ABU DHABI—The Middle East has an anorexia problem, say researchers, and it’s largely ignored.
“We used to think of it as a rich white girl’s disease, but that’s not true anymore,” says Melissa Rizk, an eating-disorder specialist who runs a clinic in Beirut. “People of all socio-economic groups, genders and ethnicities can suffer, but the awareness is low.”
Data on the regional prevalence of anorexia—an eating disorder and serious mental-health condition in which sufferers often think they are fat even when they are extremely underweight—is far from complete. But the figures that do exist suggest the problem could be significantly worse than rates seen in Europe and North America.
Justin Thomas, a professor of psychology at Zayed University in Abu Dhabi, researches eating disorders and body-image perceptions among Emirati women. In his recent studies, he asked female students at his university to fill out questionnaires—the same ones which public-health professionals use to identify people at risk of developing an eating disorder like anorexia or bulimia. His results place between 24 and 30 percent of participants in this category.
This percentage is higher than many of those reported among Western populations. In the United Kingdom, for example, a recent study concluded that 6.4 percent of adults displayed signs of an eating disorder. However, this statistic takes men into account, whereas Thomas’s studies focused on young women, who are more likely to suffer from eating disorders.
“I would, however, shy away from direct nation to nation comparisons,” warns Thomas. “These studies are generally on different populations, and differences might be related to age or socioeconomic status.”
A Need for More Data
The picture is less clear in Lebanon. “We don’t have the numbers yet, but it’s probably comparable to the rest of the Middle East,” says Carine el Khazen, a clinical psychologist and vice president of the Middle East Eating Disorders Association, in Beirut.
That’s why the region needs more research papers like those conducted by Thomas, says Rizk.
“Any public-health project always starts with studies and numbers. If you want to increase awareness, then we need to do these studies,” she says. “When you show people it’s a real problem, that’s when things start to change.”
The Arab world is slowly waking up to the threat of rising obesity rates, says Thomas, but it lags behind in anorexia awareness. (See a related article, “Patterns of Disease Are Changing in the Arab World.”)
“But it’s the other side of the same coin,” he says. “Obesity can also be a mental-health problem, and there are overlapping causes.”
It can be hard to pinpoint the precise reason why a person develops an eating disorder, but experts do agree that culture plays a significant role.
“In the Arab world and especially in Lebanon we have the cult of appearance. The clothes you wear, the car you drive, and the shape of your body are all really important,” says Rizk.
Part of this explains why women are more likely to have an eating disorder than men, she adds. “We have a culture where it’s OK for men to look a little overweight but it’s not OK for women. However, I also believe that men are underdiagnosed because they’re frightened of looking like they have a woman’s disease.”
Few Treatment Providers
“The problem is getting worse because of social media,” says el Khazen. “But in general, doctors and mental-health professionals are getting better equipped to identify the disease but not to treat it.”
“We’re terribly bad at developing treatment here,” says Rizk. “You can count on one hand the number of people who are specially trained to deal with eating disorders in Lebanon and I’d bet there are no more than 200 in the entire Middle East.”
The healing process is a protracted one; it takes years and can require help from clinical psychologists, nutritionists and psychiatrists. “We talk about seven years as a time to get a patient back to having no issues with food or body image,” she says.
The time frame and coordination required between specialists is one reason why treatment of the disease is poor. For starters, you need to have good insurance and even those who do often wait too late to seek help, says Nadine Zeeni, professor of nutrition at the Lebanese American University.
In a 2015 study, she conducted focus-group discussions with health professionals who treat patients with eating disorders.
“I contacted a sample of psychiatrists and dietitians to get an idea of the profile of people seeking help,” she says. There was a general feeling amongst those she interviewed that their patients often waited until the condition is well developed before reaching out.
“It makes treatment harder and also suggests to me that many people aren’t seeking help at all,” she says.
While researchers say there are undoubtedly holes in the treatment of eating disorders in the Arab world, a chemistry student at A’Sharqiyah University in Oman wants to help bridge the gap. Zainab al-Balushi is trying to make a skin patch to deliver much needed nutrients to patients suffering from the most severe stages.
She has already conducted trials of her prototype on mouse skin and found that vitamin D, E and folic acid were successfully absorbed. “This kind of treatment is needed because many people with anorexia are facing serious malnutrition but still won’t eat,” she says. “We hope eventually that it could be used by outpatients but we are waiting for approval for clinical trials in humans.”
While more innovative solutions like this are welcomed by experts, ultimately anorexia and other eating disorders can already be cured with well-established and multidisciplinary treatment protocols. What’s really needed in the Arab world, they say, is a drive to increase awareness and offer those treatments in a coordinated way.