Fat Arab
Eating Disorder
New Obesity Boom
In Arab Countries
Has Old Ancestry
December 29, 2004
Eating Disorder
New Obesity Boom
In Arab Countries
Has Old Ancestry
Western Habits Fueled Weight
Of Women Prized for Size;
Some Girls Are Force-Fed
Ms. Mohammed Tries a Diet
By GAUTAM NAIK
Staff Reporter of THE WALL STREET JOURNAL
December 29, 2004; Page A1
NOUAKCHOTT, Mauritania -- Jidat Mint Ethmane grew up in a nomad family in this impoverished nation in the western Sahara. When she was 8, she says, her mother began to force-feed her. Ms. Ethmane says she was required to consume a gallon of milk in the morning, plus couscous. She ate milk and porridge for lunch. She was awoken at midnight and given several more pints of milk, followed by a pre-breakfast feeding at 6 a.m.
If she threw up, she says, her mother forced her to eat the vomit. Stretch marks appeared on her body and the skin on her upper arms and thighs tore under the pressure. If she balked at the feedings, her mother would squeeze her toes between two wooden sticks until the pain was unbearable. "I would devour as much as possible," says Ms. Ethmane. "I resembled a mattress."
Today, Ms. Ethmane, 38 years old, is slender because her family ran out of money to continue the force-feeding technique, known as gavage. The term stems from the French word for the process used to force-feed geese to make foie gras. Yet in a recent interview in her family's one-room house, Ms. Ethmane says she still believes in the practice. "Beauty is more important than health," she says. Her husband, Brahim, agrees: "It is thin women who are not healthy."
The belief that rotund women are more desirable as wives helps explain why much of the Arab world -- which stretches from the Persian Gulf in the east to Mauritania in North Africa -- is experiencing an explosion of obesity. About half of women in the Middle East are overweight or obese, according to the United Nations' World Health Organization. In some communities, many of which were nomadic until a few decades ago, oil wealth has dramatically improved living standards. The resulting urbanization has introduced some Western habits: high consumption of sugar, fat and processed foods and more sedentary lifestyles.
In Bahrain, 83% of women are obese or overweight, according to International Obesity Task Force, a London-based think tank that tries to persuade countries to tackle the problem. In the United Arab Emirates the figure is 74%; in Lebanon it is 75%, the groups says. By comparison, about 62% of American women are overweight or obese. The prevalence of childhood obesity in the Middle East has risen rapidly in recent years and diabetes is spreading across the region, according to WHO.
Even predominantly Arab North African countries without oil wealth are wrestling with the challenge, in part because of a traditional preference for larger women. Half of all women in Tunisia and Morocco are overweight or obese -- two standard measures of a person's weight -- according to a 2001 study published in the U.S.-based Journal of Nutrition.
"We thought obesity was restricted to resource-rich countries, but it's also being reported in poor stratas," says Kunal Bagchi, a Cairo-based nutrition expert for WHO.
Mauritania is the only nation today where force-feeding of girls is systematically practiced, mostly in rural areas. Efforts by women's groups and the government to stamp it out have largely been ignored. In a land that suffers from a constant shortage of food, plump women are assumed to be both wealthy and more likely to bear healthy children. "It has long been totally acceptable for women to be not just rotund, but voluminous," says Philip James, chairman of the International Obesity Task Force.
After years of not acknowledging the health problems associated with obesity, Arab governments are now growing concerned about their financial impact. Obesity and associated illnesses, such as diabetes, account for an increasingly large share of the Middle East's total health costs, according to the International Obesity Task Force.
In early December, representatives from WHO, the U.N.'s Food and Agricultural Organization and about 20 Middle Eastern and North African states met in Cairo for the first time to develop dietary guidelines that take into consideration local eating habits. One nutritionist noted than an anti-obesity plan would have to take into account the region's preference for rotund women, according to Jaffar Hussain, a Cairo-based WHO medical officer, who attended the meeting. He says country representatives decided to study the issue and report back in at least six months.
In few places is the clash between culture and health more pressing than in Mauritania, a predominantly Arab nation of three million people. Mauritania borders Algeria, Mali, Senegal and Western Sahara and is roughly the size of France, from which it won independence in 1960. Today the country is a closed society ruled by an authoritarian Islamic government.
Gavage in Mauritania originated decades ago at a time when many prosperous families kept slaves. Back then, men stayed lean through working while women led more sedentary lifestyles. Faced with life in a harsh desert landscape, men typically sang songs not about the beauty of nature, but the attractiveness of the large women who might bear them healthy children.
Force-feeding is usually done by girls' mothers or grandmothers; men play little direct role. The girls' bellies are sometimes vigorously massaged in order to loosen the skin and make it easier to consume even greater quantities of food.
The practice of gavage has survived even though, since the 1970s, Mauritania has suffered prolonged droughts that have led to food shortages. That situation could worsen. Earlier this year, locusts invaded Mauritania in swarms up to 25 miles long, ravaging its crops and pasture land.
There are no current data about gavage, in part because the country's isolation makes it a difficult study for international health agencies. A 2001 government survey conducted by Measure DHS, a research firm in Calverton, Md., estimated that about 22% of Mauritanian women were force-fed as young girls. Half of those girls became overweight or obese as adults and many suffer from diabetes, heart disease and gastric ailments, the survey says. Local officials say some women are so fat they can barely move.
In the survey of 7,000 adults, 15% of the women said their skin split as a result of overeating. One-fifth of women said their toes or fingers were broken to make them eat. One-third said they regretted they had been subjected to overeating. Most cited the health consequences, the difficulty of walking and the pain they endured while being force-fed. A small number said their excess weight had made childbearing more difficult.
Charlotte Abaka, a Ghanaian advocate for women's rights in Africa, says gavage also encourages women to marry young because their rapid weight gain makes them appear older.
Even in the capital city, away from the rural areas where the practice is most prevalent, many Mauritanian women appear stout. Women wear a loose wrap-around dress, known as a mehlafa, which makes it difficult to see the outlines of their bodies. But their discomfort is obvious; many struggle to keep up with their husbands. Most men in Mauritania are slim.
Neya Mint Ally was force-fed for five years as a young girl. Now, 36 years old, Ms. Ally is about 5 feet tall and weighs more than 160 pounds. She finds it difficult to walk and suffers from gastric problems. "It was painful," recalls Ms. Ally. "But as a child I wanted to be fat to be beautiful."
One year ago, Ms. Ally founded a volunteer organization to help stamp out the practice and traveled to remote areas to publicize the health consequences of being overweight. Another group, the Mauritanian Association for Women's Promotion, known by its French acronym, AMPF, shows videos about gavage-related health problems in nine youth centers around Nouakchott. About four years ago, the Mauritanian government, alerted to the health risks of gavage, launched a radio and television campaign to put an end to it.
The anti-gavage campaign has been slow going, in part because about 65% of Mauritanian women are illiterate. That can stymie educational efforts. "If we encourage girls to go to school they will realize that gavage isn't good for them," says Mariem Bint Ahmed Aicha, who became the country's first female minister in the early 1990s when she was put in charge of women's affairs. She also sits on the ruling party's executive committee and is the founder and president of AMPF.
Wanton overeating has virtually disappeared among Mauritania's educated classes, Ms. Aicha says. Ms. Aicha's mother tried to get her to put on weight when she was young, but was overruled by her father, a teacher.
Ms. Aicha's daughter, a 19-year-old law student and mother of a 2-year-old baby, is slender even by Western standards. She says exposure to Western TV shows and magazines convinced her it's healthier to maintain a middling weight. "I don't want to be too fat, but I don't want to be too thin either," she says.
Other changes are more subtle. "Nowadays, many parents don't use physical force as much as psychological force to get their daughters to gain weight," says Ahmed Ould Isselmou, chief of the Mauritanian Department of Social and Demographic Statistics, a government agency. He helped design the government's 2001 survey. Ms. Isselmou adds that some girls now make a personal choice to overeat because they think it increases their chances of finding a husband.
Ms. Ethmane, who grew up in the nomad family, says her family is too poor to force-feed their three daughters. She had considered sending their oldest daughter, Mariam, to a relative who would force-feed the girl for a fee, but the family couldn't raise the money. Mariam, a slender 19-year-old, regrets her parents' decision not to fatten her up. "My friends went through this process," she said. "Now I don't like hanging out with them because I'm too thin."
One recent night, at the Pharmacy of Everlasting Beauty in downtown Nouakchott, the owner displayed four popular drugs that are sold as appetite enhancers. The most expensive, sold under the brand name Tres Orix, was priced at a hefty 2,070 ougyuia, the equivalent of about $8. The annual per capita gross domestic product in Mauritania is about $1,800. Nonetheless, business in the drugs is brisk. "It's mainly women who buy them," said the pharmacist. "They're very popular."
Oum Kelthoum Mint Mohammed, who lives on the outskirts of Nouakchott, was a lithe 13-year-old when she got married in 1999. She says her parents had previously tried to make her overeat but she rebelled and they didn't force her. "I couldn't see any reason to be fat," she said.
But months after her wedding, Ms. Mohammed began to eat voraciously, worried her new husband might leave her for a chubbier woman. She didn't own a set of scales and frequently visited shops in the city center to check her weight. Her husband, who doesn't have a preference for stout women, objected to her new regimen.
Recently, Ms. Mohammed weighed in at about 200 pounds. Her bones hurt and she found it increasingly painful to move or walk. To alleviate her pain, she has since set herself a new weight goal: 190 pounds. "I've eaten enough," she says. "Now I'm on a diet."
--Anne Hardy contributed to this article.
Write to Gautam Naik at gautam.naik@wsj.com1
New Obesity Boom
In Arab Countries
Has Old Ancestry
December 29, 2004
Eating Disorder
New Obesity Boom
In Arab Countries
Has Old Ancestry
Western Habits Fueled Weight
Of Women Prized for Size;
Some Girls Are Force-Fed
Ms. Mohammed Tries a Diet
By GAUTAM NAIK
Staff Reporter of THE WALL STREET JOURNAL
December 29, 2004; Page A1
NOUAKCHOTT, Mauritania -- Jidat Mint Ethmane grew up in a nomad family in this impoverished nation in the western Sahara. When she was 8, she says, her mother began to force-feed her. Ms. Ethmane says she was required to consume a gallon of milk in the morning, plus couscous. She ate milk and porridge for lunch. She was awoken at midnight and given several more pints of milk, followed by a pre-breakfast feeding at 6 a.m.
If she threw up, she says, her mother forced her to eat the vomit. Stretch marks appeared on her body and the skin on her upper arms and thighs tore under the pressure. If she balked at the feedings, her mother would squeeze her toes between two wooden sticks until the pain was unbearable. "I would devour as much as possible," says Ms. Ethmane. "I resembled a mattress."
Today, Ms. Ethmane, 38 years old, is slender because her family ran out of money to continue the force-feeding technique, known as gavage. The term stems from the French word for the process used to force-feed geese to make foie gras. Yet in a recent interview in her family's one-room house, Ms. Ethmane says she still believes in the practice. "Beauty is more important than health," she says. Her husband, Brahim, agrees: "It is thin women who are not healthy."
The belief that rotund women are more desirable as wives helps explain why much of the Arab world -- which stretches from the Persian Gulf in the east to Mauritania in North Africa -- is experiencing an explosion of obesity. About half of women in the Middle East are overweight or obese, according to the United Nations' World Health Organization. In some communities, many of which were nomadic until a few decades ago, oil wealth has dramatically improved living standards. The resulting urbanization has introduced some Western habits: high consumption of sugar, fat and processed foods and more sedentary lifestyles.
In Bahrain, 83% of women are obese or overweight, according to International Obesity Task Force, a London-based think tank that tries to persuade countries to tackle the problem. In the United Arab Emirates the figure is 74%; in Lebanon it is 75%, the groups says. By comparison, about 62% of American women are overweight or obese. The prevalence of childhood obesity in the Middle East has risen rapidly in recent years and diabetes is spreading across the region, according to WHO.
Even predominantly Arab North African countries without oil wealth are wrestling with the challenge, in part because of a traditional preference for larger women. Half of all women in Tunisia and Morocco are overweight or obese -- two standard measures of a person's weight -- according to a 2001 study published in the U.S.-based Journal of Nutrition.
"We thought obesity was restricted to resource-rich countries, but it's also being reported in poor stratas," says Kunal Bagchi, a Cairo-based nutrition expert for WHO.
Mauritania is the only nation today where force-feeding of girls is systematically practiced, mostly in rural areas. Efforts by women's groups and the government to stamp it out have largely been ignored. In a land that suffers from a constant shortage of food, plump women are assumed to be both wealthy and more likely to bear healthy children. "It has long been totally acceptable for women to be not just rotund, but voluminous," says Philip James, chairman of the International Obesity Task Force.
After years of not acknowledging the health problems associated with obesity, Arab governments are now growing concerned about their financial impact. Obesity and associated illnesses, such as diabetes, account for an increasingly large share of the Middle East's total health costs, according to the International Obesity Task Force.
In early December, representatives from WHO, the U.N.'s Food and Agricultural Organization and about 20 Middle Eastern and North African states met in Cairo for the first time to develop dietary guidelines that take into consideration local eating habits. One nutritionist noted than an anti-obesity plan would have to take into account the region's preference for rotund women, according to Jaffar Hussain, a Cairo-based WHO medical officer, who attended the meeting. He says country representatives decided to study the issue and report back in at least six months.
In few places is the clash between culture and health more pressing than in Mauritania, a predominantly Arab nation of three million people. Mauritania borders Algeria, Mali, Senegal and Western Sahara and is roughly the size of France, from which it won independence in 1960. Today the country is a closed society ruled by an authoritarian Islamic government.
Gavage in Mauritania originated decades ago at a time when many prosperous families kept slaves. Back then, men stayed lean through working while women led more sedentary lifestyles. Faced with life in a harsh desert landscape, men typically sang songs not about the beauty of nature, but the attractiveness of the large women who might bear them healthy children.
Force-feeding is usually done by girls' mothers or grandmothers; men play little direct role. The girls' bellies are sometimes vigorously massaged in order to loosen the skin and make it easier to consume even greater quantities of food.
The practice of gavage has survived even though, since the 1970s, Mauritania has suffered prolonged droughts that have led to food shortages. That situation could worsen. Earlier this year, locusts invaded Mauritania in swarms up to 25 miles long, ravaging its crops and pasture land.
There are no current data about gavage, in part because the country's isolation makes it a difficult study for international health agencies. A 2001 government survey conducted by Measure DHS, a research firm in Calverton, Md., estimated that about 22% of Mauritanian women were force-fed as young girls. Half of those girls became overweight or obese as adults and many suffer from diabetes, heart disease and gastric ailments, the survey says. Local officials say some women are so fat they can barely move.
In the survey of 7,000 adults, 15% of the women said their skin split as a result of overeating. One-fifth of women said their toes or fingers were broken to make them eat. One-third said they regretted they had been subjected to overeating. Most cited the health consequences, the difficulty of walking and the pain they endured while being force-fed. A small number said their excess weight had made childbearing more difficult.
Charlotte Abaka, a Ghanaian advocate for women's rights in Africa, says gavage also encourages women to marry young because their rapid weight gain makes them appear older.
Even in the capital city, away from the rural areas where the practice is most prevalent, many Mauritanian women appear stout. Women wear a loose wrap-around dress, known as a mehlafa, which makes it difficult to see the outlines of their bodies. But their discomfort is obvious; many struggle to keep up with their husbands. Most men in Mauritania are slim.
Neya Mint Ally was force-fed for five years as a young girl. Now, 36 years old, Ms. Ally is about 5 feet tall and weighs more than 160 pounds. She finds it difficult to walk and suffers from gastric problems. "It was painful," recalls Ms. Ally. "But as a child I wanted to be fat to be beautiful."
One year ago, Ms. Ally founded a volunteer organization to help stamp out the practice and traveled to remote areas to publicize the health consequences of being overweight. Another group, the Mauritanian Association for Women's Promotion, known by its French acronym, AMPF, shows videos about gavage-related health problems in nine youth centers around Nouakchott. About four years ago, the Mauritanian government, alerted to the health risks of gavage, launched a radio and television campaign to put an end to it.
The anti-gavage campaign has been slow going, in part because about 65% of Mauritanian women are illiterate. That can stymie educational efforts. "If we encourage girls to go to school they will realize that gavage isn't good for them," says Mariem Bint Ahmed Aicha, who became the country's first female minister in the early 1990s when she was put in charge of women's affairs. She also sits on the ruling party's executive committee and is the founder and president of AMPF.
Wanton overeating has virtually disappeared among Mauritania's educated classes, Ms. Aicha says. Ms. Aicha's mother tried to get her to put on weight when she was young, but was overruled by her father, a teacher.
Ms. Aicha's daughter, a 19-year-old law student and mother of a 2-year-old baby, is slender even by Western standards. She says exposure to Western TV shows and magazines convinced her it's healthier to maintain a middling weight. "I don't want to be too fat, but I don't want to be too thin either," she says.
Other changes are more subtle. "Nowadays, many parents don't use physical force as much as psychological force to get their daughters to gain weight," says Ahmed Ould Isselmou, chief of the Mauritanian Department of Social and Demographic Statistics, a government agency. He helped design the government's 2001 survey. Ms. Isselmou adds that some girls now make a personal choice to overeat because they think it increases their chances of finding a husband.
Ms. Ethmane, who grew up in the nomad family, says her family is too poor to force-feed their three daughters. She had considered sending their oldest daughter, Mariam, to a relative who would force-feed the girl for a fee, but the family couldn't raise the money. Mariam, a slender 19-year-old, regrets her parents' decision not to fatten her up. "My friends went through this process," she said. "Now I don't like hanging out with them because I'm too thin."
One recent night, at the Pharmacy of Everlasting Beauty in downtown Nouakchott, the owner displayed four popular drugs that are sold as appetite enhancers. The most expensive, sold under the brand name Tres Orix, was priced at a hefty 2,070 ougyuia, the equivalent of about $8. The annual per capita gross domestic product in Mauritania is about $1,800. Nonetheless, business in the drugs is brisk. "It's mainly women who buy them," said the pharmacist. "They're very popular."
Oum Kelthoum Mint Mohammed, who lives on the outskirts of Nouakchott, was a lithe 13-year-old when she got married in 1999. She says her parents had previously tried to make her overeat but she rebelled and they didn't force her. "I couldn't see any reason to be fat," she said.
But months after her wedding, Ms. Mohammed began to eat voraciously, worried her new husband might leave her for a chubbier woman. She didn't own a set of scales and frequently visited shops in the city center to check her weight. Her husband, who doesn't have a preference for stout women, objected to her new regimen.
Recently, Ms. Mohammed weighed in at about 200 pounds. Her bones hurt and she found it increasingly painful to move or walk. To alleviate her pain, she has since set herself a new weight goal: 190 pounds. "I've eaten enough," she says. "Now I'm on a diet."
--Anne Hardy contributed to this article.
Write to Gautam Naik at gautam.naik@wsj.com1
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