World Obesity Day: A growing number of Gulf youth are having bariatric surgery

“Studies have shown between 20 and 30 percent of children under the age of 18 in Saudi are overweight or obese,” says surgeon Dr. Aayed Alqahtani.
Updated 11 October 2018
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World Obesity Day: A growing number of Gulf youth are having bariatric surgery

  • A Saudi surgeon who is an expert in bariatric procedures will operate on children if it saves their lives
  • A Dubai doctor says there is a ‘serious incidence of obesity among children in the Middle East’ 

DUBAI: Rocketing obesity rates among children and adolescents in Saudi Arabia and the wider Middle East are leading to a growing number of young patients going under the knife for bariatric surgery.

Surgeons say region-wide awareness and prevention measures to tackle obesity are needed in homes, communities and in schools as they blame widespread access to unhealthy foods and sedentary behaviour for soaring numbers of severely overweight children.

Saudi surgeon Dr. Aayed Alqahtani, professor and consultant of minimally invasive and obesity surgery at King Saud University, told Arab News that over the past decade he has performed bariatric surgery on some 2,900 children and adolescents, including a four-year-old Saudi boy who weighed 70kg.

“His weight was killing him,” said Alqahtani. “A year later, thanks to bariatric surgery, he lost almost 20kg. It saved his life.”

Bariatric surgery includes a variety of procedures performed on people who are obese (those with a Body Mass Index of 30 or more) or morbidly obese (a BMI higher than 40). A person’s ideal BMI should be between 18.5 and 25.

The most common weight-loss surgeries involve either reducing the size of the stomach with a gastric band — restricting food intake — or non-reversible procedures that involve removing of a portion of the stomach or by re-routing the small intestine to a small stomach pouch.

Alqahtani said “more and more children” in the Middle East are having bariatric surgery. “It correlates with the rising number of obese children,” he said. “Studies have shown between 20 and 30 percent of children under the age of 18 in Saudi are overweight or obese. I would say this is the same in many Gulf states.”

Families from the Middle East travel to Saudi Arabia specifically to seek the help of Alqahtani, a renowned bariatric surgeon who is adamant — despite mixed views worldwide — that radical weight-loss surgery should be used on children of “any age” if their health is critically threatened by their size. 

There are no standards at which bariatric surgery is presented as an option for severely obese adolescents, but many countries set minimum age limits as guidelines for surgeons. In the UAE, for example, while guidelines differ by emirate, in Abu Dhabi and Dubai there are regulations suggesting surgeons should not operate on those under the age of 18. 

“People are concerned about bariatric surgery,” said Alqahtani. “Why? They believe that bariatric surgery will stunt a child’s growth, think children are not compliant, and they ask who has given consent for them to have this surgery.”

Alqahtani has published a series of research papers on the benefits of bariatric surgery, including a five-year study which followed the health progress of two groups of children; one who had undergone bariatric surgery and another who had followed traditional weight management techniques. On average, the children who had undergone surgery actually grew 10 centimeters taller than those who had not.

“Why? Because among other things, obesity stunts growth,” said Alqahtani. “Children ARE in fact compliant — despite beliefs of the contrary — and regarding consent, well, we should treat obesity like we would treat any other serious chronic disease. If you have cancer in a child would you wait until he is 18? No, you will discuss what is in the best interest of that child and make a decision.”

Children with severe obesity are at risk for health problems including Type 2 diabetes, sleep apnea, liver diseases and hypertension.

While Alqahtani advocates surgery as “by no means a first option” — stressing children who are eligible for surgery have spent months attempting traditional weight loss methods — he believes it should never be ruled out. “I would say, why should we wait until children are dying from these obesity-related diseases? Age should not be an issue.”

Alqahtani, who has performed more than 10,000 bariatric surgeries over his career, believes Gulf countries have the highest percentage of bariatric procedures, which include sleeve gastrectomy, gastric bypass and the placement of a gastric band, performed in the world. He himself has operated on a 21-year-old who weighed 610kg, having struggled with obesity since childhood. Today the patient weighs 68kg.

The fact that so many children and adolescents are undergoing radical weight loss surgery is an indicator of the obesity epidemic across the Kingdom and wider Middle East.

Children should be taught that a healthy lifestyle should be a daily routine and a lifetime habit, say the experts.

Last month, 2,500 health specialists from around the globe gathered in Dubai for the annual World Congress of International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO 2018), hosted by Gulf Obesity Surgery Society (GOSS).

Dr. Faruq M. Badiuddin, head of the organizing committee for IFSO and a laparoscopic, gastrointestinal and obesity surgeon in Dubai, said there is a “serious incidence of obesity among children in the Middle East.” 

“It is really a combination of all the things we talk about in relation to obesity; it is a sedentary lifestyle among children as well as a huge excess of food and the wrong types of food. The problem is, we know obese children grow up to be obese adults. That is a fact.”

Badiuddin, an Egyptian, said weight-loss surgery among children varies across the Gulf. “Saudi, for example, is probably one of the only places in the world where the incidences of bariatric surgery in children are very high,” he said. “A lot of surgeries are done there.” 

Compare that, he said, to the neighbouring UAE, where a single governmental hospital in Sharjah is the only one that allows bariatric surgery for under-18s. 

Dr. Basim Alkhafaji, consultant laparoscopic, gastrointestinal and obesity surgeon at Dubai’s Canadian Specialist Hospital, said bariatric surgery is recognized as an effective and relatively safe procedure for morbidly obese adults.

However, with children, there are concerns about the non-surgical risks revolving around a children’s development, chiefly the effect nutritional changes will have on a still-growing body. “When you are cutting something from the stomach, you are altering the autonomy of the body — so there are some objections from the endocrinologist and the dieticians. 

“Always, they urge surgeons not to jump to this step unless it is a hopeless case, a case where a child is unable to do any sports or activities, cannot control himself with food and cannot follow instructions from specialists. We also look at the psychological state of the child.”

So should young children be offered bariatric surgery? Dr. Alkhafaji is unequivocal about his answer. “If there is no other option then surgery is the right thing,” he said. “When you get a child who is aged 10 and reaching 100kg, psychologically he will be in a bad condition, physically he cannot do anything. In my opinion, then, surgery is the right option.”

Dr. Ali Khammas, president of GOSS and Emirates Pediatric Society, said many people fail to grasp that obesity is a disease.  “The major threat to health in the Gulf region, I would say, is obesity,” he said. 

Khammas said weight-loss surgery is not a cure for severe obesity in either children or adults.

“You can imagine — we are talking about millions of people who are obese across the Gulf. In the UAE alone, about 1.5 million. We can not operate on all of them. 

“We are not going to tackle this disease by surgery. We need prevention. We need campaigns in every single school in the region. There should be someone at every school campaigning for a healthy food culture.”

Dr. El Zaqui Ladha, a consultant in bariatric and general surgery at Abu Dhabi’s Bareen International Hospital, described obesity levels across the Middle East as “shocking.”

“You have kids who are overweight at the age of two. Can you imagine? I had one patient this age: The boy could barely breathe. Kids are so heavy that it impacts on everything. For example, the knees have to bear the weigh, but for children, the knees and cartilage are not properly formed.”

Mansoor Ahmed, director of health care, education, development solutions and PPP for the MENA region at advisory firm Colliers International, said obesity is one of the top lifestyle diseases that appear to increase in frequency as countries become more industrialized and life expectancy increases.

“As a result of urbanization and rising disposable income, the majority of the GCC population, including KSA, have adopted a sedentary lifestyle characterized by an aversion to exercise and consumption of processed food leading to increased chronic diseases (such as diabetes, coronary problems and other obesity-related illnesses) previously uncommon to the region.

“To control obesity, the problem should be established during childhood and parents and teachers can play a leading role in this case. Kids should be taught that healthy lifestyle is important for their future life and that a healthy lifestyle should be a daily routine and lifetime habit.”

The obesity pandemic can be solved only in strong collaboration between the public and private sector, non-profit and philanthropic organizations and society, including parents and children, said Ahmed.

“The key here is awareness,” he said. “Awareness the problem exists, awareness of appearance and awareness of how to fight this disease and especially how to
prevent it.”

 


Saudi ‘smart glove’ inventor thrives in the age of innovation

Updated 19 min ago
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Saudi ‘smart glove’ inventor thrives in the age of innovation

  • Hadeel Ayoub is the founder of BrightSign, a London-based company specializing in assistive technology
  • BrightSign's signature product is a smart glove that can facilitate communication by individuals with speech disability

LONDON: Saudi inventor and tech innovator Hadeel Ayoub is giving people who can’t speak new hope — and a new voice.

The founder of London-based tech company BrightSign is the driving force behind a smart glove that allows individuals who are unable to speak to communicate by translating sign language into text and speech.

After more than four years’ work, Ayoub, a designer, programmer and researcher in human computer interaction, plans to launch the device later this year.

Some of the biggest beneficiaries will be families with children who have speech disabilities and want to be better connected through technology. The BrightSign glove will enable these children to become better signers and communicators, but can also be hooked up with a web app to provide instant translation in most languages.

The architecture of a BrightSign glove is relatively straightforward: Multiple sensors, embedded under an outer glove, track finger positions, hand orientation and dynamic movements. The hardware is contained inside a slender wristband.

Hand gestures are translated into text that appears on a screen embedded in the glove, and speech is made audible via a mini-speaker. The user can select the voice and speech language.


BIO

• Founder and chieftechnology officer, BrightSign

• Experienced lecturer, researcher and entrepreneur with experience in the higher education industry

• Skilled in innovation, creative coding, programming and design research

• Ph.D. in human-computer interaction and gesture recognition from Goldsmiths, University of London


Ayoub has been featured in Forbes magazine, tech programs on the BBC and Discovery channels, and has spoken at discussions organized by Britain’s Financial Times and Guardian newspapers. She has also taken part in a number of exhibitions with innovation and assistive technology as their themes.

Recalling the inspiration for the smart glove, the Saudi inventor said she was originally designing a device for an air-draw program — the air was the canvas, and the hands and fingers were the drawing tools. Her aim was to replace the mouse and keyboard with trackable wearable technology.

On the basis of her design, Ayoub was selected to represent her university at an IBM global hackathon in artificial intelligence for social care. She reprogrammed the glove to translate sign language and won the competition.

When news of the smart glove was circulated in the media, Ayoub’s inbox was flooded with inquiriesttt from parents wanting the glove for their children, from speech therapists for their patients, and from teachers for their students.

The tech innovator quickly realized there was a need for this kind of technology and decided to make it the focus of her Ph.D. research.

Hadeel Ayoub’s BrightSign smart glove allows people with speech disabilities to translate sign language into text and voice. (Reuters)

“I want to break the current barriers facing those who wish to broaden their experience with sign language beyond the current traditional method,” Ayoub said.

She believes that at least three improvements are urgently needed: Integrating children with disabilities into mainstream classrooms; equipping adults who have disabilities with technologies that will help them perform tasks as well as their peers manage; and making smart-glove devices available in public locations such as airports, shopping malls, government offices and hospitals to offer a smoother service to visitors with disabilities.

A global award winner for her technological innovation, Ayoub regularly tests and improves the BrightSign glove, which she describes as a work in progress.

“The glove has gone through multiple rounds of prototyping and testing. I have implanted the users’ feedback to develop hardware, software and design,” she said.

“It is now being used in six schools to help non-verbal children overcome their communication challenges in the classroom.”

Ayoub said that further studies would help her develop the final product. “I am now taking glove pre-orders on the BrightSign website,” she said.

The Saudi inventor said that she has always been “a progressive thinker and a dreamer of possibilities,” and described a childhood spent immersed in books rather than playing with dolls.

She remembers her family library with fondness and reminisces on quiet evenings spend reading.

As well as being an innovator, Ayoub is a mother who talks lovingly about her children.

“They are very much involved in the development phases of BrightSign,” she said. “I consider their opinions on the products designed for children. I always encourage them to do what they love since that would mean that they will excel in it.

“They get excited every time they see someone using BrightSign and they can see how it helps people live better.

“They also understand the concept of tech for good and aspire to work one day on technologies with a social impact.”

Ayoub sees herself as problem solver with an eye for technical detail, a kind of instinctive trouble-shooter. “When I attempt to solve a problem, I go through cycles of trial and error until I achieve a breakthrough,” she said.

“I encountered a number of problems that were unprecedented, so I wasn’t able to turn to a source or a reference. I guess this is what prompted me to get creative and think outside the box, which eventually put me on the innovation route.

“I find dead ends challenging. When someone tells me that something has never been done, it does not mean that it is not doable. On the contrary, it motivates me to keep going until I find a solution.”

As for the current model of innovation, Ayoub admires the global interconnectedness.

“The mindset now is collaborative rather than competitive,” Ayoub said.

“I am part of inventors’ groups in Saudi Arabia, the Gulf region and the Middle East. Most of us got business training at some point in order to secure investment and go into production.”

I find dead ends challenging. It motivates me to keep going to find a solution.

Hadeel Ayoub

Being a innovator has been far from a walk in the park for Ayoub. She believes what really pushed her in her chosen field was her desire to learn something new in every degree she pursued, starting with design, then programming and, finally, technology.

“More often than not I find myself the only woman speaking at a tech conference or giving a tech talk at an event,” she said. “I am proud to represent my country in global exhibitions and am even prouder when I walk away with awards at competitions.

“I hope that I can inspire young girls to experiment with technology and use it to enhance their respective practices.

“I have created a ‘women in tech’ group where we have regular meetings to share our challenges and extend our support each other.”

Based on her experiences, Ayoub has a message for young Saudis: “This is the age of innovation and entrepreneurship. If what you are passionate about doesn’t exist as a field of knowledge, create it.

“Learn how to code. It will be useful in any career you pursue and will enable you to integrate technology into your practice.”