic analyst with experience in both Oman and the UAE. "It may not seem ideal, but that is why people are always looking for offers, and they plan their purchases on the basis of what costs less. When the supermarket flyers come to your house, or when you look at the big posters offering discounted prices or 'buy one get one free' items, that is what stays in your mind because you realise that is what gives you maximum value."
"When it comes to eating fruits and vegetables, it is a case of quality over quantity, and because there is a need to save at the moment, there might be some households that prioritise the latter,” he added. “In any case, if cost is an issue, then there are also many offers available on fruits and vegetables in supermarkets these days, and I would advise people to keep an eye out for these."
“These are often clearly mentioned in their flyers, as well as in supermarkets, so there are plenty of options available to suit everyone's budget,” said Venkatesh. “In a country like Oman, there are pricing options to suit everyone's needs. For example, if someone likes apples from New Zealand, they are available, and if someone wants apples from China, they are also available, so there is plenty of quality available without putting a lot of pressure on the wallet."
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Key facts to pursuing a healthy diet
A healthy diet helps protect against malnutrition in all its forms, as well as non-communicable diseases (NCDs), including diabetes, heart disease, stroke and cancer.
An unhealthy diet and a lack of physical activity are leading global risks to health.
Healthy dietary practices start early in life – breastfeeding fosters healthy growth and improves cognitive development, and may have longer-term health benefits, such as reducing the risk of becoming overweight or obese and developing NCDs later in life.
Energy intake (calories) should be in balance with energy expenditure. To avoid unhealthy weight gain, total fat should not exceed 30% of total energy intake. Intake of saturated fats should be less than 10% of total energy intake, and the intake of trans-fats less than 1% of total energy intake, with a shift in fat consumption away from saturated fats and trans-fats to unsaturated fats, and towards the goal of eliminating industrially-produced trans-fats.
Limiting intake of free sugars to less than 10% of total energy intake is part of a healthy diet. A further reduction to less than 5% of total energy intake is suggested for additional health benefits.
Keeping salt intake to less than 5g per day (equivalent to a sodium intake of less than 2g per day) helps prevent hypertension, and reduces the risk of heart disease and strokes in the adult population.
WHO member states have agreed to reduce the global population’s intake of salt by 30% by 2025; they have also agreed to halt the rise in diabetes and obesity in adults and adolescents, as well as in overweight children by 2025.
World Health Organisation recommendations for a healthy diet
For adults
A healthy diet includes the following:
Fruit, vegetables, legumes (e.g. lentils and beans), nuts and whole grains (e.g. unprocessed maize, millet, oats, wheat and brown rice).
At least 400g (i.e. five portions) of fruits and vegetables per day, excluding potatoes, sweet potatoes, cassava and other starchy roots.
Less than 10% of total energy intake from free sugars, which is equivalent to 50g (or about 12 level teaspoons), but ideally is less than 5% of total energy intake for additional health benefits. Free sugars are all sugars added to foods or drinks by the manufacturer, cook or consumer, as well as sugars naturally present in honey, syrups, fruit juices, and fruit juice concentrates.
Less than 30% of total energy intake from fats, unsaturated fats (found in fish, avocados and nuts, and in sunflower, soybean, canola and olive oils) are preferable to saturated fats (found in fatty meat, butter, palm and coconut oil, cream, cheese, ghee and lard) and trans-fats of all kinds, including both industrially-produced trans-fats (found in baked and fried foods, and pre-packaged snacks and foods, such as frozen pizzas, pies, cookies, biscuits, wafers, and cooking oils and spreads) and ruminant trans-fats (found in meat and dairy foods from ruminant animals, such as cows, sheep, goats and camels).
It is suggested that the intake of saturated fats be reduced to less than 10% of total energy intake and trans-fats to less than 1% of total energy intake. In particular, industrially-produced trans-fats are not part of a healthy diet and should be avoided.
Less than 5g of salt (equivalent to about one teaspoon) per day. Salt should be iodised.
For infants and young children
• In the first 2 years of a child’s life, optimal nutrition fosters healthy growth and improves cognitive development.
• It also reduces the risk of becoming overweight or obese and developing NCDs later in life.
• Infants should be breastfed exclusively during the first six months of life.
Infants should be breastfed continuously until two years of age and beyond.
From six months of age, breast milk should be complemented with a variety of adequate, safe and nutrient-dense foods. Salt and sugars should not be added to complementary foods.
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